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Ebola worrying and medical incompetence

2014-10-10

We just thought you’d like to know: a Pew Research Center study reported that 32 percent of people were at least somewhat worried about catching the Ebola virus.  Gallup, on the other hand, indicated that 22 percent of people had worried about personally getting Ebola in the past day.  Fourteen percent said it was at least “somewhat likely” that they would personally catch Ebola, and eighteen percent said that they thought there would be a major outbreak in the United States.

Fortunately, there is no political difference in the rate of Ebola worrying: 33 percent of Republicans and 30 percent of Democrats were at least “somewhat” worried about catching Ebola.

Now that the first “American” Ebola patient has died (despite the best in American health care…) there is at least some cause for worry.  At least, American doctors will think of Ebola when they see someone from Liberia complaining of a fever; the first time our “American” patient went to the emergency room with symptoms of Ebola, he was sent home.  It seems that the nurse who took down the information that he had just flown from Liberia in the last week, failed to impress that fact upon the doctor who was doing the man’s examination.  Or was the doctor too …… to think of Ebola when he saw a black man with a foreign accent complaining of a fever… or too poorly trained to take a travel or social history for himself instead of relying on a nurse to take the history, and then ignoring the information the nurse provided?

The fact that he was sent home, and was on the loose with active Ebola for two or three days, probably didn’t do any good for his prognosis, and certainly vastly increased the number of people who had to be quarantined as contactees.  Who ever was responsible for letting him leave the hospital when he first presented with a fever should face some consequences, like a remedial course in history-taking and an evaluation of that professional’s overall competence.

This reminds me of the time I saw a young woman with an ear infection.  She complained of pain and loss of hearing in her right ear.  I looked in her ear and found a mass of wax completely blocking the ear canal, as well as redness and swelling of the part of the canal I could see.

She stated that she had gone to the “Urgent Care” department a couple of days before, and the doctor she saw told her to put hydrogen peroxide drops in her ear and use Q-tips (trademark) to remove the wax.

As anyone who’s had more than one ear full of wax knows, you can’t get the wax out with a Q-tip.  It just pushes the wax further in.  What’s more, hydrogen peroxide is very irritating to the skin and the skin of the ear canal is especially sensitive.  As a general practicioner, I had been presented with ear wax blockage hundreds of times; the standard procedure everywhere I worked (and that was a lot of offices) was to wash the ear out with warm water and a syringe.

I treated the woman’s infection with some Cortisporin (trademark) ear drops, not an ideal medicine, but sure to be effective at relieving the inflammation.  I told her to come back in a couple of days so we could wash out the wax (there are syringes specially designed for this purpose and most doctor’s offices have them.)  I also told her she could get carbamide peroxide ear drops over the counter to break up the wax and make it easier to wash out.  There is also a special rubber bulb syringe made for patient use that has a block preventing the syringe tip from being inserted too far into the ear canal.

I then went and complained to the supervisor of the doctor who had told her to use hydrogen peroxide; I said that this person (a man) was incompetent and that every doctor who knows anything about outpatient routine medical care knows not to put hydrogen peroxide into someone’s ear.  What’s more, I pointed out to the supervisor that it says on every package of Q-tips not to stick them into one’s ear.

The supervisor defended this person, saying that while he may not know about cleaning out ears, he probably was real good on important emergencies like cardiac arrest.  I snorted and said that was unlikely.  What struck me as absurd was that this supervisor didn’t seem to think that it was the least bit important to tell this person how to clean out ears, nor that it was indicative of his general competence that he didn’t already know this.  The supervisor apparently thought that ear wax blockage was beneath his dignity to treat as an “Urgent Care” physician.  Never mind the fact that ninety-nine percent of all patients presenting to the “Urgent Care” center don’t have “urgent” or even significant problems–but nonetheless require appropriate treatment and guidance in order to cure the problem rather than making it worse.

I left that giant medical complex in  Los Angeles shortly thereafter, looking for someplace else to go.  I never found it, and eventually gave up.

Given the average level of intelligence among doctors in this country, there could indeed be a widespread epidemic.  Fortunately, Ebola isn’t contagious, merely infectious: this means that you have to have close physical contact with a patient and especially the patient’s vomitus or stools (or the skin of a deceased patient) in order to catch the disease.  So a widespread epidemic in this country is unlikely because we don’t touch each other nearly as much as they do in West Africa.  There isn’t the crowded housing here that they have in the slums of Monrovia.  People who are sick are usually quickly isolated; they are not sent home due to lack of beds, to infect more people as they suffer and die at home.

So, even with semicompetence reigning, Ebola probably won’t get us all.  However, there is an airborne contagious virus that is similar…

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