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Mengele on SI? Arthur Anderson Art artnscience-(at)-yahoo.com rs,

I know you weren't being personal. That's why I kept changing my reply. Flummoxed describes it pretty well don't you think. I know about those cases you referred to, both from our conversations and from articles I have read.

I have to admit that my mind reacted with rage when I autopsied a 5 year old who had bruises on his arms and legs and a tub scald mark that indicated that he had been lowered into a tub filled with boiling water. He died of complications after a short stay at Johns Hopkins Hospital. There was no hospital policy about reporting abuse at that time and I almost had to be physically restrained when I insisted in doing something about it. Docs can be irrational but I believed someone needed to pay for what happened to this kid. My rationality was also affected by the fact that my wife and I were foster parents to a 6 month old handsome little boy who was completely paralyzed and not all there after his mother left him in the tub with a 2 year old brother so she could go down the street and make a phone call on a pay phone. He was only a month old when it happened. She returned and found him unconscious under water. My wife was his physical therapist and the hospital utilization committee said he didn't qualify for more therapy....we took him as foster child so that she could continue to treat him and get him to improve enough to get better placement. That situation added to my rage at the scalding case. This was almost 30 years ago.

The problem with docs is that their business does not allow them to make decisions with all the information at their finger tips. If they take too long to decide, indecision gives the condition the upper hand. No decision is a decision against the patient.

I am a pathologist...I get to see all the information but it is way to late to do anything for the patient lying on the autopsy table. The doc taking care of the living patient has to decide what the patient has so he has a rational plan for treatment.

If docs allowed themselves to obsess about whether their initial medical opinion were correct after starting to take an action, they would never get any sleep and that would effect their ability to provide care. This is why so many of my colleagues behave as though they KNOW EVERYTHING and can DO ANYTHING.

It's not an endearing trait but it keeps them alive, off drugs and alcohol and the decisions they make usually are conservative and in the right ball park. Docs also get second opinions as long as their egos aren't threatened.

The "recovered" memories of abuse, digoxin case and some of the others you alluded to all involved exploring how jumping to conclusions through prejudice can adversely effect justice. A lot of things take away the ability to cooly deliberate over a patient among which was the rage I felt when I jumped to the conclusion that the boy had been scalded.

I also felt a rage when I was overseeing one of my residents doing an autopsy of a patient who had been accidentally killed by another resident while hurrying to resuscitate her. The medical resident accidentally cut the femoral artery while trying to surgically place a catheter into the femoral vein in a patient who was dying from a cerebral hemorrhage. The potentially life-saving procedure which was being conducted to give fluids and raise the blood pressure resulted in 5 liters of blood spilling out on the floor in less than a minute. How that resident could cooly write down that all this blood passed per rectum dumbfounded me. There wasn't a trace of blood on the body or even in the organs that putatively were the source of bleeding. After my pathology resident finished dissecting the organ blocks and did not find a source of bleeding anywhere, I went to the refrigerator, took out the body and found the hole in the femoral artery. The hospital lawyers wouldn't let me use the real cause of death on the report. Furthermore, there were never any consequences to the person who made the mistake. If I were this medical resident, it would haunt me for the rest of my life until I took responsibility for it and made reparations to the family.

I noticed that Bill Clinton just signed some document about public acknowledgement of medical mistakes. I think this is a good move. First because you can't do anything about preventing mistakes if you don't know they happen; and, second the mistake harms the doc as much as it harms the patient. Maybe not immediately or as critically but over time the doctors life will be less worth living as these ugly secrets build up.

Art

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