Laidback Al
Well-known member
An infectious disease doctor commenting on the recent Ebola case in Texas.
High-tech medicine alone will not protect U.S. from Ebola ? we need to get the basics right
High-tech medicine alone will not protect U.S. from Ebola ? we need to get the basics right
By Celine Gounder
October 1, 2014
. . . On Sept. 20, the patient, a Liberian national identified as Thomas Eric Duncan, arrived in Dallas, Texas, from Liberia. He didn?t develop symptoms of Ebola until four days later. On Sept. 26, he went to the emergency department at Texas Health Presbyterian Hospital complaining of fever and nausea. Though he told a nurse that he?d traveled to West Africa, where an epidemic of Ebola has broken out, he was diagnosed with a ?low-grade, common viral disease? and sent home with antibiotics. Never mind that antibiotics shouldn?t be prescribed for viral infections like the common cold ? why was he sent home?
The U.S. healthcare system is the most sophisticated in the world. It is also byzantine and inefficient, and those systemic flaws may have allowed a patient with a deadly virus to slip through the cracks.
As a doctor, I know that healthcare providers sometimes don?t get basic things right. We don?t spend enough time talking to patients to understand their stories, their worries and why they?ve come to see us. We often don?t communicate well with our patients and with the other providers involved in their care. . . .
Even among physicians, hierarchies abound. Infectious-disease specialists, experts in diagnosing and treating diseases like Ebola, (full disclosure: I am one) are the least-well-paid doctors in the United States ? even though some may have more years of training than, say, a generalist. Those of us who go into the field have reasons other than compensation for doing so.
Though a news report quoted a hospital official as saying Texas Health Presbyterian Hospital was ?well prepared? to care for a patient with Ebola, it was unlikely that an expert in diagnosing and treating diseases like Ebola was asked to examine the patient in Dallas before he was sent home. That oversight, if true, would expose a serious ? and dangerous ? shortcoming of a system that assigns different values to different doctors.
There is another reason why the patient may have been sent home. America is a society enamored with technology. This helps explain the public?s continuing fascination with new drugs and vaccines as the best way to fight Ebola. In medicine, this love of technology has partly encouraged the overuse of laboratory and radiology testing at the expense of doctors taking the time to talk to their patients. Some physicians even seem to have forgotten how to perform a thorough physical exam.
Simple and low tech as these practices may seem, they make for the bigger difference in outcome ? fewer people getting sick. . . .
Whether Ebola infects others beyond the Dallas patient is a good litmus test for our high-tech health system. Ebola is still spreading in Liberia, Sierra Leone and Guinea, which all have primitive health systems. But in Nigeria, where almost 900 people were exposed to Ebola and 20 were diagnosed with the disease, the outbreak has been stamped out. In Senegal, more than 60 people were exposed to a single Ebola patient ? and no one came down with the disease.
The Dallas patient was isolated within four days of becoming sick. But not before possibly exposing a dozen or more to the deadly virus. If new cases of Ebola develop in Texas, this will only serve to highlight the systemic problems in the world?s most expensive and sophisticated medical care system.
http://blogs.reuters.com/great-deba...la-what-is-needed-is-to-get-the-basics-right/
October 1, 2014
. . . On Sept. 20, the patient, a Liberian national identified as Thomas Eric Duncan, arrived in Dallas, Texas, from Liberia. He didn?t develop symptoms of Ebola until four days later. On Sept. 26, he went to the emergency department at Texas Health Presbyterian Hospital complaining of fever and nausea. Though he told a nurse that he?d traveled to West Africa, where an epidemic of Ebola has broken out, he was diagnosed with a ?low-grade, common viral disease? and sent home with antibiotics. Never mind that antibiotics shouldn?t be prescribed for viral infections like the common cold ? why was he sent home?
The U.S. healthcare system is the most sophisticated in the world. It is also byzantine and inefficient, and those systemic flaws may have allowed a patient with a deadly virus to slip through the cracks.
As a doctor, I know that healthcare providers sometimes don?t get basic things right. We don?t spend enough time talking to patients to understand their stories, their worries and why they?ve come to see us. We often don?t communicate well with our patients and with the other providers involved in their care. . . .
Even among physicians, hierarchies abound. Infectious-disease specialists, experts in diagnosing and treating diseases like Ebola, (full disclosure: I am one) are the least-well-paid doctors in the United States ? even though some may have more years of training than, say, a generalist. Those of us who go into the field have reasons other than compensation for doing so.
Though a news report quoted a hospital official as saying Texas Health Presbyterian Hospital was ?well prepared? to care for a patient with Ebola, it was unlikely that an expert in diagnosing and treating diseases like Ebola was asked to examine the patient in Dallas before he was sent home. That oversight, if true, would expose a serious ? and dangerous ? shortcoming of a system that assigns different values to different doctors.
There is another reason why the patient may have been sent home. America is a society enamored with technology. This helps explain the public?s continuing fascination with new drugs and vaccines as the best way to fight Ebola. In medicine, this love of technology has partly encouraged the overuse of laboratory and radiology testing at the expense of doctors taking the time to talk to their patients. Some physicians even seem to have forgotten how to perform a thorough physical exam.
Simple and low tech as these practices may seem, they make for the bigger difference in outcome ? fewer people getting sick. . . .
Whether Ebola infects others beyond the Dallas patient is a good litmus test for our high-tech health system. Ebola is still spreading in Liberia, Sierra Leone and Guinea, which all have primitive health systems. But in Nigeria, where almost 900 people were exposed to Ebola and 20 were diagnosed with the disease, the outbreak has been stamped out. In Senegal, more than 60 people were exposed to a single Ebola patient ? and no one came down with the disease.
The Dallas patient was isolated within four days of becoming sick. But not before possibly exposing a dozen or more to the deadly virus. If new cases of Ebola develop in Texas, this will only serve to highlight the systemic problems in the world?s most expensive and sophisticated medical care system.
http://blogs.reuters.com/great-deba...la-what-is-needed-is-to-get-the-basics-right/
