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Failure Is the System

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Federico Arroyo

on 5 November 2013

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Transcript of Failure Is the System

Personal Story
Disparities between insured and uninsured patients

-Unhealthy life style/Dangerous looking
-Heart disease/Bipolar

-Healthy life style/Clean cut looking
-Malformed heart

Part 11: Failure Is The System
By: Federico Arroyo
Connor Contorno
Carolyn Macleary
Lisette Martinez
Rebecca Mladucky
Divesh Raheja
Alexa Seda

The University Hospitals Case Medical Center
Year: 1986, Time: 2am

Dr. Otis Brawler
Has to determine whether the patient is having a heart attack

Norma Shevchenko (56yrs Old)
No examination gown.
Blue Dress, cameo brooch, eye shadow, and perfume.
Centered Communication- in which health professionals do most of the the talking, chose conversational topics,and begin and end communication episodes.

Dr. Otis
How are you?
- "Bad", "Maybe a little", "Some"
Family History
Blood Pressure

What is wrong with Mrs. Norma?
Physically: Absolutely nothing.

"Norma was overcome with excruciating loneliness and desire to be seen, touched, cared for. Thirsting for social interaction".

GOMER: Get Out of My Emergency Room
- The House of God

- Three- Quarters were female
- Rarely thin
- Always Widowed
- Symptoms of Depression
- Dressed up tp see the Doctor
Whats Next?
1. You dont know whether you are right or are just missing something.
2. She just might return to the ER with a cardiac arrest when you told her to go home and rest.
- has no ability to filter impurities, everything runs through it.
- the opposite of a sieve
Decisions could have enormous implications

Norma is a classic LOL in NAD- a Little Old Lady in No Apparent Distress
The appearance of patients in the ER such as Norma is an indication of failure of the system. Emergency rooms are the only ones in Amerca's health care system that are legally obliged to care for everyone- and then they get bashed for it.
- The problem is vast, its cost enormous.

- 56% of patients said that the ER is their usual
source of care

- Misuse of the ER is almost never the patients fault.
If you are poor, good luck trying to find a private
primary care physician.
Patients & the ER
Brought into the ER for "failure to thrive"
only responds to pain
has stage IV lung cancer
spread to both lungs, spine, pelvis, and liver
Treated for chronic obstructive pulmonary disease
Doctors unaware if he is able to see, hear, smell, or taste
has evidence of infection
"The systems in his body are failing in a relentless, rapid cascade."
Saving Mr. Huzjak
Has a private physician- Jim Claren
Mr. Huzjak is near death
Doctors want a DNR "Do Not Resuscitate"
Cannot get one from the daughter
Saving Mr. Huzjak
Brawley tries to relate to Mr. Huzjaks family
Describes his poor condition
Describes possible solutions
1. Treat all of his problems "discomfort at best, agony at worst"
2. Treat his pneumonia and monitor him
3. Let nature take its course
Family chooses option 1
Saving Mr. Huzjak
Family wants everything done to save Mr. Huzjaks life.
"Everthing reasonable or everything possible?"
"Everything possible is everything reasonable, as far as we are concerned."
Saving Mr. Huzjak
Brawley estimates the cost to be around $250,000 (this was 30 years ago)
Doctors will disregard data to benefit financially
"However, I cannot think of a single anecdote of doctors creating or encouraging situations where a patient who is ready to die is instead subjected to aggressive care."
Saving Mr. Huzjak
Doctors know that they cannot benefit the patient, they can only do harm
"I pray for my patients, and that morning I pray that Huzjak is not really aware of what we are about to do to him."
Lilla Romero re-diagnosed with breast cancer in 2000

Prescribed Procrit for “cancer fatigue” caused by
radiation therapy and low hemoglobin

Nurse promoted Procrit as a simple, safe and clean
way to help the body produce higher levels of hemoglobin

“Trust” in the System
Lilla and other cancer patients were sure that
doctors wouldn’t recommend a drug that would be inappropriate
for a cancer patient

Procrit was FDA approved

Direct to consumer ads promoting Procrit displayed cancer
patients regaining strength as a result of the drug

Failure in the System
Procrit caused strokes, heart attacks and in some cases
made tumors grow

Physicians benefitted financially

Largest selling class of drugs used in oncology

$4.85 billion dollars US in 2006

Direct to consumer ads were scripted, staged to convince
patients to pressure their doctor to prescribe

Procrit label did not say anything about “fatigue” or “strength”
words central to direct to consumer ads

Failure of the System Continued
FDA scientists attempted to stop these ads but pro-industry attorneys appointed by the Bush administration blocked the scientists’ efforts

2003 Research evidence by Michael Henke and the BEST
(Breast Cancer Erythropoietin Survival Trial) concluded that patients who received drug did not live as long as those on placebo

Evidence was disregarded and financial incentives to induce oncologists
to prescribe more

Insurance was paying for drugs that was causing harm

Who should be held most accountable for our system’s

What to do with Mr. Huzjack?

Being treated like a lab animal, undergoes many invasive procedures

Wild dave bronchs him
Dobhoff tube
Ends up in ICU

Concerns with family wishes
"Everything be done" vs "focus on making Mr. Huzjak comfortable
Multiple doctors talk to the family-Otis, Claren, & Ginn
"god is calling and who are we to say no?

Questions to Consider

Does a doctor's appearance play a role into how people receive medical news?

Should doctor's always abide by family wishes regardless of a patient's condition?

When do we draw the line in terms of procedure's a patient undergoes?
does a doctor have the right to refuse certain care for a patient?

should doctor's strive to save every and each patient?

ESA: Erythropoiesis-Stimulating Agent

Red Blood Cells

FDA Restrictions

Alternative Medicine

Lilla Romeo

"I asked for the original flow sheets and got the shock of my life.
My first dose was administered 01/11/2001. And almost weekly
thereafter. All in all I was given 221 1/2 doses"

Tumor Promotion
Lilla Romeo

I asked for the original flow sheets and got the shock of my life. My first dose was administered 01/11/2001. And almost weekly thereafter. All in all I was given 221 1/2 doses”
Nearly 6 times the doses
Hemoglobin costs $400,000-$600,000
Dr. Brawley
Questions to consider
Full transcript