A recent issue of the Annals of Surgery which  studied the burn-out rates and the levels of stress in the US among 9000 surgeons revealed an additional interesting finding…9%  of surgeons said they were concerned they had made a “major medical error” in the preceding three months.

The American College of Surgeons reported that one in ten surgeons admitted to a recent error in surgery

No matter how you look at it, these figures are alarming in today’s hospitals where patient safety is a top priority. Also, compared to physicians, errors made by surgeons have more severe consequences for patients due to the interventional (read – invasive)  nature of surgical practice. The survey, commissioned by the American College of Surgeons, also showed that 40% were ‘burned out‘ and 30% showed symptoms of depression.

So how do you avoid mistakes when going for  surgery ?

Some pointers include looking for a hospital with a good safety record as well as those possessing a recognised accreditation standard (such hospitals voluntarily undergo screening by a recognised review body, such as the JCI, in order to provide services of a certain minimum quality).

Find out from your doctor where he sends his relative to. What’s good enough for a doctor is usually a stamp of approval. Why, even nurses in the hospital may provide the right doctor if one cares to ask.

Look for someone who’s busy. Sure, it means long waiting times, but this might be worth it in the long run.

Finally, some health department websites do provide statistics on how many specific operations are done in a year and what the complication rates are. This way one can opt for the best hospitals for a particular procedure. This website provides info of the best hospitals in the US, for instance -  click here.

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With the H1N1 flu pandemic showing no signs of abating, Santa Claus’s bag is bound to contain some hand sanitizers, throat spray, tissues and spare gloves…anything to keep the bugs at bay.(Pic taken at an Edmonton,Canada mall,courtesy of Edmonton Journal)

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Mention Orlando, Florida and one tends to think of Mickey Mouse and Disneyworld, but the current proceedings of the American Heart Association at the gigantic Convention Center are revealing some data that seem to take the mickey out of the public.

Graphic details..but each CT scan of the Heart results in over-exposure to Radiation

Researchers studied heart patients in 49 hospitals in the US (here) and found that the battery of tests given to a heart attack patient adds up to a radiation dose equivalent to 725 chest Xrays! That’s about a third the annual maximum accumulation permitted for workers in nuclear power plants.

CT Scan in progress - benefits may not be worth the risk sometimes

A patient was given an average of seven tests using ionizing radiation, which included repeated chest Xrays, angiograms, multi-slice CTs and ordinary CT scans. The US Food & Drug Administration (FDA) has warned that the principal risk associated with  radiation dose  from a CT scan is the small possibility of developing a radiation-induced cancer some time later in that person’s life.

While I believe that doctors should not withhold tests involving ionising radiation where appropriate, there has been a significant overuse of such devices in recent years for inappropriate and irrelevant reasons. Part of the reason may be the necessity to recoup the capital costs as quickly as possible (especially in physician-owned machines located in stand-alone set-ups) but the other reason is also from  demand from the  public for the latest tests without appreciating the true benefits and possible dangers.

Whatever the reason, an informed consent is mandatory so that the parties involved can weigh on the benefits versus the risks.

See my related article:

Why the latest Heart Scans are popular..but not foolproof

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BBC News reported today that research at Cambridge revealed that patients did not need to fast for 12 hours before having their blood taken for cholesterol measurements (here).

This seems to have created a ripple of excitement amongst patients and care-givers – no more skipping breakfast to have their tests done and potentially, it also meant that blood tests could be taken at any time of day…or so it seemed.

Tests for fats in the blood, including triglycerides, still require fasting

I’m not disputing the findings of the study involving 300,000 people but what the news report failed to specify is that the study refers to the measurement of cholesterol, period. As long as it involves total cholesterol, HDL-cholesterol (the ‘good’ one) and LDL-cholesterol (‘bad’ one),  that’s well and good.

However, often a lipid profile test includes triglycerides, another type of fat found in the bloodstream. It is essential for people to fast 12 hours or so for this test as intake of food affects the reading significantly. In fact, the most common cause of high readings of triglycerides is inadequate fasting before the test is done.

The measurement of triglycerides is important because high levels play an important part in several diseases like metabolic syndrome, heart disease and pancreatitis.

So it looks like its back to what it was, folks.

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The seven leading causes of stress, according to a University of Washington study are finances, work, family, personal concerns, personal health & safety, relationships and death. I’m going to take it they left out flying.. because they forgot to ask anyone who’s taken a trip by air. Many will agree that taking a flight is one of the major causes of stress in modern everyday living.

The amount of stress involved in flying starts way before the actual flight, right on the ground itself. First and foremost, the long trip to the airport itself is fraught with stresses, from lack of timely taxis to traffic jams to  making sure the kids are ready on time. Even if you decide to take to take to the road yourself, there’s the outrageous airport parking charges and the distance they are located from the terminal..

Having reached the terminal, there’s the queues, the far-from-easy electronic check-in terminals and the extra charges, ranging from that for overweight baggage to really unexpected surprises – Ryan Air insists you print your own boarding cards and if you misplace yours, they’ll print it for you..for a fee, 40 British pounds to be precise.

Then there’s the security screening..more stresses if you have shoes with bootlaces or laptops. By the way, the liquids ban mean you need clear plastic bags which are now sold at 1 pound each at some UK airports. Departure delays..these are a way of life nowadays with airlines cutting back on flights due to bad times.

Despite Attempts to Improve Economy Class, some Stressors Cannot be Eliminated

Once in the air, your problems are about to begin. If you turn left on entering the aircraft, well and good; but if you turn right, be prepared for cramped seating conditions (noticed the shrinking leg-room, especially on low-cost carriers?). If you can stomach the low-quality food, this may not stay down too long if the plane hits into turbulence – this has been cited as the top cause of stress while flying.

Once settled down, your mind may be jarred by a seemingly endless stream of in-flight announcements, in multiple languages, informing that you are 35,000 ft in the air (who really cares?). Add to this, the snoring passengers and crying babies and the soon-to-be-allowed mobile phone-calls and one can see why there’s so much stress.

Don’t forget polluted cabin air..a recent report in the London Telegraph confirms that the smell of jet-fuel in some cabins is far from imaginary.

TCP,from jet-fuel present in cabin air, causes drowsiness,nausea and headaches

33 million pieces of luggage were misplaced in 2008

Once landed at your destination and after surviving the long queues at Immigration, you might have to face the heart-sinking sensation of lost luggage (God forbid!) and the monumental paperwork that comes with it. And you thought London Oxford Airport would be at least near London.. be prepared for a 60-mile journey to the city!

And..long after reaching your final destination, there’s still the perennial fight with jet-lag! Numerous antidotes have been promulgated – but that’s another story..

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Where there’s a pandemic, there’s profits to be made..and even the most reputable of companies will fall prey to their marketing strategists in order to boost the financial bottom-line. Take the case of the well-known pillar of health foods – Kellogg’s.

Take a closer look at the bottom half of the package and you can sniff the marketing overhype, especially as the world is facing the resurgence of the H1N1 pandemic. Not only is the claim misleading but the timing bad, especially when the H1N1-conscious public is grappling with the shortage of flu vaccines. Some city councils have sent letters to the US FDA asking Kellogg’s to back its claim.(The FDA has jurisdiction over false or misleading labeling. FDA officials are not permitted to discuss specific cases under consideration and declined to comment on this one.)

I’ve written in an earlier posting “Pandemic,Panic and Profits”,  about the way some multinationals are using  herd psychology in these troubled times to imply, by soft association, the link between H1N1 infection and various remedies. But this one takes the cake..the FDA may have the last word yet..

Update 6 Nov 2009: Kellogg Co just announced that they will pull out the immunity claims from all their cereal boxes. See here.

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With unsolicited offers of credit cards coming ‘free-for-life’, its not surprising that many consumers will find that, with easy credit in hand amounting to a few extra thousand dollars, there’s a tendency to  treat it as extra spending money and over-indulge with bliss..till the end of the month, that is.

The real danger is when credit card usage passes the barrier of overspending and enters the realm of addiction. Yes, there are increasing numbers who will treat cards as extra spending money and go on a splurge , thereby  forgetting about the liabilities of spending beyond their means and ending up with huge balances at the end of the month, leading to, in extreme cases,  financial ruin.

Credit card addiction (I call it credit carditis) strikes when you least expect it. As with most addictions, the person with the problem is often the last one to realize that they have a problem.

How do you spot the warning signs of credit card addiction?

According to financial planner Julie Casserly, you’re there if you have 3 or more of the following features:

• You never have cash in your wallet
• When you do have cash, it burns a hole in your pocket.

• You buy things just because they’re on sale, or because they make you feel better if you’re upset.
• You have more than two “branded” or store credit cards.
• You and your spouse or partner argue over money.
• Credit cards balances are growing — and not being paid down — each month.
• Your cards are all maxed out. But instead of paying them off, you open new ones in order to have additional credit.
• You don’t know how much you owe on the cards you have.
• You own several things you’ve never worn, used, etc.
• You hide your credit card statements from your spouse.

How do you cure this addiction?

• Spend cash – this reduces the risk of impulse purchases.
• Hide the card – out of sight, out of mind.
• Set your short-term and long-term financial goals.
• If all else fails, seek counselling. There’s some websites worth looking  -Debtors Anonymous,
  Credit Cards.com

Some governments feel that by imposing an annual surcharge/fee for using each credit card, this  will help reduce the number of cards and help solve the addiction. As one can see from the experience of taxing cigarettes, this method is highly ineffective!

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Spotted in a Hong Kong newspaper – an ad warning against breast cancer.

There are many reasons to push through President Obama’s health reforms urgently despite the rhetoric – escalating health costs, 80 million uninsured Americans, inefficient delivery systems, to name a few. But there’s one question that needs to be addressed for which the answer is  practically unanimous.

Are Americans dying too soon? The answer is a resounding YES.

When it comes to “preventable deaths” -  illnesses and injuries that should not kill at an early age with access to timely and effective health care – the United States ranks last among 19 industrialised nations, according to the Commonwealth Fund.

Well, the study may be a few years old, but the fact remains that not much has changed since and the belief is that the US continues to lose ground. And what are the diseases Americans most likely to die from that can be prevented? Gun-shot injuries and motor vehicle accidents top the list but chronic diseases like diabetes, stroke and epilepsy are bigger drivers of healthcare costs.

Many will defend US healthcare as one of the finest in the world. True, to a certain extent. When its good, its really good. But when its bad, it can be really terrible. The OECD (Organisation for Economic Cooperation and Development) describes the performance of the U.S. system as a mix, at best.

Radiation Therapy for Breast Cancer - the treatment of cancers is one field where US healthcare excels universally

It ought to be noted that diseases like  complicated cancers, AIDS and most heart diseases, while often treatable, are not considered preventable, because even with the best of modern medicine, patients often die before old age.

Can he cure the ailing healthcare system?

As the health reform debate rages on as to the best methodology to resuscitate, rehabilitate and enhance healthcare delivery in the US, thousands will continue to die from preventable causes. Many are asking whether the President will have the panacea for the ailing system.

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