From a reader who wishes to remain anonymous: My work at an ophthalmologist’s office in an assistant capacity has provided anecdotal illustrations of many of the points Robin has made about medicine. One particular instance of the notion that medicine is more about showing you care than health follows:
Yes,probably due to stupidity rather than selfishness. That can always be interchanged in these scenarios. Yet looking good compelled the doctor to clean the stuff that didn't matter. Perhaps that is the point.
There may be something to this:
After examining 638 in-use containers, Hovding et al. recovered bacteria from 82 bottles (12.9%) when the solution was dripped from the bottles. They also found clinically and microbiologically significant growth in 12 cases (1.9%). In other studies, serratia keratitis has been transmitted by contaminated eye-droppers, and contaminated eye drops have caused Pseudomonas aeruginosa corneoscleritis. Additional studies have confirmed that in-use container contamination occurs and that serious eye infections can be transmitted from such containers. These studies also refute the belief that doctors, nurses, and patients will always apply eye drops properly, without causing contamination by touching the containers.
At my eye doctor, they wipe the top of the bottle with an alcohol swab Wouldn't this make an infection from the bottle very unlikely ?
This post would be a lot more interesting were it talking about actual eye infections rather than the untestable potential to cause eye infections by the untested exposure from touching eyelashes. If fact based medicine says (and it does) the doctor should wash his hands where I can see her do it, so be it. If fact based medicine is not implicating ophthalmologist's eye droppers in eye infections, then hit me again.
This is why I liked Kaiser so much. They spent a lot of effort showing me they care by speeding me through visits and telling me that "we could run a test, but we aren't likely to find anything".
I don't know about other people, but I feel better with a doctor who isn't hyperventilating about my health.
Dave, I don't know about eye-infections but large numbers of people do die on the operating table. The RAND health experiment showed no difference in mortality, which could indicate medical harms were about as common as medical healing. And Robin's mention about the sincere desire to help does not sound like he's arguing about corrupt people who know better conspiring for selfish reasons.
Here's a post at orgtheory on mortality that also involves the signalling model of education:http://orgtheory.wordpress....
Humans having a tendency to miss glaring risks is universal, what is this supposed to be evidence of in this case again? I think people are pretty aware of the massively lengthened lifespans in the last century this hardly seems more than a wakeup notice, as we all experience frequently in our respective fields and endeavors.
Besides, placebos and other psychological treatments can and do offer medical value, I don't see evidence that a common error in application of eyedrops is more important a matter than reassuring patients who could be adversely affected by fear. (Making important tasks routine carries its own risks too, I'm not claiming that I have evidence the placebo value of demonstrated cleanliness is high, I'm just saying the counterclaim doesn't seem complete either.)
I think this is miscategorized; it's a story about misestimating probabilities for unfamiliar situations, rather than caring per se.
This point of view comes from the ever so popular school of thought that goes this way: All the day to day things we encounter that are conventional and claim to be authoritative, and good and are controlled by people who have power, are in reality corrupt and harmful ,and this is known to the authorities, who conspire to keep these evils in effect for their own selfish reasons.
The problem with this theory is, other than in the news media, where are the bodies? In this instance, where are the patients streaming back to the doctor with eye infections?
This is not to say that the procedure the doctor uses is great. If the procedure he is using, is out of date the he just didn’t learn it during his training. His professional association will eventually recommend some changes, which due to human laziness he may not follow. Perhaps government intervention ,or a lawsuit will occur. Or perhaps a drug rep will visit him and convince him to use a new improved,but expensive product. The problem is more cultural than any thing else.