High-tech medicine alone cannot protect U.S. from Ebola – we need to get the basics right
On Tuesday, The Centers for Disease Control and Prevention confirmed that a second healthcare worker in Dallas tested positive for Ebola. The next day, the health authority issued a statement saying that the nurse travelled by air on October 12, the day before she reported symptoms.
The nurse had been caring for the now deceased Liberian Ebola patient, identified as Thomas Eric Duncan, who arrived in Dallas, Texas, from Liberia on Sept. 20. He didn’t develop symptoms of Ebola until four days later. On Sept. 26, he went to the emergency department at Texas Health Presbyterian Hospital complaining of fever and nausea. Though he told a nurse that he’d traveled to West Africa, where an epidemic of Ebola has broken out, he was diagnosed with a “low-grade, common viral disease” and sent home with antibiotics. Never mind that antibiotics shouldn’t be prescribed for viral infections like the common cold — why was he sent home?
The U.S. healthcare system is the most sophisticated in the world. It is also byzantine and inefficient, and those systemic flaws may have allowed a patient with a deadly virus to slip through the cracks.
As a doctor, I know that healthcare providers sometimes don’t get basic things right. We don’t spend enough time talking to patients to understand their stories, their worries and why they’ve come to see us. We often don’t communicate well with our patients and with the other providers involved in their care.
Medicine is among the most hierarchical of workplace cultures. This is great for issuing orders and making sure they’re obeyed, but can mean certain team members are valued and listened to more than others. Nurses function as patient advocates, for example, but physicians often dismiss their concerns.
Even among physicians, hierarchies abound. Infectious-disease specialists, experts in diagnosing and treating diseases like Ebola, (full disclosure: I am one) are the least-well-paid doctors in the United States — even though some may have more years of training than, say, a generalist. Those of us who go into the field have reasons other than compensation for doing so.
Though a news report quoted a hospital official as saying Texas Health Presbyterian Hospital was “well prepared” to care for a patient with Ebola, it was unlikely that an expert in diagnosing and treating diseases like Ebola was asked to examine the patient in Dallas before he was sent home. That oversight, if true, would expose a serious — and dangerous — shortcoming of a system that assigns different values to different doctors.
There is another reason why the patient may have been sent home. America is a society enamored with technology. This helps explain the public’s continuing fascination with new drugs and vaccines as the best way to fight Ebola. In medicine, this love of technology has partly encouraged the overuse of laboratory and radiology testing at the expense of doctors taking the time to talk to their patients. Some physicians even seem to have forgotten how to perform a thorough physical exam.
But even ZMAPP, an experimental drug for the treatment of Ebola, is no substitute for a thorough physical exam and following public-health basics — what CDC director Dr. Thomas Frieden has called “tried-and-true public-health interventions.”
Simple and low tech as these practices may seem, they make for the bigger difference in outcome — fewer people getting sick. Unfortunately, public health departments and the CDC, which are responsible for the unglamorous, seemingly mundane tasks that keep us safe from outbreaks like Ebola, have sustained substantial budget cuts over the past several years, reducing their effectiveness.
Whether Ebola infects others beyond the Dallas patient and the two nurses who treated him is a good litmus test for our high-tech health system. Ebola is still spreading in Liberia, Sierra Leone and Guinea, which all have primitive health systems. But in Nigeria, where almost 900 people were exposed to Ebola and 20 were diagnosed with the disease, the outbreak has been stamped out. In Senegal, more than 60 people were exposed to a single Ebola patient — and no one came down with the disease.
The Dallas patient was isolated within four days of becoming sick. But not before possibly exposing a dozen or more to the deadly virus, including the two nurses who have since fallen sick. If further cases of Ebola develop in Texas, this will only serve to highlight the systemic problems in the world’s most expensive and sophisticated medical care system.
PHOTO (TOP): The Aeromedical Biological Containment System is shown in this undated handout photo provided by the Centers for Disease Control (CDC) in Atlanta, Georgia, August 1, 2014. REUTERS/CDC/Handout via Reuters
PHOTO 2: A general view of Texas Health Presbyterian Hospital in Dallas, Texas, September 30, 2014. REUTERS/Brandon Wade
PHOTO 3: A burial team wearing protective clothing, prepare to enter the home a person suspected of having died of the Ebola virus, in Freetown, Sierra Leone, September 28, 2014. REUTERS/Christopher Black/WHO/Handout via Reuters