How twitter helped a technology consultant escape from an evil hospital

http://inmantechnologyit.blogspot.com/2009/09/social-media-and-my-escape-from-spinal.html

by gluejar • 17 years ago

132 88 17 years ago

inmantechnologyit.blogspot.com

gruseom6• 17 years ago

That is a harrowing story. If it's half true, the hospital really is evil.

wheaties• 17 years ago

Doubt the doctors are the evil ones. If they're using an outdated procedure it means they haven't been kept up to date on the latest treatment protocols. The hospital beaurocrats trying to keep their accredation and earn big bucks, those are the evail ones.

fnid2• 17 years ago

They are evil because they were thinking of themselves before the patient and using lies to intimidate her into agreeing with them -- when they were wrong.

That's evil. Unfortunately, it's a story repeated across the nation every day.

gruseom6• 17 years ago

It's interesting that you try to absolve the doctors by rendering them passive ("they haven't been kept up to date" - whose responsibility is that? and how did they react when presented with correct information?). Most evil happens by default. The same is no doubt the case with the hospital administrators.

The interesting characters in the story (again, assuming this is all true) are the sympathetic subordinates - nurses and so on - who supplied information about what was really going on.

gluejar• 17 years ago

According to the author, the story is being used as fodder by both sides of the healthcare debate. All I can see is the perverse economic incentives on display.

potatolicious• 17 years ago

AFAIK Canada gets around this problem by capping the number of billable patients a doctor can see per day (adjusted by specialty of course). Any patients in excess of the cap is only paid by the government at a steeply discounted rate.

This discourages doctors from overworking themselves and offering shoddy care (instead choosing to move patients through like a cattle farm), and also discourages the sort of unnecessary treatment this article talks about.

yummyfajitas3• 17 years ago

I suspect that the doctors at this hospital would be well under the quota you speak of. Remember, the author suggested the hospital might lose it's accredition for this type of surgery since they didn't do enough of them.

durana• 17 years ago

The story really doesn't involve Twitter much at all.

gruseom6• 17 years ago

But that's not true. It describes her as using Twitter throughout the ordeal. Most importantly, it was through Twitter that she met the ethical neurosurgeon who saved her.

Incidentally, her title references "social media" rather than Twitter, which I think is right; it's not hard to imagine, say, Facebook playing the same role. What's relevant is that she got word of her plight out to a network of people in a way that would be harder to do otherwise, and that feedback from this network led to a fundamentally different outcome than that experienced (I imagine) by most people with broken spines who are having unnecessary surgery and narcotics forced on them against their will.

jimmybot3• 17 years ago

Are people that responsive on Facebook?

fnid2• 17 years ago

It never occurred to me that carrying high-level heath insurance would mark me as a candidate for unnecessary surgery.

Perhaps this is exactly why health care costs have gone up so dramatically. We have insurance, so the doctors take advantage of it -- needlessly. We very well could be spending a lot less money for the same amount of health care.

I think the solution to the health care problem is for someone to start saying NO, like in that other article on the front page now. No to more test, no to unnecessary treatments and surgeries and non-generic drugs.

Say no!

gruseom6• 17 years ago

We very well could be spending a lot less money for the same amount of health care.

... not to mention greater actual health.

When health care was the leading issue in Canada a few years ago and every politician was going around promising to expand it, I remember wondering if I was the only one thinking we need less of it, not more.

It might be helpful if we used a more accurate label than "health care" (perhaps "disease industry").

windsurfer• 17 years ago

Hey, as a Canadian, if you feel you don't want as much health care, just use it less. The system is designed so that people take as much as they need, but not more.

kmavm• 17 years ago

This is essentially the thesis of Arnold Kling's "Crisis of Abundance":

http://www.amazon.com/Crisis-Abundance-Rethinking-Health-Car...

Except for a few blockbuster interventions (antibiotics for bacterial infection, orthopedics, reading glasses), the expected return of many health care interventions is negative; they cost so much, and have the potential to do so much harm, for such uncertain good, that we're better off avoiding them. The only reason individual consumers subject themselves to so many negative-expected-value treatments is that they do not bear their full costs, sharing the financial part of them with their insurers.

Retric4• 17 years ago

The problem with that philosophy is there are thousands of "blockbuster" treatments, everything from a simple filling, to a Tylenol would be miraculous if you steeped back a few hundred years.

Finding the right balance between cost and heath is hard, but blaming everything but the blockbusters is the wrong place to start. Two years ago my father went from fine to dead in one week in part because the doctor failed to ask for a single test. He had health inshurance, went to a doctor who liked to avoid extra tests and died. A hundred years ago, dieing at 62, could have been seen as living a long life, but today a simple test and a quick surgery and he could have lived another 20 years in good heath.

PS: If you really want to look for waste in heath care figure out where the money goes. Starting with the payments to your heath insurgence company and how little get's back to actual treatments.

cwan• 17 years ago

The remedy isn't about saying no, the remedy is sunlight and transparency. There should be consequences to overbilling, unnecessary treatments. There are after all a great deal of medical treatments and tests that are necessary and should be done but because of third party payers, it creates perverse incentives and discourages competition and accountability which is what we really need.

markerdmann• 17 years ago

This article in the New Yorker is excellent:

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_...

Atul Gawande argues that the problem with healthcare in the US is overutilization.

The surgeon gave me an example. General surgeons are often asked to see patients with pain from gallstones. If there aren’t any complications—and there usually aren’t—the pain goes away on its own or with pain medication. With instruction on eating a lower-fat diet, most patients experience no further difficulties. But some have recurrent episodes, and need surgery to remove their gallbladder.

Seeing a patient who has had uncomplicated, first-time gallstone pain requires some judgment. A surgeon has to provide reassurance (people are often scared and want to go straight to surgery), some education about gallstone disease and diet, perhaps a prescription for pain; in a few weeks, the surgeon might follow up. But increasingly, I was told, McAllen surgeons simply operate. The patient wasn’t going to moderate her diet, they tell themselves. The pain was just going to come back. And by operating they happen to make an extra seven hundred dollars.

sireat• 17 years ago

My wife had the exact same problem: first time gallstone pain, and the hospital wanted to operate immediately. Instead, we got second opinions from various sources and decided to wait.

I am sure the pain will come back some day and then we will have to make another decision, but meanwhile we have avoided an invasive surgery.

JimmyL• 17 years ago

As much as I think "tort reform" is a right-wing dog-whistle term, medical malpractice law has a lot to do with cases like this. Put simply, if you're insured and there's an incredibly remote chance that a test could show something, most doctors will issue it - it doesn't cost them anything, it doesn't cost you anything, and it protects them if something happens to you in the long run, at which point they can say "well, we tested for it and it was negative, so it's not our fault". From the doctor's point of view, ordering the additional test (or surgical procedure, etc.) has very little downsides and either marginal or significant upsides, depending on what ends up happening.

If you're interested in this, read up on the PSA (Prostate-Specific Antigen) test: it's the main test used to check for prostate cancer in males. You'd think that doctors would issue it to all males of a certain age annually, and up until recently most doctors did that. But there's been an interesting change of thinking in the past few years: someone noticed (and importantly, some insurance companies agreed) that the combination of an increase in the power of drugs/surgical techniques available to treat the disease and a stabilization of the relatively-high false-positive rate in the PSA test (and the dangers of what happens with a false-positive) means that unless someone has a predisposition to prostate cancer, it's often better not to test for it. The net result when the options are getting prostate cancer and taking the treatment vs. getting screened early and undergoing the invasive diagnostics needed to confirm a PSA test at that stage, it's usually a better choice just to get prostate cancer.

Note that this math goes out the window, however, if you have a family predisposition to prostate cancer. In that case, the risk of option #1 goes up (since it's predicated on the relatively low incidence rate of prostate cancer), and the dowsides of option #2 go down (since the probability of a false-positive is much lower).

po• 17 years ago

Another good article which I don't think is getting as much press as the New Yorker article:

http://www.theatlantic.com/doc/200909/health-care

shykes• 17 years ago

This is a fascinating read. It's long but worth it.

mhb• 17 years ago

http://news.ycombinator.com/item?id=760477

ryanwaggoner• 17 years ago

Fantastic article, but it was on the front page about a month ago:

http://news.ycombinator.com/item?id=760477

SarahCortes3• 17 years ago

I agree, and I said, No! Less was way more, for me.

catch23• 17 years ago

A friend of mine who works for Qualcomm in san diego says this happened to him as well. He went to the dentist to have all 4 wisdom teeth removed. They asked him to schedule it over 4 separate days rather than doing it all at once, just so that they could charge the maximum allowable amount per day to the insurance company -- they actually explained that to him!

DannoHung2• 17 years ago

And the ultimate lesson of all of this: If your friend jumps off a bridge, are you going to jump off of a bridge too?

gruseom6• 17 years ago

Although your comment looks like a vacuous redditesque one-liner, I'll respond: I've jumped from similar heights under similar circumstances, i.e. a spot favored by locals, surrounded by people happily jumping and swimming. It's only in hindsight that what she did was an obviously bad move, and even then it sounds like a slightly different angle would have made it harmless.

This aspect is hardly "the ultimate lesson of all this": if the post were merely about someone who jumped into a pond when they shouldn't have, no one would be discussing it.

jimmybot3• 17 years ago

Three other people were injured that day from jumping, and the ambulance that was called wasn't even called for the heroine of our story. I don't know what the denominator is, but it doesn't sound good.

I do agree though, that jumping or not wasn't the main issue here.

DannoHung2• 17 years ago

I wasn't really trying to be funny; it's advice my Mother gave me, repeatedly. I think it's sound, regardless of the issue with the hospital.

Here, let me repackage it for you so it's less topical: if people are doing something that you think is dangerous, don't do it just because they did it.

protomyth• 17 years ago

If my friends (who are sane and not dumb) decide it is best to jump off the bridge, I think I will jump also. I get the feeling that there is something on the bridge that will have a higher chance of killing me then the fall from the bridge. Also, it is always the idiot who stays and says "what's going on" that get killed in the horror movies.

andreyf3• 17 years ago

Oi, that sure was lengthy. Summary: Some hospital in Pennsylvania tries to make money by doing unnecessary procedures on patients with good health insurance and went to great lengths to keep this lady from seeking a second opinion regarding her injury.

IMO, this is the incentive of nearly all doctors in America - the dentists I've had span the entire spectrum of opinions about my wisdom teeth. From "if we don't take them out, you can die from a gum infection" to "do they hurt? no? do you eat meat? then you should keep them, they'll makes it easier to chew".

davidw3• 17 years ago

About 15 years ago, the dentist I went to said dire things about the immense pain my wisdom teeth were going to cause in my immediate future. I told him I'd make an appointment right away when that happened, even though his advice was to intervene as soon as possible to 'avoid any future problems'. I still have all of them and aside from the occasional twinge, they are just fine.

pyre8• 17 years ago

It's not necessarily about money though. To my knowledge, most people have problems with their wisdom teeth coming in wrong and screwing up their other teeth. If this is the majority case, then going on the offensive and taking care of them early can make sense rather than waiting to have issues.

Sometimes these cases end up sounding to me like the people who try to decry the state laws requiring you to wear a seatbelt by pointing out the relatively few cases where not wearing a seatbelt did save (or could have saved) someone's life. They completely ignore the overwhelming number of cases where seatbelts do save people's lives. It's just a case of people trying to make the facts fit a conclusion that they've already come to and don't want to change.

JulianMorrison• 17 years ago

Raze that place to the ground, and throw those "medical" staff in jail for life.

caa09hh2• 17 years ago

That is an amazing story!

caa09hh2• 17 years ago

Its also why we need to fix healthcare.

benatkin2• 17 years ago

Since that time, people on both sides of the health care debate have listened to my story and pointed out it supports their views, both pro and con.

Unsurprising. I think this is more about patients' rights than healthcare funding, though.

SarahCortes3• 17 years ago

True, but clearly that some have too little and others, relatively, too much- i think that was a major issue in my situation.

pyre8• 17 years ago

Yea. I can see people on both sides saying crap about this.

Pro: This wouldn't happen with government healthcare because there would be standards in place (i.e. the 'mobility test' would be standard everywhere not just in 'cutting edge' facilities)

Con: In government-run healthcare, she would have been forced to stay in that hospital so as to minimize the costs of treating her (i.e. no expensive transport from PA to Boston). The government would be taking away her individual rights to take ownership of her situation.

The healthcare debate is a lot more nuanced than the 'Arg! Socialism!' or 'Arg! Health insurance is evil!' crowds make it out to be.

desu• 17 years ago

Well, it's more like the pro is that there is no profit motive to keep her there. The staff would be delighted to get rid of her to a bigger facility elsewhere. I live a kilometre north of a large hospital in Sydney, Australia and we get helicopters coming in all hours of the day and night, presumably doing just that.

The "con" would probably be that there would be no facility for spinal surgery in a rural area in the first place. She would not be able to choose to be treated there and she's getting on one of those helicopters.

DEinspanjer2• 17 years ago

I wonder if the treatment was really all about the "really great health insurance" and not just the doctors at the hospital deciding that they knew better than another doctor many hours away that had not seen the patient or the pictures of her spine.

Upon reading the description of how the accident took place, my first thought was, "Really, is her insurance going to pay for that!?" And according to the last comment on her blog post, apparently the answer is, "No."

I would imagine either hospital would have to have enough familiarity with that type of accident to question whether her insurance would cover it as well.

SarahCortes3• 17 years ago

Ah,is that really a question? My comment on my blog that my health insurance decided it was best to leave me on the ledge to die of exposure was-need I say-tongue in cheek.You must be under the impression the insurance companies are in possession of that awesome perfect blame calculator - parsing an infinite number of scenarios to detemine blame for accidents and disease, then confirm or deny coverage based on their magic box. That is your insurance company, not mine. Please reply quickly, unless you are tied up arguing with them about whether they should cover your AIDS since everyone knows sharing needles is unsafe.

nkassis• 17 years ago

I got too say, I would be surprised if an insurance would not cover something like this. This is equivalent to a sports injury. Frankly no one can tell me that jumping off a cliff mountain biking is less dangerous than a bridge jump. I've bridge jumped before (not fifty feet I believe but high) and I wasn't the only one around, I didn't think it was that dangerous at the time but I understand how a bad landing could cause such an injury. Hell Olympic divers have really bad landings doing 33 feet dive and don't die.

rdouble3• 17 years ago

My dad's a doctor in a rural environment, and I had a bad back injury including ruptured discs and cracked vertebrae when I was in high school. I can offer some insight on the psychology of the doctors and even a little bit of information on this particular injury.

A rural surgeon is going to be professionally offended if their patient calls up an egghead at Harvard from their pre-op hospital bed and then tells him she doesn't trust his judgement and instead wants to be medivac airlifted back to Boston. It's like when you watch a detective show when the FBI takes over and the local cops are all bent out of shape. The hospital staff may have been thinking about health insurance and losing their accreditation but I doubt it was a sinister plot to meet their spinal surgery quotas. It was probably more along these lines: "a crazy lady from Boston just broke her back jumping off a bridge with some 13 year olds. Now she's telling us to schedule a chopper to Boston because she's Facebook buddies with some prick neurology prof at Harvard. Quick, give her some morphine and get her under the knife before her spinal column collapses and she's paralyzed and we get slapped with a half billion dollar malpractice suit... "

Note that I'm not defending that sort of attitude. That's just what I think they would be thinking, rather than some nefarious conspiracy to maximize insurance profits, which is what the article and most commenters on this post seem to be suggesting.

The other thing is that I don't think the doctors were necessarily wrong in their diagnosis. The higher you go up in the spine, there's a lot more danger of paralysis or other severe spinal cord problem. If you're over 30 and shatter your T12, there's a 50% chance you're going to end up with a serious neurological problem. The odds for recovery are far better the sooner you have surgery, if the surgery is necessary.

Timing of surgery is also an important issue in the treatment of thoracic spine fractures. ... Some studies suggest that patients with thoracic spine fractures treated within 72 hours, irrespective of concomitant injuries, do much better physiologically postoperatively than those in whom stabilization is delayed.

http://emedicine.medscape.com/article/1267029-treatment

Lastly, I don't think a patient requested 370 mile helicopter flight for a treatment which could be performed locally could possibly be covered under any insurance plan, no matter how good the coverage is.

param• 17 years ago

I want to agree with you, but what I am interested in knowing is why the boston doctor was insisting on a mobility test prior to surgery and why the small town folks were insisting on surgery first.

The same thing happens in small town India as well where doctors are more interested in keeping you admitted above and beyond the needed duration and doctors in large cities are just better because they have a greater patient load to be well versed with complex surgeries if needed.

rdouble3• 17 years ago

Watching her in the hospital and knowing that she swam to shore and stood up would have made a mobility test irrelevant. Being 40+ with a shattered T12, she made the riskier decision by opting out of the surgery. If you remove the hyperbolic language from her story, it reads like the hospital was being relatively conservative and trying to take the approach with the least risk of paralysis or other spinal cord injury. That said, It's awesome that she's able to recover without surgery. Even "successful" back surgeries usually have many complications. Surgery or not, back injuries suck and require tons of PT, exercise and lifestyle changes to get back to normal.

yummyfajitas3• 17 years ago

The article suggests the small town folks were following outdated procedures, while the boston team was following modern procedures.

keeptrying• 17 years ago

That's not really true. There are a lot of insurances that cover an airlift upto a million dollars. Some kitebording insurances I know do so.

iamelgringo2• 17 years ago

An airlift from the scene of an accident is different than an air transport from one qualified trauma center to another per patient's request.

iamelgringo2• 17 years ago

Having worked as a trauma nurse for years, I really can't believe that the entire hospital staff was conspiring to keep him there because he had good insurance. More often than not, we are kept entirely in the dark about people's insurance.

They may well have had a poor bedside manner, and they may well have tried to pressure him into having a surgery they thought necessary, but doctors disagree with treatment methods all the time. That doesn't mean that they were necessarily evil in disagreeing with the doctor in Boston.

It's also fairly standard practice for insurance companies to decline to pay a patient's hospital bill if that patient signs out against medical advice. So, if they said that he would have to pay out of pocket, they may well have been telling the truth. If he was signing out against medical advice, he may well have been responsible for the entire transfer bill, which would likely have been in the tens of thousands of dollars.

Also, if the hospital was the closest qualified trauma center, and if it was deemed by the Attending Neurosurgeon that he have surgery soon or risk permanent paralysis, it's understandable that they would have been reluctant to transfer the patient. And, if he was refusing emergency back surgery and if he was demanding transfer, he may well have been risking permantent paralysis as well as being financially liable for the hospitalization.

marze• 17 years ago

This seems like a situation where knowing a certain phrase might help. I don't know what that phrase might, but a lawyer or someone else familiar with the medical industry might.

Something like "I will not authorize you to perform this procedure and have notified my physician and lawyer of this, if you perform anything that I have not authorized will result in an expensive lawsuit" or something.

Anyone know what the right terms to use are? It seems in other situations there are magic words that can be used to produce immediate results.

Kadin• 17 years ago

You can always -- provided you are sane, sober, and alert -- decline treatment or even just check yourself out of the hospital "against medical advice." Generally this involves signing some forms releasing the hospital from all responsibility for you. And then you can just walk out.

Hospital personnel will try to strongly discourage you from doing this -- not because they're evil, but because in most situations it's a really, really bad idea. But if you just keep saying "no, I don't want treatment, I want to leave, give me the forms to sign out AMA," and you're not clearly nuts or high on morphine or otherwise impaired, you can pretty much just leave.

However, unless you have a very specific reason for believing that the treatment protocol at work isn't correct or best for you, it's generally a bad idea.

skybrian• 17 years ago

"According to Ithaca Fire Department statistics, Lowe was the fifteenth person to die in Ithaca's gorges since 2000—and the fourth to drown in that particular pool since 1986. When most people think of gorge deaths, they think of the jumpers who have given Cornell an unwanted (and unwarranted) reputation as a suicide hot spot. But Ithaca Police Officer Doug Hoyt estimates that about half of those fifteen deaths were accidents caused by turbulent water, slippery rocks, fallen trees, and a host of other natural features. The local community has mourned each death. But Lowe's passing—coming in the wake of the drowning the previous year of Jeevan Mykoo, a thirty-year-old tourist from Ottawa, and the 2006 death of Navin Parthasarathy, a visiting graduate student from the University of California, Santa Barbara—has spurred a widespread debate about how to deal with the dangers and appeals of one of Cornell's great natural attractions."

http://cornellalumnimagazine.com/index.php?option=com_conten...

theklub• 17 years ago

This really just amounts to part of the Twitter Hype machine.

How twitter helped a technology consultant escape from an evil hospital

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