Doctors vs Patients: online
p2p news / p2pnet:- Members of the medical profession used to be regarded as virtual saints and were used as unimpeachable character witnesses in all kinds of contexts.
But that’s changed as more and more medics have been found guilty of being human. Just like everyone else.
The difference between medics and most other people, however, is: like lawyers, doctors and other medical workers generally practice behind near-impenetrable professional screens and when complaints succeed in penetrating them, more often than not, other doctors (or lawyers) sitting on boards dispense ‘punishment’. Consequently, tales of abuse and self-serving decisions are rife.
Then, along came the Net meaning people who weren’t satisfied now had a way of expressing their dissatisfaction and, “that has some medical providers on edge,” says the Wall Street Journal.
“Several Web sites have sprung up that encourage patients to post anonymous reviews of doctors and dentists, and some frustrated patients have created entire Web sites to criticize specific physicians.”
Disgruntled ex-patients have posted sites such as LasikFraud.com, DentalFraudinFlorida.com, and “several Web sites have emerged in the past year that feature anonymous reviews of doctors,” says the WSJ. “These sites differ from official state medical-board Web sites that post background information about licensed medical practitioners, such as hospital disciplinary actions.
“One of the new sites, called NDDB.net, for National Doctor Database, invites visitors to review thousands of doctors listed on its site, but so far has collected only about 600 reviews. The owner of the site is not identified and refused to give his or her name in an email exchange, saying in part that the site is wary about potential litigation.”
“The potential problems are huge,” Matt Messina, a dentist in Fairview Park, Ohio, and a spokesman for the American Dental Association, is quoted as saying. “My reputation is my stock in trade … and we work years and years to build that reputation. To have that shattered potentially [by an Internet posting] is a concern.”
Patient advocates, however, say patients have First Amendment rights to describe their experiences with physicians, says the story, which has Charles Inlander, president of People’s Medical Society, a patient advocacy group, saying, “Blogs and personal Web sites are no different than talking over the back fence. Those who read it have to take it with whatever grain of salt you would take, just like a neighbor. It’s too bad if doctors are insulted by this.”
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See:-
Wall Street Journal – As Angry Patients Vent Online, Doctors Sue to Silence Them, September 14, 2005
September 16th, 2005 at 10:35 pm
Well this couldn’t happen in Europe because Data Protection law’s. Such sites could easly come foul as Data Protection law ban’s it.
To provie the point Trading Standers can not publish information on business they have had an issue with. Even that if could publish such info it would be of great use to the public.
September 17th, 2005 at 7:01 am
This keeping track is not new. For ages, doctors have had access to those most likely to sue for malpractice. I am not sure whether this database was maintained by the insurance companies or if it was a doctor setup type network.
Apparently the tables are now turned and many of the patients who did not recieve quality care and had no alternative to turn to when things went bad now have a place to voice and pass the word on. Just goes to show you, doctors aren’t the only ones that consider risks and just how important it can be when it comes to your health.
September 17th, 2005 at 9:08 pm
This doesn’t directly deal with the internet/file sharing and doctors, but it gave me the creeps.
Actually, it has something to do with the above article, in that it deals with “doctors” who believe they are above the law and everyone else — and that they can do as they damn well please.
The article deals with “entire face transplants” — Yeah, you heard me. Cutting off and peeling the ENTIRE FACE (ears too?!)…. kinda gross, the “medicine of the future” if you ask me.
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>http://apnews.excite.com/article/20050917/D8CM47U09.html
Doctor Pushes for First Face Transplant
Email this Story
Sep 17, 12:27 PM (ET)
By MARILYNN MARCHIONE
CLEVELAND (AP) – In the next few weeks, five men and seven women will secretly visit the Cleveland Clinic to interview for the chance to have a radical operation that’s never been tried anywhere in the world.
They will smile, raise their eyebrows, close their eyes, open their mouths. Dr. Maria Siemionow will study their cheekbones, lips and noses. She will ask what they hope to gain and what they most fear.
Then she will ask, “Are you afraid that you will look like another person?”
Because whoever she chooses will endure the ultimate identity crisis.
Siemionow wants to attempt a face transplant.
This is no extreme TV makeover. It is a medical frontier being explored by a doctor who wants the public to understand what she is trying to do.
It is this: to give people horribly disfigured by burns, accidents or other tragedies a chance at a new life. Today’s best treatments still leave many of them with freakish, scar-tissue masks that don’t look or move like natural skin.
These people already have lost the sense of identity that is linked to the face; the transplant is merely “taking a skin envelope” and slipping their identity inside, Siemionow contends.
Her supporters note her experience, careful planning, the team of experts assembled to help her, and the practice she has done on animals and dozens of cadavers to perfect the technique.
But her critics say the operation is way too risky for something that is not a matter of life or death, as organ transplants are. They paint the frighteningly surreal image of a worst-case scenario: a transplanted face being rejected and sloughing away, leaving the patient worse off than before.
Such qualms recently scuttled face transplant plans in France and England.
Ultimately, it comes to this: a hospital, doctor and patient willing to try it.
The first two are now in place. The third is expected to be shortly.
The “consent form” says that this surgery is so novel and its risks so unknown that doctors don’t think informed consent is even possible.
Here is what it tells potential patients:
Your face will be removed and replaced with one donated from a cadaver, matched for tissue type, age, sex and skin color. Surgery should last 8 to 10 hours; the hospital stay, 10 to 14 days.
Complications could include infections that turn your new face black and require a second transplant or reconstruction with skin grafts. Drugs to prevent rejection will be needed lifelong, and they raise the risk of kidney damage and cancer.
After the transplant you might feel remorse, disappointment, or grief or guilt toward the donor. The clinic will try to shield your identity, but the press likely will discover it.
The clinic will cover costs for the first patient; nothing about others has been decided.
Another form tells donor families that the person receiving the face will not resemble their dead loved one. The recipient should look similar to how he or she did before the injury because the new skin goes on existing bone and muscle, which give a face its shape.
All of the little things that make up facial expression – mannerisms like winking when telling a joke or blushing at a compliment – are hard-wired into the brain and personality, not embedded in the skin.
Some research suggests the end result would be a combination of the two appearances.
Surgeons will graft skin to cover the donor’s wound, but a closed casket or cremation will be required.
It took more than a year to win approval from the 13-member Institutional Review Board, the clinic’s gatekeeper of research. Siemionow assembled surgeons, psychiatrists, social workers, therapists, nurses and patient advocates, and worked with LifeBanc, the organ procurement agency she expects will help obtain a face.
At first, not everyone was on her side, acknowledged the board’s vice chairman, Dr. Alan Lichtin. After months of debate, Siemionow brought in photographs of potential patients.
Looking at the contorted images, Lichtin said he was struck by “the failure of the present state of the art to help these people.” He decided he didn’t want to deprive the surgeon or patients of the chance.
The board’s decision didn’t have to be unanimous.
In the end, it was.
Surgeons wished they could have done a transplant six years ago, when a 2-year-old boy attacked by a pit bull dog was brought to the University of Texas in Dallas where Dr. Karol Gutowski was training.
Other doctors had tried to reattach part of the boy’s mauled face but it didn’t take. The Texas surgeons did five skin grafts in a bloody, 28-hour surgery. Muscles from the boy’s thigh were moved to around his mouth. Part of his abdomen became the lower part of his face. Two forearm sections became lips and mouth.
“He’ll never be normal,” said Gutowski, now a reconstructive surgeon at the University of Wisconsin-Madison.
Surviving such wounds can be “life by 1,000 cuts.” Patients endure dozens of operations to graft skin inch by inch from their backs, arms, buttocks and legs. Only small amounts can be taken at a time because of bleeding.
Surgeons often return to the same areas every few weeks, reopening old wounds and building up skin. Years later, many patients are still having surgeries. A face transplant – applying a sheet of skin in one operation – could be a better solution.
Despite its shock factor, it involves routine microsurgery. One or two pairs of veins and arteries on either side of the face would be connected from the donor tissue to the recipient. About 20 nerve endings would be stitched together to try to restore sensation and movement. Tiny sutures would anchor the new tissue to the recipient’s scalp and neck, and areas around the eyes, nose and mouth.
“For 10 years now, it could have been done,” said Dr. John Barker, director of plastic surgery research at the University of Louisville, where the first hand transplant in the United States was performed in 1999.
Several years ago, these doctors announced their intent to do face transplants, but no hospital has yet agreed. They also are working with doctors in the Netherlands; nothing is imminent.
However, Siemionow had been doing experimental groundwork. She already had creatures that resembled raccoons in reverse – white rats with masks of dark fur – from years of face transplant experiments. She developed a plan and got clinic approval before going public, and insists she is not competing to do the first case.
“I hope nobody will be frivolous or do things just for fame. We are almost over-cautious,” she said.
Siemionow, 55, went to medical school in Poland, trained in Europe and the United States, and has done thousands of surgeries in nearly 30 years. The success of this one depends on picking the right patient.
She wants a clear-cut first case. No children because risks are too great. No cancer patients because anti-rejection drugs raise the risk of recurrence.
“You want to choose patients who are really disfigured, not someone who has a little scar,” yet with enough healthy skin for traditional grafts if the transplant fails, she said.
The person must bond with the transplant team, especially Siemionow. How much would she want to know about the person?
“Everything possible. It’s a commitment on both sides,” she said.
Dr. Joseph Locala will decide whether candidates are mentally fit. His chief concern: making sure they realize the risks.
“They almost need to understand as much as the surgeon,” he said.
A psychiatrist who has worked with transplant patients for 11 years, Locala knows they often have been coached on what to say to be chosen. He’d veto candidates who had abused alcohol or drugs, because they may not comply with medications.
Likewise someone who had attempted or seriously threatened suicide, or with little family or friends for support.
“I’m looking for a psychologically strong person. We want people who are going to make it through,” he explained.
Dr. James Zins, chairman of plastic surgery, expects to be among the 10 to 12 doctors involved in the transplant and has been screening patients.
“We get some pretty strange calls from people who are really not candidates,” he said. For someone to be chosen, “they’re going to have to get a pass from every member of the team.”
Matthew Teffeteller might seem an ideal candidate.
Hair is driving him crazy. What used to be a beard can’t grow through the skin-graft quilt that Vanderbilt University doctors stitched over parts of his face that were seared off in a car crash. Trapped under this crust, hair festers, leading to staph infections, pain and more surgeries.
“It’s a nightmare and it never ends,” he said. “Being burned is the worst thing that can happen to you. I’m about sure of it.”
Teffeteller, 26, lives south of Knoxville, in the foothills of Great Smoky Mountains National Park where he worked, ironically, as a fire fighter. The day after Valentine’s Day in 2002, he was taking his pregnant wife to buy a cowboy hat and go country line dancing to celebrate their first anniversary.
“The next thing I remember, everything just went all to pieces…there was a big explosion. I remember seeing gas splash off of the windshield,” he said.
Rear-ended by a truck, his car flipped and caught on fire. His wife died. He was burned trying to free her.
“They said my face was charcoal black,” he said.
He didn’t see it for two months, until he glimpsed a mirror on his way to therapy.
“Oh, my God,” he thought. “I remember seeing my eyes pulled open. I remember my ears were burned off, and I remember my bottom lip being pulled down.”
Three years later, his face still frightens children. Yet he wouldn’t try a transplant.
“Having somebody else’s face … that wouldn’t be right. When I look in the mirror, I might be scarred but I can still tell that it’s me,” he said.
“I’d be afraid something would go wrong, too. What would you do if you didn’t have a face? Could you live?”
Bioethicist Carson Strong at the University of Tennessee wonders, too.
“It would leave the patient with an extensive facial wound with potentially serious physical and psychological consequences,” he wrote last summer in the American Journal of Bioethics.
Such worries led the Royal College of Surgeons in England and the French National Ethics Advisory Committee to decide it shouldn’t be tried. Any doctor considering it should examine soul and conscience, Strong wrote.
Ironically, people most emotionally devastated by disfigurement are those most likely to seek a transplant and least able to cope with uncertain results, media attention and loss of privacy, ethicists from England wrote in the same journal.
One worried that a donor family might have unhealthy expectations of seeing a loved-one “live on” in another person’s body, or that recipients might want to see and approve a potential face.
No way, said Siemionow.
“It’s not a shopping mall. They need to rely on our judgment. If they are starting to shop, they are not good candidates,” she said.
Siemionow said critics should admit that risks and need for the transplant are debatable.
“Really, who has the right to decide about the patient’s quality of life?” she asked. “It’s very important not to kind of scare society…. We will do our best to help the patient.”
If all of the candidates back out, “that’s OK. It means that we are not ready yet,” she said.
But if a transplant succeeds, many people who live in misery could benefit, said Gutowski, the Wisconsin surgeon.
“Someone’s got to push the envelope,” he said. “In retrospect, we’ll know whether it should be done.”
September 18th, 2005 at 12:54 pm
Having conveyed the truth originally is always an absolute defense to charges of defamation, libel, or slander.
If one focuses on the facts and supports conclusions with facts and refrains from personal attacks, speculation, hyperbole or whimsical opinion, one should not fear posting such comments.
Also, under the Telecom Reform Act of 1996 (USA), the operators of a ‘communications service’ (website) can not be held responsible for what is communicated via their service (posted on their site.) However, they must take action when their attention is drawn to certain infractions supported by some degree of proof. A simple denial (That isn’t true!) is insufficient to absolutely demand a take down.
September 18th, 2005 at 7:01 pm
Scary how the doctors can use this to discriminate against you. One would correctly assume that this would have an effect when they treat you. Especially when they know you are “likely to litigate”, so they would consciously/unconsciously underperform… bad things are likely to happen.
September 19th, 2005 at 9:38 pm
We need a database like this for police officers, and others who have authority over us. It sure would be helpful in eleiminating bullies.
September 19th, 2005 at 9:40 pm
A FreeWan or a Peer to Peer type of list can be used or a report website can be located offshore. There is almost always a way to pass information.