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Tue Oct 11 15:02:22 BST 2005

Avi,

Thanks for the info ― it's the same old story. He who has the gold makes the rules. 

Bill

William J. Bromberg
Savannah Surgical Group
912 350-7412

>>> avir at bgumail.bgu.ac.il 10/11/05 04:26AM >>>

Bill, 

In Israel, the government is called to intervene on many things that in
the US are left to be sorted out by the citizens. This is sometimes good,
and often bad. 

The health minister is a politician, and rarely has an inkling about
health care issues. The director general of the health ministry is a
physician, but is appointed by the minister, as a political nomination.
The actual work is done by the permanent deputy director general, who is a
pro, and a real expert on health care issues.

The Director General issues dirctives from time to time. Most of the
directives are administrative, for example, procedures for giving
blood, or the procedure for determining death by neurologic criteria. 

They issue clinical directives very rarely, and when they do, they tend 
to adress the needs of vulnerable segments of the population, and are
usually based on sound epidemiological data.   

The reason for the directive re head CT in eledrly victims of minor falls
because there was an unacceptably high incidence of missed SDH in this
group.  

I don't see a problem with this, as the government also pays for the
health insurance, and owns half the hospitals. They can decide how to
spend their money. 

Avi 

 On Mon, 10 Oct 2005, William Bromberg wrote:

> Avi,
> 
> What's the data on that? I would hope  that before the government completely eliminated physician judgement on an issue they would first have irrefutable, unmistakable leve I data, if not, why?
> 
> Bill B
> 
> P.S. This by the way is coming from someone who within the last year saw an 80 year-old s/p fall. No LOC but confused who got a head CT, read as normal by radiology (final read) and was sent home in 23 hours. She died at home from a SDH and on review of her admission CTH they said "Oh look at that » a small SDH sorry we missed it." I have no strong feelings on the use of CTH but come on » a government mandate? 
> 
> William J. Bromberg
> Savannah Surgical Group
> 912 350-7412
> 
> >>> avir at bgumail.bgu.ac.il 10/09/05 04:40PM >>>
> Elderly patients are a trap.  In Israel, we do head CT on all patients > 70,
> with any serious trauma, including those that fell at home. 
> This is an administrative order of the ministry of health, which means that
> missing this SDH could result in disciplinary action against the physician. 
> 
> Avi 
>   
> 
>  
> 
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org 
> > [mailto:trauma-list-bounces at trauma.org] On Behalf Of Maureen Canavan
> > Sent: Sunday, October 09, 2005 7:31 PM
> > To: trauma-list at trauma.org 
> > Subject: head CT
> > 
> > Had a elderly lady PMH asthma, involved in a MVA  
> > rollover,dx.  fracture pelvis..after twenty four hours she 
> > was found unresponsive she was intubated and sent to CT with 
> > a diagnosis of large SDH with midline shift. Unfortunately no 
> > CT of head was done in the ER.  Should this be protocol and 
> > is it protocol in other level one hospitals, when the MVA is 
> > a rollover???
> > 
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==========================================================================
Aviel Roy-Shapira, M.D.              Soroka University Hospital &
Dept. of Surgery A. and              Ben-Gurion University Medical School 
the Critical Care Unit               POB 151, Beer Sheva, Israel

email:avir at bgumail.bgu.ac.il         Fax:972-7-6403260 voice:972-7-6403390

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