[HSF] Standard of care for lawyers {OT}

Sat Apr 12 12:42:48 EDT 2008

> Ani,> I'm satisfied with the results of my caseload.> > Hal

Hal

That your results are good does not necessarily mean your system is alright or adequate. If not why then are you thinking of getting intensivists? 

An analogy can be drawn from the airline industry. This week over 500 american airlines planes were grounded for safety checks - this had nothing to do with results. Indeed american has not has a fatal crash I believe for 7 years, none of those MD 80 planes has crashed, and the last few years have been among the safest in american avaition history. American or the FAA does not say "they are satisfied with their results", which by the way are excellent, so there is no need to ground planes for emergency safety checks. If you were flying in one of those planes without the safety check done, you would not take comfort in the fact that none have crashed in over 10 years. The same way I am not sure your patients would necessaaily take comfort in knowing the last 100 patients did just okay with an ER doctor . 
Sometimes (indeed most times) patients survive despite poor systems (such as in mine as you pointed out in your other thread) so results is not what defines whether our systems are safe or standards acceptable . The issue raised by Michael is what do we feel is a safe way to take care of these patients. We do not have to wait for a catastrophe (or an aircrash in airline analogy) before we take corrective actions but the aim is to have a safe system that will prevent most catastophes in the first place - as the parallel thread started by michael shows, this is not an easy task nor one we have a clear solution for.

Ani

> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] Standard of care for lawyers {OT}> From: hgrmd at aol.com> Date: Fri, 11 Apr 2008 22:31:54 +0000> CC: > > Ani,> I'm satisfied with the results of my caseload.> > Hal> Sent from my Verizon Wireless BlackBerry> > -----Original Message-----> From: Ani Anyanwu <anianyanwu at hotmail.com>> > Date: Fri, 11 Apr 2008 22:19:10 > To:<openheart-l at lists.hsforum.com>> Subject: RE: [HSF] Standard of care for lawyers {OT}> > > So Hal, the patients do not know then that on the first night after surgery all they have in house is an ER doctor... I was raising this not as a question as regards your practice but as we are discussing standards about another profession (lawyers) whether it is acceptable standard of care and information that we do not inform patients of these deficiencies in ICU coverage that exist in different surgical units. > > Should patients have a choice or should they just accept what they are dealt? I certainly know for sure that regardless of who was doing the operation, I would not have my surgery in a hospital manned by nurses and ER doctors on first post-operative night as I do not think that meets a minimum acceptable standard of post-surgical patient care. I suspect some of Hals patients with the information might say same. > > Answer to Michael's question about my unit is we have a surgical physicians assistant (PA) most nights (some nights a CT fellow) and five nights a week an inhouse intensivist. We know that is not perfect and are moving towards a model of 24 PA and 24h intensivist inhouse cover (not sure that is perfect either though).> > Ani> > > > > To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] Standard of care for lawyers {OT}> Date: Fri, 11 Apr 2008 17:07:38 -0400> From: hgrmd at aol.com> CC: > > Ani,> I guess the upside for the patient is that I'm the one actually doing the surgery, not some resident who was shucking gallbladders 3 months previously. Look, it's not a perfect system, and I'm working to improve it. In fact, I was talking with the CEO earlier today about my plan to get intensivists for the hospital. I will say that the vast majority of the CVICU nurses recognize when one of the docs needs to come in.> > Hal> > > -----Original Message-----> From: Ani Anyanwu <anianyanwu at hotmail.com>> To: openheart-l at lists.hsforum.com> Sent: Fri, 11 Apr 2008 10:36 am> Subject: RE: [HSF] Standard of care for lawyers {OT}> > > > > Frankly, I'm amazed that I'm able to > get my case load through with good > esults considering it's only the nurses > and the ER docs in the house at > ight.> > Hal> > al> > re the patients you operate on in this hospital aware that not of your team are > vailable at night of their surgery and that they will be looked after only by > R doctors and nurses? With this knowledge do some ever (or would you expect > ome to) opt to have surgery in another hospital you operate?> > ni> > > > From: Hgrmd at aol.com> Date: Fri, 11 Apr 2008 06:49:05 -0400> Subject: Re: [HSF] > tandard of care for lawyers {OT}> To: OpenHeart-L at lists.hsforum.com> CC: > > > ichael,> Our current approach of postop management is a delicate balance > etween > the cardiac surgeons, P.A.'s, cardiologists, pulmonologists, as well > s any > other consultants who might be on the case. It generally works, but > t's far > from perfect. In fact, I'm currently pushing for 24/7 intensivists > or one of > my hospitals. You really need a doctor in the house at all times if > ou're > going to provide the best postop care. Frankly, I'm amazed that I'm > ble to > get my case load through with good results considering it's only the > urses > and the ER docs in the house at night.> > Hal> > > > > *************Planning your summer road trip? 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