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Hawaii J Med Public Health. 2017 March; 76(3): 94.
PMCID: PMC5349119

The Weathervane

Russell T Stodd, MD, Contributing Editor

It's just a Broken Hip. He can Wait Till Tuesday…Not!

For an elderly person, a fractured hip may be a sentence of death. At least 1/3 of such patients die within one year, and fewer than one in five return to their previous level of activity. Now a new approach to such problems may possibly improve the outlook. The established method of placing such patients in bed and sedated for three days or more before operating to assure stability, may be at fault. An estimated 340,000 older adults suffer hip fractures in the United States annually, and many have other medical issues. Because physicians and orthopedists have taken the position that fractures are not real emergencies, operations are often delayed. Now more hospitals are putting hip fracture patients on a fast track for surgery from the emergency room to the OR, repairing the fracture within six hours or so. A review of more than 2 million patients led by a team at NYU Langonge Medical Center's Department of Orthopedic Surgery published last year in the Journal of Orthopedic Surgery found that compared with same-day surgery, each day of delay was associated with a significantly higher overall complication rate. Surgery two or three or more days after admission was associated with higher rates of death. “We have to start thinking differently, and treat a hip fracture with the same urgency as a heart attack or a stroke, “says Philip Devereaux, cardiologist and researcher at McMaster University in Hamilton, Ontario. Delays can cause the physical trauma of a fracture to stimulate inflammatory responses in the body. That will increase stress on the heart and the immune system which will increase the risk of complications. A pilot study in 2013 published in the Canadian Medical Association Journal suggested that accelerated surgical patients had a 40% lower risk of major complications. The current mantra for physicians and orthopedists should be “Get the fracture patient to the OR. Get him/her up and moving after surgery.” 75% of such patients return to independent living.

Organized Medicine Needs a Hammer.

A study published in the New England Journal of Medicine reported what insurance companies have known for years; 1% of physicians accounted for 32% of paid malpractice claims over the past 10 years. While this might appear to be good news since almost all doctors can be trusted to meet the acceptable standard of care, but the ugly truth is little is being done to hold the bad doctors accountable. The new study analyzed more than 66,000 claims paid against 54,000 physicians between 2005 and 2014. The small number of bad docs showed “distinctive characteristics,” implying they can be identified at an early stage. Put another way, health care providers could eliminate 1/3 of medical malpractice — along with patient pain and suffering, cost of corrective surgeries, long term care and indemnity payments. So, why not identify and punish the bad docs? Restrictions built into the National Practitioners Data Bank prevent identifying the doctors by name. Only in Colorado is medical malpractice a matter of public record. Shielding the very worst doctors not only harms patients, it also casts a shadow on the vast majority of competent, careful and caring physicians. Talk to your state legislators and open the windows.

Your Phone Could be a Tattletale.

Your cellphone can become a treasure trove of information for a forensic expert. The smudges on your phone reveal intimate details about your life style, a new study from the University of California in San Diego reports. Traces of molecules and microbes left when you handle the phone can add up to a composite portrait, including gender, diet, medications, clothing, beauty products and even places visited. The new technique reported in the Proceedings of the National Academy of Sciences is not yet admissible in court, nor is it precise enough to identify a single person like a fingerprint or a DNA sample. Still, it has the potential to help investigators use objects found at a crime scene to narrow the range of possible suspects. Existing forensic techniques have come under criticism recently: bite marks, hair and tool-mark analysis, fail to meet scientific standards. Now experts have a new and more reliable source. No doubt this technique will expand with technology.

Over the Hills and Through the Woods to the MEs Lab We Go.

When a 58-year-old man collapsed and died at a convenience store in eastern Montana in August 2016, his body had to be driven 300 miles to South Dakota for autopsy. The problem is the dearth of medical examiners (forensic pathologists) across the Unite States. “There is a shortage,” said David Fowler, vice president of the National Association of Medical Examiners. There are about 500 practicing board-certified forensic pathologists, less than half the number required. While television stories make the work appear interesting and rewarding, that is rarely the case. It is not glamorous, not attractive and doesn't pay much. Moreover, the corpse may be several days old and a challenge to the olfactory sense. The shortage also means that some autopsies are performed by people who are not forensically trained. The US Justice Department in 2013 approved recommendations to increase the number of forensic pathologists by raising salaries, introducing student-loan forgiveness and increasing exposure to the profession in medial school. So far, programs are undersubscribed, and the annual number getting board-certified has remained between 30 and 40 for the past 10 years.

She is Beautiful and She is Strong.

Television personality Erin Andrews, hostess of “Dancing With The Stars” and sideline commentator of National Football League (NFL) games had recent surgery for cervical cancer. She is a survivor and not giving up her roles with Fox network. The positive side of her experience is the notoriety for the 13,000 women who die with the disease each year. Cervical cancer is readily preventable with use of the HPV vaccine, but the downside is the relative lack of vaccine acceptance in this country. All 69 of the nation's National Cancer Institute-designated centers urged parents and health-care providers to have children complete the regimen by their 13th birthdays. Just 40% of girls and 21% of boys have received the vaccine according to the Centers for Disease Control and Prevention (CDC). The US rates stand in marked contrast to some other countries, including Australia at 75% of boys and girls, the United Kingdom at between 84% and 92% and Rwanda where 93% of children are in compliance with World Health Organization recommendations for HPV shots.

In Vino Veritas.

An elderly woman was sitting on the lanai and sipping a glass of wine. She said, “I love you so much I would not want to live without you.” Her husband sitting beside her said, “Is that you or the wine talking?” She replied, “It's me, talking to my wine.”

Addenda

  • One-third of the entire population of Sweden emigrated to the United States in the 1800s.
  • Woodrow Wilson was the last president to type all his own letters.
  • Old people should not eat health foods. They need all the preservatives they can get.
  • Most people don't know what they are doing, and a lot of them are really good at it.
  • Kinky sex involves the use of duck feathers. Perverted sex involves the whole duck.
  • Death sneaks up on you like a windshield sneaks up on a bug.

Aloha and keep the faith rts

(Editorial comment is strictly that of the writer.)


Articles from Hawai'i Journal of Medicine & Public Health are provided here courtesy of University Clinical, Education & Research Associates