Tuesday, April 26, 2011
mmm, never realized i actually emailed you that terrifying night before a grisly surgery...........but now that i have you, might as well describe my experience. was intensively studying anesthetics to be used the next morning for surgery to repair my left wrist with a metal plate, the wrist broken badly in an attempted mugging in the caribbean.....had long previously read extensively about general anesthesia and sedation also so knew more than nearly most any layman on the subject.....a control type, (me too) the idea of complete strangers injecting powerful drugs to make me lose awareness has always been difficult for me to accept. i had read about versed for coloonoscopy (at 55 the next cloud on my horizon). (According to the medical personnel who have written to me, control freakishness by anybody other than themselves is a major mental health issue.)
the big day came on april 7. i was expecting versed and axillary nerve block of the entire arm (this is EXACTLY what I was expecting) but upon check in the chirpy 29 year old anesthesiology resident (I had a youngish chirpy CRNA who was masquerading as a Dr.) informed me i would be having the whole banana----LMA (laryngeal mask anesthesia-----sevoflurane via tube in your throat) and michael jackson's infamous white propofol, as well as versed and nerve block. the works. (Once again this whole issue is left until the very last second when you are naked, maybe fearful and usually once the IV is running. At least Jon was apprised of the situation. My team simply did it to me without warning!) this news got my heart racing even faster than the 105 beats measured at check in. so they threw everything at me including fentanyl. i feared the anesthesia more than them filleting my forearm and drilling screws into my bones. (me too and my experiences with anesthesia make me even more alarmed) the whole prospect was without a doubt the most frightening experience of my life, and i'm 55, nearly crashed a small plane i was piloting solo in florida 35 years ago as a student pilot in over his head in a violent thunderstorm----but this was far scarier to me.
the versed was for me not a bad experience. in the block room i recall nervous chit chat with the two too young anesthesiologists preparing to inject the local anesthetics into my arm pit....(I got, you guessed it, a little anesthesia NURSE) last memories were thinking how intensely fluorescent orange and bobbly/soapy was the betadyne. i was not aware of them actually injecting the sensitive armpit area, thank god.....then i think they let me float back briefly before taking me to the operating room. i have vague memory of the dr. telling me she used only 2 or 3 mg. versed to that point (i had expressed interest in the procedure/dose, to a point, had asked if they could use lowest dose possible consistent with lowering anxiety and pain). (2 to 3 mg. Versed is NOT a low dose. 2 mg is usually enough to create amnesia and abject obedience. .5 would have been a low dose. Versed doesn't alleviate pain, Fentanyl does. In fact, in many cases Versed exacerbates and even creates anxiety. Especially judging by how many patients blood pressure and heart rate shoots up after injecting this poison.) then i remember them telling me they were going to put an oxygen mask on me, and last memory was them slipping a clear oxygen mask over my face and a warm, comfortable relaxation. that was my last memory. that's when they must have deepened the versed again. never saw the o.r., or if i saw it, never remembered it. next thing i knew 2 hours had passed and i woke in recovery with a pleasant short nap refreshed feeling, no nausea, and a bizarre completely numbed arm that remained numb for 12 hours. (Wow! So different than my experience! I woke up yelling and throwing things while my nurse cowered in a corner. Even my husband was terrified of me! My arm was numb as well, with the added effect of a CAST on it which I was wielding as a club. I was so uncoordinated that I was having some very near misses with my face, so I quit swinging it. My numbness has abated mostly, but all these years later it is still an issue. Due entirely to this particular surgery.)
i can certainly understand people's anxiety about a drug that seems to hit everyone differently. i'm 145 lbs male and not a drug user not even prescription drugs if avoidable so the benzodiazepines hit me like a freight train. i've talked to others who had unpleasant colonoscopy experiences under versed including pain.
one question i might ask you, the doctors barely spoke to me throughout this odyssey, very impersonal medicine, (I guess they are too good to speak to you, you are beneath contempt! As a patient you are only there to enrich them, you certainly have no standing as a human being, nor are you worthy of wasting their valuable time actually interacting with you! Answer questions? Explain themselves? Are you kidding? Sorry, but that's the attitude.) everything i know i learned myself from the net.......(yes and why is that? Whatever happened to "informed" consent? That's exactly how *I* learned about any medical stuff. It's the LAW that medical people must reveal all! Why then are we all having to discover this stuff on our own, online?) in recovery i very briefly saw a very detailed sheet used in the o.r. by the anesthesiologist, with all sorts of hand written details like drugs given, dosages, blood pressure and other anesthesia tech readings.....i believe this is called the "intra-operative anesthesiologist's report"? i've scooped up all my med records from the med records office but have been unable to ever see this particular again....i really want to see it because it's by far the most detailed record of how my body reacted to the anesthesia, exact time in operating room, etc. is there anything else this is called? is it commonly available to the patient/kept in files, or, discarded? (I have tried without success to obtain my anesthesia report as well. I have several posts about this very issue! It's the LAW that they must release this information, but having tried everything imaginable including complaining to the FBI and other regulatory and compliance bureaucracies, I have gotten nowhere. That's why you can't see a copy of my own anesthesia report. They won't release this in defiance of the law. I guess when you can't even get copies of your medical chart at all, a copy of the anesthesia report is out of the question. The law states that this information be kept for a number of years, I think it's 8, but I could be wrong. Of course when does compliance with the LAW have anything to do with medicine? The best you can do is get a copy of the BILLING from point of treatment. The drugs will be listed and amounts given that they charged you for. At least you will have some idea of what the Hell they pumped you full of and an approximation of the amounts.)
hope this account of one more person's experience with versed adds to your record of its effects.
So as you can see, even though Jon had no problem with Versed, his EXPERIENCE with medical care parallels mine. He has the same complaints about the quality of care, the sudden change of plan to include g/a when he was at his most vulnerable, the lack of adequate dialogue between he and they, the inability to obtain his patient records, all of this goes to the heart of medical care in today's world.
I also want to add that Jon has had many of the same problems with his wrist surgery that I have had... This ORIF surgery for distal radius fractures is highly dangerous and it seems, not very effective. He is facing additional surgery and has the motion problems like I had. We should have been told about the RISKS of this surgery so that we could choose another course of action. I would NEVER, EVER have this surgery again. I wouldn't have had it in the first place if the horrendous risks had been fully revealed as the law requires!
So he flouted the law all along, treated me with complete and utter disregard for my safety, botched the surgery and allowed a nasty little control freak nurse to dope me against my will, now HE IS FIRING ME, without even the courtesy to inform ME of his plan! I guess once you screw up the patient badly enough you can simply wash your hands of the whole mess by simply jotting a note to the referring entity!!!!
Well not so fast Dr. Here is the proper procedure for firing a patient... First you tell THEM! IT'S THE LAW! Anyway, I didn't know this. I thought that a cowardly communication from the doctor to my nurse practitioner was the way business was done. Can't have the patient find out that they were fired! Especially if it looks like the patient won't be coming back for more sub standard treatment anyway! This royally pissed me off! On top of everything else the man who ruined my life thinks that *I* am a lower life form unworthy of even this much communication!
How bad was it? I was super angry at the CRNA, a total idiot with delusions of grandeur. I was not so mad at my surgeon because *I* assumed that the reason the surgery was performed so badly was because I fought while under anesthesia, just like I have done every single time g/a has been administered in my long and injury prone life. I blamed the CRNA for the poor outcome of my surgery. However, once I discovered that the surgeon thought that his bad surgery was actually good, that my surgeon was perfectly happy to allow my tendons and nerves to continue to be shredded and damaged by his surgery, and all the rest of it, impugning my mental health, etc. now he was firing me without telling me? That's when I turned on him. Enough subterfuge is enough. Final straw. Here's the article...
by Adam Alpers, DO
Occasionally, you may encounter patients who you no longer wish to treat. Reasons for ending the physician-patient relationship may include chronic non-compliance, rudeness to office staff, or non-payment of bills. (Not applicable to me...)
While these patient behaviors can affect the interactive care-giving process, they may also identify patients with a propensity to file a claim against you. To help reduce the risk of a future claim, a physician may terminate or discharge a patient from the practice. (Finding out that the ARROGANT man who wrecked my hand and mental health was firing me, AND the way I found out CAUSED me to sue him! Oh yeah, he just cared so much that when I had a bad outcome, instead of helping, he fired me. He could care less, not when he performed the surgery and certainly not after. Complain and you are gone.)
There are, however, certain exceptions that apply to terminating a patient.
- You may not terminate your professional relationship for any discriminatory purpose or in violation of any laws or rules prohibiting discrimination such as the Americans with Disabilities Act.
- You also are not permitted to terminate a patient where you know, or reasonably should know, that no other healthcare provider is currently able to provide the patient the type of care or services that you are providing to the patient.
Reduce the risk of abandonment for the patient
Abandonment occurs when a physician suddenly terminates a patient relationship without giving the patient sufficient time to locate another practitioner.
A patient, however, may withdraw from a physician’s care at any time without notifying the physician.
- To reduce the risk of allegations of abandonment, it is recommended that you discuss with the patient in person the difficulties in the physician-patient relationship and your intention to discharge the patient from the practice. (emphasis mine)
- Be sure to document the discussion fully in the patient’s medical record, also noting the presence of any witnesses such as a patient’s family member or a member of your office staff. (What discussion? What medical record? No such thing exists or at least was given to me, except a letter he wrote to my NP, which was in the only part of my patient records I was given... letters to others! A copy of this is on the blog elsewhere.)
Write a formal discharge letter to the patient
You are required by law to notify the patient in writing of the termination. The letter must state that you will no longer provide care to the patient as of a date certain. The date certain must be at least 30 days from the date of the letter. You must also state in the letter that you will be available to provide emergency care or services, including provision of necessary prescriptions, during the 30 day notice period. (Why a patient would want emergency care from a physician who can't stand them is beyond me. I never got a formal discharge paper at all. My NP didn't get one either as he was already gone to another job by the time that the letter from my surgeon was sent. )
The discharge letter should also include:
- A description of any urgent medical problems the patient may have.
- An offer to forward copies of the patient’s medical records to the subsequent treating physician. (This is not a good idea... Really! Please see the letter from my surgeon to the second opinion Dr. As a patient you do not want this discussion to take place. Your guy will probably try to black ball you, if he/she is anything like mine.)
- The name and phone number of a local physician referral service or the local/state medical society to assist the patient in locating a physician who is accepting new patients.
The care of a patient is a mutual agreement and is in many ways a team between you, the provider, and the patient, but when that relationship is strained and you can no longer feel that you are able to provide quality care to the patient, at that point it is time to end that patient-provider interaction. Make sure you have attempted all you can do to help and when you realize there is no more to do, discharging the patient may be the only course of action.
This is all laughable isn't it? What team? I was the sub human underling and he was almighty God. My surgeon didn't provide quality care from the start, so what changed? What exactly did he do to help? Nothing but denigrate me and my concerns out of hand. Go read what he said about me and about the problems I had with the surgery, it's all here. Look at my x rays. Read what other surgeons have said about the problems I had. The relationship was strained because of HIS behavior and performance, NOT mine. I took exception to the whole nasty business, and I'm the bad guy? Then this final act of lawlessness on HIS part in not following the laws about how to fire a patient.
Sunday, April 24, 2011
(I have removed the doctors name. If you are that interested you can see it by clicking the link I provided above.)
As my final thoughts; We do need malpractice attorneys. They perform a valuable service to patients, not just the financial reparations to "make the patient whole" but also to constantly pressure "health entities" to make us safer, to make these entities more responsive to patients and to convince them that it's in their best interests to follow the law, and do their job to the best of their abilities. Without lawsuits there is nothing to prevent medical practitioners from doing whatever they want without fear of repercussions. Jail is a huge deterrent to me. It makes me obey the law. What if there were no consequences? Trust me, I would be speeding around in my Mustang. I would put everybody at risk with my driving, even though I feel that I am an ace driver and that *I* can control my car under any circumstance. Ditto with medical people. If there is no deterrent, then what is to stop them? It's not like we can lock up doctors that perform badly! The only recourse is financial, and we patients need this in order to police the health entities. There really is no other way at this time. Come up with some mediation, or something like it to address grievances! Maybe doctors would rather be put in jail for infractions and deviations from the law, just like the rest of us?
That post I sent you about "Minimal Sedation" has been deleted from Yahoo Answers ! (I wanted to see if anyone had responded to the question, and it now says "This question has been deleted." It's gone !) That has never happened before.
Why would that be ? Too many people viewing it? (If so, that must mean lots of medical people are reading your blog even if they're not posting any comments...and obviously, someone didn't want anyone to see what really happens to patients who request "minimal sedation" !"
I don't know what to think! I know that medical people will defend Versed with their dying breath. They will NOT hear anything against it, so it may be that somebody requested that the question be removed lest others tell the truth about the questioner's predicament. As for deleting the question... It's here on this blog and it's not going anyplace. The only way I will remove that question is if the person who posted it e-mails me and asks me to! And it better be the patients name as shown on the question IN the e-mail address and it better have Italy as country of origin in the I.P. Of course I would try to delve further into their debacle, and enlist their help in getting the word out about "sedation" practices...
Thursday, April 14, 2011
Open QuestionShow me another »
Midazolan minimum dose for sedation (colonoscopy)?
Monday, April 11, 2011
First the "bad" quote :
" In one hospital where I used to work, we were not involved in the GI cases, and we jokingly called screening colonoscopies "screaming" colonoscopies "
( quote from "Pangolin" @ http://answers.yahoo.com/question/index?qid=20110322110339AADCX6K
And now the "good" quote:
"I find that Versed adds virtually nothing to propofol sedation. You might give it for excessively anxious patients in preop or pediatric patients, but most adults can handle the brief 2 minute or less transport from preop into the procedure room. They may say that they need something to calm them down but when you explain to them that Versed will prolong their post procedure stay for up to an hour, most people won't mind a little anxiety before the start of the procedure"