I thought I’d reprint this excellent and amusing research study
reported in Ars technica which is a very good technical website and well worth
looking at.
It’s Christmas nonsense but given the problems I’ve had with
some Doctors it made me laugh.
I’ve put the simple explanation for this at the end of the
reprinted article;
Ars
technica
When the
doctor’s away, the patient is more likely to survive
Deaths due
to heart problems drop during major cardiology gatherings.
by John Timmer
- Dec 26 2014
"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.
As
additional controls, they checked a number of additional meetings for oncology,
gastroenterology, and orthopedics specialists. They also looked at the impacts
of additional critical injuries, like gastrointestinal bleeding and hip
fractures, as well as non-critical cardiac problems.
In total,
there were tens of thousands of patients involved. And the trends were clear.
At teaching hospitals, the rate of death after heart failure was 24.8 percent
on non-meeting days. While the cardiologists were out of town, it dropped to 17
percent. A similar trend was apparent with cardiac arrests, where death rates
fell from 68.6 percent to 59 percent while cardiology meetings were happening.
There was no significant difference with acute myocardial infarction patients.
So, having
specialists in town appeared to make matters worse for patients—the exact
opposite of the hypothesis the researchers set out to examine. The various
controls suggested the effect was robust, and it persisted after adjusting for
other potential influences, like age and sex.
In a press
release accompanying the report, one of its authors, Anupam Jena, said
"That's a tremendous reduction in mortality, better than most of the
medical interventions that exist to treat these conditions." What could possibly
be causing it? The authors consider three possibilities. First, there's
something involved with the changes in cardiology staffing that occur when
specialists go out of town that actually increases care. The second is that
there are fewer people having outpatient or same-day procedures, given that
doctors wouldn't schedule these when they knew they'd be absent. This would
allow the remaining physicians to better focus care on the serious cases.
The final
possibility that they consider is that the doctors that remain behind are more
cautious about the care they give, avoiding aggressive procedures such as the
use of angioplasty or stents to re-open clogged heart vessels. This would be
consistent with the lack of effect in acute myocardial infarction patients,
where this procedure is used less often.
Although
their analysis can't distinguish among these possibilities, it's clear that
this effect warrants further attention. Both because it's possible that the
long-term survival evens out thanks to more aggressive treatment, and because
we might find out that we've been acting a bit too aggressively.
Obviously, the reason why death rate falls when senior
Doctors are away at conventions is very simple; these are the most experienced
and senior doctors. They do the most complex and dangerous procedures and they
make sure they are available to follow up operations.
When there is a convention, they reschedule difficult
procedures for when they are back.
The most complex and dangerous procedures (being the most
risky) are most likely to result in deaths.
Still, a bit of Christmas fun!
Neil Harris
(a don’t stop till you drop production)
Contact me: neilwithpromisestokeep@gmail.com
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