3 ms·

I think this is more a case of the normal ways things are run practically everywhere, not all that many steps from total disaster. If I remember correctly, you

by hga 12y ago

I think this is more a case of the normal ways things are run practically everywhere, not all that many steps from total disaster. If I remember correctly, you've been around for a while; compare your experiences in organizations of smallish absolute size like a hospital such as this one. It's big as they go, 900 beds, but as an organization not large, let alone giant. And they've got a zillion priorities, with Ebola being rather low, prior to the nation's first Ebola tourist showing up. After all, we were assured the probability of this was "extremely low". Hmmm, I guess I should follow the links, especially with the revised report on Duncan's highest temperature during his first visit, but someone was saying the CDC's guidelines as of then would not say "EBOLA!" From what I've heard he presented with symptoms consistent with a lot of things (fever and pain are not in the least rare!), and they certainly went to a lot of effort trying to diagnose what was wrong. For the 2nd visit, I wouldn't expect any other random hospital to be better. Even the special 4 have not yet, to my knowledge, set up a triage station before the ER with a suited up attendant. Which is what's really required :-(. As for your prescriptions, while it's easy to say this outfit isn't as good as Mayo's, or probably many university hospitals, you give no evidence, nor do I know of any, that it's possible to achieve a universally, qualitatively better result across the nation. I've been noting WRT to the now two infected nurses that we're at this point in time at best only quantitatively better that West Africa, and I'm not sure about that, we'll find out with more cases outside of the special 4 hospitals when they get known Ebola cases. Your dislike of "the market model" does not mean there is a better one, and we know of many that are worse (e.g. I can't remember the last time a patient died because the staff failed to feed them, although searching for that it hopeless since it's the standard way to euthanize patients). As far a political capital, we're now in a Nixon in China state for the foreseeable future. Only a "hawkish" Republican (e.g. not Rommnycare Romney, or McCain) could do this. And do we wonder how the other side of the aisle will respond???

anigbrowl 12y ago
As I recall when Duncan first went o the hospital he said he had recently come from West Africa (or maybe Liberia in particular) but may have dishonestly denied having had contact with others who had Ebola. You're right that a fever on its own doesn't suggest Ebola, but that plus travel should have aroused someone's curiosity leading to further testing or at least observation. Obviously, you could get a lot of false positives using a standard like that. But with a disease that has a longish incubation period and a 70% mortality rate, I'm OK with that. I'm no epidemiologist or even an amateur scholar of them; I just learned about it the same way as most other people, reading news on the internet, watching news documentaries on PBS, visiting CDC.gov. I feel I have the public health awareness of a normal middle-class adult taxpayer, ie nothing special other than a good level of general education and an interest in current events. Basically I'm saying that I would have expected senior administrators and clinical staff at a large hospital to have significantly better awareness of this issue than I would, because it;s their job.
- hga 12y ago
  I guess what I'm getting at is that, especially at this stage of the game, I expect errors like this. Doctors and nurses are going to make mistakes, no matter what sort of organization they're in, humans and their ailments are complicated. That's why malpractice is almost always a civil, not criminal matter. The problem here is that with Ebola, the consequences of making what would often be a minor and correctable mistake are uniquely grave. For that matter, an early Ebola diagnosis currently hinges on the patient's self-reported travel and Ebola exposure history. These screening criteria will completely miss 2nd stage (? what's the term for this) infections when the patient doesn't know he had been exposed to someone who'd been to West Africa, or some place else it will hit in due course. Until the patient gets much worse and a lot more infective, with the same grave consequences. If we get enough primary Ebola infections in the US this appears to be certain to happen. When was the last time our medical system had to deal with something like this? Pre-antibiotic, I would think. Nothing comes to mind, only partial analogues. I've got a pretty good layman's background in medicine from nurses and doctors close to me when I was growing up, and serious study of biology and chemistry, plus paying above average attention to the big events like this. I.e. I can read the Merck Manual and other secondary and primary sources etc. without frequent recourse to a medical dictionary. I think we have reasons to be worried, as outlined in my postings and the obvious extrapolations.

by hga 12y ago

anigbrowl 12y ago

As I recall when Duncan first went o the hospital he said he had recently come from West Africa (or maybe Liberia in particular) but may have dishonestly denied having had contact with others who had Ebola. You're right that a fever on its own doesn't suggest Ebola, but that plus travel should have aroused someone's curiosity leading to further testing or at least observation. Obviously, you could get a lot of false positives using a standard like that. But with a disease that has a longish incubation period and a 70% mortality rate, I'm OK with that. I'm no epidemiologist or even an amateur scholar of them; I just learned about it the same way as most other people, reading news on the internet, watching news documentaries on PBS, visiting CDC.gov. I feel I have the public health awareness of a normal middle-class adult taxpayer, ie nothing special other than a good level of general education and an interest in current events. Basically I'm saying that I would have expected senior administrators and clinical staff at a large hospital to have significantly better awareness of this issue than I would, because it;s their job.

hga 12y ago
I guess what I'm getting at is that, especially at this stage of the game, I expect errors like this. Doctors and nurses are going to make mistakes, no matter what sort of organization they're in, humans and their ailments are complicated. That's why malpractice is almost always a civil, not criminal matter. The problem here is that with Ebola, the consequences of making what would often be a minor and correctable mistake are uniquely grave. For that matter, an early Ebola diagnosis currently hinges on the patient's self-reported travel and Ebola exposure history. These screening criteria will completely miss 2nd stage (? what's the term for this) infections when the patient doesn't know he had been exposed to someone who'd been to West Africa, or some place else it will hit in due course. Until the patient gets much worse and a lot more infective, with the same grave consequences. If we get enough primary Ebola infections in the US this appears to be certain to happen. When was the last time our medical system had to deal with something like this? Pre-antibiotic, I would think. Nothing comes to mind, only partial analogues. I've got a pretty good layman's background in medicine from nurses and doctors close to me when I was growing up, and serious study of biology and chemistry, plus paying above average attention to the big events like this. I.e. I can read the Merck Manual and other secondary and primary sources etc. without frequent recourse to a medical dictionary. I think we have reasons to be worried, as outlined in my postings and the obvious extrapolations.