Friday, July 24, 2009

Performing Heart Surgery in Consideration of the Age of Patient -- An Ethical Question for You

I have a question for you:

Should a 97-year-old man undergo an expensive, dangerous open-heart operation to repair a lethal tear in a main artery of his heart? A Pennsylvania news article this week asked the question. (If interested: Click link for referenced article: For America's aged, surgery at any price? )

The question begs for consideration of the "value" of life. Physicians are reminded of the Hippocratic Oath, which is founded on moral code and respect for human life. What about quality versus quantity of life? Where is the line that society crosses in playing God? Given the advanced medical technologies of 2009, the medical profession provides us all many choices and options in health treatments, both from a user/patient perspective and from a professional/physician perspective.

I can't help but consider the dilemmas of our times: the U.S. economy in 2009, the ensuing politicking about national health care, the issues of our aging Baby Boomers (and the generations following) and the wonderment and concern of social security benefits' future as a viable source of help to people. Given all the technological advancements and capabilities to extend life, when does it become imprudent to do so?

In our business, we tend to see (although not always) the sickest of the sick and oftentimes those who are elderly receive open heart surgery. Asking the hard ethical questions is important.

My memory brings back to me a quote I heard which may incite some readers:

I hate the men who would prolong their lives
By foods and drinks and charms of magic art
Perverting nature's course to keep off death
They ought, when they no longer serve the land
To quit this life, and clear the way for youth.

-Euripides 500 B.C.


The above quote is ages old, but it's a way of thinking a large population espouses. Dan Callahan, PhD an ethicist and founder of the The Hastings Center , published books on this topic 20 years ago and blogs about it. He's 78 years old now, which is interesting in that he still stands behind his comment that that health care should be rationed for the elderly as a way to keep Medicare solvent. Further, he once stated 20 years ago that the age of 80 should be a cutoff point for the most expensive technologies (e.g. open-heart surgery), even if they might be life-saving.

I'd be interested to hear your reaction to these thoughts. Comments Welcomed.

Sincerely,

Ralph E. Jordan
CEO & President
Trident Health Resources, Inc.

Tuesday, July 14, 2009

Computer Gaming and Medical Technology in 2009: The Role of Nintendo in Medical Education and Practice

I was reading in this week’s news that the American Heart Association (AHA) pledged $50,000 towards the completion of a project to support CPR training through applications on Nintendo’s, Wii. That shouldn’t be all too surprising… other games on the market allow players to play doctor and perform knee surgery, for example. So it seems, it’s just fun and games for now. But when the AHA project is ready, the CPR training will be offered for free at its website.

Like many of you reading this blog post, the wave of computer gaming is probably not a foreign concept, regardless of your generation… You may be a player, yourself, unwinding after work; you might be the concerned parent of the proverbial lump on the couch (your teen who spends too many hours playing); or, perhaps you’re like me, a grandfather who truly gets a kick out of a sporting event involving swinging an invisible golf club or competition against the grandbabies whereby I am punching the air, which simultaneously knocks out the bad guy on the TV screen. Whatever your involvement, gaming is, has been, and continues to be integrated with American entertainment.

But recently, scientists have stepped in to explore the outcomes of gaming on more of paradigm shift and considering the implications in the medical field. In our business of cardiovascular surgery and perfusion, it is noted that robotics are a surgical method which is seen in several procedures. Laparoscopic surgery is used for hysterectomies, some heart procedures, on prostates, colons, gall bladders and almost anything that can be accessed by a small incision. Given this fact, recognize that the surgeon’s hands are not inside the patient’s body when robotic surgery takes place. Instead, the surgeon uses tools which are not unlike a computer gamer’s “joystick”. In surgery, it is through a tiny incision that the work is done through manipulation of tools. These are watched on a video screen, coordinating the hand motion remote movement.

Several published research papers in the past year reported on the (positive) effects of gaming in healthcare learning and performance. Specifically, in an article by the American Psychological Association, several studies about gaming and its parallel to surgery were made. Specifically, in Four Dimensions of Video Game Effects by psychologist Douglas Gentile, PhD, and William Stone, it was found that 33 laparoscopic surgeons who gamed could not only perform advanced surgeries more quickly but also made fewer errors in surgery (APA, 2008). Another study, focusing on 303 surgeons, found that their spatial skills and dexterity were improved by games that require both (APA). The Wall Street Journal blog reported on another study (unnamed) and stated that,“…playing certain video games on the Nintendo Wii helps surgical residents to hone their fine motor skills and improve their performance on a serious surgery simulator.” An article in Science Daily reported the following statistics: surgeons who played three hours or more games made 37% fewer mistakes. They were also faster by 27%.

Fascinating. Technology has come a long way since a little yellow ball chased ghosts and ate them in the classic and highly addictive early computer game called, Pacman. Who would have thought that the Pacman experience would be the precurser stimulating the Robvotics Industry as a reality in our future?

Comments welcomed.


Sincerely,

Ralph E. Jordan
CEO & President
Trident Health Resources, Inc.
***

Wednesday, July 8, 2009

Important News! Heparin Case Award

Jury Awards 10 million in Heparin Case
This is a reprint from: Injuryboard.com 7-4-2009 Article
Beth Janicek

In Houston, Texas, a jury recently awarded 10 million in a medical malpractice case against Methodist Hospital and the doctors who treated John German. He sustained an amputation of his left leg above the knee, all the toes on his right foot and all of his fingers following heart surgery. The lawsuit claimed the hospital nurses failed to properly monitor him after he had been administered Heparin. He had a reaction commonly referred to as HIT, heparin-induced thrombocytopenia. The hospital claimed the nurses had not done anything wrong and had helped save Mr. German’s life. Apparently, the jury did not agree.

The jury award will help provide for the extensive medical care Mr German will have in the future.

As he stated,” It’s like closing a painful chapter in my life, even though I have to live every day like this.”

The hospital intends to appeal the case. Hopefully, the verdict will stand on appeal. I have blogged in the past about the devastating damages which result from HIT and the importance of the medical community to be vigilant in monitoring patients following heart procedures. This Texas jury has sent that message to the medical community.

Wednesday, July 1, 2009

Trident's July HEARTBEAT Newsletter



Unique Staffing Conditions
in Hospital Heart Programs
and the Dedicated Perfusionists Within Them

It's not just about the bottom line-- certainly not in our business so focused on patients and employees. Want to read more?" Click to see Trident's July Newsletter.

Comments welcomed here!