And if you missed it, here's Alice's experience, in her own words:https://t.co/D7qbOctgjd
— Jake Tapper (@jaketapper) December 16, 2022
१६ डिसेंबर, २०२२
Jake Tapper's "14-year-old daughter, Alice, almost died as a result of a misdiagnosis."
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५५ टिप्पण्या:
maybe, she should move to Canada, and try Their med care?
Medicine is an art; there's a reason doctors are described as "practicing." The medical field is and should always be striving to get better, but there will always be missed diagnoses because the human body is a strange and not fully understood thing. She says herself that she didn't present with appendicitis symptoms.
This essay would have been better coming from a doctor who could discuss the lessons offered by this case rather than from the patient (the child of a famous person) for whom it's too personal to present usefully.
And yet we are turning out more ignorant doctors for equitys sake
Medical mistakes account for about 250,000 deaths per year. I Dont think missing a rare presentation of a common medical condition is a mistake.
We're talking leaving sponges, prescribing the wrong medication. Missing medication interactions. wrong dosses. Terrible surgeries, drug impaired Dr's
Its a big deal that has not changed in 50 years.
But self advocacy? Like not taking a vaccine? Or wearing a mask that has no efficacy? What about blindly obeying the experts.
We just went through this last week. My brother in law is special needs, +70 years old. He has suffered 2, tension pneumothorax. Last week it happened again. ER Dr's had his files and put in a chest tube and got over the emergency. The Pneumologist Dr. came and talked about the recommended treatment. When we asked if this was the other lung this time....The Dr hadn't checked. He just assumed it was like the last two times.
Not life threatening, but he might have undergone a useless procedure.
I simply don't understand how there could be such a lack of testing to rule out possibilities. I'm sure it was a good and reputable hospital and the Tappers have excellent health ins. Even if, for some bizarre reason, CNN is chintzy about what its health ins. policies cover, Tapper makes a lot of money and this is one of those times to say, "I don't care what it costs. Run some damn tests." Frankly, the whole story is crazy. It should never have gotten so bad for this young girl.
My father had disorientation, lack of mobility one one side of his body, and hallucinations.
The doctor in the ER diagnosed him with Covid and sent him home.
He went to a different doctor the next morning. He had a subdural hematoma and midline shift of his brain.
The financial incentives in our medical system are completely broken by the Insurance Companies and our government.
gilbar said...
maybe, she should move to Canada, and try Their med care?
Why are you reflexively defending our medical system?
Our medical system is terrible.
Jake Tapper is a shithead.
Both can be true.
I am struck by how beautiful Mr. Tapper’s daughter is, even at death’s door. As beautiful as paintings of saints in their martyrdom.
I agree that it's weird they didn't do an ultrasound or sonogram. I've had family members with severe constipation and when they ended up in the ER, one of the the first things the doctors did was take a look inside. It could have been an ulcer or kidney stone. Those would also need a scan. Weird.
God bless her, I'm glad she is well.
Misdiagnoses are of course always preventable. But what is that prevention? Part of the big push during the reforms around Obamacare were to save money by not throwing the expensive test at something. I'm certain the Tappers have excellent insurance and money to pay for tests, so in this case the problem was obstinate doctors.
I'm irritated that she said girls aren't listened to because they are more often diagnosed. Being misdiagnosed doesn't mean not listened to. I don't know what ages she's talking about, but girls and women often have menstrual pains that can be misunderstood to be something else. As she says in her article, appendicitis can present in multiple ways.
I'm glad she is well, and I'm glad her parents could be her advocates. Of course, good doctors are the solution too often when they aren't available.
Quite the contrast with my experience. Four years ago, after about 18 hours of relatively minor abdominal pain that I first thought was a gastronomical issue, I drove myself to an urgent care after dinner. By that time, I suspected appendicitis due to location. The urgent care told me to go to an ER because they didn't have the imaging equipment needed to take a look. From my arrival in the ER to when I was getting scanned was about 20 minutes, maybe 25. Appendicitis confirmed. It wasn't more than 45 minutes from walking in ER to being settled into a hospital room to wait for surgery the next morning.
I'm perplexed why they didn't take Tapper's daughter to imaging at least once they were stumped. I went very quickly even though I was older than when appendicitis usually occurs. Maybe it was just that the hospital I went to was having a very quiet night - no one else in ER, doctor saw me quickly, no waiting in imaging. And I wasn't in that much pain so speed wasn't motivated by that.
Word to the wise, as explained to me, appendicitis pain is largely due to other organs reacting to be pressed upon by the expanding appendix. My appendix expanded in an atypical direction in my abdomen where there was more space so less irritation of other organs. So don't think that if that pain isn't severe, it can't be appendicitis.
I'm surprised they didn't treat her for hysteria. As good as medical care is, you have to assert your command authority to get the care you need. A lot of this b******* has nothing to do with medical Care it is because every doctor has a team of for profit free market insurance company bean counters second-guessing everything they do because an extra sonogram here and there could effect the stock price.
Under old Twitter could this have been labeled as misinformation, disinformation or malinformation?
Never forget!
Cops are not allowed to make mistakes in stressful situations. ER physicians are given a tad bit more leeway but not much. Journalists, however, can screw up a major story and win awards for their screw ups.
Tough shit Tapper.
I clicked through and read the CNN article by Alice Tapper. In it, she tells of a doc who invented a quick and easy test for docs to use to evaluate children who present in the ER and to evaluate them for appendicitis. That has been done with the Apgar and SLUMS test. A valuable thing.
And thanks to the Tappers and CNN for doing this. A good deed.
Sydney:
I had the same thought.
And Michael K will probably agree with me: The quality and ability of doctors varies.
Don't worry; soon diagnoses will be made by AI. Maybe they already should be.
Democrats are not competent (see 5 million illegal border entrants since Biden took office)
why should anyone else be expected to be competent?
Democrat elites lead by example.
See Hunter Biden for the ultimate in *competence.
The butterfly effect or karma? You don't ask Fauci any hard questions and now your daughter's life is in danger.
Alice, my wife, and I
Made me think Alice was the wife.
Tim@7;11
This should always be the patients starting point. While "medicine" is awash in "science", Treatment is the huge ART needed to apply the science. If you are the majority and have never had to be immersed in the medical scene, you just don't understand all the ambigous and unknown that goes into your medical care. Personalities are huge.
My surgeon was great (most patients thinks theirs is the best). But when friends asked who I had, several labeled him an ego driven quack. This difference, the man was a clear and concise communicator. But, I never felt like he pushed me through so he could get to the next patient. I always felt he would answer questions until I stopped asking. He was always on schedule, but never rushed me.
Hospitals and doctors (the below average ones anyway, which is half of them) never think they are wrong.
Just be lucky when that you get one that believes biological sex is a real thing
I read the article. That case of an acute surgical abdomen should not have been missed. Once she demonstrated pain when jumping, that clinched it, but low blood pressure and high heart rate with elevated white count also points to need to delve deeper and not send home without imaging.
Hey Jake. I sincerely hope your daughter is ok.
But the medical industry has gone downhill severely in the last two years.
And you are part of the reason.
Sounds like a day at the VA.
"Vaccine" injuries and negative side effects of the forced mRNA shots supported by the likes of Tapper are happening all over the world to young people. Hey, Gene Simmons from Kiss said suck it up a shoot more of the mRNA poison in your body. Dr. Feelgood says so. So does Howard Stern. And Anthony Fauci.
How many people are heading to emergency rooms and hospitals where the fear of career destruction your prevents doctors from investigating the root cause of a young male athlete with myocarditis? If you don't know the true root cause... you can't treat shit.
Welcome Jake. Perhaps you might now consider how people feel who suffer from the mRNA injuries...of have kids that are suffering.
Reminds me of a great story by one of my old professors. They were in Egypt doing fieldwork (Fayum Depression) and he woke up with rather severe pain upon reliving himself. Went to an Egyptian hospital where they promptly removed his appendix.
Turned out he just had a bladder infection.
OK, so what? Doctors are human too and they make errors. Sorry. That's life. How many mistakes has Jack Tapper made? A lot. But then he's just a journalist. If he was a doctor, they'd have to expand the morgue.
Years ago my partner experienced acute late night abdominal pain. I diagnosed likely appendicitis from symptoms in consumer medical book and drove her to urban ER. Because she was within age group of fertility they refused to do anything until she peed enough for pregnancy test, which she was having problems doing. Her moans drew attention of adjacent couple in for his gunshot wound! They berated staff to get move on with a proper diagnosis. Appendicitis.
Acute appendicitis, as common as it is, is classically difficult to diagnose in many circumstances. It cannot be done definitively 100% of the time. It is especially difficult to diagnose in a female of child-bearing age. I know - I spent my entire career as an emergency physician puzzling over the problem and endeavoring to not miss an acute appendicitis. The maxim then was, if you are not finding a normal appendix occasionally on operating for appendicitis, you are not doing enough of these operations. Diagnosis has since improved with routine use of ultrasound and CT in suspected appendicitis but is still not perfect.
But there is something wrong with this story and that could pertain to the patient, or to the doctors, or both.
Parts of this young woman's narrative are a bit dramatic, which leads one to wonder about the accuracy of other parts of her story. "The doctor and nurses didn’t know what was wrong and stood around me confused, as if they were waiting for me to tell them what to do." (Yes, they didn't know what was wrong at that point and, no, they weren't even waiting for you to tell them what to do.) Her skin turned green. (Yeah, I don't think so.)
But the delay by the doctors to do definitive (as close to definitive as can be attained with the current diagnostic tools) is puzzling. At the point of the failed heel-drop test in the context of fever and high white blood cell count, appendicitis/ruptured appendicitis should have immediately been promoted to near the top of the diagnostic list (along with various gyn problems). Ultrasound and CT should have been done and surgical consultation should have been obtained. She was transferred to another hospital? Why? There are very, very few hospitals in which the diagnosis could not be fairly promptly narrowed to appendicitis and a couple other things.
I don't know who, if anyone, screwed up. But I can tell you that this story doesn't make a lot of sense. And I can pretty much assure you that what is in this article is not all of it.
Our daughter Kathleen, then twenty years old, was misdiagnosed in reverse of Alice Tapper--she had lower right quadrant sudden-onset pain and I immediately suspected appendicitis. Her pediatrician said she would need to go to the emergency room to have diagnostic tests. I do not recall if she was given an X-ray or any similar imaging, but that diagnostic fixation described by the pediatrician featured in Jake Tapper's video kicked in and everything began to focus on how to handle the "appendicitis." The emergency room doctors quickly decided to do an emergency surgery that would involve a huge mid-line incision instead of laparoscopy due to the apparent urgency of the operation.
Kathleen was saved all that by another doctor who came by to consult--thank you G-d! That doctor noted that our daughter just didn't LOOK sick, which is good old-fashioned medical judgment where you look at the whole patient. She suspected an ovarian cyst; imaging was done, and that's exactly what it was---a large fluid filled cyst that required no treatment beyond watchful waiting. In hindsight I can't believe that major surgery was averted at the last minute by a doctor who noted that Kathleen had no fever, no pallor, and only a very slightly elevated white blood cell count.
This story is hard to believe, but I don't doubt that it happened.
Ms. Tapper probably got the VIP treatment. If she had been Alice Average, she would have been seen by a junior resident, CT of obvious acute abdomen done within 15 minutes, and in the OR within the hour.
But, she was Alice Tapper.
Likely waited to be seen by the Chief, or the Emeritus Professor, who knows that modern technology is overused, especially in children, and treated her like the VIP that she was.
In a hospital, don't be important. It could kill you.
@IceNine: One thought- poorly trained and poorly supervised mid levels. But, yes, I doubt anyone was wondering what she thought they should do. That is most likely a teenager’s egotistical interpretation of their uncertainty which she was able to pick up on. And maybe their anxiety about their uncertainty.
What a nightmare for a parent.
I'm wonder if Jake Tapper and his wife had any kind of discussion post-surgery with the dismissive doctors. I certainly would have.
Note to all: There are bad doctors in every Hospital. Just ask the nurses!
I read the entire story, and a lot of it makes no sense to me- you either have completely incompetent ER personnel at that hospital, or the Tappers are taking liberty with the facts in that story. I know this- I don't trust Jake Tapper further than I could pick him up and toss him, so the burden of proof is on him.
Doctors cover for each other and bury their mistakes. That said, I owe my life and excellent health to a half dozen excellent physicians and surgeons... all of whom were the second or third doc I saw for the problems.
Analyzing medical death rate data over an eight-year period, Johns Hopkins patient safety experts have calculated that more than 250,000 deaths per year are due to medical error in the U.S. Their figure, published May 3 in The BMJ, surpasses the U.S. Centers for Disease Control and Prevention’s (CDC’s) third leading cause of death — respiratory disease, which kills close to 150,000 people per year.
This story has the potential to turn into a Libby Zion escapade, with similar terrible outcome.
Libby was a college student who was taking antidepressants, also cocaine, and presented to an ER in NY in 1984. She was treated by a couple of low level residents, and subsequently died. Her father was a prominent lawyer who also wrote for the NY Times. The residents who cared for her were typically overworked and undersupervised. The result of this tragedy was that Libby's father wrote some inflammatory stuff in the Times and got NY State to outlaw traditional medical training. The restrictions on resident work hours are now a national standard. Now we get the docs we have.
One of the reasons that it takes so much time and money to get an evaluation in the ER is that there is a CT bottleneck. Everyone gets a CT, there are not enough radiologists to read them timely, and everything gets backed up.
Woe to the physician who uses clinical judgement and tries to get by without a CT. If he's wrong, even 1 or 2% of the time, his insurance company will just write the checks to the malpractice lawyer, and he and his colleagues will learn the lesson.
If the patient is seen by a PA or NP, no clinical judgment will be involved- the CT gets ordered automatically. Better in this particular case, but it's estimated that every 1500 CTs generates one cancer, and every one costs a grand or so, and every unnecessary CT results in delay of care to everyone else. This could result in a de facto law that every bellyache gets the CT.
The financial incentives in our medical system are completely broken by the Insurance Companies and our government.
Yes. When I was in training the Bible was "Early Diagnosis of the Acute Abdomen." by Zachary Cope. Later editions were edited by Bill Silen. It is still in print. My training was long before CT or ultrasound. We were taught that right lower quadrant pain and tenderness, a temperature above normal but lower than 102, and a wbc count around 10,000 and any reasonable history left a 90% chance of appendicitis. Rebound tenderness was also significant. This is determined by tapping the abdomen away from the tender spot and seeing if pain at the tender spot occurs. A cough will also elicit rebound.
Later on, I did over 500 laparoscopic appendectomies. The recovery is usually 24 hours. When I first started doing them with the scope, a doctor acquaintance called me on a Friday afternoon to see his 9 year old daughter. I took her appendix out that evening. The school nurse heard she had had surgery and, on Monday morning called the hospital to see how she was doing. The kid was in class. I videotaped all laparoscopies and, after a month, offered the tape to the patient. A second grader took it to school and shared his video with his class.
Ct and ultrasound have added a bit. A study in Chicago a few years ago reported that the percentage appendices that were perforated at surgery increased substantially when HMOs became more common.
Perforated appendices in young females leave a substantial risk to fertility. In one hospital in a beach town, we saw lots of uninsured kids and for young women we would take them to the OR and laparoscope them rather than observing them in the ER. PID is another risk in this population. Laparoscopy would make the diagnosis and cure appendicitis. It was cheaper for the hospital and safer for the kids. Even anesthesiologists agreed it was worth doing for free because none of ever got paid.
I did not read the story as all I saw was the Twitter posts.
How does "self-advocacy" fit with the message of the last three year's that all Americans should SHUT UP and follow the "science"?
"I don't know who, if anyone, screwed up. But I can tell you that this story doesn't make a lot of sense. And I can pretty much assure you that what is in this article is not all of it."
"I read the entire story, and a lot of it makes no sense to me- you either have completely incompetent ER personnel at that hospital, or the Tappers are taking liberty with the facts in that story. I know this- I don't trust Jake Tapper further than I could pick him up and toss him, so the burden of proof is on him."
It's so weird to try so hard not to believe something that happens every day all the time and probably has happened to you or someone you know and love.
My wife went in to a good hospital with horrendous pain in her back. The kind of pain that makes you another person entirely. They ran tests, found kidney readings that indicated possible kidney stone. Disregarded them, refused to page a nephrologist, diagnosed her with a lower back muscle pull, gave Tylenol. When we pushed hard including asking for nephrologist, the PA screamed at her "we are done diagnosing."
As confirmed by a doc we saw later, she was passing a stone.
My Dad was saved from back surgery for compressed nerve hours before going under, when a different doctor he had contacted investigated further and realized his lower leg numbness was from sitting with his legs crossed too much.
Thousands of other stories. Lots of mixed incentives. Lots of not listening to women and girls. This is just the regular pulse of the health system in this country.
Or maybe Tapper made it up to finish the job he started when he forced Obama to pass Obamacare.
Diagnosis has since improved with routine use of ultrasound and CT in suspected appendicitis but is still not perfect.
This is bizarre to me -- I mean a CT takes like, what, five minutes? And for ultrasound they can just wheel that device into the room and gel you up. I'm sure they took her to a good hospital, so they must surely have been able to fit her into the schedule. But (1) hospitals seem to have limited imaging capacity and (2) I don't think hospitals will image you just because you ask for it -- I think you still need a prescription and insurance pre-approval. Maybe outpatient centres will even if hospitals won't? I have found them a lot more flexible with scheduling than hospitals (I say, with my adult experience of one hospital system and two imaging centres in the US . . .)
In our family's experience, Urgent Care and ER doctors are better at trauma than they are at diagnosing diseases. Our oldest was at the ER of the hospital where I worked and was diagnosed as having a garden variety viral URI. His symptoms didn't improve over the weekend so we took him to his pediatrician who looked at his throat, immediately determined it was strep, and prescribed an antibiotic which handled it in short order.
More recently, our daughter had a sore throat and, thinking to medicate it herself, drank part of a bottle of benadryl. We live out of state now, so her caregiver took her to Urgent Care. They determined that she hadn't taken enough to cause harm and were preparing her for release when they called to see if I had any questions. I asked if they had run a COVID test - they had not - so I said, "Would you please?" They ran the test but had to send it to a lab, so results (it was on Saturday evening) were not available that night. I checked her online chart through the day on Sunday but nothing was posted until Monday morning. She tested positive, but no one bothered to call! So I canceled her rides to work and notified all parties concerned. I wasn't pleased. She has come through it OK but it could have gone sideways if we hadn't found out about it.
Now do Covid death protocols of Remdesivir, sedation, withdrawal of nutrition and vent.
Ah..can't talk about that.
I was once sent home from the ER with appendicitis. I was still in pain in the morning, so I went to an urgent care where there was a real doctor, and he said I had classic textbook symptoms and sent me back to the hospital. Turned out that the radiology had been outsourced overseas. Back in the hospital, the supervising doctor apologized to me and said that it was clear on the film. It had burst while I was out of the hospital. His apology probably saved them a lawsuit. I was several days in the hospital and home in bed for a several more, which is how I came to watch all 200 episodes of Friends in order. I refused to pay the bill and they dropped it, at least my share of it.
50 shades of planned parenthood, planned parent/hood (e.g. Whitmer-event cover-up), transgender/neo conversion therapy, Covid-19, 20, 21, 22 mandates, etc.
And then there's this guy.
Taylor Decker and his appendicitis
When we pushed hard including asking for nephrologist, the PA screamed at her "we are done diagnosing."
The operative word in your story is "the PA." PAs and nurse practitioners always have an MD supervising them, or should. "May I speak to your supervising physician ?" Is the response.
Blogger Temujin said...
And then there's this guy.
Taylor Decker and his appendicitis
I had the OR supervisor come to me one time and ask me about her abdominal pain and swelling. It had gone on for a month. I examined her and she had an appendiceal abscess. She was working in the OR for a month with a perforated appendix. No accounting for some folks.
What is astounding to me is that, appendicitis aside, they couldn’t diagnose an acute abdomen, which requires further examination and surgery. BTW, it isn’t a gastroenterologist you want, it is a surgeon.
Then there was, of course, this:
appendicitis misdiagnoses are more likely in children under 5 — and in girls. I was disappointed but not surprised to learn that girls can be listened to and taken seriously less often.
Hmm, girls taken less seriously... the jokes write themselves. But really, it's the parents who are in charge with kids. Maybe if Jake wasn't such a lying jackass the docs would have taken him more seriously.
And a link to an Atlantic story about sexism in ERs. Not gonna read it.
I had a near death experience when I was 16 in a big city ER at 2am. Maybe not near death, but I was in severe respiratory distress, and left on a gurney in the ER ward for at least an hour struggling to breathe before anyone came in to see me. My mother was out in the waiting room not knowing what was going on. The problem was that I went in to the ER under my own power and said I was experiencing shortness of breath. So they probably put me as low priority behind all the gunshot wounds, but my condition deteriorated greatly after that. I and/or my mother should have been screaming bloody murder but I'm not sure if I was even able to scream. The doc eventually saw me and said something about how I should have been seen sooner. Thanks. Anyway, he gave me a shot of adrenaline or something, and I survived, obviously.
Doctors have become automatons who have been beaten about the head so much about losing their licenses that they do not take any chances or think out of the box. If they do, they risk their license. Ivermectin is an example.
Yeah but did you see the TikTok dance those medical professionals did while she was waiting for treatment?
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