I just wasted 7 years of my life in medical school.
Naturally, when you live in the country with the likes of professor Marcel Ghanem, Dr. Joe Maalouf, Tony Khalifeh and their friends, is there a point for you to remotely try to get an education? They will tell you what you need to know, give you medicine crash courses and guide public opinion on the matter.
Clearly, they’re the ones who know everything and those doctors are just backward-minded folks who only care about money.
Ella Tannous is a young 9 months old whose pediatrician is now in jail. Why is he in jail? Because we live in a corrupt country where security forces get carried away by the sensational reporting of Kalam Ennas and other similar shows to ruin the life of a man simply because of the science of Marcel Ghanem’s report and that dramatic Lord of the Rings music in the background and the tears of the child’s mother as she whispers: why can’t my little girl play with barbies?
Again, what would I know. I’m sure that policeman in between his Malek el Tawou2 sandwiches was busy reading medical textbooks. Give me the differential of a crying baby, kind sir. Oh, you have cramps from all the garlic consumption? Excuse me.
According to her parents, Ella had a high grade fever for which they contacted her pediatrician, Dr. Issam Maalouf, who ran some tests that revealed Ella most likely had a viral illness and prescribed medications to lower her fever.
However, Ella’s fever did not subside and upon contacting the doctor again, he told them not to worry and to use cold towels to try and drop her temperature.
When the parents saw that their child’s situation did not improve they took her to the hospital. It was a Sunday. The pediatrician did not see Ella that day and instead saw her the following day when she had already deteriorated.
He got her transferred to AUBMC where further treatment was done. Ella, however, was in shock and in a state called DIC (Disseminated Intravascular Coagulation) and had gangrene in her limbs, which had to be amputated to save her life.
This is what happened with Ella Tannous according to her parents:
*cue in dramatic music.*
What happened to their child is surely devastating to them and Ella’s parents have every right to be sad and heartbroken over what happened to their daughter.
But just because someone’s daughter had complications does not make that person a doctor who can go on air and pretend they know what makes sense scientifically and what doesn’t. It also does not give Marcel Ghanem or any Lebanese media, who were quick to jump on this very delicious scoop, the right to become full blown medical professionals who spent their times doing night duties in pediatrics.
So let’s go with what we know one by one:
1) Ella’s blood tests revealed a viral illness. Viruses are not treated with antibiotics as Ella’s father was alluding should have happened. In fact, the side effects of those antibiotics and possible increasing resistance to them make their use in viral illness not recommended. How do you treat a viral illness, scientifically? You provide symptomatic relief. A patient has fever? You give anti fever medication. A patient has a sore throat? You provide pain relief, etc.
2) Ella’s fever persisted. Viral illnesses can have fevers that persist. You still give anti-fever medications and monitor. This is what you do, unless LBC or Annahar have new guidelines that we need to be aware of, in which case enlight us please.
3) Ella deteriorated and they contacted her physician as they took her to the hospital. He didn’t recognize them at first. Well, bring the guillotines. A pediatrician could not recognize over the phone a patient out of the hundreds that he has. He must be incompetent. Issam Maalouf’s mistake? He did not go see Ella that day at the hospital. However, that hospital is a university hospital and they should have been reporting back to him every single that happened with Ella as she would’ve been admitted under his care.
4) Ella’s fever continues and she starts experiencing decreasing urine output and becomes lethargic. These are signs of dehydration and deterioration. Dehydration can lead to kidney damage because blood flow to the kidney is decreased which causes something that is called acute kidney injury. This is not what probably happened to Ella, however.
5) Because of her decreasing immunity fighting the virus, Ella contracted another bacteria called Group A Strep (GAS). This bacteria is virulent and has been known to cause a wide array of complications when not recognized and treated early. To recognize and treat it early, you need to maintain a very high level of suspicion which in the setting of a clear viral illness, such as Ella’s case, was not the case.
Due to her low immunity, Ella had a dissemination of GAS. This led her to go into septic shock and full blown DIC. Septic shock is an extremely lethal condition whereby the body cannot adequately find the overwhelming infection. DIC is a complication of septic shock that leads to the depletion of the body’s ability to coagulate the blood through the formation of little clots that block blood vessels across many organs and vessels. The condition is extremely lethal.
In fact, the combination of septic shock and DIC is usually unescapable. Ella is lucky to be alive. Do you know why she’s lucky to be alive? Because her pediatrician saw the signs early enough to transfer her to a hospital that can manage her well.
Bring The Pitchforks, Why Don’t You:
After all that they’ve done, I can’t believe the Lebanese populace still trusts Lebanese media blindly when it comes to medical issues just because they’re sensationalized enough for their liking.
This is the same media that wanted to convince you we had a Guillain-Barré virus.
This is the same media that, a few years ago, ruined an OBGYN’s life by pretending they know medicine and accused him of killing one of his patients who was giving birth. That patient had an amniotic fluid embolism that is a lethal and extremely rare complication of giving birth. That doctor’s future was ruined anyway. He was also thrown in jail for something out of his hands before the courts realized that he was thrown in jail simply because of Tony Khalifeh’s report at the time.
Issam Maalouf joins the growing list of doctors whose entire career rests upon the whims of a reporter who understands nothing and who goes by what the parents or family of a patient are saying as if they know what’s happening, as if they know the medicine behind diseases. A devastated parent is not a doctor.
This is the same media that now has you convinced a competent doctor is now where he belongs, behind bars, and has you changing your display pictures to “Justice for Ella” snapshots.
When faced with a report from the Lebanese Order of Physicians about what actually happened, that same media downplays the report as inaccurate. Because clearly, the Order of Physicians does not know the medicine behind what’s going on. Those physicians did not go to med school for years and then did residency and fellowship programs for more years only to be ridiculed on air for being imbeciles.
Complications in medical scenarios happen. Not every single complication, despite how deliciously journalistic it looks, is a headline story.
With all due respect to a patient’s family, the esteemed reporters across the Lebanese republic and the people holding the pitchforks in Ella’s defense: You really have no freaking clue what you’re saying. Stop suggesting treatment modalities. Stop suggesting scientific explanations. Stop ruining people’s lives just because it makes for fancy headlines.
And then you get the Ministry of Health pretending they suddenly understand medicine to bring their pitchforks too. You know, that same ministry who turned Lebanon’s food safety issue into a Star Academy-like nominee-every-week report fashion.
There is a reason we go to medical school for endless years. There is a reason we do residency for another batch of endless years. Only doctors can know when medical errors occur. Only doctors can judge another doctor who does a medical error. Only doctors know how to treat patients and diagnose them. Only doctors know how to manage complications.
This is not elitism. This is common sense. This extends to other professions as well. I can’t judge the work of an architect, but an architect can. I can’t judge the work of an electrical engineer, but another electrical engineer can, etc.
The bottom line is: I just wasted 7 years of my life in medical school, that much is clear. Because clearly, Marcel Ghanem and his friends know better than me and all my colleagues.
A Separate State of Mind | A Blog by Elie Fares 
They’re very skilled at twisting the story whether they actually investigated or not, regardless of the consequences this will have on everyone…especially considering the emotional impact in influencing people this sensitive case will have
They should try covering actual malpractice cases or the countless corruption cases out there
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They should throw Marcel Ghanem and all these other reporters that create bullshit like this for inciting fear, panic, etc… In jail where they belong!!!
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Doc i really respect the scientific explanations you just gave, i’m so perplexed by your complicated medical codes (my narrow journalistic mind can’t can’t even dare to try to assimilate) so i must say that the Holy Ghost cause this “mal fortune” to Ella or maybe in some twisted conspiracy theory scenario (you know we low i q journalists love this sh*t) her parents did this to her … the last thing anyone should do is try to hold the first person responsible for her health condition, her DOCTOR … dear sir, no matter how hard you try, and your colleague Dr Maalouf could be innocent, i’m no judge, but i’m sorry to inform you that your reputation as whole medical body in Lebanon is well beyond tarnished by some of your colleagues bad practice & commercial treatment & abusing of patients… we respect your very serious & noble mission in life which is handling other people’s lives, just try to not freak out when held accountable!
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If you want to hold someone accountable, the least you can do is have the scientific backing to do it. Just because her mother shed a few tears, her father raged on a TV screen does not mean this is a medical holy grail case that would have never ever happened had the pediatrician been accomplished. It’s actually that simple: you want to hold the doctor accountable, go ahead. But at least do it in a less sensational way AFTER you make sure that you can actually do so, ruin his reputation and get him in jail illegally by simply double checking the medical facts behind the case.
Ella’s parents are not doctors. Marcel Ghanem and his friends are not doctors. There’s a reason medical school takes forever. There’s a reason post-medical school training takes another forever, and it’s because there are a ton of things to learn and a ton of things that can go wrong and a whole bunch of complications that can take place at any moment.
The fact that the Lebanese medical body has a tarnished reputation, as you say, is not an excuse to bring the guillotines every time a medical story breaks into the regular news cycle, simply because it looks scandalous. It’s far from it.
Not every single patient who enters a hospital, regardless of how minimal his initial presentation is, leaves that hospital without any repercussions. Not every single child gets sick without complications. The fact that you don’t hear about MOST of disease cases in Lebanon means that we are doing a hell of a good job at treating people. But some people slip through the cracks of what we can do, what we can treat and what we can diagnose and it is then that we play games of catch up.
Journalists love sensational click-bait titles. They’re the same people who made Guillain-Barre into a virus a week ago. Excuse me if I’m reading through the bullshit.
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so you are another shitty doctor who comes in here and brags about it? doctor in what? in bullshit? Ella’s mother shed a few tears? What would have said if it was your mother you animal?
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Man mfakrin halon allah. ino henne drs w nehna l shaab l bhim w hinneh afham mena. trekon. maalouf is guilty haje yestaheblouna.
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My God Gus you read my mind. He is an animal. I want to say I wish this on him but…
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you just read an angry (yet accurate) post by a doctor. Said doctor did not single you out, but spoke about the media as a whole. If you feel implicated by this article, that is your problem and I feel sorry for you.
There are unethical people in every profession but in this case, the doctor is not responsible, the doctor was not nonchalant, the doctor did what he could given the circumstances he was put in.
There are lots of things, dear journalist, that are unsaid in this article because they are too scientific or too detailed for lay people to understand properly. This is a 5-day series of events summarized in a few lines.
Despite these outrageous accusations which seem to stem from a personal vendetta against an entire institution, and despite your extremely polite and eloquent answer, we carry on our mission graciously until pushed to a breaking point. This point has been reached, so now our attention is split between unfair inaccuracies in the media’s reports AS WELL as our patients who rightfuly put their trust in us.
If you feel like we are not to be trusted, by all means resort to your shamans and fortune tellers.
Oh and by the way, you will find that in other countries, the population of lebanese doctors is EXTREMELY well looked upon, whether locally or abroad, so please spare us the talk of reputation which you surely know very little about
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i usually do debates to get fruitful answers & conclusions, i don’t do insults… the least you could do as a respected person who should be well educated is to respect my right of free speech & look that somewhere i might, i just might, have a minimal good point, but no you couldn’t do this! you had to ride the high horse of insult … you’ve just reminded me of priests who tried to cover up for child rapes all over the world until it became a catastroph & dealt a huge blow to the global image of the church … i respect people of all kinds of professions, those who put their efforts to make our lives better, but you sir surely won’t fall under this category.
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I am sorry I wasn’t aware that I was insulting you at any point.
You say you are expressing your right of free speech, and so am I.
You say you engage in debates yet feel conflicted when I give my own take on things.
You say I rode the high horse of insult when you used sarcasm and words like “Sh*t” and statements like our reputation in Lebanon is tarnished.
oops
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Well said!
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fadi; you maybe right about our reputation in Lebanon nevertheless it is much brighter than yours as stupid dummy journalists who just recite what your sponsors in saudi arabia dictate upon you; further, if you as journalists have such a bad reputation, we should not throw in jail the first journalists who commits a mistake by publishing a free, non sponsored honest article in his magazine because he broke the maffia rules of journalism in lebanon
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i already told you that i respect your profession & how much forevers it takes you to become a doctor (i have a few respected ones in my family, as most lebanese families have) but you are so defensive & you refuse the idea that one of your colleagues might have simply been WRONG about something, it’s the media’s fault, these “yellow journalism merchants” .. what raises suspicion about you guys is this harsh way of defending each and every one of your own no matter how unjust or oppressed he was, you don’t leave room for possibility that a doctor might be mistaken… the way reporters who went to cover the press conference in your syndicate, were treated is very shameful to say the least … i was stunned when i saw the report, i was like “are these lebanese doctors the creme de la creme of our society?!! why are they acting that way?!”
dear sir, covering up always leads to more harm done in the shadow, exposing it helps come up with solutions.
thank you for your valuable time & i wish you the best of luck in your noble career.
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This is not a conspiracy. This guy, as you call him, was illegally arrested and has been arrested for over 48 hours without cause. Of course his colleagues will be defensive. Of course they will be outraged by this. What about journalists who got outraged at the Egyptian government apprehending all those Jazeera reporters? Or the many countless examples of Lebanese authorities doing the same to you?
The fact that we are defensive is not suspicious. If this hadn’t been turned into the sensational scoop click-bait story, Issam Maalouf would have been investigated normally and this would have taken part in the background of the country’s collective consciousness like the many accusations of malpractice that take place daily.
However, that is not the case. Covering up can happen, but it is not in this case. When the scientific and medical investigation points to one explanation, pointing out that explanation is not being defensive or covering it up or being hostile just because it doesn’t crucify the doctor.
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“If this hadn’t been turned into the sensational scoop click-bait story, Issam Maalouf would have been investigated normally”
Agreed. However, normally in Lebanon means that he will get away with it. This would have happened under the usual patronage of the Order of Physicians which obviously wants to suspend the medical practice in Lebanon over a doctor who confessed his mistake.
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exactly. letting the whole country pay for a mistake a dr. did, and they dont wanna hold him accountable because drs. study for 7 years. they are better than us engineers who study for 5. and we do not understand their scientific language. only they do. and they do not make mistakes, if they do, they do not pay. they are way above mankind cz they studied for 7 years!
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PS: we defend the lebanese population when wrongfully accused, not just our colleagues
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diana; doctors have much better insight than you engineers ( i studied engineering before shifting to medicine as i found it a dry stupid job for mental retards); i need to tell you that engineering is an exact science whereas medicine is a combination of art and inexact science; there is no white and black in medicine; certain issues that are believed true today, may turn to be wrong tomorrow…..oh btw, next time ypou need a cesarian section or an appendectomy, try the veterinary surgeon; he is not registered in the order of physicians; good luck
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It keeps happening and happening and happening…….. Dr Issam was my Dr and he saved my life once… he saved the lives of many.. and just because the media needed a big scoop to gain money, and just because the people in this country follow the media like sheep, his reputation is shattered… That makes my heart break,,,, and let me think, what is the solution?? how these TV programs can be forever stopped (the one with joe maalouf, tony khalife, kalam nnas when it is not politically related), we need to think of a solution!!Enough!!!
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No doctor has ever been held accountable in Lebanon… Always covered by the corrupt order of physicians… So spare us the drama!!
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Just because you haven’t heard of it doesn’t mean it didn’t happen. Not everything makes for sensational media stories.
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In the US lawsuits against doctors are more public because people understand that it is normal. If u don’t get sued, ur not practicing enough. In Lebanon the doctors career is ruined and people don’t understand that it’s part of the profession, so trials are kept secret. I know many doctors who lost their license when neglect or lack of capacity is proven, but it’s kept secret to protect dignity and those proven innocent
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the idea of mistakes not happening is ethereal..but neglect is what should drs be punished for, if proven.
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try veterinnary doctors next time
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shall we understand from point 3 that the Hospital is reponsible because they did not report back Ellas deterioration?!?
If so ,then there is no doubt Ella has been the victim of mistake/misscomunication and nonchalence!!
Maybe if the Dr knew earlier, he would have taken other measures!
Bottom line, yes we are not medical doctors and we can not judge scientifically Ella’s case but it is obvious- even from your article-that there is a missing loop for which someone should be held responsible!!!
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I said it’s a university hospital, which means there are residents and doctors on call other than him.
From what I gathered, that hospital does not have a pediatric ICU, which means extreme monitoring of the patient was not feasibly allowed.
Not all hospitals are supposed to have PICUs, which is why the country has referral centers: SGH, AUBMC.
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Sorry,Dunno why my comment was posted twice….
Again here you are confirming my argument that there was no extreme monitoring of Ellas illness!She has been treated by residents which in her sensitive case does not help!!! Her pediatrician should have interfered on the spot and asked the parents to transfer her to a referral center!
If the residents took her case lightly then the hospital should be held responsible!
And as u mentioned that we- non medical people- are not the ones to judge then how are u asking the parents to decide whether she needs a PICU or No? How can they know that the university hospital does not have what is necessary for their baby?!? Here comes the responsibility of the hospital and the Dr!! The delay in their reaction is what caused this bad outcome to this poor baby!!!
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The residents told the family that there was no ICU in their hospital. the residents may not have the same amount of training as their attending physicians, but they are the final line before reaching the attending physician who is ALWAYS informed of what is going on by ACCURATE reports by his pupils who have studied OVER 10 YEARS to perfect.
Furthermore, a senior resident took time away from her OWN PATIENTS to travel with the family to another institution in order to ensure the baby was in good hands.
That being said, I am no suggesting that little Ella deserved what she got, and I am not suggesting that the family deserved what they got.
The journalists being treated in a less than gracious way only reported what happened after they, within the confines of the Order of Physicians, had pushed and harassed the doctors to reach that point.
Please use your common sense and consider that we as a population in Lebanon always tell when corruption occurs, and this instance is not one of them. Please focus on the more pressing matters that the media covers up by reporting on these kinds of stories.
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You are absolutely right Diana. I almost lost my leg because of my GP in Canada as she was not giving the proper medications until a nurse told me not to listen to her and to go to Emergency. They took xray and scan and they contacted the infectious disease doctors right away to give me the correct antibiotics and medicine. Had he contacted an infectious disease doctor on time, none of this could of happened to Ella. He caused her and her parents to suffer for the rest of their life. I am learning now that most doctors in Lebanon have no conscientious whatsoever. How can they support him while the poor Ella is lying with no hands and legs. I wish I was in Lebanon but I rely on you people and the media to do something about it. Please do marches and demonstrations in support of Ella. There should be a fund for Ella and this son of a …. should be sued for a every penny he got along with the doctors who are supporting him. He only belongs in Jail. Him and the hospital are responsible and should pay for it.
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no diana; even though this hospital is a mediocre hospital, i do not think it is the hospital mistake; it is just the natural course of the disease which could not be arrested…. whether there were some lacunae in the approach i do not know but they would not have made a hell of a difference; whose mistake is it: it is marcel ghanems mistake and kalam el nass for being just a sensational newsmedia looking for numbers and money
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shall we understand from point 3 that the Hospital is reponsible because they did not report back Ellas deterioration?!?
If so ,then there is no doubt Ella has been the victim of mistake/misscomunication and nonchalence!!
Maybe if the Dr knew earlier, he would have taken other measures!
Bottom line, yes we are not medical doctors and we can not judge scientifically Ella’s case but it is obvious- even from your article-that there is a missing loop for which someone should be held responsible!!!
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Replied to you on your other comment.
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My dear “Fadi”, you have missed the point, not once, not twice, but three times.
I don’t see anyone being “defensive”, and no one is trying to cover up for mistakes.
What the community, the media and yourself is failing to understand is that this is not the way things are handled. In the Western world, when an error happens, it is investigated through, and a proper trial is held in which experts in the field are brought and the case is scrutinized from A-Z, the management is scrutinized and a judgement is passed by the court. In our example here, the experts were the parents, the judge was Marcel Ghanem. If a court is to be held, and the doctor was proven to have made a serious mistake, and the child was mistreated, all the doctors that you perceived as “defensive” will all step down, and that decision would be respected. Our “defensiveness” is not for the sake of covering up a mistake.. Our “defensiveness” is to how an issue like this should be handled.
Was there an investigation? NO. Was there a proper trial? NO.
Have you ever seen anyone going to jail in the western world just because he was on CNN for a few hours, without a proper investigation or trial? I don’t think so.
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كشف المدعي العام التمييزي القاضي سمير حمود للـLBCI، أنّ “الطبيب عصام معلوف اعترف خلال التحقيق معه بالخطأ في تشخيص الوضع الطبي للطفلة إيلا وعلى هذا الأساس تم توقيفه وإحالته الى قاضي التحقيق في بيروت جورج رزق”.
Is that enough for you ?!
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la2. khalas de2 l may may. 3taraf w baadon bisher3o. lol
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This has nothing to do with medical error. This is an issue of neglect. MEDICAL NEGLECT. when a doctor is told that an infant Ella’s age has a fever, and for that duration, it is his job to see her immediately, take her medical history, ask if she has been near anyone sick in the last week…. It is his job. It is not mere politeness. And it is by no means acceptable to prescribe medication over the phone, and postpone VISUALLY SEEING a patient that age when they have a fever.
Stop generalizing this case and likening it to the case of the pregnant woman with the embolism. This is not a case of medical error. We all make mistakes. It would be a shame if all doctors went to jail for that. But as a medical student, I’m very well aware that this is not a medical error in itself. This is neglect. This is ethics. The reason Ella’s condition reached the point of DIC was because she was not seen at an earlier date.
We are not discussing some untreatable illness, or someone who is on the brink of losing their limbs. This is a case of a little girl who was neglected the appropriate treatment as per protocol. For all we know, in an alternate universe, her pediatrician may have seen her and given the proper care and she would still be here. (If that was the case he would not be at fault) For all we know, the very same events could have occurred except that by some miracle Ella didn’t lose her limbs. In both scenarios, her pediatrician is guilty of NEGLECT.
So perhaps Marcel Ghanem is crossing the line making accusations he doesn’t understand, but his ignorance, doesn’t justify the actions of the doctor he is accusing.
When you become a doctor you take an oath to put your patients before yourself. Their health before yourself. The moment Ella was neglected, that oath was broken. And that is ALL.
You conveniently mention many cases of “wrongfully accused medical doctors” as per the media. However, let us not turn a blind eye to the more common scenario, in which neglectful doctors are protected by the law.
All in all, we can all hope for easier times for the families of both Ella and those who tried to help her including her pediatrician.
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Let’s not talk about neglect.
First time the family was told to come to the hospital they said they wouldn’t come right away but come the next day instead, so even if you call it medical neglect (which boils down to medical error), there are other factors in play…
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I love your text.
It says exactly what we should all say very loudly.
How can we translate to arabic and distribute ?
You didn’t waste 7 years studying. Leave the country and go work in a civilized surrounding. They deserve to be treated by doctors trained in russia or east europe. This is what this people is asking for, and this is what this country is going to have very quickly. Don’t waste your time answering their comments. Hopeless.
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May I suggest a 2 part solution:
1- The Lebanese Order of Physicians appoint a Scientific committee that presides over medical cases of contention formed by well recognised specialist with an impartial and exemplary reputation… the committee will be the reference for all media and medical concerns related to the case
2- To have a specialised tribunal for medical cases including specialised Judiciary / medical experts that would be seized by the case and address it adequately…
The presence of a number of bad doctors should not be an excuse for this media witch hunt against the whole profession who still encompass a big number of exemplary , consciencous and patient loving doctors…
The worldwide mortality rate of necrotising fascitis is reported by scientific reviews to be between 50 and 80 per cent…
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We may have a shitty justice system with shitty laws but I don’t think it’s that shitty to convict people based on what the media thinks. So I believe that this whole thing should be left to the justice department to deal with. Not the media, not the public and certainly not other doctors. Whether what Ella’s parents said or what Dr. Maalouf said no one can know the whole truth. As the proverb says “ma 7ada 7atet fo2 raso 5ayme”, let’s stick to that because we will never know what actually happened. What we know is it is a tragedy as a young girl’s life is ruined and that we should pray for her instead of playing the who’s at blame game.
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It is useful to analyze the situation, to comment it and to remember all the details and the facts that lead to it but I hope that everyone can remember that the objective is not only to see who was wrong and who was right. The objective is to make all the procedures so that this kind of accidents do not happen another time.
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This happens in hospitals all the time in Morbidity and Mortality conferences.
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Agreed. And also, to find a solution to make her life better.
This, for example, might help Baby Ella: https://www.youtube.com/watch?v=oEx5lmbCKtY
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Medical mistakes happen and I had the misfortune to witness few ones (not with outcomes like Ella). In her case, the Dr. is 99% right, there is nothing much to do with viral infections, true. So where did the remaining 1% go? Remember people, the doctor is a human being and yes, like all of us, he can make innocent mistakes (no need for pitchforks). There’s nothing more hurtful than watching a loved one suffering or having a complication and you can’t do anything. The humane side is hard to digest for all of us but that Dr. (and i know him personally), is very renown to be skilled, ethical and people flock to his clinic because of this. Again, before any one judges me, Ella paid a hefty price, call it bad luck, call it karma, call it “saybit 3ein” but the Dr ain’t that bad. Sure the media needs a scapegoat because they sometimes mingle with things beyond them, those trio (Ghanem, Maalouf and Khalife) like to blow things out of proportion because it’s their job to highlight a story and, sadly, take biased opinions without listening to reason. No, not all journalists are like this but they only focused on the humane side. Now if you open a law book, it is stated that every illness or procedure has an inclusive risk even low (pulling a tooth out can kill you, yeah it can, even though remotely). So the Dr.’s, whether we like it or not, can’t be held accountable unless he purposely neglected his patient, which I don’t see it in this case. If you won’t to judge someone in this country and blow it out of proportion people, start with our politicians. They are killing us in so many ways every single day!
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it is obvious dear DOCTOR who has studied 7 years ….. That u have something against journalists. Well i am sooooo happy that this and even more could happen to this neglecting doctor as he ruined the girl s life. Not once so far were medical errors punished and this is mainly due to the corruption you are talking about. It is about time these things change and doctors start taking their job more setiously!
It would be in your interest to concentrate on your work rather on media to make sure you avoid medical errors in your practice.
God forgive you ….
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Seeing as the media has affected us so negatively recently, I think, on the contrary, that we need to focus on the media. (I won’t comment on the childishness of your post)
The difference, however, is that we look at things with a critical eye, whether it is during our 7 years of study, our five year of specialty training (during which we study), our 3 years of subspecialty training (during which we study) or our practice (during which we study to stay up to date).
If we don’t do this, we fail to properly help you… so please don’t think we don’t take our jobs seriously.
You have just demonstrated your unfounded spite, simply because someone has “something against journalists”. You took personal offense at a generalization.
I understand that journalists also look at things in a critical eye, don’t get me wrong, but you are founding your arguments on emotion rather than medicine.
Indeed, corruption exists, but that is going unreported except for small fluff pieces before the evening news. The headlines are taken by things that the media believe they can influence, rather than what they should be attempting to influence. This happens in every country.
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Thank you for looking past what they are trying to make us focus on.
This is the same kind of coverage/bad publicity that other people have received by the media and subsequently our politicians when much more serious and pressing matters were presenting themselves and being overshadowed by those very same politicians
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It is obvious that the Lebanese people have lost trust in authorities, the order of physicians in this case. It is also obvious that the problem was not approached the way such cases should be approached i.e professional investigation followed by a verdict. I suggest the Lebanese order of physicians rely on a neutral non-Lebanese committe, composed of specialists that re-investigate the case. In case the the Doctor is found guilty he goes to Jail, in case the doctor found innocent then Marcel Ghanem and Joe Maalouf go to Jail …Fair enough?
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They should go to jail anyways because at this rate they will be soon be leading panic riots across Lebanon.
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What do you mean by illegally arrested fro 48 hours? how can this happen ?
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Unfounded arrests occur in Lebanon all the time, usually to satisfy a political plot
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well.. thank you for acting like Marcel Ghanem and giving the same unfounded argument.. especially in field in which most of the people are not expert in.
The Doctor admitted during the investigation that he made a mistake in assessing the case of Ella. On the basis of this deposition, the Prosecution decided to keep him in custody for 48 hours (renewable) for the needs of the investigation. During these 48 x 2 hours, the prosecutor will decide, base on the investigation, to charge him and transfer him to court, or just release him. He can also release him and charge him in the same time.. he will eventually ask him to hand over his passport to make sure he remains in country.
The above is just an objective legal approach of the case.. so stop saying that he was illegally detained, like Marcel ghanem and the other stupid guy tony khalifeh and Joe (forgot his last name!!!) will bark on TV… just saying!
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Personal experience… just saying
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I’m a nursing student within aub’s faculty of medicine. I just think it should be recognised that nurses should too be taken into account and ought to be defended just as fairly as many nurses are given cra* for things they ought to not be held responsible for, but they do not get recognised seeing as Lebanon has managed to make the idea of an MD holy, and that of an RN not. I think it should be taken into account that nurses detect medical errors, judge medical decisions (the number of timesI have corrected a physician’s order seeing as they were too busy being far up their a** are endless), diagnose and treat patients too. This false idea ought to be recognized seeing as this post focuses on how media-driven our society is, and one of the many media-driven socially built values we have created is that it is somehow okay to shi* on nurses but not on doctors.
DIC is lethal and there isn’t much that could have been done. (A woman in labor once developped it and instantly passed) I wish good and fortunate rehabilitation to Ella and her family.
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True
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this is an excellent explanation
The real issue in Lebanon is that the public has absolutely no clue when it comes to their healthcare.
Their health should be a matter of discussion and debate but instead they treat their physicians as gods. As they do to all authority figures (politicians…)
” Take this medicine. Oh okay.
Why am I taking it. What should I expect. Any side effects. What condition do I have.”
Nope.That sense of curiosity and desire to learn is absent. Taken over by blind trust. “Ma my doctor told me to take it ”
As a practicing physician in the U.S. , having done med school and 2 years of residency in Lebanon the differences are vast when it comes to both healthcare and patients
Physicians are not held accountable regarding their quality of care. Evidence based medicine is not practiced consistently.
Go to ten different doctors for strep throat and all ten in the U.S would prescribe penicillin/amoxicillin. Do the same in Lebanon and you get ten different meds depending on what drug rep shows up the most.
Patients are not educated about their health , their test results or their medications. “The doctor never called me so my MRI must be normal ”
Patients as stated above need to be held accountable for their bodies , what meds they put into it and how satisfied they are with reasons/explanations regarding their illnesses.
“I have headaches weight loss and vision changes. My doctor told me it was a migraine and gave me Tylenol.” Really you’re okay with that explanation !?
I’m not saying go to webmd or the doctors and read up on everything. But a sense of curiosity and learning basic terms and concepts does lead to a better understanding over time
So I believe both sides are at fault here
1- please obtain a copy of the Lebanese order of physicians report regarding the above incident. I would be happy to help you translate and analyze it.
As of now there are plenty of gaps regarding the timeline of her care , “blood tests show it was a virus ?” , she likely had strep from day one , once she got to the hospital what initial testing was done and who took over her care and so forth
2- regarding the patients parents. It seems they were seen in clinic once and rest of communication occurred over the phone on the weekend. Perhaps they did not understand or relay the severity of their daughters situation over the phone else she probably would have been sent to the ER sooner.
You should never ever make a diagnosis over the phone as we always used to do in Lebanon.
Again I could go on for days about the frustration I had and continue to have regarding healthcare in Lebanon
Awareness is key. When you educate your patients you empower them to make better decisions and involve them in their health.
Power is knowledge
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“Knowledge is power.”
Amen to that.
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I agree with that… so if u ignore the law, u better not give ur legal opinion also on the fact that the Dr. Is being arrested for the investigation needs.. just saying!
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100%
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I don’t think there is a reasonable way to communicate the details of this case with the general population. If doctors simplify things to their level, they will say that the physicians are riding their high horses and don’t think the population would understand (at best), or there will be many points open for misinterpretation. If doctors present the facts as they happened, to demonstrate every detail of the case, then the general population would most likely not understand two words of what was said, or they will again think that doctors are using their fancy shmancy medical jargon to sway the public opinion.
I am not a doctor, but I do have some basic background in life sciences. And the striking thing about the media is that, without exception, they all referred to the Streptococcus organism as a virus. Any minimal amount of research – I do not mean a high-end scientific database search, but a simple Google query – would have clearly showed that this Streptococcus is a bacteria, and not a virus. Even Mr Tannous says it in his reportage. This is a simple proof that the journalists/media are not researching their topics before reporting them. Unfortunately, this says a lot about the quality of their work.
I am not defending the doctor in question here, for I do not know the specifics of what happened. This task is for the investigative task force of the Lebanese Order of Physicians to carry on, and then made public. In my opinion, only then can the media, advised by external physicians or people with some background in medicine, criticise/publicise/report/blame/praise/exert their right of freedom of speech.
At any rate, my question for the future Dr Fares is this: how did you know that Baby Ella was suffering from DIC and not necrotizing fasciitis (Wikipedia search of GAS)? or that it was caused by GAS and not GBS?
Finally, we are all to blame. The doctor for his *potential* neglect as Raya mentions, the media for their aggressiveness and lack of research, and the health system in Lebanon as a whole. By that, I mean the mentality that only the patient’s doctor has to see her, whereas the parents could have easily went to the emergency room, and whichever doctor “on call” would have assumed her care until her physician came – assuming hospitals even have that system.
P.S: In the reportage, Mr Tannous mentions that the Lebanese Red Cross could not come because there were no “7ajez”. I would like to also blame all of us for this reality, because the LRC are doing their best with the very limited funding they have. If we want more daytime availability, then there needs to be more paid emergency responders (because the volunteers all work during the day), and the only way this can happen is through *our* donations.
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Responding to my question, usually Necrotizing fasciitis needs a route of entry through the skin (trauma, wound, etc…) and an immune suppressed person.
Ella does not, as far as I know, have the obvious skin lesion, which makes DIC and sepsis more likely. I am aware it’s GAS because that was what the subsequent culture returned as a result.
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Okay. But doesn’t being a child in itself make her immunosuppressed?
I also read (Wikipedia again), that a diagnosis of DIC needs to meet certain criteria. Do you know if these criteria were met?
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True and she was ill. But the route of entry through the skin is not there as far as I know.
I do not work at AUBMC so I don’t have access to her lab work, but yeah you need blood markers to indicate DIC. A pediatrics resident told me that was the case, however.
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I have a question re Ella’s case. if a doctor examined Ella on Sunday would he be able to assess her case and prevent the amputation? Scientifically speaking.
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It depends on how her presentation was on Sunday. If she was just febrile and tired as her parents made it look, then it is less likely.
The kind of complication she likely had is not something you can predict.
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What about the thousand other doctors who are neglecting poor patients, lying and making unnecessary decisions to fill their pockets?
The problem is that, Marcel Ghanem didn’t care about what some doctors are doing to people until he had a small experience with someone in his family being neglected inside a hospital. When personal gain, political interest and revenge are the only fuel that drives the lebanese media into taking real action, I don’t really give a shit if the wrong doctor got jailed.
If you’re not ready to address the real problem here, then you’re feeding on this story to drive traffic just like any of the corrupted lebanese media.
Oh and you’re in med school, we get it.
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So your solution is to ruin any doctor you can just because there are some that are corrupt? Brilliant.
And I’m done with med school, please. ✋
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Marcel Ghanem’s relative was end stage. And since that moment he has had a personal vendetta against the hospital. Since then he has searched high and low to find people who were willing to slander the hospital.
In the process he has lead to an entire population of med students, residents and doctors to be unfairly treated, disrespected and insulted while going about their daily duties trying to help and reassure patients and their families.
He didn’t address the real problem, he only addressed his own interests and emotional (in)stability.
Here’s a problem: a TV personality drops a patient at the emergency room and leaves his car stuck in the middle of the entrance to the ER. When he is politely asked to remove the car to the parking lot, he goes on a rant about how important he is and who he knows. Long story short, the security guard is fired and the reason is a man who is supposed to use his TV show to let the people have a voice decided he is above the people he claims to be an advocate of…
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Please doctor spare us the mother Theresa rhetorics. No one forced you to spend 7 years studying. Mostly most of people does it for money and prestige. I am not saying this is a bad thing but still you are not a charity…
Back to this unfortunate baby girl. She spent her Sunday in the hospital without Dr. MAALOUF bothering visit her despite her situation. We are know doctor how incompetent residents are especially when alone on Sunday. This aggravated her situation. The order of physician blamed him on ethical ground but stopped short for blaming him for the consequences.
This mafia mindset must be stopped.
Whether the limbs of this baby could have been saved our not I am in no position to judge but one thing is sure is that the negligence of Dr. Malouf played an important role in this dramatic event.
So please cut the crap…
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You should read the Hippocratic Oath. This is the code that most doctors follow. It is true that some forsake this oath, but it is well known who these people are, at least within the medical community.
You should also refrain from insulting every single resident by saying they are incompetent, especially if you have no part to play in the healing of others.
The doctor was away, but his instructions are carried out by your incompetent residents to the letter because at the end of the day, he is still their Attending, their mentor and their boss. In addition to carrying out his instructions, they report to him every single thing that is deemed a major event, and when residents become seniors, they are far from being incompetent as you are suggesting.
Your certitude that Dr. Maalouf was negligent is false as explained in the above paragraph.
If you have an informed comment to make, or a valid point of view please do so.
If you have unfounded accusations based on your own twisted perceptions, please cut the crap
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Dear Andreas,
I think you can clearly see that being a doctor in Lebanon brings neither money nor prestige. They are eaten alive by the media and people, and I believe hearing that the average salary (over the 12,000 or so doctors in Lebanon) is about $1,000. For the same amount of hours they invest (I think it’s more than 80 hours per week, according to my friends in medicine), they could be making more money working at McDonald’s.
What you are referring to are the top 0.1% who make it into the big academic hospitals. Again people, do your research.
And as for the baby, you cannot possibly believe that an entire hospital consisting of students, nurses, residents in training, emergency physicians, attending physicians, and other pediatricians on call, was not able to help her but only Dr. Maalouf had the magical knowledge and that his Sunday visit would have been curative. Is this what a good health system is, in your opinion? What if Dr. Maalouf was abroad… is there no one else at the hospital capable of assuming the care? So, enough with the mentality that “my doctor HAS to come see me”. There are many other doctors who are equally qualified.
And another simple Google search of “Disseminated Intravascular Coagulation + Amputation” would tell you that “a complication of DIC can be symmetric gangrene and amputation”, which is sadly what Baby Ella suffered. But you will also read that DIC, even when optimally treated, is fatal in up to 50% of cases.
As harsh a reality as it, the disease took away her limbs. The doctors saved her life.
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Well said, good sir.
Doctor
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Very well said!!!
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Her pediatrician did not save her life. He acted negligently, and he’s the reason she’s lost all her limbs.
And what a bunch of baloney you’re spewing about the average salary of doctors in Lebanon being $1,000! Maybe that’s the salary they dishonestly declare to the government. Maybe you’re counting the retired MDs who are no longer working. But in reality, what you say is not true. An average salary of doctors, even here in lowly Tripoli, is at least a few times more than what you say.
You said, “do your research people!” I say, show us the source of your ridiculous claim.
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Simply people and “DOCTORS”, according to the law every suspect -and yes even if he was a “DOCTOR” or what we accurately call: a physician- can be detained for duration of the investigation.
If you want to raise an issue about the media, then this is a mere drop in the vast ocean… media is controlling policies of major international powers -political, military and economical-, so I guess that you need to tackle the problem on a major scale.
“DOCTOR” Hussein Hijazi
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Very interesting–thanks for the medical analysis. As you say, judgement of such a complicated case (indeed judgement of any issue) should be based on sound fact as determined by those qualified to assess the facts. Each case is unique, with many variables at play, and there is no place for the speculation of the media or the masses. Wanting to find blame for life’s often tragic circumstances may be a natural urge, but it is a dangerous one. It is surely no substitute for dealing with the fundamental causes of the situation: research and understanding of the virus and the infection, why they occur, what can we do to manage their occurrence, and so on.
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Reblogged this on MedVice and commented:
Well said. The case of the media having the right to slaughter a doctor’s life in minutes. Doctors should have a right not to be mentioned by name on the media nor slandered at least without their physical presence to defend themselves.
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Hi There,
I usually don’t post responses but I thought I can contribute. I work in Infection Prevention and Epidemiology in the US and when I read the summarized incident, I told myself “most probable septic shock” as soon as I read viral infection with constant fever not responding to medication. A couple of things to note. Delivery of healthcare involves all disciplines (not only physicians). As a one time patient in Lebanon, we have a very very weak link and that is nursing (my background is nursing). Having said that, there are anti-virals that can be considered (I don’t know the exact capability of giving anti-virals in this case but I hope that was looked into). Did a physician assess the child upon transfer? I don’t know if AUBMC has onsite physicians that are eligible to treat the child. Septic shock screening protocols are probably not in place. The child was going into organ failure. Never believe that there is no opportunity for improvement! As soon as you believe that, you have lost. Was the baby put in NICU upon arrival? Was there a call to the physician when no urine output was identified? Was hydration adequately prescribed? Were blood cultures obtain frequently (fever did not go down)? Was the nursing staff trained to identify symptoms of shock? Etc…Again, there is always room for improvement. We have great minds in Lebanon but we don’t have the right healthcare infrastructure that could have limited the damage. The peer review board should consists of physicians and nursing leadership (that probably did not happen). A root cause analysis should occur at the hospital to identify gaps (I hope that happened).
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Birds of a feather..
It seems natural to defend your order and sarcastically ridicule everyone else. Accusing everyone of idiocy seems oh too farfetched by Lebanese med students.
Arrogance blinds that sane order which in turn places them on a pedestal higher than everyone else. Their best cover is their service to humanity and all those endless years of ‘suffering’ in med school.
Half your article is full of fallacies. Journalists serve their own agenda just as much as doctors do. Accidents happen due to negligence just as much as anything else. The poor girl lost her limbs. When we have a case, our doctor remembers every detail. Some are just good like that and others are not. It is a shame that you feel an enormous amount of duty towards negligent for the fear of doing that same mistake. I hope all negligent people that deal with people’s lives end up behind bars. Cheers and I’m sorry for the 7 years of hell you endured.
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With all my respect to what u wrote but this does mean that doctors are prophets and dnt commit mistakes;yes complications can occur but there are also other aspects that should be addressed with pat relatives COMMUNICATION and in such cases polite COMMUNICATION showing them our love ‘tender and care .
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So god is to praise and thank when a child/ person is cured, but god is not to blame when a child loses her limbs?
typical! god gets the credit, doctor gets the blame.
someone tell the parents they are lucky she’s alive. (something to thank god for of course)
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So now you want to be thanked like a god for letting her live !!
The way physicians are approaching this is putting you guys in a deeper problem !!
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i am not a doctor, not even close. i don’t know why you assumed a person would not agree with the blogpost unless he is a doctor. we as people just tend to like pointing and blaming. i might not agree on every single point, but i do know that complications happen, and things get hard, and not everything is predictable, and as a person whose best friend is a doctor i do know how hard it is on them and how much they have to work to get to where they are. and i do know how many long hours they spend at hospitals day in and day i out, and i do know the effort, the nerves, the responsibility that comes with all of it. i say hats off to them, you cant save 100% of your patients, no matter how good a doctor you are, because people die, that’s the truth of life. and i do think people should show doctors a little more appreciation, because they practically have no life (no offense to all you MDs in here) just they get a chance to save yours.
i’m not saying thank them like a god, i dont believe in gods, i do believe in science and doctors though, so i thank doctors.
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Why are you defending all the doctors out there? Who attacked them? Both my uncles are doctors! Im attacking the person responsible not ur friend nor my uncles or my doctor friends! I respect all of them and im in the medical field so yeah hats off to all of the people in healthcare who care about their patients.
Regarding this case there was negligence! Period!
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the guy im replying to attacked them. and attacked me with them for assuming i am a doctor.
i really hate commenting on blogs because i hate getting into discussions, it’s pointless.
let’s agree to disagree, i dont think it was negligence from the doctor. perhaps the hospital staff should have been there more, but i don’t see how the doctor went wrong.
that doesnt mean there are no bad doctors. i know several bad doctors, who don’t care, who dont stay up to date, who are just not good at what they do. what im saying was not defending all doctors. it was me feeling bad for the fact they never get credit, and always get blame (even if some of the blame is well deserved)
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if you are not a doctor, please look up the meaning of negligence and then lets come to discuss your point of view.
with all due respect to your best friend, but they chose this road and if they’re not ready or up to it then why do they put themselves in this position ! its called accountability.
on another point, when later to this you said “the guy im replying to attacked them”; i didnt attach anyone !! i simply voiced out that they approaching this issue the wrong way and this matter has turned into a public matter now due to the unprofessional decision of the Order of physicians to suspend medical practice (except emergencies) the most (not all) doctors took this personally! should we be spectators to this !
PS: doctors do get the credits and everyday,however, we’re not here to distribute medals.
Please allow me to share an MD’s opinion and then i think you will have another thought of what you are standing for…
“We doctors make mistakes. Our patients know that. they still take their chances with the doctor they trust. In return to their “tolerance”, we promise to do our best and at least, care! To minimize our mistakes when we don’t know what is going on to a very sick baby, we make few phone calls, seek second opinions, and try to show up 2-3 times daily to examine the baby trying to look for clues. This is the least to expect. A doctor should not be crucified for a wrong judgment if he/she really did his best, abided by the standards of care, consulted everyone possible and genuinely cared for his patients.
What we have here however , is a different story. Should the reports we heard and seen about our doctor are true, then the guy is grossly negligent and should not be allowed to practice Medicine again; the least put him on probation and educate him and have him work under supervision. He was not only negligent, he never abided by the standards of care. He never did what every pediatrician (yours truly being one of them) will do in the presence of a highly febrile infant with no source for the fever.Never obtained the appropriate cultures (Blood and urine at least), ignored many cues from the parents and the nurses about renal failure and poor perfusion to the extremities and did not show the appropriate concern. There can’t be more evidence to this guy’s negligence and incompetence.
To further and deepen the disgrace of this profession in Lebanon, The order of physicians (Naquabeh), deepened the wound when they thought the doctor did everything he could and downplayed the element of negligence. They should be all ashamed of themselves for defending a ticking bomb who one day may be treating one of their kids’ or grandchildren’s. (would they seek him?). It is for this reason that the Press and Department of Justice should not only expose this doctor, but all the members of the order of physicians and make them all liable for this cover up. Knowing that there is going to be no punishment to this doctor worse than his conscious and living with the guilt of what he has done, the Naquabeh should be cleaned inside out. the disciplinary committee turned out to be as corrupt as the country in general. The AUB_MC (my alma matter) doctors who took part in the strike should also think about what they have done and start giving their students a better example. We exist to take care of our patients and not ourselves! Sheesh, what a joke of a Naquabeh!”
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Are you a parent?
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no i’m not a parent. and i do understand that it is devastating to see your child (or any human) in this situation. however i also do understand (as i read up a bit about it) the fatality rate of what she had, and when that rate exceeds 60%, then yes, she is lucky her doctor caught it early on (As it progresses really fast) and she is lucky to be alive.
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That explains everything then!
Her doctor caught it early? We should be thankful for that? Or we should probably feel sorry for the negligence that happened?
Once u become a mother you will understand. When u see ur baby taking his first step or holding his bottle you’ll understand.
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once i become a mother i will understand what?
that it’s okay for blaming people for things they have no control over?
yes you should be thankful the doctor caught it early, a couple more hours she would have been dead.
would have things been different if the doctor saw her the night before? unless his eyes are in fact able to perform testing and are in themselves medical equipment, it is not very likely him seeing her would have changed anything.
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but then again, i do understand seeing your child like this is very painful, and i dont blame the parents for blaming the doctor, maybe it makes them feel better to put blame on someone. i do however blame the media, for many things, for playing on people’s emotions for a few more views, for not checking their facts, for endangering the career of a person who instead of being innocent until proven guilty, is guilty until proven innocent.
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I will not continue my argument with you. You are focused on one thing only.
It’s too bad, people have lost a lot of faith, compassion, etc nowadays. God bless you and may you never have to endure anything like this family.
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One last thig Maria, i had a case after delivery 10 months ago. My doctor (obgyn) cane every day for 4 days to check on me day and late night. So hats off to these kind of doctors.
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Gutsy. I like it and I fully agree.
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well Doctor, if you’re not a human to sympathize with the poor child and objectively contribute to delivering justice rather than tryin to simplify the role of the physician and trying to make him seem inocient. The medical facts you stated are true however the delay in proper treatment is what got the child into such complications. This is negligence. Early detection and appropriate/timely referral are of the basics.
Saying “You wasted 7 years of your life in med school” means that you’re still fresh in medicine and do not have profound experience. So, it’s not early to shift to research of you think that you’re not up to it…
http://www.lbcgroup.tv/news/217352/قضية-الطفلة-ايلا-طنوس-تابع
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There’s an obvious negligence with this little girl’s case. I believe the hospital and its staff are the ones to blame and not Dr. Issam. Should Ella have got a proper treatment and follow up at the hospital from nurses and resident doctors her case wouldn’t have detoriated the way it did. I’m not a doctor but I exactly know what I’m talking about because I lived a similar experience with my son, when he was 7 month old but luckily we live in the US. He was 7 month old when he started a fever, the tests came negative for bacterial infection but after 4 days of high fever his pediatrician (who’s by the way Lebanese and AUB graduate) recommended we check him in at the hospital. They immediately put him on antibiotics even before the cultures results came out. Nurses were coming to our room every 2 hours checking his temperature, changing his diaper and weighing it every single time (they wanted to know how much he was peeing). When I asked why he’s been giving antibiotics when he didn’t have a bacterial infection, the answer was that they didn’t want to take any risks with babies that young especially that they can catch easily a bacterial infection. We stayed 5 days at the hospital until all bacterial cultures came out negative and the fever went down. His pediatrician only visited him once, the pediatric section nurses and doctors were the ones primarily following up and keeping his pediatrician informed.
I believe we have great doctors in Lebanon but unfortunately I cannot say the same about the hospitals. Lebanese hospitals are for the majority simply horrible.
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i wonder how come that 1 year old girl stayed 5 day with high grade fever without antibiotics.
Maybe your medical guidelines should be modified to prevent such complications, Because a simple streptococcus infection which is treatable with a simple antibiotics if it was well diagnosed from the very biggining would this happen.
You are afraid from prescribing abx because ur guidelines say this increase resistance
Allow me sir to apologize that a one years old girl with a weak immune system extremely need abx to recover specially more than 3 days high fever
Even guideline say for otitis for pediatric less than one year old need immediate abx.
All my respect
Benefits out weight the risk
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Hey youssef, i was going through this blog and I found your comment by mistake! I’m a student doing his clerkship now in a lebanese hospital!
Allow me to tell you dear, the international guidelines are not based on chaos and personal opinions! These are years-long studies conducted on many models and published with many reviews! In the case we have here, any human being who is infected by a virus doesn’t have/need/can take any antibiotic, not only for the risk of resistance, but the drug won’t help doing anything, you’d be mistreating your diagnosis, not only that but antibiotics do have side effects and sometimes they have serious ones! As an analogy because my colleague was not able to make this idea clear maybe, consider you have a car with non functioning brakes and you decide to fix it by changing the fuel pump, that won’t only make you waste your money, doesn’t fix you car but also it might get you killed because of the non functioning brakes.
Additionally, this is not a simple strep infection, it’s an infection that got disseminated because of a patient who got immunocompromised, which led to a septic shock! This infection was a consequence of low immune system and not a cause of the patient not taking antibiotics!
Allow me finally to tell you, in medicine there are no midway measurements, research is conducted, studies are done, experiments are conducted for years and on a non-stop basis, and guidelines are always updated! So please next time you have a contribution in this field, be sure you’ve read the least of these studies, research, mechanisms, physiology, pathology, treatments and your contribution would be valuable!
With all respect
Medicine is not based on personal opinions
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I think you are confusing the term “presumptive treatment” with “empiric treatment”.
When a child has otitis media, you would have diagnosed otitis media based on certain clinical findings. Therefore, you can give “empiric antibiotics” targeting the most likely organism.
However, when a child has a fever with no other symptoms, then the management is based on the child’s age. The emergency department has these protocols on how to triage children presenting with fever. For example, between 0 and 1 month, rule out sepsis. Between 1 month and 3 months, rule out meningitis. (Do not quote me on the specifics, for I am not sure of them).
But the most likely cause of fever in a child more than 3 months old is a virus. And antibiotics do not work on viruses.
Here is a reliable source: http://emedicine.medscape.com/article/801598-overview#aw2aab6b8
I would appreciate it if you would also quote your sources. It makes for a more fruitful debate.
I hope this clarifies things a bit.
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You have a sick and toxic baby. sick enough to put her in a hospital, High grade fever and no source. You wouldn’t obtain a blood culture? At least a blood culture?! forget about this guy’s negligence, what did he learn in medical School?
May be he should not have been arrested. But the desperate parents were not helped by the corrupt Order of Physicians. Where else would they go? the Judicial system had to interfere and do something. Sad, but it is all the mistake of the Naquabeh. They led us here. Have they been transparent and honest and have they disciplined their doctor the guy would not have been in Jail now. In court probably, but not in jail.
Please review the Rochester criteria for fever with no source in infants 3-36 months. Most of us (Pediatricians) in the US abide by it.
http://www.fpnotebook.com/ID/Peds/FvrWthtFcsMngmnt3T36Mnths.htm
http://www.uptodate.com/contents/strategies-for-the-evaluation-of-fever-in-neonates-and-infants-less-than-three-months-of-age
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She was not toxic in the first few days, only febrile. And from what I heard the fever was not even high grade, but about 38.5 degrees max.
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Amalia,
She was not toxic maybe, but sick enough. Not only the criteria above make you obtain the blood cultures, but common sense. I am not sure if he was stubborn or plain ignorant. Why did he not take his patient more seriously? If sepsis is normal and unpreventable, than all of us are doomed. Our job is to catch the infection before the patient gets septic and more importantly way before it turns into DIC! Of course her temp was 38.5 in the beginning, It would have. Still she got septic in the hands of her doctor. The guy did not do his job properly and betrayed his oath. I guess this is what gross negligence and incompetence look like. If this guy was not negligent, than who is?
Everybody talks about a virus. What Virus was that (do we have an id?) If they are relying on the CBC and the differential, we all know that the CBC can be often misleading. How many patient with lobar pneumonias did you have with a normal white count and mostly lymphocytes?.
Cheers
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Dear Doctor, with all due respect to you and your profession, I do not agree with you. At first i thought you must be right but then I saw the report and heard the name of the hospital that the baby was admitted to and I was petrified. In my opinion and from personal experiences this hospital should be closed. Human beings and their health are not lab rats for students to experiment on and doctors rarely do come when needed at this hospital. My father stayed there for a whole year on and off and he was nearly killed due to neglect from a certain doctor.
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Ohhhh for heaven’s sake shut up!!! No doctor has ever been held accountable in Lebanon…
Always covered by the corrupt order of physicians…
So spare us the drama and shut up!!!!
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“When the parents saw that their child’s situation did not improve they took her to the hospital. It was a Sunday. The pediatrician did not see Ella that day and instead saw her the following day when she had already deteriorated.”
He should have seen her on Sunday. Period. That’s his negligence.
The hospital should have communicated the seriousness of her condition to the doctor, or he should have gotten that info from whomever saw her, that’s on the hospital.
The parents should have gotten a second opinion, especially since her condition was that bad and obviously they were not convinced with the docs diagnosis. That’s on them.
So in summary there’s a lot of blame to go around and it has nothing to do with how much knowledgeable you are in the matters of science out medicine.
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raw2ouwa ya shabeb
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Reblogged this on Ned Hamson's Second Line View of the News and commented:
Profit motives of press, corrupt around the world. The doctor saved her life, not ruined it!
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First off let me define negligence in medicine: the commission of an act that a prudent person should have not done or the omission of an act that a prudent person should have done that results to harm, injury or death of a patient.
This situation is a classic example of negligence. You scrutinized the situation point by point but did it ever dawn on you that it is of sound judgement of a prudent doctor to send a 9-month old infant with high grade fever suspected with viral infection under the watch of parents who are untrained with no medical background? Do you think what he did is not negligent? This is a 9-month old infant with underdeveloped immune system and is unable to maintain homeostasis immediately. It is very likely this infant is also not eating well, hence, dehydration occurred. Giving all these circumstances and the 7 years of med school you endure, based on your professional judgment, will you send the infant home or send the infant to be admitted in a hospital?
Yes, viral infections are treated palliatively and let the patient ride the tide. As a medical doctor with years of experience I supposed and 7 years of med school, will you let a 9 month old patient with viral infection, high grade fever, presumably loss of appettite, ride the tide under the watch of untrained parents or will you let the patient ride the tide in a hospital wherein she can be monitored 24/7?
You said despite the absence of the attending pediatrician, residents and on-call doctors in that university hospital reported what was happening to the patient. But mind you, you reitirated that hospital had no PICU, hence, these doctors do not have an intesive care training, they do not have the keen eyes of a trained, competent pediatrician or intensivist. In 10 of the reports from these residents, how many of them are accurate? This point is another evidence that this is a case of negligence because the doctor did not act accordingly and left the patient under the case of doctors with training wheels.
You claimed that the GAS was detected early. This is utterly rubbish. Not to offend your 7 years of med school, but You do know that it takes considerable amount of time or inaction before it advances to full-blown septicemia? And septicemia leads to DIC. Patient went into sepsis then DIC basically proves that the GAS was not diagnosed in the early stage and was already in the end stage of infection.
Of course, you are also fully aware that DIC is just a secondary diagnosis due to increase in tissue factor(found in cell membranes) that messes up the clotting and bleeding cascade. And in this case, the increase in tissue factor is caused by sepsis which caused cell destruction. And you are also fully aware that sepsis is preventable if treated early? And early treatment means there should be early detection? So with your experience and 7 years of med school, do you think the doctor detected the GAS at an early stage? Do you think if the dctor commenced rigid blood work up and started antibiotic therapy for GAS or even just prophylactic antibiotic while waiting for results, this tragedy will happen?
Do not equate amniotic embolism to this case. The closure of uterine sinuses is out of the hands of the doctors and the patients. But sepsis especially DIC are preventable complications if handled properly. or if he was not able to prevent at least you could have attempted to if he was prudent enough.
I don’t know if this blog you wrote will help you because it did reveal what you have reached with your 7 years of med school and endless years of training you have under your belt. Not everyone are unintelligible that they will believe what you wrote because you kept bragging about your 7 years of med school and endless years of training and giving them superficial medical truth about viruses, DIC and sepsis.
This is a case of negligence if there is a victim here, clearly it is that kid who lost her limbs and that is something she has to endure all her life. Oh, and one more question, with your 7 years in med school, all your knowledge in medicine and your training as a medical.doctor, if this happened to your kid,your siblings what will you do? Support this doctor or do what the parents are doing?
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Bravo on the “etalage de connaissance”! Im sure you graduated and you’re probably one hell of a doctor. Bringing a story like that on the media doesn’t mean that marcel ghanem or anyone is a doctor. It means we’re human, we get emotional.
Marcel Ghanem has years of experience in his field and I’m sure he did his research before bringing something that big on tv. So maybe you should try and be less ironic and more compassionate because what happened is unacceptable.
And yes a mistake was made, I don’t care about the medical terms you used, if we want to find an excuse to every mistake that has been made then we have a big problem.
If this happened to someone related to you, I’m sure i wont be reading this article.
I am not related to the family, i just saw what I saw and i think it’s time for people paying the prices for their mistakes.
At the end of the day you and you doctor friend don’t have to worry about your morning run or how to handle your sushi sticks; you still have your arms and legs but that poor girl is doomed for life.
No offense!
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“It means we’re human, we get emotional”.
True. But that doesn’t mean we can let ourselves and others be ruled by emotion. There have to be strict laws. Innocent until proven guilty, and not otherwise. There should be a full investigation, looking into the medical records, before publicising everything, no?
Again… that poor girl lost her arms and legs because of her illness, there is no denying that. But she will live a long and healthy life because of her doctorS.
You will be amazed at how much children can adapt. You will be even more amazed at where technology is taking us: https://www.youtube.com/watch?v=oEx5lmbCKtY
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Could you be any less of an insensitive asshole? Innocent until proven guilty? That poor girl will live a “long and HEALTHY life”????? Are you a plain idiot? What life? That doctor your are defending took away everything from that poor soul with his malpractice. Allow me to amputate your hands and legs and let me see how you will adapt with your amazing technology you moron. You can’t be a human being.
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100%
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Yes 🙂 a long and healthy life. Look at her. She looks like a healthy, well-fed, playful child. Forget about the hands and feet, and you couldn’t even tell that she was AT THE BRINK OF DEATH. She doesn’t have any significant or debilitating internal organ damage, she has no signs of long term mental/neurologic impairment. As far as her health is concerned, she might not need to be hospitalized again. Only rehabilitation.
On a separate note, are you 100% certain that if the doctor avoided his “malpractice”, he would have without a doubt saved her limbs?
Please, read Danielle’s post below.
And I also suggest you go get yourself an education. Your narrow repertoire of vocabulary and insults, as well as your lack of proper argument formation, only proves the quality of your parenting and education.
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Post your name here so people would know who the hell you are. Who the hell gives you the right to pour in your judgements on this poor girl’s parents and the journalists who brought this story to light? You spent 7 years of your life at Med school so you may come in here and type some medical terms hoping to impress the readers? Those terms should make you sound like a doctor? Yes you do have the right to judge an architect’s work when his design crumbles and falls on your thick head; Anybody has the right to judge a -wannabe- doctor if this doctor f*cks up in malpractice. Can you be any less insensitive towards this little child? What quality of life will she have when she grows up and learn that she is crippled because of a malpractice? Have you thought about what her parents are going through when they see their child like that? I just wish that you and all those ugly horns that back you up will have your daughters’ limbs amputated and let us see what you will post here… You spent 7 years of your life learning in Med school and you’re still a worthless jackass….
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U said what I forgot to say in my previous comment! 👌🏻👌🏻👌🏻
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The author’s name is present all over, you just don’t know how to read which makes you the worthless jackass. Jesus, people who can’t even understand the point come with insults. No one is saying Ella deserves what she got, but if you think ANYONE should be thrown in jail, have their name thrown in the mud WITHOUT investigation is fine, then 3a2belak
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so Amalia you do understand the point? Enlighten us with your idiocy and stupidity with your understanding of the point of what happened to this poor girl… you are worried about this doctor’s reputation????? are you a bit worried about this girl’s life you insensitive idiot? oh forgive me did I insult you here? or did you bring the insult upon yourself? maybe the point will become clearer to you when 3a2belik w 3a2bel your daughter and every child you love…. just another idiot jackass
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Reverting to ad hominem attacks. Very mature and Lebanese of you. *slow claps*
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ad hominem? so now you are trying to impress the readers here that you know a few Latin words? you forgot the “argumentum”… very mature and Lebanese? I gave up my Lebanese nationality a long time ago because of narcissistic people like you and that criminal doctor who play God and prey on the sick to make your 100$ consultations every 5 minutes. Inchallah you spend those dollars on your own health and the health of your loved ones(more mature and Lebanese words for your slow clapping). My words may have been immature, but I can’t think of better words to address your insensitive and cruel approach.
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You sir are the perfect example of the vindictive and spiteful spirit that plagues our country.
I wish that you will never have to live anything like what Ella’s parents did.
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We doctors make mistakes. Our patients know that. they still take their chances with the doctor they trust. In return to their “tolerance”, we promise to do our best and at least, care! To minimize our mistakes when we don’t know what is going on to a very sick baby, we make few phone calls, seek second opinions, and try to show up 2-3 times daily to examine the baby trying to look for clues. This is the least to expect. A doctor should not be crucified for a wrong judgment if he/she really did his best, abided by the standards of care, consulted everyone possible and genuinely cared for his patients.
What we have here however , is a different story. Should the reports we heard and seen about our doctor are true, then the guy is grossly negligent and should not be allowed to practice Medicine again; the least put him on probation and educate him and have him work under supervision. He was not only negligent, he never abided by the standards of care. He never did what every pediatrician (yours truly being one of them) will do in the presence of a highly febrile infant with no source for the fever.Never obtained the appropriate cultures (Blood and urine at least), ignored many cues from the parents and the nurses about renal failure and poor perfusion to the extremities and did not show the appropriate concern. There can’t be more evidence to this guy’s negligence and incompetence.
To further and deepen the disgrace of this profession in Lebanon, The order of physicians (Naquabeh), deepened the wound when they thought the doctor did everything he could and downplayed the element of negligence. They should be all ashamed of themselves for defending a ticking bomb who one day may be treating one of their kids’ or grandchildren’s. (would they seek him?). It is for this reason that the Press and Department of Justice should not only expose this doctor, but all the members of the order of physicians and make them all liable for this cover up. Knowing that there is going to be no punishment to this doctor worse than his conscious and living with the guilt of what he has done, the Naquabeh should be cleaned inside out. the disciplinary committee turned out to be as corrupt as the country in general. The AUB_MC (my alma matter) doctors who took part in the strike should also think about what they have done and start giving their students a better example. We exist to take care of our patients and not ourselves! Sheesh, what a joke of a Naquabeh!
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Who wrote this post and the other one? Really well written. Objective and shows the reality of media in Lebanon. Please let me know if you have a twitter account.
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A reply for those who are defending M Ghanem (then a reply for the one who calls people Jackasses):
1-If I want to be nice – Marcel is using the catastrophe that hit a baby, a family, and a Doctor, to try to correct the health care system in Lebanon. He is saying (his words): We have to put all the bad doctors in jail. He doesn’t dare putting the bad judges, politicians, bankers, … in jail, because they can destroy him in minutes, so he finds a juicy story about a doctor, and use this dramatic event to become our hero. If I want to be nice, I will say that he really thinks he is improving the health care system in Lebanon.
2-If I want to be objective (not nice) – Marcel got a lot of money and exposure from this story. He didn’t hesitate to splash in front of everybody the drama hitting the family and the doctor. He knows he will not improve our medical system, he knows that he might lose a few doctor friends of his, but he thought that the media impact of this sad story is worth it. Additionally, he has a personnel vendetta against that hospital.
Now for the one calling doctors Jackasses: You are a stupid person. There are idiots everywhere, and you are one of those. You can’t help it, and neither can we.
I am sure you are a successful man in your professional life with your way of thinking, unless you are one of those marcel ghanems that live in this country and tear it apart slowly.
As for what should be done: The lebanese order of physicians and Mr Abou Faour, and the minister of Justice must take hold of this issue immediately: They must forbid any public use of discussion of this story. Then a taskforce is to be created (with Lebanese and non-Lebanese professionals), to analyze the root causes of this unfortunate complication. Then the truth shall be announced and everyone will knw what happened and who was mistaken. It may be the hospital, the doctor, a resident, a nurse, it can be all of them, and to different degrees because the disease can also be something fulminant and unstoppable easily.
Please everybody, start thinking !!
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I agree with Fadi. Doctors in Lebanon ruined their own reputation, this s why no one belives them anymore when they issue “reports” to prove the innocence (or not) of their collegues. I am no expert in medicine either, and i am surely not accusing Dr. Maalouf, but I think his is paying the price of years of malpractice of some of his colleagues.
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Now I don’t know who the moron is who wrote those lines but I am sure he is a physician like me and that he must understand what I am going to say here.
A physician is not God and some dire complications may stil happen no matter what you do. But as long as you did do YOUR best to prevent a complication no one can blame you. Did that physician do his best? I don’t think so and I am not judging him by the result of his actions (or inaction) i.e. the amputation. I am going to explain.
It is most likely a horse but rarely it is a zebra and you should at least try to identify it. When the fever in that poor baby started it was normal to think it is most likely viral. But when she got admitted she was certainly getting worse and it didn’t happen like with a light switch that she developped DIC with microangiopathic embolization that led to amputation. And what did her physician do? NOT show up for 24 hours to tend to her and therefore NOT try his best to look for the zebra. He let disease natural history run its course and when it was too late he sent her to AUB where she could have died or, worse, have a stroke or kidney failure or distal limb amputation or any other complication of DIC. Had he showed up he could have identified a group A infection and given her penicillin. And even if he did not identify it or even if antibiotics didn’t work and in that case disease had run its course like it did, he would have done his best to prevent a complication. But since he spent his Sunday in his summer house and enjoyed the barbecue and arguileh and showed up Monday too little too late for that poor kid he was certainly wrong and he must pay for his action/inaction.
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Wow, very gracious of you to call someone a moron, especially when you are bound by oath to respect your peers. I’m not saying that you should defend what the imprisoned doctor did; you are entitled to your opinion and it would be more informed than another person.
I understand your point though I may not totally agree, and would like add that there are two parties in this story. Although I don’t want to point blame, have you considered the action of the family? I know for a fact they put off going to the ER when they were first asked to do so.
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How far in your medical career are you in?
I understand the concept of horses and zebras, but I thought that you, as a doctor, would also understand that medical care resides on an entire medical team, and not simply one physician.
IF you indeed are right, and the mistake is the failure of recognising that the patient was getting worse, then I think the entire medical team should be at fault. The residents (if there are any at the initial hospital), the nurses, and other physicians on call (including the ER physicians) (if there are any), and ultimately our entire health system. I ask again, what if that doctor was unavailable for some reason? What would have happened then? Should all his hospitalised patients stop receiving the required care?
And kindly refrain from using improper terms like “moron”. One would think that someone with your educational background would have the capacity and decency to provide a proper argument without referring to petty adjectives. Thanks.
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Does your practice in your country apply the principle of respondeat superior when it comes to accountability?
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I am not a physician, so I do not know. But I would assume you are right where the most superior should be held accountable, but only after due investigation, and not a priori.
However, accountability in this country is virtually non-existent, and clearly exercised through emotions fuelled by the media, and not reason and law. It is just sad to see this man suffering for the more obvious and flagrant mistakes of other physicians before him, while they, along with women-beaters, murderers, and corrupt politicians are walking freely among us. (off topic maybe, but true)
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i am sorry but the doctor should have come and see her the same day at the hospital. When my daughter was admitted for a similar case on a sundat night at 9pm, her doctor rushed to the hospital.
Symtomatic reliefe bullshit …. There is always a slight chance that your diagnosis is wrong, so when fever persists for several days you push your tests further, proof being is that he messed up a baby’s life ! He deserves to be in prison. When you do a mistake you have to pay the price
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There are many variables. A doctor this experienced can tell the difference, even if it does often seem like a similar case.
And speaking of mistakes, consider that despite the unavailability of an intensive care unit in the first hospital, they sent the patient to another institution, accompanied by a senior resident, this senior resident is there for a reason.
He doesn’t deserve to go to prison. If you want to investigate, you can, and possibly imprison later on. She is alive. Results in medicine are not always what we hope for.
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Before anything, I’d like to say I wasn’t there, I do not know however my strong impression is what follows from what I have understood both from the reported video and the blog writer’s additional information:
I don’t really see what people are talking about neglect, there was nothing that could be done and that’s why the girl’s disease progressed. There is clearly no neglect as the girl is alive, amputated but alive. DIC has an extremely high mortality rate and develops very rapidly. Even with early treatment it is still hard to treat, this patient received mid-early treatment, that’s why she is still alive. If she received “late” treatment she would have already been dead. It is hard to imagine that all our diseases cannot be solved with magic medicine. The doctor did nothing wrong, he did whatever he could medically, he made the right calls. The patient had a 50% chance to outright die WITH treatment (WHICH THIS PATIENT GOT!). Just google DIC and read about it. She has the worst type of DIC too, which was secondary bacterial infection due to immunocompromisation.
The reason everyone is so mad is that they think this patient had this complication when the doctor looked at her, which is not true. She didn’t have DIC till after her condition progressed. She had viral fever, and in this 1 in a million chance it progressed to ONE of the MILLION complications that are possible due to viral infection. She could have easily developed encephalitis that would later cause some sort of brain damage, there are many things that are possible. The worst of this is DIC has no direct cure, and even with early adequate treatment mortality is very high.
For those who are interested, in a simple manner, DIC is a form of the blood coagulating and creating many clots that make organs not become able to breath (they get no oxygen supply, ischemia) and fail/die. Causes can be anything from bacteria infection (this case) to just mechanical trauma (like a car accident). Treatment depends on the cause, in this case they would have to administer special antibiotics to the required area and surgically remove the infected area which antibiotics simply have no effect or amputate necrotic tissue. There are other treatments which I won’t get into.
Some (actually many) conditions that develop in medicine have no cure, no treatment. It is scary but this is reality, this is the world we were made in. It is a semi-tragedy in this case but trying to blame someone for it occurring when it isn’t his fault IS NOT a coping mechanism. Furthermore, the point of this article is not even about this case! We doctors see cases like these all the time, I’ve even heard of someone going in for a face-lift and having a hematoma compress the trachea leading to coma. These aren’t true medical errors, these are complications that occur in medicine which occur independently whether your doctor is from Harvard or ____. This article is about the shameful reporting of the lebanese media which has no obligation to apologize for a fake dramatized report. It is a sad case, but to blame someone for more views when its just life is not ok. In any other civilized country, the news station would be sued for defamation (wrongful lies that ruin reputation) and would be forced by LAW to apologize. Something that would never happen here in Lebanon. This is the issue. People outside Lebanon are just as pitchfork minded, but the reason they are civilized is because they have laws enforcing groups like media stations that they cannot defame and spread misinformation on these types of issues. Media here has no ethics because they have no responsibility. It is a shame. Trash media creates trash news and influences people to be ignorant, a good media source would have done a special about the DIC and educate their populous. It truly is shameful that the difference between Lebanon and “li bara lebnen” is so small yet so big.
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Dear Ahmad Medical Student,
You bring good points, but your job as a physician (and from the sounds of it you are going to be a great one), is to “first do no harm”. this means your goal is not only to keep your patient alive, rather keep her healthy and safe. keeping her alive after the sickness reached that level, only speaks of the great skills her doctors had at AUH.
the fact that the patient was allowed to become septic is the neglect itself allowing the sepsis to get into DIC by not identifying it earlier is even worse. not showing up to see his patient, not reacting to the nurse’s concerns and more importantly not following the standards of care in a febrile infant is the neglect itself. let us not hide behind our fingers here.
saying that most fevers are caused by viruses is like saying most abdominal pains are caused by gas. not showing up in a timely manner to examine your patient to make sure it was not appendicitis or a surgical condition is neglect. True, most patients die from a ruptured aortic aneurysm, but should you show up to examine the patient, Look for cues, follow the standards of care, preventing the rupture of the aneurism would have prevented the morbidity. the examples are many. Our gentleman had many chances to react appropriately, but he did not.
the Media is free to report anything. Thank god they exposed this corrupt system. You will graduate one day and hopefully get to pursue your residency in a country that respect human beings. You will learn the exact meaning of medicine. The attitude that you are being taught in Lebanon now is as corrupt as the system itself. Don’t become like them.
I remember when i got into Medical school at AUB, a prominent teacher used to walk into the lab looking at us proudly and saying:” you are the creme do la creme”‘. They never say that in the US. The humility I learned in the US was my greatest lesson. they beat you up right and left, the nurses shout at you and the patients teach you all the time. A good doctor will listen, care, and try to prevent bad outcome. Not wait for it to happen and than say tough luck. everybody dies from DIC, then hide in the pockets of his naquabeh!
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I was literally shaking my head when this medical student blatantly said she suffered a complication from the natural progression of infection and diminished it to a complication that is in no one hands. He just made it sound so natural. It is true that DIC has poor prognosis and has a HIGH mortality. But it is preventable. In this case, if the sepsis (precipitating factor of DIC) was halted, DIC may have been prevented, then embolization may not have occurred, her limbs may still be intact. I hope you got flow. Please study hard. Do not emulate these people. Serve the people and not your profession.
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Can’t agree more. The Doctor in question agreed he was negligent, but not the naquabeh and the majority of doctors. It is a question of attitude Ice. It is fed to the students the minute they get into medical school. This cannot continue like this.
I read your posts and fully agreed. Hang in there. We seem to be a minority
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Small correction to Dr Kassas: the doctor in question agreed to misdiagnosis, and not negligence.
Now, this might be true or not, but that was his confession.
P.S: In my opinion, he probably said this at the advice of his lawyers. Admitting to negligence means – as someone previously mentioned in a post – that he wilfully did not provide adequate care. However, admitting to misdiagnosis can be then played in court as a human error, and then they would present evidence to support that the diagnosis really was not evident at first, and so he would serve a smaller sentence.
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The only point I am making is that the writer of the blog said the doctor in question did do a blood test and revealed no signs of sepsis, and pointed to viral infection. To diagnosis such a case, specific lab tests need to be ordered after physical signs (not just a prolonged fever). Any medical student knows lab tests usually take at least 2 days to culture a bacteria. This case seemed like it developed over 48 hours, they saw the girl get worse (this is when the parents asked for another checkup, its not like they asked the doctor for the full 5 days) and then took her to the hospital, the doctor in question blatantly was “lazy”, had the idea “its a virus” and waited till the next day. This isn’t a crime, you can visit in a 24 hour period. The doctor could have had clinics all day with other patients, the doctor could have just said “ey I’ll see her tomorrow”. There are some doctors who don’t even visit (that’s real negligence). The hospital themselves did not obliged the doctor to come down. Then in 24 hours he came checked on the patient and made the right call to transfer her. All I am pointing out is that it is understandable.
That is what I have understood from this case. Its easier to blame then to understand the exact circumstances and label immediately as “negligent”. I understand in Lebanon and even more so in the states there are corrupt doctors. I am an American citizen I know the healthcare down in NY. But this guy just waited till the next day to check up on her, don’t make it bigger than it is. If you really want a news report, go report on doctors recommending unnecessary surgery for money, or famously in New York organ harvesting from unsuspecting people. That’s real evil, don’t tell me 24 hours is a crime, especially when the outcome would have been the same. Doctors don’t have X-ray vision and wasta with god to know that the patient had sepsis when she did not present any INITIAL signs/symptoms/or lab tests! It is a natural error, there was no ill will, there was nothing wrong done in my opinion. Talk about real misconduct instead of the errors whos outcome seems horrific but the steps were clearly logical for those who practice. It seems foreign to think “no way this outcome can be if they took the proper treatment”, but that’s reality of certain diseases.
I’m still a student, you tell me what to do when the patient developed no evidence and the hospital in question doesn’t oblige you to come (aka not an immediate ‘right now’ emergency). His actions are understandable, and he came for the treatment within 24 hours. What more do you want from a human, him to be god? He couldn’t do anything, once the parents took her to the hospital she already had sepsis. Nothing would have changed.
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Sorry I spoke to quick about one point, organ harvesting in NY, I meant Eastern Europe however these organs ended up in NY and London. Though there are still many cases of true malpractice in America. Some include the famous “baby died” then put up for adoption and the famous “syphilis study” on black Americans to say a few. Sorry no edit function.
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And one last thing, go look at this man’s Facebook page with his previous patients and students. It is heartbreaking to the extend the news report took it. Go see his previous patients say “this man saved my child”, “this man called me 3 times in 1 day when my daughter had so and so”. People in the medical profession should be ashamed to judge another doctor under these circumstances when they themselves are no better.
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Again let me reiterate the definition of negligence in medical ethics. It is the COMMISSION of an act that should have not been done by a prudent person or the OMISSION of an act that should have been done by a prudent person, that led to harm, injury, or death of a patient.
With that being said, and on the premise that people on the extreme end of the age groups (the young and the elderly) have the HIGHEST health risk, the doctor is culpable of negligence on several instances: 1) he sent the infant home despite having a tentative diagnosis of viral infection accompanied by high grade fever, he did not prescribed admission to the hospital where the patient can be monitored by nurses and doctors yet he let the infant go home and be watched over by her parents with no medical background. 2) he medically advised to apply cold compress for persistent high grade fever secondary to viral infection and giving the parents false reassurance instead of advising them to go the ER 3) he failed to commence PROPHYLACTIC antibiotic when the patient was admitted to the university hospital wherein by that time he knows that the patient is immunocompromised considering the age and condition. He should know that the patient is a sponge ready to absorb any nosocomial infections. This case is not just about the 24 hours he did not show up.
Dr. Kassas is right, if he acted accordingly on any of these circumstances, this tragedy may have been avoided.
To medical student, if within 48 hours the infection progressed to full blown sepsis, basically within 12-24 hours of the culture, a pathogen may have been identified and isolated.
Please bear this mantra in your mind, prevention is always better than cure.
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1) You don’t hospitalize viral infection, even bacterial infection at the stage he saw the patient. They do the same at the hospital which you do at home, provide symptomatic relief through anti-pyretics and rehydration. I don’t even know any insurance which covers the hospital for such a reason, if you find one give me their number quick! You live in lala land my friend, not even America does that.
2) Yeah that’s what you do with high fever, in the hospital you do the same. Do you work at a hospital? You know this patient didn’t suddenly get all better at the hospital, it was when she got transferred to AUH FOR SURGERY. Hospitals aren’t mini-hogwarts academies where people go in and suddenly they are better.
3) You NEVER commence prophylatic antibiotics on viral infection. GO READ THE GUIDELINES, GO TO MEDICAL SCHOOL. Antibiotic side-effects are deadly, I have a friend who can’t hear out of 1 ear of his because he took antibiotics at 5 years of age. Antibiotics can reduce your normal flora and potentate a super infection even, why do you think clostridium dificile is seen in patients? And if you are in medical school, god help you and your practice, I pray the day you get something similar.
Go look up diagnosis of DIC and how hard it is, in AUB there was pregnant lady who died the other day in 48-72 hours after labor from DIC. You going to prosecute them too? Of course not. In America, same case happened recently, same circumstances and they praised god+doctors that the mother got to stay alive despite cutting off her limbs. I know prevention is better, but it was not applicable get your head out of your ass. Get educated.
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No matter how you twist it, and whatever mumbo-jumbo medical speculation, conjecturing and explanation you keep offering us, the guy has CONFESSED to his negligence. That’s why they took him in. (I personally do not agree with jailing him at this point in time.)
Now the only thing that has to be determined is whether he was criminally negligent.
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He did not confess negligence, they specifically said misdiagnosis. There is a giant difference. Misdiagnosis is claimed because he had no idea the girl had DIC, a extremely rare condition. Misdiagnosis is not a crime in cases as such.
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To Ahmad Medical Student:
Misdiagnosis could easily amount to medical neglect. When the doc did not follow standard guidelines, that’s not just misdiagnosis; that’s neglect.
(It’s important to note that the act does not need to be intentional to rise to the level of neglect.)
Now, whether he was criminally neglectful, that’s for the courts to decide.
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Dear Samira,
Misdiagnosis does not equal neglect. What is frustrating about this case is that the doctor did follow the right protocols. I saw someone post the international guidelines for this situation, you can read them.
He followed everything accordingly. That’s why this case is very frustrating to the medical community. This case makes us doctors not want to practice in Lebanon and furthermore, the current mentality that is developing in Lebanon is that when we receive a difficult case we don’t treat and try to refer to another physician avoiding such cases. Many patients will die in the future due to this mentality which is forced upon physicians.
This is the ultimate conclusion that is happening in Lebanon. You cannot blame innocent people. Lebanon’s medical confidence and quality level is dropping because of this public reaction due to terrible lies the media reports. I personally have decided to work abroad, and so will many of my fellow colleagues if given the chance, This is Lebanon’s loss, politics to appease the masses will destroy this country.
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There is a case of negligence that led to putting the doctor under investigation. The order decided to strike as if saying doctors are above the law. Then media got all over this.
It is the order of physicians that made things worse. A mistake occured and the doctor himself admitted to wrong diagnosis, so there is a case here. The doctor is apprehended for investigation, he was not yet prosecuted and jailed.
You need to be calmer and stop passing judgement on people, media, the parents. No one is assuming the role of a doctor, but people can identify negligence. Throwing around aome medical terms and mentioning 7 years of med school in every paragraph does not make you righteous.
If the doctor was innocent he will be let go. The order of physicians need to quit this mafia mentality.
Last, you need to research and understand that the minister of health has several doctors as consultants, this is why he did not refute the order’s statement, he just said it’s ambiguous and unclear.
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I believe you are wrong on a few points. “Only doctors can know when medical errors occur. Only doctors can judge another doctor who does a medical error. Only doctors know how to treat patients and diagnose them. Only doctors know how to manage complications.” Quoted from above. Namely – doctors are human. They can make mistakes – yet not every instance of poor outcome means unethical protocol.
Saying this as a mum of a baby in the hospital system – it is the most heart breaking thing to watch your baby deteriorate and not being able to do anything about it. I watched my baby go blind from hydrocephalus and was told on numerous occasions it was temporary and from other causes … when a simple albeit very risky procedure could have prevented it. It can send you to the edge of insanity knowing that they can help but won’t – while they believe that no harm will come and that a procedure is more likely to cause harm than good ie. risk of infection.
Yes, as doctors it is their judgement to make these decisions and I am sure they make many hard choices all through their careers. But as a parent – this is OUR child and we all expect and will fight for the very best care for our children. When we believe our child is not getting the help they need and then suffer for it – how can we not lash out? In a hospital setting there is often no one to turn to if your doctor says there is nothing they can do or will not do as they believe it is unnecessary. We may not be doctors but we are parents – and our input on OUR children is important – especially when they are young and cannot speak for themselves.
In, Queensland, Australia, that is why “Ryan’s Rule” was introduced.
My thoughts and prayers are with this little girl and her parents.
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