When the doctor’s away, the patient is more likely to survive

[LiberalArkie]

http://arstechnica.com/science/2014/12/when-the-doctors-away-the-patient-is-more-likely-to-survive/



"Don't get sick on a weekend." That advice is also part of a title of a research paper that evaluates the fates of patients who go through the emergency room on a weekend. These patients are more likely to die. It's just one of a number of studies that suggests patients who enter the hospital while the staffing is lower or the staff more relaxed end up with worse results.

But the precise cause of this enhanced weekend mortality has been hard to determine; is it the reduced staff, a more leisurely approach to care, or some other factor? To try to get at the cause, some researchers obtained records of heart patients who had a critical event during a time when hospitals were at full staff, but heart specialists were likely to be out of town. Unexpectedly, they found that the patients did significantly better when the relevant specialists were unavailable.

The study relied on medicare records to track patients that were admitted to a hospital with a serious heart condition: acute myocardial infarction, heart failure, or cardiac arrest. The key measure was simply whether the patient was still alive 30 days later.

That may sound simple, but the rest of the analysis was remarkably sophisticated. To figure out when heart specialists were most likely to be present at hospitals, they selected two large cardiology meetings: the American Heart Association and the American College of Cardiology, both of which attract over 10,000 participants. Patients admitted during the meetings were compared with groups admitted three weeks before and after. Reasoning that researchers are more likely to attend these meetings, they analyzed teaching hospitals separately from regular ones.

Snip

[BrotherIvan]

1. Not shocked

In my experience, nurses in the hospital are far more knowledgable and give better care than the doctor. The article states that one of the reasons for the better outcome when heart specialists are away is because they might prescribe more aggressive/risky treatments when they are there. Because of a lack of listening to the patient, or having an ounce of compassion, I have also found that they take a patient who really needs rest and care and puts them through an endless gauntlet of stressful and invasive tests to try to guess what's wrong (often just shrugging their shoulders when the test doesn't reveal anything). Always got a straight answer and a clear plan of care from the nurse--doctors very, very rarely. Not a huge fan of the system as you can see.

[PADemD]

2. When Doctors Go On Strike Patients Stop Dying

For example, in a strike in Los Angeles County, California in January 1976, doctors went on strike in protest over soaring medical malpractice insurance premiums. For five weeks, approximately 50% of doctors in the county reduced their practice and withheld care for anything but emergencies. One analysis, quoted by Cunningham and colleagues, found the strike may have actually prevented more deaths than it caused.

It's the fact that elective, or non-emergency surgery, tends to stop during a doctors' strike, which seems to be the key factor. It looks like a surprising amount of mortality occurs following this kind of procedure which disappears when elective surgery ceases due to doctors withdrawing their labour. Mortality declined steadily from week one (21 deaths/100,000 population) to weeks six (13) and seven (14), when mortality rates were lower than the averages of the previous five years.

However, as soon as elective surgery resumed, there was a rise in deaths. There were 90 more deaths associated with surgery for the two weeks following the strike in 1976 (ie when doctors went back to work) than there had been during the same period in 1975.

http://www.huffingtonpost.co.uk/dr-raj-persaud/when-doctors-go-on-strike_b_1513689.html

[Ilsa]

3. I hope surgery is safer now than it was 40 years ago.

I hope that there would be little difference between Before and During surgeons' strikes if they occurred today. I'm not saying that the difference is only about the surgery, but I doubt it is exclusively about the doctors. Some of it has to be about surgical risks.

[PADemD]

5. Me, too.

But it wasn't for my Mom seven years ago.

[Marr]

4. Isn't it likely because the specialists make themselves available for procedures that attempt to

address a problem, and all medical procedures are risky?

I mean, say someone has brain cancer. They're going to die within a year or two. They have 50/50 shot at surviving if a surgeon can remove the tumor. They die the one day the surgeon is in the hospital. Not surprising, since the surgeon is the one attempting to fix the problem.