WHO issues a surgical checklist.

A lot has been written about surgical errors during operation including incidents of left behind surgical instruments, wrong site surgery, operating on wrong patients and so on.

The WHO has issued a checklist which it hopes will go a long way in reducing such errors by enforcing a ‘time out’ when all personnel participating in a procedure will check and mark on the checklist ensuring compliance of necessary formalities. Such checks are further made at the end of procedure.

I agree that such checklists and timeouts will be quite helpful in reducing the number of errors but surgeons are resourceful and dogged of determination; they will find a way around this.

As an aside if you have read books by Atul Gawande you will be aware of his fascination for idea of checklist similar to those used by the Aviation industry(very effective) to reduce medical errors. His Harvard group and folks at IHI and The International Society for Quality in Health Care have been quite active at getting this off the ground.

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Second opinion at a distance

There is an interesting piece of new in todays USA today about taking second opinion for health conditions online from experts. You send your medical records with or without your primary doctor’s help via internet to Experts( places providing paid service) and get their opinion after a week or so.

Online second-opinion services offer patients consultations from specialists based on the medical records that they fax, mail or send via the Internet. The average cost, payable upfront via credit card, is $500 to $1,500, depending on the number of radiology or pathology interpretations required. Patients then receive online access to a second opinion in about two weeks.

What I find very interesting is the amount of changes in treatment or diagnosis as per this article.

More choices, ‘more peace of mind’

Not all remote second-opinion services require that a patient’s local physician participate. The Cleveland Clinic, for example, delivers consultations directly to a patient, while POSC shares them with the physician first and then with the patient.

In Harlow’s case, her physician “welcomed” the idea of a second opinion. Harlow says she opted for the whole-breast radiation treatment, based on the report from Lawrence Schulman, a leading oncologist at Dana-Farber Cancer Institute,

“In about 5% of the cases, we actually change the diagnosis of the patient. In 85% to 90% of the cases, we alter the treatment,” says Jonathan Shaffer, managing director of e-Cleveland Clinic. “What we are able to do is give the patient more treatment options and hopefully give the patient more peace of mind,” he says.

Shaffer says people are beginning to realize the convenience of e-health technologies. “It continues to grow every year.”

Considering the rapid progress in internet technology and telemedicine these are bound to increase. Radiology is quite in the forefront. But is it viable in the long run?

Quite a majority of cases are such where the diagnosis and the treatment is not in doubt and the physician is quite comfortable in following through the treatment. It may happen that the patient remains unsatisfied and may want a second opinion or alternative treatment. And why not? after all it is his money and body. He might remain dissatisfied with the second opinion as well.

Physicians have been taking second opinion unofficially and consultations officially whenever they are unsure about management of a particular disease or presentation; but will they follow up on perceived unsolicited advise?

Do not expect the primary physician to follow and carry out the advice given by the Case manager /Second opinion provider unless he himself (or herself) co-initiated the consult. It is quite apparent that the second opinion will also be a medical consultation with its attendant liability and responsibility unless waived off by the patient( and then that has its own consequences).

The need for second opinion arises more in evolving fields like Oncology or where there are multiple treatment options under evaluation. For example- If the patient remained unconvinced by the doctor providing second opinion then what? back to square one..Patients need to have faith in their doctors and the doctors need to have knowledge to get that trust.

Whatever shape it takes in future; there is money to be made and does fill in a perceived need so will catch on.

Read the complete article from USA Today.

Pic from http://www.flickr.com/photos/luca_eos/

Reversible Vasectomy

At present Vasectomy is the only reliable method of male contraception. While it is relatively simple procedure and quite cheap besides the fact that the government pays you to get it done, yet it is not that popular. 

The reasons for that is the irreversibility of the procedure and the perception of loss of ‘manhood’. Male desiring further children have to undergo recanalization which are not always successful and is expensive ( vas may block again, antibodies to sperm may develop etc.). So any reliable alternat e  method  is bound to be popular and in the  news. from rediff.com

Once upon a time, a scientist, rather an engineer-cum-doctor, toyed with an idea — what if there were a male contraceptive? What if a simple injection to a male prevented unwanted pregnancy?

His ever-active brain started thinking and years of research followed. And after 30 long years, RISUG (Reversible Inhibition of Sperm under Guidance) was born.

The credit goes to Indian biomedical engineer Dr Sujoy K Guha and his group at the Indian Institute of Technology-Kharagpur,

In this situation a method of reversible blockage or sperm inhibition would be a wonderful thing; increasing the usefulness and acceptance of male contraception. This is where the method of RISUG comes in. Though still in advanced trial stages it is quite promising. It consists of partial blockage of the vas deferens lumen(the conduit passing sperm from the testes to the ejaculate) using polyelectrolytic compound and can be effective upto 8-9 years. The block can be reversed when desired by flushing using solvent or local stimulation.

The method is pioneered by Dr. Guha at IIT Kgp. In case you need to know more you can visit the Risug site or

Reversible inhibition of sperm under guidance – Wikipedia, the free encyclopedia.

(Pic from iitkgp )

I was reading

I just finished Grisham’s latest novel The Appeal. His latest book is much better than his last few offerings which I found a bit dull. The story reolves around desperate measures to influence the legal procedure, tort reforms and a mega corp willing to bend any rule for profit.

Set in the state of Mississippi,U.S. having a supposedly tort friendly judiciary a mega corp is accused and convicted of dumping carcinogenic waste into the environment. In order to overturn the verdict and avoid paying the huge compensation awarded the billionaire owner plots to influence the appeal process and the judges involved (I wont go into the details of the plot as you may want to read the book). The novel has interesting side forays into difficulties of being trial lawyers, false & misleading advertising campaigns, medical malpractice and injuries from aluminium baseball bats. Do we have cricket bats made of aluminium or are they banned by ICC?
Just as I finished reading this book I came across this piece of news

The family of a boy who suffered brain damage after he was struck by a line drive off an aluminum baseball bat sued the bat’s maker and others on Monday, saying they should have known it was dangerous.

coincidence or author’s inspiration?

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