Archive for December, 2008

What to do when doctors go bad

// December 22nd, 2008 // 2 Comments » // Health

When I started blogging, I got excited, and made far too much of a commitment. So now I have some articles that I am proud of stuck on a blog that I no longer update, and is becoming a bit of a spam magnet. So I am taking the opportunity to edit them up an republish them here. I ask the indulgence of those who have already read this.

When doctors act inappropriately, it is alright to complain.

A friend of mine visited a doctor, when she was feeling crook with a cold and had “pinched something” in her back. She was so sick, she agreed to see a new doctor to get a quick appointement. The doctor seemed really put out about her symptoms, and suggested that she might have depression, as what she was saying made no sense to him. My friend works as a mental health professional, and she was upset by the doctors snap assessment, and appalled that mental health could be treated so flippantly. She walked out of the appointment feeling angry, dissatisfied and frustrated.

Luckily, my friend is a clever woman, and decided that the doctor was useless. However, if the situation was different, she may have been very upset, or even endangered. If she had have been depressed, she could have reacted badly to being ignored. She felt the communication problem may have been cultural. If you have a bad experience with a doctor, it often comes down to communication and culture in some way. But there are ways to make sure it doesn’t happen to someone else.

When should you consider a formal complaint?

If you simply don’t like a doctor, you have the right to visit another practitioner. Complaining is pointless. You definitely have permission to not like a doctor.

However, if you think that the doctor may have done something unprofessional or inappropriate, then you should consider complaining. It is hard to say what is appropriate, but if you are made to feel embarrassed, afraid or ashamed, then it is worth complaining. Examples would be a doctor using their position to do something unexpected, or poorly explained. These are situations where you might consider complaining.

There are lots of useful ways to make complaints about the medical system, that can help diffuse the situation quickly.

Could the doctor have done something illegal?

Occasionally doctors can act like any other unscrupulous person and rip you off, or even assault you. If you think a doctor, medical practice or hospital has broken the law, you should make a complaint to the police. Due to confidentiality concerns, most other professional bodies do not investigate fraud or assault well enough to rule out a legal problem.

Complain to the doctor’s employer

All doctors are employed by somebody, although it may be themselves. If you had bad service at a restaurant, you might complain to the restaurant owner. Likewise, if you feel someone was rude to you, for example, you could complain to the clinic manager. This method is good for dealing with minor problems, particularly where the doctor was not the only staff member involved.

If you have a complaint about something that happened in a hospital, complaining to the hospital is a good first step. Hospitals often have a patient liaison officer to deal with complaints. They will listen to what happened, investigate, and even organize mediation.

Complain to the Medical Board

Good doctors want “bad” doctors to be sorted out. Often, problems like poor communication, and cultural problems can be sorted out with education and even supervision. In most states and territories across the world, there is a public board that manages medical registration. Their role is to make sure doctors are qualified and have the necessary experience to see patients. They can also regulate what areas doctors are allowed to work in. For example, newly qualified doctors are usually supervised by more experienced doctors, and the board makes sure this happens.

The Medical Practitioners Board (named slightly differently across the world) is staffed by doctors and lawyers who understand what is reasonable in a consultation, and what is unreasonable. They will investigate any complaints and decide what consequences the doctor will experience. Sometimes they go through mediation, or further education. If the complaint is serious and the doctor has acted very poorly, then they may have their registration suspended, restricted or cancelled.

Your medical board can be found by doing an online search, or looking in the government section of your phonebook. The Medical Practitioner’s Board of Victoria covers my registration in Melbourne, Australia.

What about using lawyers to make complaints?

Television legal shows, and prominent ads for personal injury lawyers are starting to make us think of lawyers when making complaints. I think this is a weird way to go. A wronged patient may get money, but they are unlikely to understand what happened and what went wrong. Furthermore, doctors become increasingly cautious with patients who have sued before, making future health care difficult.

If you are keen on getting a lawyer to help you make a complaint, it is useful to exercise some of the other methods of complaint first. They may be quicker, and solve the problem more effectively. Furthermore, no one stands to gain financially, so you will hopefully get a bit fairer treatment. If you don’t reach a solution, then you can try legal avenues later. And if you do reach a conclusion, it is much easier to get a settlement in court if the doctor has already been judged in the wrong.

It’s beginning to feel a lot like Christmas

// December 20th, 2008 // 2 Comments » // Family

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I have been reading some very impressive blogs with ideas for exciting and creative Christmas crafts (like Advent calenders and Paper snowflakes. I have no time for intricacy at this time of year, but I had a day of making decorations on the weekend that was lots of fun

MissZ (2yrs) could almost make paper chains by herself, and definitely had fun helping me. We made them out of strips of leftover wrapping paper.

Then I had a bit of a paper snowflake frenzy. I used plain white printing/photocopy paper trimmed into squares. Fold each square in half 3 times through the centre of the square and cut random shapes. If that isn’t enough instruction, then try this tutorial with pictures. This can be an artform if done with a sharp knife and cutting board, but it is also really fun just freehand. Trying different shapes for different effects is very addictive.

I had a lot of fun on my craft chrsitmas day, and my toddlers loved helping me with this stuff. MissZ’s contribution was mainly about the guillotine, and MrJ (1yr) specialized in distribution of the tiny scraps of paper. Advent memories are made of this.

Anyway, if you are looking to do some last minute Christmas crafty things, here are some more simple crafty Christmas and gift ideas:

  1. Soap with snakes

    This is a cool last minute gift. You will need to buy some glycerin soap. Takes about 15minutes.

  2. Jewel Case wall art
  3. I would like to use this for my kids paintings. I would scan the artwork fragment, print it out on photo-paper in the right size, and put it in the frame.

  4. Beaded bookmarks
  5. Handmade books

    Again, an excellent way to palm children’s artwork off onto Grandparents. I mean, preserve children’s artwork.

  6. Walnut boats for decorating your tree
  7. Baking: Christmas and Cranberry biscuits
  8. Fabric gift tags

    Oh so simple, suitable for the youngest of helpers.

Image credit: cutendscene (Flickr)

How to be an organ donor

// December 19th, 2008 // 2 Comments » // Health, Surgery

I recently wrote about what it was like for me to witness surgical organ retrieval for transplantation. It is important that I remind you how to become a organ donor.

AS I write this, only 1198828 Australians have registered to donate. That is only 5.6% (According to ABS population clock). Even taking out children and other inappropriates, that is pretty poor.

There are almost 2000 people in Australia on organ transplant waiting lists at any given time. Some of them will die waiting.

The Australian Organ Donor Register is Australia’s only national organ and tissue donor register and serves as a lifeline to the people on those waiting lists. (Australian Organ Donor Register)

Organ donors are special people

In order to qualify for organ donation, you need to be a very special type of person. You need to have died in a way that hasn’t damaged your organs (head trauma is common). Usually, you need to have died on or near life support, with a beating heart, so that your liver, kidneys, intestine, heart and lungs are in good nick.

Someone needs to consent to donation within a short period of time. It is tough to ask your next of kin to do this, when they are dealing with the grief of your (sudden) death. If you love them, give them a clear idea of your wishes by registering to donate now. There is no better time. Can you guarantee that you won’t be hit by some idiot wielding a big crunchy car this holiday season?

You don’t need to be Mr or Mr fit. You don’t have to fit an age range. You don’t have to be medically perfect. We are undersupplied with transplant organs in this country, and we can use some organs from virtually anyone. Thousands of people are waiting for transplantation, and dying without them. In fact, most transplant units will consider everyone who is appropriate. Transplantation of marginal, or poorer organs is becoming more common, and the boundary of what is acceptable and what is not is moving daily.

The Australian Organ Donor Register

The Australian government has set up the Organ Donor Registry to enable you to give legal consent to organ donation before your death. The system has been a bit haywire in Australia, so remember you are not registered unless you have this card:

AODR-card-front.gif

If you are not sure, then register again. Multiple registrations is a smaller problem than not being on the register at all.

It is important you talk to your family members about your decision to donate. Some families object to the process, despite a well-documented advance directive from the patient. This can mean your organs are NOT able to be used. Make sure you answer all your family’s reservations in advance. Australians can register online using this form.

Organ donation from the inside

// December 17th, 2008 // 11 Comments » // Surgery

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It seems car accidents must be an integral part of any holiday season. As road death is a key source of organ donors, I want to share the relationships I have had with organ donors, after their deaths.

This post is longer and more serious than my usual stuff. Less tirade, less jokes. But this is serious stuff, and if you are lucky, you may get to participate in this procedure one day (Of course, another version of lucky would be to die a peaceful death).

Where they found me

As a surgical registrar attached to a liver transplant unit, I was offered the unique chance to be on call for liver retrievals. Basically, this means if the unit is offered a liver, I am called to travel to where the donor is, and help the transplant surgeon remove it at an operation. For a surgical trainee this is a win-win situation. The operation is complicated, intense and not often witnessed by trainees. Transplant surgeons like to have research bunnies to get out of bed to assist in a semi-aware manner, allowing another member of the team to stay in bed, so they can help with the implantation later.

A call for transplant always occurs late. Patients are usually pronounced brain dead in the light of day, after a ward round. Over that day, the family has to come to terms in “death” in a loved one who has not outwardly changed, and whose ICU machines are still beeping. In the midst of that, they try to get their head around organ transplantation, with the help of doctors and transplant nurses. So when the call comes, they ask if you are free at 11pm, or 1am, or 2am. Very tempting to turn it down. But the times I took up the challenge, I was tiredly happy with my decision.

Even if the decision is made quickly, it takes time to perform blood-typing, and then the waiting lists are reviewed and decisions are made to offer each organ to a particular centre. Donors can share their tissue (ranging from corneas to kidneys, hearts and intestines) to recipients across a state, and often across the country. Some units, particularly heart units like to retrieve themselves, so they might fly to the operating theatre. I was once involved in a retrieval in Darwin, which involved us (the abdominal team) flying in a private jet from Melbourne, and the heart team traveling from Queensland.

Getting organised

Usually, an organ retrieval is booked as the last case of the day. It is important that the donor, who has died and is stable, does not delay emergency surgery on people who are alive and sick. However, if they start to decompensate, they may be bumped ahead in the queue - their organs “belong” to usually at least three or four sick people, and that hangs over everyone’s head. As the least experienced person in the team, I am generally focussed on not being the person to ruin everything.

Without thinking, I guess I imagined organ retrieval to be a bit shady, done in a dimly lit theatre, with cheap intruments. Maybe there are too many urban myths about guys in icy bathtubs with scars on their backs. But the procedure is top drawer. Although it doesn’t occur until most others have gone home, it looks like any other big operation - the drapes, the gloves, the scrubbing, the anaesthetist, the works. The operating surgeons don’t accept sub-standard equipment, and throw tantrums in much the same way they do for any other critical case.

In the down times waiting for operating time, I liked to ask the surgeon about the liver recipient. Usually, they wouldn’t share much, but I’d find out their age, or sex or disease. The surgeons seem to care a lot about the waiting list - how long the patient had been waiting; why they chose this one above that other one. During the procedure we talk about which organs we are taking and where they are going. It is amazing to see a broken body, and know that they were sending their organs across the country.

The last operation

The operation is one of those nerve bending, high concentration affairs. The task initially is to make sure there is no unknown medical or anatomical contraindication to transplantation. If the vessels are too short, or in the wrong place, it is sometimes not possible to implant the organ. Sometimes the liver will be of poor quality, so will be rejected as unsuitable, or is resected with a biopsy to be reviewed prior to decision to implant. At the home hospital, the recipient doesn’t start their long operation until they know they will have a liver.

Isolating the organ, and identifying the relevant vessels is an intricate procedure. Dealing with big blood vessels is always nerve-wracking for surgeons, as a slip means blood loss, and stress. In an organ retrieval it can mean damage to the organ, and a difficult or impossible transplant. If the surgeon is under stress, it normally means the assistant is taking the brunt. Cannulation of the IVC (big, fat blood vessel) is stressful with a surgeon you know well, but you don’t always get to operate with surgeons you like. Nuff said.

Amidst all this stress, it gets a bit busy. The chest team (who are responsible for the heart and lungs) and the abdominal team (responsible for the pancreas, liver, kidneys, intestines and vessel patches) take turns around the table, or work in tandem. At times, this means four or more surgeons and at least two scrubbed nurses and their equipment sharing elbow room. Meanwhile, a corneal bank representative works at the head end to harvest the corneas. Busy can’t mean frantic, though. The organs are important, and the only urgency is external. So the surgery proceeds without hurry. These surgeons are some of the best technicians around, and they don’t rush.

Operating underwater

All organs for transplant require transporting, even if it is around the corner to an adjacent operating theatre. In order to reduce the damage to the organs, the transport time is minimised, and they travel in ice water (”cold ischaemia”). Therefore, before the organs are removed from the body, they are cooled. This means buckets of ice cold fluid, with big chunks of ice and slurry is poured into the abdominal cavity. Then the organs are further flushed with cold solutions through their blood vessels. And the surgeons operate on with icy numb hands, and wet feet.

The attitude and the aftermath

Logically, I shouldn’t have been surprised. But it was really cool when I saw how much all those staff care about the donor. Only the transplant organs are removed and the incisions are sewn up carefully. The sutures and dressings are almost the same as those done on living patients, and provide minimal deformity. The patient is cleaned up and covered with a sheet, and then treated as respectfully as any other patient who dies in hospital.

The theatre staff and the assistant (me) return home after a long night, usually meeting early morning traffic on the way. I got a speeding ticket in the middle of the night more than once. The surgeons take the organs to their new homes, and often can’t resist hanging around to watch the marathon implantation.

Why I am a registered organ donor

Transplant surgeons care about donors. Staff respect them, and the decision they have made. Their job in this case is to implement the wishes of the donor and not waste their sacrifice. I have dissected a human cadaver in medical school and that is why I don’t want to donate my body for dissection. I have assisted at an organ retrieval for transplant, and that is why I am on the Organ Donor Register.

Photo credit: madaise via Flicker