

How twitter helped a technology consultant escape from an evil hospital - gluejar
http://inmantechnologyit.blogspot.com/2009/09/social-media-and-my-escape-from-spinal.html

======
rdouble
My dad's a doctor in a rural environment, and I had a bad back injury
including ruptured discs and cracked vertebrae when I was in high school. I
can offer some insight on the psychology of the doctors and even a little bit
of information on this particular injury.

A rural surgeon is going to be professionally offended if their patient calls
up an egghead at Harvard from their pre-op hospital bed and then tells him she
doesn't trust his judgement and instead wants to be medivac airlifted back to
Boston. It's like when you watch a detective show when the FBI takes over and
the local cops are all bent out of shape. The hospital staff may have been
thinking about health insurance and losing their accreditation but I doubt it
was a sinister plot to meet their spinal surgery quotas. It was probably more
along these lines: "a crazy lady from Boston just broke her back jumping off a
bridge with some 13 year olds. Now she's telling us to schedule a chopper to
Boston because she's Facebook buddies with some prick neurology prof at
Harvard. Quick, give her some morphine and get her under the knife before her
spinal column collapses and she's paralyzed and we get slapped with a half
billion dollar malpractice suit... "

Note that I'm not defending that sort of attitude. That's just what I think
they would be thinking, rather than some nefarious conspiracy to maximize
insurance profits, which is what the article and most commenters on this post
seem to be suggesting.

The other thing is that I don't think the doctors were necessarily wrong in
their diagnosis. The higher you go up in the spine, there's a lot more danger
of paralysis or other severe spinal cord problem. If you're over 30 and
shatter your T12, there's a 50% chance you're going to end up with a serious
neurological problem. The odds for recovery are far better the sooner you have
surgery, if the surgery is necessary.

 _Timing of surgery is also an important issue in the treatment of thoracic
spine fractures. ... Some studies suggest that patients with thoracic spine
fractures treated within 72 hours, irrespective of concomitant injuries, do
much better physiologically postoperatively than those in whom stabilization
is delayed._

<http://emedicine.medscape.com/article/1267029-treatment>

Lastly, I don't think a patient requested 370 mile helicopter flight for a
treatment which could be performed locally could possibly be covered under any
insurance plan, no matter how good the coverage is.

~~~
param
I want to agree with you, but what I am interested in knowing is why the
boston doctor was insisting on a mobility test prior to surgery and why the
small town folks were insisting on surgery first.

The same thing happens in small town India as well where doctors are more
interested in keeping you admitted above and beyond the needed duration and
doctors in large cities are just better because they have a greater patient
load to be well versed with complex surgeries if needed.

~~~
rdouble
Watching her in the hospital and knowing that she swam to shore and stood up
would have made a mobility test irrelevant. Being 40+ with a shattered T12,
she made the riskier decision by opting out of the surgery. If you remove the
hyperbolic language from her story, it reads like the hospital was being
relatively conservative and trying to take the approach with the least risk of
paralysis or other spinal cord injury. That said, It's awesome that she's able
to recover without surgery. Even "successful" back surgeries usually have many
complications. Surgery or not, back injuries suck and require tons of PT,
exercise and lifestyle changes to get back to normal.

~~~
btilly
She made the riskier decision? What qualifications do you have to claim that?

According to the Harvard neurosurgeon she made the less risky decision. Given
the choice between believing a random poster to hacker news and someone with
those qualifications, I'm going with the known expert every time. It is just
icing on the cake that the expert's opinion fits with what I've been told
about the risks of back surgery by multiple doctors, physical therapists, and
even a panel appointed by the US government. (Admittedly the last is somewhat
out of date.)

~~~
rdouble
I read it in the article I linked to in my previous post. But you're obviously
more up to date on the facts, so you win.

------
fnid
_It never occurred to me that carrying high-level heath insurance would mark
me as a candidate for unnecessary surgery._

Perhaps this is exactly _why_ health care costs have gone up so dramatically.
We have insurance, so the doctors take advantage of it -- needlessly. We very
well could be spending a lot less money for the same amount of health care.

I think the solution to the health care problem is for someone to start saying
NO, like in that other article on the front page now. No to more test, no to
unnecessary treatments and surgeries and non-generic drugs.

Say no!

~~~
po
Another good article which I don't think is getting as much press as the New
Yorker article:

<http://www.theatlantic.com/doc/200909/health-care>

~~~
ryanwaggoner
Fantastic article, but it _was_ on the front page about a month ago:

<http://news.ycombinator.com/item?id=760477>

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gluejar
According to the author, the story is being used as fodder by both sides of
the healthcare debate. All I can see is the perverse economic incentives on
display.

~~~
potatolicious
AFAIK Canada gets around this problem by capping the number of billable
patients a doctor can see per day (adjusted by specialty of course). Any
patients in excess of the cap is only paid by the government at a steeply
discounted rate.

This discourages doctors from overworking themselves and offering shoddy care
(instead choosing to move patients through like a cattle farm), and also
discourages the sort of unnecessary treatment this article talks about.

~~~
yummyfajitas
I suspect that the doctors at this hospital would be well under the quota you
speak of. Remember, the author suggested the hospital might lose it's
accredition for this type of surgery since they didn't do enough of them.

------
DEinspanjer
I wonder if the treatment was really all about the "really great health
insurance" and not just the doctors at the hospital deciding that they knew
better than another doctor many hours away that had not seen the patient or
the pictures of her spine.

Upon reading the description of how the accident took place, my first thought
was, "Really, is her insurance going to pay for that!?" And according to the
last comment on her blog post, apparently the answer is, "No."

I would imagine either hospital would have to have enough familiarity with
that type of accident to question whether her insurance would cover it as
well.

~~~
SarahCortes
Ah,is that really a question? My comment on my blog that my health insurance
decided it was best to leave me on the ledge to die of exposure was-need I
say-tongue in cheek.You must be under the impression the insurance companies
are in possession of that awesome perfect blame calculator - parsing an
infinite number of scenarios to detemine blame for accidents and disease, then
confirm or deny coverage based on their magic box. That is your insurance
company, not mine. Please reply quickly, unless you are tied up arguing with
them about whether they should cover your AIDS since everyone knows sharing
needles is unsafe.

~~~
nkassis
I got too say, I would be surprised if an insurance would not cover something
like this. This is equivalent to a sports injury. Frankly no one can tell me
that jumping off a cliff mountain biking is less dangerous than a bridge jump.
I've bridge jumped before (not fifty feet I believe but high) and I wasn't the
only one around, I didn't think it was that dangerous at the time but I
understand how a bad landing could cause such an injury. Hell Olympic divers
have really bad landings doing 33 feet dive and don't die.

~~~
DEinspanjer
The reason I questioned whether they would cover this is because in the past
I've seen exclusion clauses that stated an insurance company would not cover
extreme sports related injuries with a standard health insurance policy. The
examples I remember for extreme sports were things like base jumping and
bungee jumping and parachuting.

I don't pretend to know much about this stuff. I did state that it was just a
question I had. If insurance companies routinely cover people who have
accidents while doing things significantly more dangerous than your typical
day to day activities then that is great... I guess.

The first part of my comment still stands regardless. I wonder how much of the
battle was over getting insurance money and how much of it might have been
over the doctor's ego.

------
DannoHung
And the ultimate lesson of all of this: If your friend jumps off a bridge, are
you going to jump off of a bridge too?

~~~
gruseom
Although your comment looks like a vacuous redditesque one-liner, I'll
respond: I've jumped from similar heights under similar circumstances, i.e. a
spot favored by locals, surrounded by people happily jumping and swimming.
It's only in hindsight that what she did was an obviously bad move, and even
then it sounds like a slightly different angle would have made it harmless.

This aspect is hardly "the ultimate lesson of all this": if the post were
merely about someone who jumped into a pond when they shouldn't have, no one
would be discussing it.

~~~
jimmybot
Three other people were injured that day from jumping, and the ambulance that
was called wasn't even called for the heroine of our story. I don't know what
the denominator is, but it doesn't sound good.

I do agree though, that jumping or not wasn't the main issue here.

~~~
pyre
Seems like it was a 'hot spot' because people used it often. Sure she says
that other people were injured, but how badly? It's possible that her injury
was the worse injury anyone has ever sustained from jumping there. If that's
the case, and parents still encourage/let their children jump from that
bridge, I would say it's a problem. (Not that I would ever let my kids jump
from a 50' bridge, at least not until they're old enough to make decisions on
their own -- I'm not advocating 'babying' your children after they've left the
nest.)

------
skybrian
"According to Ithaca Fire Department statistics, Lowe was the fifteenth person
to die in Ithaca's gorges since 2000—and the fourth to drown in that
particular pool since 1986. When most people think of gorge deaths, they think
of the jumpers who have given Cornell an unwanted (and unwarranted) reputation
as a suicide hot spot. But Ithaca Police Officer Doug Hoyt estimates that
about half of those fifteen deaths were accidents caused by turbulent water,
slippery rocks, fallen trees, and a host of other natural features. The local
community has mourned each death. But Lowe's passing—coming in the wake of the
drowning the previous year of Jeevan Mykoo, a thirty-year-old tourist from
Ottawa, and the 2006 death of Navin Parthasarathy, a visiting graduate student
from the University of California, Santa Barbara—has spurred a widespread
debate about how to deal with the dangers and appeals of one of Cornell's
great natural attractions."

[http://cornellalumnimagazine.com/index.php?option=com_conten...](http://cornellalumnimagazine.com/index.php?option=com_content&task=view&id=264)

------
gruseom
That is a harrowing story. If it's half true, the hospital really is evil.

~~~
wheaties
Doubt the doctors are the evil ones. If they're using an outdated procedure it
means they haven't been kept up to date on the latest treatment protocols. The
hospital beaurocrats trying to keep their accredation and earn big bucks,
those are the evail ones.

~~~
fnid
They are evil because they were thinking of themselves before the patient and
using lies to intimidate her into agreeing with them -- when they were wrong.

That's evil. Unfortunately, it's a story repeated across the nation every day.

~~~
andreyf
No accreditation means no funding, means no hospital, means no job. So by your
definition, the only way doctors can _remain_ doctors at said hospital is by
being evil. Hence, I would blame the short-sighedness of whoever created and
approved for the rules of accreditation for hospitals, not the people at the
whims of those rules.

~~~
gruseom
If you're right, all it means is that no ethical doctor would remain at said
hospital. Ethics only count when they go against one's own interests,
otherwise they'd be pointless.

I can't believe you're making excuses for doctors who (if the story is true)
tried to bully a woman against her will into having major spinal surgery that
she clearly didn't need.

~~~
andreyf
Not quite making excuses, just pointing out that the system that necessitates
'evil' behavior is also to blame...

------
andreyf
Oi, that sure was lengthy. Summary: Some hospital in Pennsylvania tries to
make money by doing unnecessary procedures on patients with good health
insurance and went to great lengths to keep this lady from seeking a second
opinion regarding her injury.

IMO, this is the incentive of nearly all doctors in America - the dentists
I've had span the entire spectrum of opinions about my wisdom teeth. From "if
we don't take them out, you can die from a gum infection" to "do they hurt?
no? do you eat meat? then you should keep them, they'll makes it easier to
chew".

~~~
davidw
About 15 years ago, the dentist I went to said dire things about the immense
pain my wisdom teeth were going to cause in my immediate future. I told him
I'd make an appointment right away when that happened, even though his advice
was to intervene as soon as possible to 'avoid any future problems'. I still
have all of them and aside from the occasional twinge, they are just fine.

~~~
pyre
It's not necessarily about money though. To my knowledge, most people have
problems with their wisdom teeth coming in wrong and screwing up their other
teeth. If this is the majority case, then going on the offensive and taking
care of them early can make sense rather than waiting to have issues.

Sometimes these cases end up sounding to me like the people who try to decry
the state laws requiring you to wear a seatbelt by pointing out the relatively
few cases where _not_ wearing a seatbelt did save (or could have saved)
someone's life. They completely ignore the overwhelming number of cases where
seatbelts _do_ save people's lives. It's just a case of people trying to make
the facts fit a conclusion that they've already come to and don't want to
change.

~~~
zargon
That comparison is like saying that when someone gets diagnosed with diabetes,
they should preemptively amputate their feet so as to avoid trouble with them
later.

~~~
pyre
So you are saying that removal of wisdom teeth gives you a disability similar
to removal of feet?

~~~
zargon
Point taken. How about giving everyone an appendicectomy, just in case?

~~~
pyre
So far as I know appendix removal is move invasive of a surgery with more risk
than removal of wisdom teeth is.

Other than that, I would want to see the numbers on '% of people that need
appendix removal' vs '% of people that need wisdom teeth removal.' My
suspicion is that the latter is much higher than the former, but I could be
wrong.

------
marze
This seems like a situation where knowing a certain phrase might help. I don't
know what that phrase might, but a lawyer or someone else familiar with the
medical industry might.

Something like "I will not authorize you to perform this procedure and have
notified my physician and lawyer of this, if you perform anything that I have
not authorized will result in an expensive lawsuit" or something.

Anyone know what the right terms to use are? It seems in other situations
there are magic words that can be used to produce immediate results.

~~~
Kadin
You can always -- provided you are sane, sober, and alert -- decline treatment
or even just check yourself out of the hospital "against medical advice."
Generally this involves signing some forms releasing the hospital from all
responsibility for you. And then you can just walk out.

Hospital personnel will try to strongly discourage you from doing this -- not
because they're evil, but because in most situations it's a _really, really
bad idea._ But if you just keep saying "no, I don't want treatment, I want to
leave, give me the forms to sign out AMA," and you're not clearly nuts or high
on morphine or otherwise impaired, you can pretty much just leave.

However, unless you have a very specific reason for believing that the
treatment protocol at work isn't correct or best for you, it's generally a bad
idea.

------
benatkin
_Since that time, people on both sides of the health care debate have listened
to my story and pointed out it supports their views, both pro and con._

Unsurprising. I think this is more about patients' rights than healthcare
funding, though.

~~~
pyre
Yea. I can see people on both sides saying crap about this.

Pro: _This wouldn't happen with government healthcare because there would be
standards in place (i.e. the 'mobility test' would be standard everywhere not
just in 'cutting edge' facilities)_

Con: _In government-run healthcare, she would have been forced to stay in that
hospital so as to minimize the costs of treating her (i.e. no expensive
transport from PA to Boston). The government would be taking away her
individual rights to take ownership of her situation._

The healthcare debate is a lot more nuanced than the 'Arg! Socialism!' or
'Arg! Health insurance is evil!' crowds make it out to be.

~~~
desu
Well, it's more like the pro is that there is no profit motive to keep her
there. The staff would be delighted to get rid of her to a bigger facility
elsewhere. I live a kilometre north of a large hospital in Sydney, Australia
and we get helicopters coming in all hours of the day and night, presumably
doing just that.

The "con" would probably be that there would be no facility for spinal surgery
in a rural area in the first place. She would not be able to choose to be
treated there and she's getting on one of those helicopters.

~~~
pyre
Well, it all depends on the 'type' of government healthcare that happens.

If hospitals are still privately owned, but the government basically starts
it's own 'insurance company' that covers everyone that isn't part of the
private insurance company plan (similar to Germany) then it's possible that a
rural area could still have spinal surgery experts. Even if the hospitals are
all government-owned and run (similar to the UK method of healthcare), it's
still possible to have spinal surgery experts in a rural area. It just would
depend on what was cheaper. Is it cheaper to have a spinal surgery-trained
staff at the rural hospital or to fly everyone 300 miles to another hospital?
(Or the 3rd option of having staff at a different hospital, but making sure
that it is less than 300 miles away -- i.e. spread out facilities that can
handle such injuries so that there aren't hugely expensive transit costs for
treatment)

~~~
yummyfajitas
With a government healthcare system, it won't simply be a cost/benefit
analysis. There is also the all important question to be answered: "does this
create jobs in my congressional district?"

------
durana
The story really doesn't involve Twitter much at all.

~~~
gruseom
But that's not true. It describes her as using Twitter throughout the ordeal.
Most importantly, it was through Twitter that she met the ethical neurosurgeon
who saved her.

Incidentally, her title references "social media" rather than Twitter, which I
think is right; it's not hard to imagine, say, Facebook playing the same role.
What's relevant is that she got word of her plight out to a network of people
in a way that would be harder to do otherwise, and that feedback from this
network led to a fundamentally different outcome than that experienced (I
imagine) by most people with broken spines who are having unnecessary surgery
and narcotics forced on them against their will.

~~~
jimmybot
Are people that responsive on Facebook?

~~~
cschep
Absolutely. I see people basically chatting in comments on status updates. I
think the problem would be more about spreading the story quickly. Twitter
doesn't have the "friend" requirement, ultimately making it the better tool(?)
here.

~~~
jimmybot
I do to from time too, but I asked because personally, I rarely see people get
questions answered on Facebook the way they regularly do on Twitter. But then
again, the people that Twitter and get questions answered quickly are probably
your blogger, big personality types too.

And then yet back on the other hand, as you say, there is no friend
requirement so those big personality types could really only amplify their
voice in that way over Twitter.

------
theklub
This really just amounts to part of the Twitter Hype machine.

------
caa09hh
That is an amazing story!

------
caa09hh
Its also why we need to fix healthcare.

------
JulianMorrison
Raze that place to the ground, and throw those "medical" staff in jail for
life.

