Bizarre medical stories ripped from the virtual pages of the Internet

A 30-year-old California woman died after a naturopath gave her an intravenous infusion of turmeric—yes, turmeric, a spice used in curry, supposedly has anti-inflammatory properties when taken by mouth.

An naturopath who only uses turmeric orally was quoted in a San Diego ABC news report, "There are some doctors who use turmeric extract in IV form to try and heighten the physiological effects, so the anti-inflammatory effects of the turmeric. It hasn’t been well studied. It’s more theoretical, so it’s more investigational.” Unlike most naturopathic treatments, IV turmeric hasn't been well studied.

According to NBC San Diego, the medical examiner said she died of a heart attack and ruled the death an accident. In fact, the story was headlined "Tumeric Solution Through IV To Blame, in Part, For Women's Death: ME." In part?

The naturopath has yet to be named in any news story. How is this not manslaughter or criminal negligence? If an MD had given say, oregano intravenously, would it still have been an accident? Would the doctor's name still be unknown? I think it would be on Yahoo's front page.

OR tech: "How do I deal with an abusive surgeon?"

Have you ever come across problems with rage and temperament issues in the OR. I have been an operating room tech for many years and have been in a variety of surgical settings.

A certain surgeon brings in a lot of money to the hospital, but he is terrible. I have been called things no one has ever called me. He throws instruments on my table and mayo stand, screams, and implies that I and my colleagues have no idea what we are doing. I have reported him to my manager and the OR director, but nothing ever comes of it.

Other surgeons have witnessed his behavior and have said something, but nothing was ever done. I understand the OR is a beast of its own, but the culture has to change with these newer guys coming out of residency. The mindset of the surgeon being our 'customer,' which is being rolled out to us now, is not reason for us to put up with abuse. What have you encountered on a peer-to-peer level on how to handle such demeaning behavior? I trained and worked at a level 1 trauma center with emotions that constantly ran high, and still it was less stressful than this particular surgeon. Thank you for your advice. 

A recent paper in the American Journal of Surgery addressed this topic. The authors interviewed 19 OR personnel including nurses, medical students, surgical residents, anesthesiologists, and 2 scrub technicians. Dr. Amalia Cochran, the paper's lead author, told me the reason there weren't more scrub techs was that they were reluctant to participate.

Facebook and unprofessional behavior among surgical residents

Have you ever wondered about the behavior of surgical residents on Facebook? I have. A study from the Journal of Surgical Education posted online in June 2014 looked at the issue.

The paper, "An Assessment of Unprofessional Behavior among Surgical Residents on Facebook: A Warning of the Dangers of Social Media," identified 996 surgical residents from 57 surgical residency programs in the Midwest and found that 319 (32%) had Facebook profiles.

Most (73.7%) displayed no unprofessional content, but 45 (14.1%) exhibited possibly unprofessional material. Clearly unprofessional behaviors were noted in 39 (12.2%) resident profiles. The paper said, "binge drinking, sexually suggestive photos, and Health Insurance Portability and Accountability Act (HIPAA) violations were the most commonly found variables."

There were no differences in the rates of unprofessional behavior between male and female residents or by postgraduate year.

I have blogged previously about the ill-defined nature of professionalism, and the papers' authors acknowledged that it can be subjective. Some of the behaviors they felt were potentially unprofessional such as photos of residents holding an alcoholic drink, holding a gun while hunting, or making political or religious comments are debatable.

They referenced another paper that found similar rates of unprofessional behavior (16%) on Facebook among applicants to an orthopedic surgery residency program.

A 2005 New England Journal of Medicine case-control study found that practicing physicians disciplined by state medical boards were significantly more likely to have had documentation of unprofessional behavior in medical school as well as lower Medical College Admission Test scores and poorer grades in the first two years of medical school.

Unprofessional behaviors listed in the New England Journal paper were irresponsibility, diminished capacity for self-improvement, immaturity, poor initiative, impaired relationships with students, residents, nurses, or faculty, impaired relationships with patients and families, and unprofessional behavior associated with anxiety, insecurity, or nervousness.

Some of those \ seem a bit vague. Are diminished capacity for self-improvement and poor initiative really unprofessional behaviors?

Facebook unprofessional behavior and the unprofessional behavior documented in the NEJM paper which pre-dated the widespread use of Facebook may not be comparable.

But I suppose one could say that some of the Facebook behaviors could be categorized as immature or irresponsible.

Until stories about residents being rejected for jobs after training start emerging, there probably won't be a change in the way they use Facebook or other social media.

Or maybe society will change.

In 1987, politician Gary Hart had to withdraw as a candidate for the Democratic Party's presidential nomination because he had an extramarital affair, and just a few years later, the president himself had a dalliance with an intern in the White House and survived.

Who thought marijuana use would ever be legalized?

Does anyone really read anything online?

Not long ago, I tweeted a link to a very long story. Within 60 seconds, it received three retweets. Since the article would have taken at least 10 minutes to read, it is highly likely that those who retweeted it did not read it.

This phenomenon is not limited to Twitter. A couple of recent articles revealed some interesting data about what people really do online.

From Time magazine in early March: "A stunning 55% [of those who clicked into an article] spent fewer than 15 seconds actively on a page. [emphasis theirs] The stats get a little better if you filter purely for article pages, but even then one in every three visitors spend [sic] less than 15 seconds reading articles they land on."

Analysis of 10,000 articles shared on social media "found that there is no relationship whatsoever between the amount a piece of content is shared and the amount of attention an average reader will give that content."

A Slate article noted that about 5% to 10% of those who open an article leave it immediately and 38% of people who click on it "bounce" [leave it] before the end of the first paragraph.

At a few hundred words into the article, about half of the remaining readers have left, and very few of the rest make it through to the end.

The amount of scrolling can also be tracked. "There’s a very weak relationship between scroll depth and sharing. Both at Slate and across the Web, articles that get a lot of tweets don’t necessarily get read very deeply. Articles that get read deeply aren’t necessarily generating a lot of tweets."

On April Fools' Day, NPR published a story called "Why Doesn't America Read Anymore?" There was no article [emphasis mine]—only the headline and an explanation of the fact that they wanted to see if people would comment anyway. They were not disappointed as many brainless comments rolled in. This Gawker post has the best of them.  

The Washington Post noted that in addition to diminishing attention spans, we are developing into a nation of superficial readers. “It’s like your eyes are passing over the words but you’re not taking in what they say,” said a graduate student in creative writing.

Attempting to stay with the trend, last week both the Associated Press and Reuters directed their reporters to limit stories to fewer than 500 words.

If anyone is still reading this, what it means is that I should not feel slighted that people are retweeting me without necessarily reading what I so carefully and lovingly select for dissemination. 

It's not me. It's you.

PS: I am aware that some people retweet things and plan to read them later. But how do they know that what they have retweeted is worthy? Or does it matter?

Review: "Scrubbing In," a new medical reality TV show

I don't watch much television except for some sports. But I feel it is my duty to comment on medical TV shows, which I generally hate. A few months ago, I reviewed two shows that, as I predicted, didn't last long. Their names were "Monday Mornings" and "Do No Harm."

A third show "Married to Medicine" is rumored to be coming back for a second season despite a storm of protests over the way it depicts black physicians and their spouses. You can read all of these reviews by entering "Medical TV shows" in the search field in my blog's upper right.

I should have known better, but something drove me to look at a new reality show on MTV called "Scrubbing In," which debuted last week.

A warning sign was that based upon only the show's trailer, both the American Nurses Association and the Canadian Nurses Association wrote to the network asking that the show be canceled because it depicts nurses in demeaning and unflattering ways.

I will spare you the details of the plot, such as it was. But here are a few highlights.

A group of travel nurses, mostly from Pittsburgh, to go to work at a hospital (which probably regrets its participation) in Orange County, California.

The cast features several extremely unlikable young women and a few equally unlikeable men. All are profane, unprofessional, and dishonor the nursing profession.

Most if not all of the women have had breast implant surgery and are not bashful about revealing that fact verbally and sartorially.

Two nurses, one male and one female, had to be removed from the orientation session at the hospital. Their California nursing licenses were held up because they both had prior arrests for DUI.

It's not clear what the show's title "Scrubbing In" has to do with anything, since all of the nurses who had licenses were working in the emergency department, not the operating room.

During the first 30 minutes of the show's premiere, which was all I could take, about 3 minutes took place in the hospital. The rest of the time was devoted to watching the ladies walk around in towels, swear, shower together (behind a curtain), and go on a "booze cruise" so they could all get acquainted.

There were some memorable lines however.

While taking off his shirt on the boat, one of the male nurses said, "Sun's out, guns out."

One of the nurses, discussing her prospects for the move to Orange County, said, "Nurses f--- doctors, and doctors f--- nurses."

And while in a car, one nurse says to the others, "Did you bring your vibrators?"

Not only is "Scrubbing In" the worst medical show I've ever seen, it might also be the worst television show in history.

It should be scrubbed.

Lawyer tricks of the trade: Billable hours

Lawyers are hardworking people. That's for sure. Take this lawyer from Ohio who billed long hours for court-appointed cases. For instance, he billed for 21, 21.5, 23 and 29 hours of work for 4 different days. His lawyer said he did the work but was simply a poor record-keeper.

Right.

Not to be outdone, a lawyer from Iowa billed for more than 24 hours of work in a day on 80 separate days. He is being charged with a felony for receiving $178,000 for what are being called improper payments for work as a public defender.

Four other lawyers were terminated from the program for similar issues.

And you thought doctors worked long hours?

The president of the Iowa State Bar Association called the findings of the audit that discovered the problems "an isolated aberration, involving five lawyers. Simply put, a few bad apples do not spoil the barrel."

Are these isolated aberrations?

I'm not so sure. A lawyer friend of mine (yes, I do have friends and even relatives who are lawyers) tells me that this is not particularly uncommon.

He said that lawyers will often schedule 5 or 6 case conferences at a courthouse over a 2-hour period and bill each client for 2 hours worth of work.

At least one lawyer feels that the "billable hour" model should be scrapped because "The billable hour makes no sense, not even for lawyers. If you are successful and win a case early on, you put yourself out of work. If you get bogged down in a land war in Asia, you make more money. That is frankly nuts."

This meshes nicely with a story my lawyer friend told me. Shortly after he became a lawyer, he proudly walked into his boss's office to report that he had settled a case in record time. His boss then chastised him for doing so and pointed out that settling the case so quickly cost the firm a lot of money.

It's too bad that legal services are a "privilege"instead of a  "right." Then maybe someone other than I would be upset about how much it costs.

Anger management for doctors

A recent Washington Post/Kaiser Health News story about anger management led with an anecdote about a surgeon who broke a scrub tech's finger by slamming down an improperly loaded instrument. The surgeon was suspended for two weeks and had to take an anger management course, which seems like a mighty small penalty for what could be described as assault.

But the story had to go where many such tales seem to go these days.

Here's a quote: "Experts estimate that 3 to 5 percent of physicians engage in such behavior, berating nurses who call them in the middle of the night about a patient, flinging scalpels at trainees who aren't moving fast enough, demeaning co-workers they consider incompetent or cutting off patients who ask a lot of questions."

Demeaning co-workers and berating nurses who call in the middle of the night? Yes, these things unfortunately do occur. But "flinging scalpels at trainees"? Sorry, I don't think so. But of course, exaggeration is a common feature of articles about doctors, especially if the story wants to portray us in a negative way.

I was a surgical chairman for many years. I know all about disruptive doctors. In a recent blog, I even admitted to throwing an instrument myself once when I was a young and headstrong resident.

A link in the Washington Post story goes to a full text paper on disruptive behavior in the Journal of Medical Regulation (who knew there was such a journal?). The author points out that isolated episodes of what some might consider bad behavior can happen, but unless there is a pattern or the incident was egregious, doctors should not be labeled as disruptive.

There are many problems with disciplining disruptive physicians. The article addressed a few of them. 

Here are a couple that weren't mentioned. 

The disruptive doctor may be a busy surgeon or big admitter of patients. This puts the hospital in a bind, especially if there are other hospitals nearby. The doctor can and will threaten to take his patients across town. 

Or the bad actor may be the only physician in a critically important specialty on staff. 

These situations give physician miscreants leverage which tends to mitigate the punishment meted out—analogous to the way pampered athletes and movie stars are treated when they commit crimes.

I have first-hand experience with this having dealt with disruptive surgeons in the past. What I wanted to do and what the hospital administration would permit me to do weren't always the same. By the way, behavior modification programs rarely result in permanent cures. A middle-aged surgical ogre is not likely to become Prince Charming after two weeks of anger management.

So the issue is not as straightforward as it seems. 

By the way, just to show how far toward equality we have come, that surgeon who broke the scrub tech's finger was a woman.

Unprofessional behavior by medical hospitalists

By their own admission, medical hospitalists are guilty of many types of unprofessional behavior says a recent paper published ahead of print in the Journal of Hospital Medicine. A group of researchers from the University of Chicago surveyed medical hospitalists from three major Chicago area teaching institutions. The respondents themselves rated each listed behavior on a professionalism scale. There were 77 responses from pool of 101 hospitalists who were sent the questionnaires. The study asked respondents to state whether they had either engaged in and/or observed unprofessional conduct.

The key findings were as follows:

• Most of the respondents had engaged in at least one unprofessional behavior.
• The most common unprofessional behavior was [I hope you are sitting down.] having non-medical/personal conversations, such as discussing plans for the evening, in hospital corridors. [Gasp!]
• Over 60% of these doctors admitted that they ordered a routine test as “urgent” as a way of obtaining results more quickly. [Can you believe it?]
• My favorite is that 40% confessed that they had made fun of or disparaged the emergency department team for missing findings. [Unreported but very likely true is that 60% of those questioned committed another unprofessional act, which was lying by claiming they had never made fun of or disparaged any ED MDs. The only physicians I know who do not routinely make fun of the ED staff are pathologists because they never deal directly with the ED. Before all you ED docs get your panties in a knot, I am certain all of you disparage all of us too.]
• Other alleged unprofessional behaviors were celebrating a blocked admission, going to working when ill and texting during conferences.

Another interesting finding was that for every one of the over 30 unprofessional behaviors listed in the questionnaire, hospitalists said they had observed many more such behaviors than they admitted to participating in.

Despite what many surgeons may have believed, this survey shows that medical hospitalists are really pretty normal. 

But I suspect there will be corrective actions for these doctors at the three hospitals. A curriculum will be developed and monitoring metrics will be established. Maybe listening devices will be placed in hallways. These scandalous behaviors must be stopped.

A final note—this study was supported by grants from two different sources.