Posts Tagged science

Occupational Health — what a job is worth

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Today’s lead story in the New York Times  (3/31/13) is about the sad result of a dangerous chemical used by workers to make cushions for furniture.   The chemical is n-propyl bromide (n-PB), a spray adhesive to stick urethane cushions together.   Click this link to see an n-Propyl Bromide materials safety data sheet (MSDS).  The workers were exposed to the chemical and suffered long-term neurotoxicity manifest by difficulty walking and using the hands.   The workers were clearly hurt and there is a lot of finger-pointing at the management and the US  Occupational Health and Safety Administration.

A true story with a better outcome follows:

A man started his own home insulation business and learned how to spray foam insulation.  He was young and very fast so he decided he could apply the foam and get out of a room so quickly protective gear was not needed.   He hired several other workers for his small company.  Time went by and he developed cough, wheezing and shortness of breath always worse after a day on the job.  His wife insisted on a visit to a lung specialist who told him he had occupational asthma from the spray and must NEVER use the substance again.  He stopped using the spray and immediately purchased safety equipment for his workers.  The company owner commented: “wow, that’s bad stuff”.

The difference between the two stories illustrates important points:

  • If the owner of a company develops a health problem from occupational exposure the doctor is not questioned and immediate corrective action is taken.  The scenario is called the “pilot’s incentive”.  Pilots are very willing to fix airplane safety problems since a crash might kill them.  But, business owners divorced from the health risk and concerned about how much the corrective action would cost do not act quickly.
  • Workers often seek help from local physicians.  The physicians are afraid of getting drawn into a suit.  And, as in this case, if the MSDS does not explicitly list the health problem no action is taken.  Doctors avoid chemical related workman’s compensation because of the paperwork and legal obstacles involved.  MSDS sheets must be updated every 3 years.  However, there is no mandate to perform research to actually add to the basic information — and it seems foreign safety data is not well accepted.
  • Knowledge of occupational-exposure risk often does not deter workers.  For example, in the late 19th century miners knew the risk of death from using the steam driven hammer called the “widow maker”.  The miners died in their 20’s from breathing rock dust, a disease later named silicosis.  But, they took the jobs anyway because the pay was good.  The pay at the furniture factory was $10/hour,  perhaps that was the best pay available.  Workers were aware of co-workers getting sick but they worked on and on despite difficulty breathing and difficulty walking.
  • Workman’s compensation insurance is required in every US State.  If an injury is caused by something at the workplace the worker usually gets monetary compensation.  And, the compensation is tax free.

Here are some simple suggestions:

  • If you have a health problem make sure to tell your doctor about your work environment and any exposure to fumes, dust, chemicals and radiation.  Bring copies of the MSDS sheets appropriate to your job (employers are required to have a file of this information).
  • If other people at the job site are having similar health issues the job may be the cause — no matter what the MSDS says.
  • If a workplace health problem is suspected see an occupational medicine specialist.  Your local health care provider may be knowledgeable but may be easily overwhelmed by the amount of uncompensated time it takes to resolve the issue.
  • There are other jobs, other cities, and other states — disability and death can never be fully compensated so don’t risk your health for a job.

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Satisfaction VS Quality

The following is extracted from data presented by the Dartmouth Atlas.

 

Data about high ranking academic medical centers is plotted above.  On the vertical axis is the patients rating of their experience at the hospital — the higher the percent the better.  On the horizontal is the rate of a severe infection complication of tubes put in the veins (which should be taken out periodically) — the lower the rate the better.  The hospitals in the lower right have the highest rate of undesirable “line” infections AND the lowest rating by patients.  The hospitals in the upper left have the lowest rate of such infections AND the highest satisfaction.

The point is:  the hospitals are all over the map (poor reliability).  Worse yet, patients seemed to give some hospitals high marks for poor performance.   To be fair, very few patients actually get line infections so the negative effect on overall satisfaction is small.  It would be interesting to evaluate  satisfaction of patients who had line infections (if they survive).

So, you say, hospitals need to work harder.  That would be true but where are the guidelines for removing these problematic vascular catheters?  The CDC and others describe how to care for the catheters but leave it to “judgement” when to take them out.  The problem is “judgement” is not conducive to reliability.

Make a rule and follow the rule!  Sure there are exceptions, like it’s the last vein the patient has — judgement is when you state why you are not following the rule.  The specter of malpractice litigation is here.   Although the rule of law is doctors are not held responsible for a well considered judgement (which later may prove to be wrong) it often does not work that way in court.   So,  a good defense would be that a national guideline was followed — if it existed.

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