Bird’s Eye: A quartet of interesting pieces about doctors. We open with the telling fact doctors are far less likely to opt for extreme measures when confronted with death. As the article says, “They know enough about modern medicine to know its limits.” Then we offer two points of view on tonsillectomies: one very critical of their ubiquity, and one in response. The debate goes on further should you want to follow up. And finally, how do you get doctors to wash their hands? An amusing study shows that changing one word in the signs makes a huge difference.
* How Doctors Die Zócalo Public Square
Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.
It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.
Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).
* Tonsillectomy Confidential: Doctors Ignore Polio Epidemics And High School Biology Boing Boing
Tonsillectomies are ancient and, as the ear nose and throat doctor said, very common. “For much of the twentieth century,” says this book,”tonsillectomy (generally with adenoidectomy) was the most common surgical procedure in the United States.” They are still very common. In 2006, half a million were done just in America.
…Any review must omit information. The Cochrane Review, however, omits a vast amount of anti-tonsillectomy information that could easily have been included. It does not omit a vast amount of pro-tonsillectomy information. There has been no series of devastating epidemics in which tonsillectomy was associated with less disability and death. There have not been thousands of experiments that imply tonsils reduce resistance to infection. In that sense, the review is badly biased. One reason may be conflict of interest. Burton is an ear nose and throat surgeon; he does tonsillectomies for a living. This is not disclosed in the review. I don’t know if his finances depend on how many tonsillectomies he does, but I am sure he has done many of them (biasing him to think they are good) and has many tonsillectomy surgeons among his friends and colleagues. He must care what they think. Negative comments about tonsillectomies would surely displease them. Burton declined to comment on this criticism.
In its omission of anti-tonsillectomy information, the Cochrane Review reflects this area of medicine. While doing research for this post, I was unable to find a single instance in which any doctor — including pediatricians, ear nose and throat doctors, and tonsillectomy surgeons — or doctor-run website told any parent (or anyone else) anything like the truth about the risks of tonsillectomies. On the Mayo Clinic website, for example, a pediatrician tells parents that “the decision to remove a child’s tonsils must be weighed against the risks of anesthesia and bleeding, as well as the missed school days to recover from the procedure.” That’s all he says about risks.
* A Doctor Responds To Seth Roberts’ Guest Post About Tonsillectomy Boing Boing
… while I didn’t agree with everything Roberts had to say, I thought his key point—tonsillectomy as a treatment for sore throats isn’t actually strongly supported by evidence—was a valuable one. That said, I R NOT A MEDICAL EXPERT. And neither is Roberts. Steven Novella, however, is a medical doctor and a clinical researcher. He has a very good blog post up that points out some important flaws in Roberts post. Here’s the gist of what he has to say: Roberts seems to have misunderstood some of the studies he linked to, and assigned too much importance to others. “Evidence” can mean a range of different things. Some evidence is better than others. Just because a study was published doesn’t mean it’s evidence worth paying attention to. And it is very easy for people to get confused by this distinction when they start trying to treat themselves with the help of Google.
For instance, Roberts provided a laundry list of potential complications of tonsillectomy and asked why the evidence-based Cochrane Review didn’t talk about any of them. The problem:
He seems to take the approach of listing any possible hypothesized risk as if it is established. The links he uses to defend each risk he cites does not support the claims he is making. Once again he is lead to the conclusion that doctors are ignoring the risks and morbidity from tonsillectomy, while those alleged risks have not been established.
For example, he lists Hodgkins disease with links to evidence for an association with tonsillectomy. He does link to one article from 1972 and disputes the association, but did not link to a 1987 review that found no association between Hodgkins disease and tonsillectomy. As far as I can see this was the last word on the issue. Roberts still gets to list Hodgkins disease as a scary increased risk from tonsillectomy without fairly representing the state of the evidence.
* How Do You Get Doctors to Wash Their Hands? Huffington Post
The researchers explored this issue in two ways. In one simple study, they posted signs above the hand-sanitizing gel stations on a hospital. At some stations, the sign was a control sign (“Gel in, wash out”). At some stations, the sign emphasized personal consequences (“Hand hygiene prevents you from catching diseases”). At a third group of stations, the sign emphasized patient consequences (“Hand hygiene prevents patients from catching diseases”). Notice that these two signs differ by only one word.
The researchers measured the amount of sanitizing gel used in the two weeks before and after the signs were posted. The health care staff at the hospital was unaware that a study was going on. Neither the control nor the personal consequences signs increased the amount of gel used, but patient consequences sign increased gel use by almost 50 percent.
A second study looked at this even more carefully. The personal consequence or patient consequence signs were hung in different wards of a hospital. A trained member of the medical team observed the staff before and after the signs were put up to examine whether the staff washed hands immediately after patient contact.
The researchers found that general staff tended to wash their hands frequently regardless of the type of sign. For nurses, the personally consequence sign had no effect, but the patient consequence sign increased hand washing by about 11 percent. For doctors, both signs increased hand washing, though the increase was larger for the patient consequence sign (28 percent) than for the personal consequence sign (21 percent).
