This post is a guest column submitted by a local physician.
Have the hospitals and clinics and physician's offices started setting up screening of their employees before they start work each day? With a loosening of restrictions soon, this should be the first requirement. Most healthcare facilities are staffed (largely) with 22-50 yr old doctors, nurses, clerks and the like. As is well known now, most of this demographic acquire the virus, develop no symptoms, shed the virus, and get over it without symptoms. They are among the great pool of the "healthy" shedding the virus. Most of the patients are in another demographic. They are the vulnerable. This is especially true in orthopedics.
The first premise of medicine is to do no harm. It should be a requirement that the vulnerable should be protected from those shedding the virus (who don't have fever or cough). That is, healthcare workers (especially for "elective” procedures) need to protect their patients from acquiring the virus from them. This will require daily (morning) screening for the virus for all physicians, nurses, clerks, greeting and billing personnel with an approved (EUA) RT-PCR test.
The cost of these screenings is the “cost of doing business” (to provide a safe environment for patients) and should be borne by the providers.
There are already medical supply distributors seeking the attention of physicians to “screen” patients with unapproved tests and allowing the physician to charge a large fee (to generate revenue) from the patients as a condition of being seen. This is deadly wrong and unethical.
The best screening test for fitness for our healthcare workers (including physicians) remains the RT-PCR test. Not all such tests are of equal quality. There are “rapid” tests (answer in less than an hour, to be performed before patients arrive). Some of these platforms (Abbott and Cepheid) have a small footprint and quick turn-around-time). There have been scientific issues with the Abbott ID Now instrument but they are being addressed.
One issue with all of the swab RT-PCR instruments is that they detect only 80-90% of positive cases. This means that some staff may slip through and test “negative” even though they are shedding the virus. This doesn’t reflect the quality of the instrument. It is sampling error.
What this means is that “look back” and contact tracing will need to be performed on all those patients seen by Nurse X or Dr. Y when, suddenly, they test “positive” one morning. Reasonably they could have been positive the day before and those patients seen must be contacted and informed that they may have contacted the virus from their healthcare provider.
When these screens are implemented, it will be great comfort to the patients (and to the staff) to have a reasonable assurance that this is a “safe” place to work and to treat patients.
When will the Governor, the Medical Board, and the state health officer require these tests as a condition of operation?
Sunday, April 26, 2020
MD Guest Column: Protect Patients Now
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Trollfest '09
Trollfest '07 was such a success that Jackson Jambalaya will once again host Trollfest '09. Catch this great event which will leave NE Jackson & Fondren in flames. Othor Cain and his band, The Black Power Structure headline the night while Sonjay Poontang returns for an encore performance. Former Frank Melton bodyguard Marcus Wright makes his premier appearance at Trollfest singing "I'm a Sweet Transvestite" from "The Rocky Horror Picture Show." Kamikaze will sing his new hit, “How I sold out to da Man.” Robbie Bell again performs: “Mamas, don't let your babies grow up to be Bells” and “Any friend of Ed Peters is a friend of mine”. After the show, Ms. Bell will autograph copies of her mug shot photos. In a salute to “Dancing with the Stars”, Ms. Bell and Hinds County District Attorney Robert Smith will dance the Wango Tango.
Wrestling returns, except this time it will be a Battle Royal with Othor Cain, Ben Allen, Kim Wade, Haley Fisackerly, Alan Lange, and “Big Cat” Donna Ladd all in the ring at the same time. The Battle Royal will be in a steel cage, no time limit, no referee, and the losers must leave town. Marshand Crisler will be the honorary referee (as it gives him a title without actually having to do anything).
Meet KIM Waaaaaade at the Entergy Tent. For five pesos, Kim will sell you a chance to win a deed to a crack house on Ridgeway Street stuffed in the Howard Industries pinata. Don't worry if the pinata is beaten to shreds, as Mr. Wade has Jose, Emmanuel, and Carlos, all illegal immigrants, available as replacements for the it. Upon leaving the Entergy tent, fig leaves will be available in case Entergy literally takes everything you have as part of its Trollfest ticket price adjustment charge.
Donna Ladd of The Jackson Free Press will give several classes on learning how to write. Smearing, writing without factchecking, and reporting only one side of a story will be covered. A donation to pay their taxes will be accepted and she will be signing copies of their former federal tax liens. Ms. Ladd will give a dramatic reading of her two award-winning essays (They received The Jackson Free Press "Best Of" awards.) "Why everything is always about me" and "Why I cover murders better than anyone else in Jackson".
In the spirit of helping those who are less fortunate, Trollfest '09 adopts a cause for which a portion of the proceeds and donations will be donated: Keeping Frank Melton in his home. The “Keep Frank Melton From Being Homeless” booth will sell chances for five dollars to pin the tail on the jackass. John Reeves has graciously volunteered to be the jackass for this honorable excursion into saving Frank's ass. What's an ass between two friends after all? If Mr. Reeves is unable to um, perform, Speaker Billy McCoy has also volunteered as when the word “jackass” was mentioned he immediately ran as fast as he could to sign up.
In order to help clean up the legal profession, Adam Kilgore of the Mississippi Bar will be giving away free, round-trip plane tickets to the North Pole where they keep their bar complaint forms (which are NOT available online). If you don't want to go to the North Pole, you can enjoy Brant Brantley's (of the Mississippi Commission on Judicial Performance) free guided tours of the quicksand field over by High Street where all complaints against judges disappear. If for some reason you are unable to control yourself, never fear; Judge Houston Patton will operate his jail where no lawyers are needed or allowed as you just sit there for minutes... hours.... months...years until he decides he is tired of you sitting in his jail. Do not think Judge Patton is a bad judge however as he plans to serve free Mad Dog 20/20 to all inmates.
Trollfest '09 is a pet-friendly event as well. Feel free to bring your dog with you and do not worry if your pet gets hungry, as employees of the Jackson Zoo will be on hand to provide some of their animals as food when it gets to be feeding time for your little loved one.
Relax at the Fox News Tent. Since there are only three blonde reporters in Jackson (being blonde is a requirement for working at Fox News), Megan and Kathryn from WAPT and Wendy from WLBT will be on loan to Fox. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both and a torn-up Obama yard sign will entitle you to free drinks served by Megan, Wendy, and Kathryn. Get your tickets now. Since this is an event for trolls, no ID is required. Just bring the hate. Bring the family, Trollfest '09 is for EVERYONE!!!
This is definitely a Beaver production.
Note: Security provided by INS.
Wrestling returns, except this time it will be a Battle Royal with Othor Cain, Ben Allen, Kim Wade, Haley Fisackerly, Alan Lange, and “Big Cat” Donna Ladd all in the ring at the same time. The Battle Royal will be in a steel cage, no time limit, no referee, and the losers must leave town. Marshand Crisler will be the honorary referee (as it gives him a title without actually having to do anything).
Meet KIM Waaaaaade at the Entergy Tent. For five pesos, Kim will sell you a chance to win a deed to a crack house on Ridgeway Street stuffed in the Howard Industries pinata. Don't worry if the pinata is beaten to shreds, as Mr. Wade has Jose, Emmanuel, and Carlos, all illegal immigrants, available as replacements for the it. Upon leaving the Entergy tent, fig leaves will be available in case Entergy literally takes everything you have as part of its Trollfest ticket price adjustment charge.
Donna Ladd of The Jackson Free Press will give several classes on learning how to write. Smearing, writing without factchecking, and reporting only one side of a story will be covered. A donation to pay their taxes will be accepted and she will be signing copies of their former federal tax liens. Ms. Ladd will give a dramatic reading of her two award-winning essays (They received The Jackson Free Press "Best Of" awards.) "Why everything is always about me" and "Why I cover murders better than anyone else in Jackson".
In the spirit of helping those who are less fortunate, Trollfest '09 adopts a cause for which a portion of the proceeds and donations will be donated: Keeping Frank Melton in his home. The “Keep Frank Melton From Being Homeless” booth will sell chances for five dollars to pin the tail on the jackass. John Reeves has graciously volunteered to be the jackass for this honorable excursion into saving Frank's ass. What's an ass between two friends after all? If Mr. Reeves is unable to um, perform, Speaker Billy McCoy has also volunteered as when the word “jackass” was mentioned he immediately ran as fast as he could to sign up.
In order to help clean up the legal profession, Adam Kilgore of the Mississippi Bar will be giving away free, round-trip plane tickets to the North Pole where they keep their bar complaint forms (which are NOT available online). If you don't want to go to the North Pole, you can enjoy Brant Brantley's (of the Mississippi Commission on Judicial Performance) free guided tours of the quicksand field over by High Street where all complaints against judges disappear. If for some reason you are unable to control yourself, never fear; Judge Houston Patton will operate his jail where no lawyers are needed or allowed as you just sit there for minutes... hours.... months...years until he decides he is tired of you sitting in his jail. Do not think Judge Patton is a bad judge however as he plans to serve free Mad Dog 20/20 to all inmates.
Trollfest '09 is a pet-friendly event as well. Feel free to bring your dog with you and do not worry if your pet gets hungry, as employees of the Jackson Zoo will be on hand to provide some of their animals as food when it gets to be feeding time for your little loved one.
Relax at the Fox News Tent. Since there are only three blonde reporters in Jackson (being blonde is a requirement for working at Fox News), Megan and Kathryn from WAPT and Wendy from WLBT will be on loan to Fox. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both and a torn-up Obama yard sign will entitle you to free drinks served by Megan, Wendy, and Kathryn. Get your tickets now. Since this is an event for trolls, no ID is required. Just bring the hate. Bring the family, Trollfest '09 is for EVERYONE!!!
This is definitely a Beaver production.
Note: Security provided by INS.
Trollfest '07
Jackson Jambalaya is the home of Trollfest '07. Catch this great event which promises to leave NE Jackson & Fondren in flames. Sonjay Poontang and his band headline the night with a special steel cage, no time limit "loser must leave town" bout between Alan Lange and "Big Cat"Donna Ladd following afterwards. Kamikaze will perform his new song F*** Bush, he's still a _____. Did I mention there was no referee? Dr. Heddy Matthias and Lori Gregory will face off in the undercard dueling with dangling participles and other um, devices. Robbie Bell will perform Her two latest songs: My Best Friends are in the Media and Mama's, Don't Let Your Babies Grow up to be George Bell. Sid Salter of The Clarion-Ledger will host "Pin the Tail on the Trial Lawyer", sponsored by State Farm.
There will be a hugging booth where in exchange for your young son, Frank Melton will give you a loooong hug. Trollfest will have a dunking booth where Muhammed the terrorist will curse you to Allah as you try to hit a target that will drop him into a vat of pig grease. However, in the true spirit of Separate But Equal, Don Imus and someone from NE Jackson will also sit in the dunking booth for an equal amount of time. Tom Head will give a reading for two hours on why he can't figure out who the hell he is. Cliff Cargill will give lessons with his .80 caliber desert eagle, using Frank Melton photos as targets. Tackleberry will be on hand for an autograph session. KIM Waaaaaade will be passing out free titles and deeds to crackhouses formerly owned by The Wood Street Players.
If you get tired come relax at the Fox News Tent. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both will entitle you to free drinks.Get your tickets now. Since this is an event for trolls, no ID is required, just bring the hate. Bring the family, Trollfest '07 is for EVERYONE!!!
This is definitely a Beaver production.
Note: Security provided by INS.
There will be a hugging booth where in exchange for your young son, Frank Melton will give you a loooong hug. Trollfest will have a dunking booth where Muhammed the terrorist will curse you to Allah as you try to hit a target that will drop him into a vat of pig grease. However, in the true spirit of Separate But Equal, Don Imus and someone from NE Jackson will also sit in the dunking booth for an equal amount of time. Tom Head will give a reading for two hours on why he can't figure out who the hell he is. Cliff Cargill will give lessons with his .80 caliber desert eagle, using Frank Melton photos as targets. Tackleberry will be on hand for an autograph session. KIM Waaaaaade will be passing out free titles and deeds to crackhouses formerly owned by The Wood Street Players.
If you get tired come relax at the Fox News Tent. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both will entitle you to free drinks.Get your tickets now. Since this is an event for trolls, no ID is required, just bring the hate. Bring the family, Trollfest '07 is for EVERYONE!!!
This is definitely a Beaver production.
Note: Security provided by INS.
39 comments:
Hope so.
I hope this happens quickly. I had a Cologuard test come back abnormal the Friday after nonemergency procedures were stopped. Now I’ve finally got a colonoscopy scheduled on the 18th to see what’s up. I’ve got autoimmune disease and high blood pressure so I’m at a high risk of COVID complications. It’s a bad position to be in knowing I need to make sure I don’t have cancer, but also knowing COVID has a likely 10% chance of proving fatal. Regular testing would help prevent unnecessary infection of patients like me who are very vulnerable.
Yes yes yes! I have been saying this all along because I know several physicians who traveled to NOLA during spring break. They returned and were seeing patients. I wonder how many patients they infected and the patients never knew where they got it.
Most physicians/facilities I work with are already planning, developing protocols and taking appropriate steps to ensure all possible compliance with CDC guidance and best practices are followed to ensure safety in the workplace and for patients.
Well reasoned and convincing. The Governor and Dr. Dobbs have got to be made aware, if they have not already.
Physicians are often cavalier about their own health, but now is the time for tripled vigilance.
"Should be borne by the providers".. pass the cost on to health insurance companies... health insurance companies, pass that expense off on to the consumer.
We're losing our jobs, those of us who still have our jobs are going to foot this bill for this massive bailout, but hey let's just require upgrades to the health care system despite all the advances we've made over the years.
@2:26 pm Actually has less than a 1% chance of proving fatal, but yes, you are a higher risk.
@2:52 Especially the physicians who don't wash their hands all day and/or never change their gloves in between patients.
false sense of security. treat every patient/employee as if they were infected, period
this testing phenomena is political in nature, not science
... but what about the thousands of contagions that cause fever that AREN’T COVID-19 and AREN’T deadly? People can run fever from stress alone!! Plus, not everybody’s normal body temp is “normal.” How will they account for all of this?
@2:26p- I mean this with all sincerity... who should pay for these constant tests required by your conditions?
Before you think I’m being rude, I have MANY family members with multiple preexisting conditions. With that being said, 95% of their preexisting conditions were caused by lifestyle choices... things they could have prevented. I know none of us are perfect and hindsight is 20/20, but should the country remain locked down because huge sectors lived carelessly for decades? This is a sincere question. We as Americans really need to look at what we’ve done to ourselves...
Comments from another "expert". They're everywhere these days. There are the experts on COVID-19 and what should or should not be done. Then there are those experts on what the government is doing - too little, no too much; too soon, no too late. Then there is group of experts who tell us to reopen for business NOW versus those that tell us to keep hunkering down at home. It seems everyone is an expert.
Hey local physician, by all means save our Grandparents (and we will do our part too ) . . . but if you have any influence whatsoever . . . please help stop these damn redundant commercials every five minutes.
From pizza and car dealers down to cell phones, insurance and candy.
It's the same shit . . . slow piano notes . . . a deep solemn voice that says "in these uncertain times, we're with you. Stay safe and buy our product".
Gawd I love capitalism, but for the sake of humanity, convince the Ad Agencies to return to the old marketing plans.
3:25 - if you want to just bitch, why go to so many words?
To answer your question, good medical providers have dealt with those issues you 'ask' about in normal times as a matter of practice.
What the Doc is saying here is - in addition to the normal practices in your office, you should follow extra protocols due to the COVID.
Despite all the JJ experts that seem to know (but are generally always wrong) about COVID and think that these extra precautions are unnecessary, any doctor I have need to see in the coming months will be following this or similar protocols.
I believe, to answer the question raised by the Doc in his closing sentences - these protocols (or something similar) have been spelled out by the CDC, and thus they would apply to MS providers already.
Good column, though. Thanks to the Doc that provided it to you, KF
@4:17p- I wasn’t bitching, but rather asking a real question. You do realize that people run varying degrees of fever all day, every day... right? Are we going to be paralyzed by fevers for the rest of our lives?
It seems more logical that resources be put into treatments NOT screenings. If COVID-19 becomes recognized as treatable, all this non-sense vanishes. This virus, like flu and other contagions, will always spread and kill... we will never change that fact.
Hoops will be jumped through all for naught. All will be exposed and no need to make the medical staff do any of this, on the way to the Dr's Office and most other times, the patients are full time exposed. Skip the theatrics, life needs to go on, people will die on schedule from all kinds of stuff.
An anonymous MD guest opinion article. Just when you think you’ve seen it all.
Who is this anonymous guest MD? Seems to have some sort of agenda against ortho, points out no other specialty like plastics, urology, dermatology, GI, etc. Maybe it’s written somewhere but I can’t find it.
6:44 Agreed.. but most of all dentists hovering over your face and mouth, hands in mouth, for prolonged periods. Sorry dentists.
"This will require daily (morning) screening for the virus for all physicians, nurses, clerks, greeting and billing personnel with an approved (EUA) RT-PCR test."
The hospital I work at screens the temperature of every single person who enters the hospital every day - no exceptions.
@8:38 You miss the point entirely. Most people (especially young healthcare workers) develop no symptoms. So testing for fever isn't testing. The only way to be successful (and screen healthcare workers) is to screen with the RT-PCR test. Every day. Because the test is good for precisely that day.
https://www.nytimes.com/2020/04/26/opinion/coronavirus-test-asymptomatic.html
@4:17 There are no treatments. Zero. So you must make sure that healthcare personnel are not asymptomatic virus shedders and killing patients. We need to reverse engineer this as the post suggests. Instead of screening patients, we need to screen the medical community (frequently young and healthy) so that they don't give it to patients. they young and health(by and large) aren't the ones at risk of dying from the virus. It is grandpa going in for his colonoscopy.
My wife is taking monthly chemo treatments. Before you enter the building they take your temp and give you a mask. Waiting room is spaced out. I don’t know what the Drs and staff are doing. Hopefully checking themselves daily as chemo patients have very low immunity.
With half the infected individuals never having symptoms and those that do don’t start showing symptoms until two or three days after being contagious a temperature check by itself is just about useless.
I’m a RN in an ortho surgery center. It’s obviously a scary time for everyone, but we are taking every precaution and providing the best care as safely as possible. Why call out ortho anonymously?
@9:43p- Wake up!! There ARE treatments being administered and they are WORKING for many. Do NOT trust the person or source that fed you that garbage... they are LYING to you!! Educate yourself!
My normal temp is 96.6, has been for as long as I can remember and I am 79, in good health, no underlying problems and I go to work every day. 3 person law office but we are careful with who we see and keeping the office cleaned twice a day. I hope that everyone gets through this pandemic. I see enough of my lifelong friends dying from natural causes much less covid.
Y'all have a great week!
Sigh....another "advocate" physician that doesn't understand limited budgets and resources, but feels the need to promote his position no matter how ridiculous it is. (They learned to do it anonymously so as not to get fired like the last princess.)
The days of doctors thinking they are gods "ordering" this or that is rapidly coming to an end. Healthcare (emergency or not) is a business.....and there will be no healthcare without money. What in the hell are the teaching students at UMMC? That Mississippi is made of money? Hahahahahahahahahaha!
3:12 pm
2:26 pm's risk percentage falls within the grouping of " all CV 19 patients with auto-immune disease", not all patients.
Please don't weigh in on subjects you don't understand, two of which are auto-immune diseases and statistics.
Congratulations to Sweden on achieving herd immunity to Covid 19! They may go back to their daily lives now. Wait, they never left it. I wonder if they threw the millions of bodies into the sea. Where did they hide the bodies?
The need to target a specific type of practice undermines this column and brings the author's (conveniently anonymous) motives equally into question.
Or he could be speaking about a specialty where the vast majority of patients are in the high-risk group.
The author comments: I appreciate all the thoughtful comments and opinions rendered. I have one objective and no others. Physicians' first duty is primum non nocere. "First do no harm." I fear that the rush to return to elective procedures will put patients in danger (for business purposes) and could lead to death by doctor's visit.
I agree that the choice of orthopedic surgeon looks like I am singling them out. That is a reflection of my poor writing and not orthopedists. Orthopedic surgery is a great profession and they do wonderful healing work. I could just as easily have said rheumatologists or Moh's surgeons or a host of other specialties. These are groups that have a disproportionate clientele of "at risk" (over 65) patients and the patient interactions are often prolonged. As such, these patients in particular need protection from their physicians who could inadvertently give them the virus and have the patient dies as a result.
What I am urging is careful protection for patients and from their physicians. Temperature checks before work are totally insufficient. The vast majority of people carrying (and exhaling) the virus have no symptoms including fever. So if you just check a healthcare worker's temperature you are allowing 70% of the rest of the infected into work.
There is a great rush to open physician offices for elective procedures. Testing patients is not the way to protect them. They need to be protected from physicians and their staffs. Neither the governor nor the state health officer nor the medical board nor the medical association have established evidence based methods to protect patients from physicians and their staffs. The proposal I laid out would do just that: Screen physicians and staff each day with an EUA (that means FDA) test for the virus. Wear N95 masks. The objection is cost. The rapid testing machines (e.g., Abbott and Cepheid) have a cost of testing at about $10. Is that too much to ask to protect patients? Would you not rather take your Uncle Charles to a gastroenterology clinic and have that clinic announce, "We know our patients are at risk. We are doing all we can to prevent the spread of the virus to our patients. We screen out staff daily for the virus."
As it stands, there are no standards. None. And I urge you to join me in seeking to have physicians live by the notion of "first do no harm."
"The only way to be successful (and screen healthcare workers) is to screen with the RT-PCR test. Every day. Because the test is good for precisely that day."
Please give us 1) a cost estimate and 2) a payment plan.
We'll wait.
@10:47 Yes, I did give the cost figure above. So if you have a clinic with 30 employees including physicians, that cost would be about $300/day. You can pay for it any method you wish. The benefit is that you won't kill patients.
7:49AM wrote: "Congratulations to Sweden on achieving herd immunity to Covid 19! They may go back to their daily lives now. Wait, they never left it. I wonder if they threw the millions of bodies into the sea. Where did they hide the bodies?"
You might want to research the latest data on Sweden before you start congratulating it. First, it is not remotely close to "herd immunity." But more telling and worrisome is that its rate of infection and deaths are rising fairly rapidly and are now something like 12% deaths per case/22 deaths per 100K, up from around 18 per 100K a few days ago (the US is currently around 5.7%/16 per 100K, Italy is around 14%/40 per 100K).
Am I the only one to say that Doctors mistakes and prescribed drugs will kill more than this virus?
@Handy, you are exactly right!!
My ONLY fear regarding this virus hype is my mother being hospitalized. She will not come out alive if she gets sick enough (for any reason) to be hospitalized. This is based on my previous experiences with her in hospitals.
After numerous stays and a multitude of errors by nurses and doctors, I truly fear them. It’s insane that families are being kept out of hospitals. On numerous occasions, my mother would have been given the wrong drugs or too many of her meds if I hadn’t HOVERED the entire time she was hospitalized. My beef is not their errors (they are human, not super natural) so much as their attempts to hide their errors and behave arrogantly about being wrong. Many medical professionals are desensitized.... it’s a true hazard of the job.
After reading this blog I wondered how my doctor could afford to do testing of her staff and her each day. As in who would pay for it? Then I found out that doctors are being paid billions now (through United Health Care) for doing nothing or for their COVID-19 expenses. The AMA describes it here:
https://www.ama-assn.org/delivering-care/public-health/fact-sheet-provider-relief-fund-second-general-distribution
Now there is no excuse for them to not protect patients from COVID by testing themselves and their staff. Hooray!
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