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Scott

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Stuff

[Jan. 20th, 2011|12:02 am]

Scott

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med school

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I didn't have Mr. S today, but my friend Tom did and reported back.

He was as angry and expletive-laden as the stories say, but for once his anger wasn't directed at his medical students. He was performing a biopsy of a lump in someone's throat. The biopsy found cancer. Throat cancer, caught at this late stage, has something like a 20% survival rate.

Mr. S was angry because the guy was supposed to have his surgery in October, but the Health Service rescheduled it for logistical reasons. In October, the lump might have been early-stage throat cancer, which has more like a 70% survival rate.

Limerick Hospital is notorious for this sort of thing. If I understand the politics correctly, when someone comes in needing immediate care and the normal rooms in which such care might be provided are full, the Health Service will seize an operating theater to keep the person in as long on the grounds that they are only canceling "elective" operations. Elective operations are the ones that aren't an obvious guy-has-lost-an-arm-and-is-bleeding-to-death emergency; although they can include a lot of little things like tonsillectomy, they can also include things like biopsying a neck lump. Which is not the sort of thing that will kill you if it's put off a few days to free up an operating theater - but if it's put off a few months for one reason after another, and it turns out to be cancer, it very well might.

According to Tom according to Mr. S, this is far from the first time this practice has killed someone, and "everyone involved should be ***** tried for murder and put in ****** jail".

I am still not looking forward to meeting Mr. S tomorrow. But I can understand why someone who deals with this sort of situation every day might develop an anger problem.

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Comments:

From:

kismetrose
2011-01-20 07:23 am (UTC)

Frankly, on that score, the man sounds right on the mark, expletives and all.

(Reply) (Thread)

From:

mme_n_b
2011-01-20 08:33 am (UTC)

So, people who definitely need immediate care get priority over people who might need immediate care? How is that wrong?

(Reply) (Thread)

From:

minion_for_hire
2011-01-20 10:57 am (UTC)

The problem is that you're right... but it is still a decision that causes deaths, and no politician will ever come straight out and say "We have limited resources. There are times when we have to cancel 'elective' surgeries to make way for emergency ones. About 5%* of the time, the person whose elective surgery was cancelled dies as a result of not getting needed surgery. However, 95%* of the time, the emergency patient will die without immediate surgery. In this way, every 20* times we do this, we save 19* lives and cost 1*. This process therefore saves 18* lives in every 20. About 1 time in 400*, this process kills someone without saving someone. This is unavoidable without more resources and thus higher taxes. Now, people of Ireland. You choose."

*all of these numbers are completely arbitrary numbers I just picked out for illustrative purposes. However, I suspect they're not too far off the mark. In any case, the example holds so long as the "immediate" risk is higher than the "elective" one, which is usually true.

(Reply) (Parent) (Thread)

From:

squid314
2011-01-20 02:28 pm (UTC)

The impression I am getting is that the surgeons believe that the hospital is much too liberal with grabbing theaters for people who don't necessarily need to be there, and that keeping a person in theater for a day may cancel five or ten operations that could have been done in that theater.

I agree that it's a risk-benefit calculation, but the surgeons sound pretty sure that it was made the wrong way. Then again, they're surgeons, so anything that gives them less operating time is going to piss them off.

(Reply) (Parent) (Thread)

From:

mme_n_b
2011-01-20 04:04 pm (UTC)

Got it. Thank you.

(Reply) (Parent) (Thread)