Category: Hospitals

This could have been done in 5 seconds but instead it took 5 hours

published date
January 9th, 2007 by

In case you don’t want to read this whole story, the moral is to try to get Dr. Robert Lindeman of Natick Pediatrics as your pediatrician if you live anywhere close to Natick, MA.

On December 23rd my preschooler came home from a play date with an aching, swollen foot. No one knew exactly what had happened except that he’d fallen. The next day he was still complaining about it and limping badly. (He’s not a big complainer or limper.) Normally I dread any interaction with the health care system so I would have ignored the injury and hoped it got better. But it was the day before Christmas and two days before we were leaving the country for a week.

We went to a family social function on the 24th. There were plenty of doctors there, including pediatricians. We asked one pediatrician (whom we don’t know well, but who practices pediatrics in the ER) to have a look. She took off my son’s shoe, had a look, and said she wasn’t sure. Her dad happened to be there, too. Turns out he is a pediatric orthopod! He had a look and said he couldn’t see through skin (since he lacks X-ray vision) and that he didn’t know if it was broken. Both told us that if it was a Jones fracture it could be serious and require treatment.

Then my wife saw our friend Dr. Lindeman, and asked him. He didn’t take off my son’s shoe or talk to him but said:

“It’s not broken. I can tell by the way he’s putting weight on it. Don’t worry about it.”

When we got home we called our pediatrician’s office. Our excellent pediatrician, Dr. Patricio Vives (old school, no website to link to), wasn’t around on Christmas Eve. The person covering for him said she couldn’t tell what was wrong and suggested we might want to go to the ER for an X-ray for “peace of mind.”

Oh no!

I took my son to Children’s Hospital and prepared for the worst. Good thing I did. Rather than complain about all the details I’ll just say it was a 5-hour experience, which included 4 hours and 45 minutes of waiting, 10 minutes in radiology, and 5 minutes with the doctor.

At one point (3 hours or so in) I was told –when I went to the desk and asked nicely– that we were next on our “track. ” (They have different tracks depending on whether orthopedic/surgical, medical, etc.). Around the 4 hour point, a staffer came out with a clipboard and after seeing our name toward the bottom of the list said, “you must have just come in.” I have to admit I almost lost my cool at that point. A few minutes later she came back and more or less admitted they’d lost track of us.

Who knows how long we would have waited after that. Luckily one of the physicians recognized our name and had us called in. It turned out to be another friend of ours. She saw my son, told us the radiology report was negative, and then had my son stand on his toes. As soon as he did that she concluded he was fine.

This experience was kind of embarrassing for me (and of course a big time waster). What I take away from it is to listen to advice from people you trust and don’t ask the opinion of people you don’t know well. If we hadn’t asked the first pediatrician and pediatric orthopod I just would have listened to Dr. Lindeman and not bothered to call the person covering for our pediatrician. (I’m pretty sure that if Dr. Vives had been around he would have steered us properly.) It also would have been nice to have a consumer-friendly decision support site, which could have taught me the tiptoes trick and saved my time and my health plan’s money.
So let me at least put in a proper plug for Dr. Lindeman (since I didn’t pay him for his quick assessment). He’s a first-rate office-based pediatrician with MD and PhD degrees from Columbia University. He’s board certified in pediatrics and pediatric pulmonology. He uses secure messaging with patients and families (though sadly he’s not using RelayHealth). He also handles call himself, rather than farming it out to someone else.
I don’t live anywhere near Natick, but anyone with kids who does should check his website or call his office at (508) 655-9699.


May 31, 2007

Yes, folks, I’m referring to the now-famous Flea blogger, so this post is getting a lot of hits today. I stand by my endorsement of Dr. Lindeman, which is based on ever-so-much-more than this particular anecdote. You’ll see a bunch of critical comments below from people who don’t have firsthand knowledge of this case and don’t know Dr. Lindeman. They’re off the mark IMHO.
David Williams

Chinese capitalism, US socialism

published date
January 5th, 2007 by

When I first visited China in 1990 I was surprised at how capitalistic it was. Somehow I’d always thought of China as a communist country but especially in the southern provinces near Hong Kong I experienced some of the most capitalistic attitudes and practices I’ve seen anywhere. Even to a dyed in the wool capitalist like myself the brash materialism and focus on money was a bit nauseating.
As I wrote in (In health care, the rich and powerful aren’t really insulated):

Overall, the rich and powerful are highly constrained in their ability to get exceptional service and quality in health care compared to other spheres in their lives.

Of course there are differences, but they are nowhere near as stark as in sectors like housing or travel.

In China it’s a different story, according to yesterday’s Wall Street Journal (Hospital Caters to China’s Wealthy and Poor):

At the TEDA International Cardiovascular Hospital just outside Beijing, patients can choose from six levels of service.

At the lowest end, for about $6.70 a night, patients must share a small room with others. The biggest suite at the hospital, on the other hand, costs about $3,200 a night and occupies half the floor of a building. It offers satellite television, an indoor garden, a conference room, two bedrooms, a massage chair and a private gym.

“It’s just like an airplane,” says Liu Xiaocheng, the hospital’s president. “In the front of the plane, they have the first class. In the middle, business class. At the end they have the economy class. But they’re all going to the same destination. It’s the market!”

The article focused on the differences in amenities (essentially the hotel aspects of the hospital). The article implies that the level of medical care  is the same for everyone  –mentioning, for example, free care given to orphans to build goodwill with the government.  To some extent that’s the situation that prevails in certain US hospitals –VIP suites for extra charge, but  the same medical care for all (mostly).

It would have been interesting if the reporters probed more on this point.  I’d be interested to know how many levels of medical care are being provided and how the hospital chooses what resources to commit to those in the lower service tiers. I wonder whether Liu’s statement about everyone “going to the same destination” is a fair metaphor.

The value of private funds for drug research

published date
December 20th, 2006 by

Babies with “short bowel syndrome” are fed intravenously to keep them alive. Unfortunately prolonged IV feeding often leads to liver failure. Doctors at Children’s Hospital in Boston haven’t been satisfied with that trade-off and have experimented with a variety of ways to avert liver problems. A particularly promising remedy is to use Omegaven, a fish-oil based formula that’s on the market in Europe (for adults) but not the US.

Omegaven’s maker, Fresenius AG doesn’t want to market Omegaven here. Basically, they’ve decided it’s not in their commercial interest. Instead Fresenius has a new product in development that they’d prefer to bring to market. Meanwhile Fresenius is happy to sell its existing product, Intralipid. That’s tough luck for babies who need treatment now. Fresenius has actively resisted efforts to allow testing of Omegaven, and the FDA hadn’t been too helpful either. The Wall Street Journal wrote an article on the topic (A Doctor’s Push For Drug Pits Him Against Its Maker) a month ago.

Now, according to another Wall Street Journal article (Trial to Test Drug for Sick Babies) the trial is going ahead. The FDA relented and The March of Dimes stepped in with funding. The trial will pit Omegaven against Intralipid. Babies who start on Intralipid will be able to switch to Omegaven if they develop liver damage. Likewise babies starting on Omegaven will be able to switch to Intralipid if they have problems.

Meanwhile Fresenius is getting a free lesson in how not to build a corporate reputation in the US.

Based on what I read in the Journal, I’m going to make a donation to the March of Dimes, and I suggest you consider doing the same. (MedImmune is matching donations dollar for dollar during December, up to $50,000.)

Henry Ford regulates pharma reps

published date
December 19th, 2006 by

The Henry Ford Health System is banning free lunches and gifts by pharmaceutical and medical equipment sales reps, starting January 1, according to the Detroit Free Press. Representatives will also have to schedule appointments with physicians and pay a $100 certification fee to Henry Ford before being allowed to do so.

“The evidence shows that when physicians are exposed to pharmaceutical representatives, their decisions are different,” Dr. A. Mark Fendrick, a U-M drug price specialist, told the Detroit Free Press. “It is very unusual to find generic drugs in a physician’s sample closet.”

The program is portrayed as a way to keep industry in line, but I look at it as part of the maturation of the relationship between pharma and docs. Sales reps buy lunch and provide gifts because doctors want that to happen; many expect it as a kind of entitlement. It’s just as well to have that practice end. I’d suggest Henry Ford use that $100/rep tax to fund an education program for physicians to help them get the most out of their interaction with drug reps. Maybe an online course to explain industry economics and help doctors ask the right questions.

There are at least a couple of companies I can think of that could benefit from Henry Ford’s decision:

  • PreferredTime, which schedules rep appointments with physicians
  • Medvantx, which makes machines that provide generic samples in doctors’ offices

Tissue snatchers?

published date
December 15th, 2006 by

Author Michael Crichton has a disturbing opinion piece in today’s Wall Street Journal (Body Snatchers, 2006) in which he describes a lawsuit over the disposition of prostate tissue samples at Washington University. According to Mr. Crichton,

When [prostate-cancer surgeon] Dr. [William] Catalona left Washington University for Northwestern, he wanted to take… tissues with him. Six thousand patients notified the university that they wished their tissues to go with him. Ignoring the requests of patients, Washington University claimed the tissue collection as its own, and sued Dr. Catalona. In March of this year the district court ruled the collection belonged to the university. Judge Stephen Limbaugh found that the patients had given their tissues to WU as a gift, and therefore the university owned the tissues outright.

Crichton argues that the judge overstepped his bounds and took away patients rights. The ultimate harm will come from patients’ loss of confidence in university research centers.

We only have Crichton’s side of the story here and I don’t find it terribly credible. What does he mean for example that “six thousand patients notified the university that they wished their tissues to go with him?” And why should a researcher be surprised that the university would assert its rights to tissues –or anything else– that was donated to the university? Why, in general, should we trust researchers more (or less) than universities?

I do agree with his last piece of advice (except the lawyer part),

In short, caveat patiens, keep copies of everything you sign, bring a lawyer to every medical appointment, and always, always watch your back