This DP article is very biased. As a physician, I can tell you that the medical comments made in this article are inaccurate. I would highly encourage the DP to get a physician or someone associated with healthcare to review medical facts prior to posting such an article. The DP is creating more of a stir than is necessary. The concept of performing a CT scan is a difficult one prior to starting antibiotics is a tricky one. Yes, CT scans are often done and they may reveal some edema (or swelling) around the brain. However, if there is a wait for the CT scanner and there is a strong suspcicion for meningococcoal disease or any sort of meningitis, current practice is to start antibiotics as soon as possible. Survival is directly proportional to the how quickly antibiotics are started. If there was a hold up for the spinal tap, there is also no need to waste time. LP (lumbar punctures) done after antibiotic therapy can still help with diagnosis. As long as blood cultures are drawn prior to starting starting the the antibiotics would be necessary though. Further, the way the article is written, it makes the reader think that Vancomycin should not have been started. However, coverage needs to broad (meaning you want to cover the most common bugs -- and STrep species which is what the Vancomycin covers is essential, given the recent reise in strep species which are more resistant to less strong antibiotics). True, Vanc should generally have been stopped. The reaction noted above (red man syndrome) is usually rate related. There is not data driven evidence, however, showing that stopping the antibiotic is necessary. But in most practices, it is generally stopped, and then the drip is started up again later. Generally speaking, until culture resutls come back, patients are almost always started on Vancomycin, Rocephin, possibly even ampicillin and acyclovir if necessary. Again, I highly encourage the DP as an MD to read through an article clearly related to medicine prior to publication. Not doing so makes you less of a professional newspaper.

HUP's ER is one of the worst I've ever been to, both as a patient and as a family member of a patient, so I wouldn't accuse the two students of just being "whiny Penn kids". I do agree the article was biased, but these are not isolated complaints about the way this hospital is run. I overheard a woman asking the cashier at Penn Tower, after trying to validate her free parking on the day of her son's 45-day stay discharge and being told she needed a different form than the one she presented to get the free parking(REALLY?!), "Why can't I get the same story twice around here?!", and I couldn't have said it better myself.

Re: Christopher Pynn Giving antibiotics before an LP is common practice, and there is no evidence to suggest that it is harmful-- especially in the face of overwhelming evidence that delays in antibiotic administration are strongly associated with poor outcomes in bacterial meningitis.[1] In a busy ER with long delays, or a situation where a CT scan is required before an LP, it is more important to begin treatment than it is to spend hours on diagnosis. After all, it is is the antibiotics and IV fluids that will save the patient's life, not the LP. [1] Lancet Infect Dis. 2007 Mar;7(3):191-200.

These types of experiences are common in most hospitals throughout the US. That is why we (the US) are ranked only 38th globally in health care delivery systems. From my personal experience, I think that Penn is still the best bet in this region, and it is where I take my family. Hopefully, Obama can fix health care. Until insurance company profits are no longer the driving factor of provifing health care, we will all continue to suffer. The Feds and the states regulate how hospitals and doctors can do business, along with many of the provisions of providing care. Insurance companies are charging higher premiums, paying doctors and hospitals less, and making record-breaking profits every year. Until the quality standards for the delivery of health care services is put back in the hands of medical professionals, where it belongs, things will get much worse!

Its unfortunate that these students are unhappy with their care, but when it comes to bacterial meningitis, you don't want to take any chances. all in all, a lumbar puncture (LP) is a safe and easy procedure- particularly when weighed against the risk of missing or delaying a diagnosis of meningitis. most people would take a post-LP headache over permanent disability or death from meningitis, which makes the discomfort justifiable. its easy to complain when everything turns out ok, but if it had been the opposite, people would be blasting HUP for not being aggressive enough. as for some of the specific complaints- 1- it is not customary to do a CT to screen for meningitis before doing an LP. CTs are only done if the patient has increased pressure in the brain from the infection and is at risk for complications from the procedure. they are not done in favor of a LP to make a diagnosis. 2- taking antibiotics before getting the LP does not preclude you from getting a diagnosis. there are several different clues from an LP that help make the diagnosis, many of which are unaffected by antibiotics. the only thing you possibly lose is the ability to grow and identify the specific bacteria- however, you can still determine whether or not the patient has the infection (see below reference) Role of empiric parenteral antibiotics prior to lumbar puncture in suspected bacterial meningitis: state of the art. AU Talan DA; Hoffman JR; Yoshikawa TT; Overturf GD SO Rev Infect Dis 1988 Mar-Apr;10(2):365-76. Lumbar puncture in pediatric bacterial meningitis: defining the time interval for recovery of cerebrospinal fluid pathogens after parenteral antibiotic pretreatment. AU Kanegaye JT; Soliemanzadeh P; Bradley JS SO Pediatrics 2001 Nov;108(5):1169-74.

This is one of the best examples of stuck up whiny Penn kids I've seen in a while. I wonder if these two kids decided to look into what meningitis actually is and how it is diagnosed before deciding to jump on the bandwagon of complaining of hospital care. Yes LPs hurt, yes you will feel like crap for a while after. That said - Meningitis kills up to 30% of the people it infects, and the only way to accurately diagnose it is to perform a LP. Complaining about the amount of time it took a nurse to respond to you in the Emergency Department is akin to complaining about traffic on the street. 7 minutes is actually damn good. Be thankful that you are alive and shut up.

While med student makes good points, particularly in Greiner's case, I don't think his complaints are entirely unwarranted. Its not so much that he objected the the LP, its that they did it wrong and dismissed his complaints of not feeling well after discharge. The most disturbing part of this article to me is the alleged behavior of SHS director Weiner. If she actually contradicted the doctors treating Greiner and threatened to make him stay in the hospital against his will when there was no evidence he had meningitis, that seems way over the line. [QUOTE id="e832c67c-754e-4404-9e76-7cb3057191ae"]Its unfortunate that these students are unhappy with their care, but when it comes to bacterial meningitis, you don't want to take any chances. all in all, a lumbar puncture (LP) is a safe and easy procedure- particularly when weighed against the risk of missing or delaying a diagnosis of meningitis. most people would take a post-LP headache over permanent disability or death from meningitis, which makes the discomfort justifiable. its easy to complain when everything turns out ok, but if it had been the opposite, people would be blasting HUP for not being aggressive enough. as for some of the specific complaints- 1- it is not customary to do a CT to screen for meningitis before doing an LP. CTs are only done if the patient has increased pressure in the brain from the infection and is at risk for complications from the procedure. they are not done in favor of a LP to make a diagnosis. 2- taking antibiotics before getting the LP does not preclude you from getting a diagnosis. there are several different clues from an LP that help make the diagnosis, many of which are unaffected by antibiotics. the only thing you possibly lose is the ability to grow and identify the specific bacteria- however, you can still determine whether or not the patient has the infection (see below reference) Role of empiric parenteral antibiotics prior to lumbar puncture in suspected bacterial meningitis: state of the art. AU Talan DA; Hoffman JR; Yoshikawa TT; Overturf GD SO Rev Infect Dis 1988 Mar-Apr;10(2):365-76. Lumbar puncture in pediatric bacterial meningitis: defining the time interval for recovery of cerebrospinal fluid pathogens after parenteral antibiotic pretreatment. AU Kanegaye JT; Soliemanzadeh P; Bradley JS SO Pediatrics 2001 Nov;108(5):1169-74.[/QUOTE]

[QUOTE id="1848feaf-a9e5-4867-a028-ceabbed1a967"]This is one of the best examples of stuck up whiny Penn kids I've seen in a while. I wonder if these two kids decided to look into what meningitis actually is and how it is diagnosed before deciding to jump on the bandwagon of complaining of hospital care. Yes LPs hurt, yes you will feel like crap for a while after. That said - Meningitis kills up to 30% of the people it infects, and the only way to accurately diagnose it is to perform a LP. Complaining about the amount of time it took a nurse to respond to you in the Emergency Department is akin to complaining about traffic on the street. 7 minutes is actually damn good. Be thankful that you are alive and shut up.[/QUOTE] Stop whining? Are you effing serious? We pay exorbitant insurance rates for overpriced medical care featuring half-assed treatment. How can you even begin to rationalize this as being ok?

What makes you think the care is sub par? What makes you think the care is over-priced? Are you a doctor? Have you ever been a part of the health care field? Did you really know what meningitis was and how to treat it before you read about it in the DP? Do you realize that your outlandish, generalized statements are the perspective of someone with no (or obviously wanting) medical education in reference to a (series of) poorly written and researched article(s) in a collegiate newspaper? It is clear that few of the people writing these articles and commenting on them have any clue about medical care. It's tragic to think that you and the rest of the muggles get to make decisions regarding anything involving our work. Moreover, if you're so distraught about what you find when you go into the hospital and how we stack up on the international scene, please move to France. Please. [QUOTE id="1848feaf-a9e5-4867-a028-ceabbed1a967"]This is one of the best examples of stuck up whiny Penn kids I've seen in a while. I wonder if these two kids decided to look into what meningitis actually is and how it is diagnosed before deciding to jump on the bandwagon of complaining of hospital care. Yes LPs hurt, yes you will feel like crap for a while after. That said - Meningitis kills up to 30% of the people it infects, and the only way to accurately diagnose it is to perform a LP. Complaining about the amount of time it took a nurse to respond to you in the Emergency Department is akin to complaining about traffic on the street. 7 minutes is actually damn good. Be thankful that you are alive and shut up.[/QUOTE]

This article is extremely biased and sensationalized. I am surprised that the editors of the Daily Pennsylvanian allowed it published as written given the inaccuracy I point out below. I also empathize with these students for their unfortunate symptoms during a meningitos outbreak prompting aggressive and appopriate treatment. Their treatment as indicated by the medical student post appears (even in this biased article) to be appropriate care. I also think it is unfortunate that these students felt the communication with their doctors was subpar, but the article went far beyond these statements of facts and made serious false allegations. I am most concerned by the following statement from the article: "They attempted to balance the rights of patients and the risks of performing certain medical procedures with the danger that a student could die from an undiagnosed infection or spread the disease." In the second student's case he reports he provided consent and in the first student's case he says the risks and benefits of the procedure were explained to him. Although he does not explicity detail this in the article, this likely means he gave informed consent in order to go through with this procedure. There was no violation of patient rights. This is a serious accusation that cannot be left uncorrected. Also I question the post by Alum where he states the LP was done incorrectly. Although the patients experienced an uncommon complication (CSF leakage) after the LP, there is nothing to suggest it was done incorrectly. Pain during an LP is common and was likely explained to the med student in the risks and benefits. However, Alum is just an online poster who is less accountable for what he says....the Editors of the Daily Pennsylvanian and the author or the artice are accountable for what they say. I believe a correction needs to be published regarding the statement of a violation of patient rights. I have always appreciated the DP for its excellent journalism, and know you will respond in the most professional manner.

Over a few days, HUP ER physicians screened a huge number of Penn students for meningitis and did not miss a single case, which was an incredible feat. Instead of recognizing this accomplishment, this article does its best to criticize and accuse these doctors of being incompetent and sadistic. If you are not in the medical field, do not assume that you understand the challenges faced by doctors and nurses nor the reasons why a certain procedure should or should not be performed. Medical mistakes do happen, and they are regrettable, but do not confuse them with known side-effects and aggressive life-saving treatments. This article is a pitiful and shameful attempt at sensationalism at the expense of the medical professionals who have worked tirelessly to protect the Penn student body from a lethal disease. I hope an apology is offerred.

Sadly, I think this kind of thing is typical. I went to HUP because of a COPD exacerbation a couple of years ago. They insisted my issues were heart-related and only my begging got me some lung treatment. They still call me for updates concerning my heart condition which I don't have! I spent nearly 12 hours in the ER without a meal. The list goes on.

I think this article misses a major point. Meningitis (diagnosis, treatment, recovery, not to mention DEATH) reeeally sucks. But that's not the doctors' fault. It doesn't matter if you're the King of England - if you come into the hospital with suspected meningitis, you will get an LP and be quaratined, both for your safety and the safety of the public. Our health system IS imperfect. But I think these students should be grateful for the care they received, which sounds like it was appropriate under the circumstances.

Dear all, Thanks for your mixed concern, criticism (constructive or otherwise), and general concern and interest in this important issue. I spoke with the DP because I think _constructive_ debate is in order for a situation of this severity and complexity. For the record: 1) I strongly object to being called a "stuck up whiny Penn kid"--wow. This sort of wild slandering of perfect strangers based on simple-minded misinterpretations of complex, multi-facetted situations is astounding to me. If you have anything to say to me about your opinions, have the courage to say it directly to me, rather than attempting public character assassinations. ***Did you consider for one moment that the reason I put up with all of this torment was to assure that I wasn't going to pass something on to other students? Did you consider that I could have left the hospital at any time, but rather opted for painful procedures, serious hospital mistreatment, and other risks (such as possibly life-threatening allergic reactions), to assure the safety of myself as well as those around me? 2) MD (if you are really that), name calling? I also object to being called a "muggle," and hope that no patients in my position are subject to the care of a doctor with such a Machiavellian view of the medical profession. If patients' rights to publicly question the validity of their medical care, and the funding thereof, is "tragic" as you say, isn't the 1st amendment as well? 3) Finally, my hope is that this article will bring the issues addressed here, including inter-hospital communication, health care costs, and most importantly, meningitis, into a more public light. I am quite thankful to be healthy, feel very grateful to be able to access top-notch medical care (though it is clearly in need of some revisions and improvements), and happy to be able to speak out publicly in hope that improvements can be made for the sake of patients in the future. Thanks for your interest. Max

Mr. Campisi has much to learn about journalism. In this article, he collected third-hand information about a complex medical case, then twisted the facts to create his own interesting narrative. He understood little about the complexity of the medical decision-making and instead relied on a two-dimensional stereotype of bad doctor/ subjugated patient to prove his own one-sided hypothesis. This story is about as compelling as an opening statement from a plaintiff's attorney in a malpractice suit. How about an article covering the three students whose lives were saved by astute Penn physicians? Why not mention the aggressive actions taken by student health to prevent the spread of this often-fatal illness? The students who approached the newspaper about their "harrowing" experiences seem immature and self-absorbed. I would expect some editorial discretion, however, in looking at their stories in a larger context.

I apologize if I went too far in suggesting that the LP was done incorrectly. Admittedly, I don't have medical training and am not sure whether this complication can occur even when the procedure is performed correctly. But what about the fact that Greiner's complaints of not feeling well after the fact were apparently dismissed by these same doctors when, in fact, he had this complication? Can you defend that? [QUOTE id="106d206f-2e95-4529-980a-461fd63ed775"]This article is extremely biased and sensationalized. I am surprised that the editors of the Daily Pennsylvanian allowed it published as written given the inaccuracy I point out below. I also empathize with these students for their unfortunate symptoms during a meningitos outbreak prompting aggressive and appopriate treatment. Their treatment as indicated by the medical student post appears (even in this biased article) to be appropriate care. I also think it is unfortunate that these students felt the communication with their doctors was subpar, but the article went far beyond these statements of facts and made serious false allegations. I am most concerned by the following statement from the article: "They attempted to balance the rights of patients and the risks of performing certain medical procedures with the danger that a student could die from an undiagnosed infection or spread the disease." In the second student's case he reports he provided consent and in the first student's case he says the risks and benefits of the procedure were explained to him. Although he does not explicity detail this in the article, this likely means he gave informed consent in order to go through with this procedure. There was no violation of patient rights. This is a serious accusation that cannot be left uncorrected. Also I question the post by Alum where he states the LP was done incorrectly. Although the patients experienced an uncommon complication (CSF leakage) after the LP, there is nothing to suggest it was done incorrectly. Pain during an LP is common and was likely explained to the med student in the risks and benefits. However, Alum is just an online poster who is less accountable for what he says....the Editors of the Daily Pennsylvanian and the author or the artice are accountable for what they say. I believe a correction needs to be published regarding the statement of a violation of patient rights. I have always appreciated the DP for its excellent journalism, and know you will respond in the most professional manner.[/QUOTE]

This sort of wild slandering of perfect strangers based on simple-minded misinterpretations of complex, multi-facetted situations is astounding to me. Now you know how the physicians accused in the story must have felt upon reading this article. [QUOTE id="7e025fb7-be8e-4530-a3a6-cc2f1a765bbb"]Dear all, Thanks for your mixed concern, criticism (constructive or otherwise), and general concern and interest in this important issue. I spoke with the DP because I think _constructive_ debate is in order for a situation of this severity and complexity. For the record: 1) I strongly object to being called a "stuck up whiny Penn kid"--wow. This sort of wild slandering of perfect strangers based on simple-minded misinterpretations of complex, multi-facetted situations is astounding to me. If you have anything to say to me about your opinions, have the courage to say it directly to me, rather than attempting public character assassinations. ***Did you consider for one moment that the reason I put up with all of this torment was to assure that I wasn't going to pass something on to other students? Did you consider that I could have left the hospital at any time, but rather opted for painful procedures, serious hospital mistreatment, and other risks (such as possibly life-threatening allergic reactions), to assure the safety of myself as well as those around me? 2) MD (if you are really that), name calling? I also object to being called a "muggle," and hope that no patients in my position are subject to the care of a doctor with such a Machiavellian view of the medical profession. If patients' rights to publicly question the validity of their medical care, and the funding thereof, is "tragic" as you say, isn't the 1st amendment as well? 3) Finally, my hope is that this article will bring the issues addressed here, including inter-hospital communication, health care costs, and most importantly, meningitis, into a more public light. I am quite thankful to be healthy, feel very grateful to be able to access top-notch medical care (though it is clearly in need of some revisions and improvements), and happy to be able to speak out publicly in hope that improvements can be made for the sake of patients in the future. Thanks for your interest. Max[/QUOTE]

Wrong, the article didn't stoop to name calling or exaggerated personal attacks, nor did my comment upon the article. To my knowledge, the article made not a single false claim (consider that most of it is based on my personal account). Why is it so difficult to limit this debate to constructive and fact based arguments? [QUOTE id="7e025fb7-be8e-4530-a3a6-cc2f1a765bbb"]Dear all, Thanks for your mixed concern, criticism (constructive or otherwise), and general concern and interest in this important issue. I spoke with the DP because I think _constructive_ debate is in order for a situation of this severity and complexity. For the record: 1) I strongly object to being called a "stuck up whiny Penn kid"--wow. This sort of wild slandering of perfect strangers based on simple-minded misinterpretations of complex, multi-facetted situations is astounding to me. If you have anything to say to me about your opinions, have the courage to say it directly to me, rather than attempting public character assassinations. ***Did you consider for one moment that the reason I put up with all of this torment was to assure that I wasn't going to pass something on to other students? Did you consider that I could have left the hospital at any time, but rather opted for painful procedures, serious hospital mistreatment, and other risks (such as possibly life-threatening allergic reactions), to assure the safety of myself as well as those around me? 2) MD (if you are really that), name calling? I also object to being called a "muggle," and hope that no patients in my position are subject to the care of a doctor with such a Machiavellian view of the medical profession. If patients' rights to publicly question the validity of their medical care, and the funding thereof, is "tragic" as you say, isn't the 1st amendment as well? 3) Finally, my hope is that this article will bring the issues addressed here, including inter-hospital communication, health care costs, and most importantly, meningitis, into a more public light. I am quite thankful to be healthy, feel very grateful to be able to access top-notch medical care (though it is clearly in need of some revisions and improvements), and happy to be able to speak out publicly in hope that improvements can be made for the sake of patients in the future. Thanks for your interest. Max[/QUOTE]

it seems as if these students received cautious yet proper medical care. the author is attempting to sensationalize these cases and the students seem to be overreacting. a spinal tap headache occurs pretty frequently. if the students didn't receive spinal taps, the article would be critical of HUP for that as well. if the students weren't kept an extra day to be cautious, the author would have criticized that point. the dp is always looking to sensationalize something. good luck writing for the tabloids when you grow up.

It is a PRIVILEGE. And YOU ARE WELCOME. Your adolescent ranting and obvious lack of education in medicine neither flatter you nor validate your concern.

One might also question why this was posted to the DP directly before spring break, thus ensuring that it would be visible on the main DP site for an entire week.

Ditto to physician @ HUP. I too am a health care professional, and Penn parent and I applaud Dr Weiner and SHS for having coordinated and pulled off the sheer volume of students triaged, seen and prophylactically treatment. Mr Greiner: you ARE whining. You ARE alive, and yes, the only way to tell if you have meningitis is to do an LP. Yes they hurt, and yes sometimes you will have leakage of spinal fluid. No this is not that uncommon. AND you are alive to tell about it(which btw is why you were treated so "agressively". So instead of criticizing the perceived subpar treatment you got, maybe say thank you to all the providers at SHS and HUP who saved your ungrateful butt..?!And yes, you do owe all of them an apology. People worked around the clock to protect YOU and all the students at Pennn. Shame on YOU.