Saturday, April 30, 2005
A call to New Hampshire physicians
The New Hampshire Medical Society is making a plea to physicians to support the bill for pre-trial panels in medical malpractice cases (SB 214). I will do my part by spreading the word through this blog. This has been exhaustively discussed previously.From a letter I received today: "Many legislators have only received one call or one letter from physicians in support of SB 214. There is still time to make these important contacts."
The NH Medical Society supports SB 214 (taken from a NH Medical Society bulletin):
* Without meaningful tort reform like SB 214, medical specialists will continue to disappear from NH or stop performing high-risk procedures. NH patients should not have to drive 50 miles or go to Boston for quality specialty care.The NH Medical society opposes the trial attorneys' version, HB 702 (again, taken from a NH Medical Society bulletin):
* This bill will work for the benefit of NH citizens because it's been working in Maine for the past 20 years.
* Maine's medical liability insurance rates are 30-40% less than in NH.
* SB 214 will stabilize rates in NH which will make it easier to recruit and retain needed medical specialists.
* SB 214 requires all med mal cases go before a 3-person panel: a judge, an attorney, and a health care practitioner of all the same or similar specialty as the defendant.
* SB 214 does not restrict anyone's right to a jury trial.
* Pre-trial panels help plaintiffs with smaller cases because panel expenses are less (many lawyers won't take a case to trial unless there are significant damages involved).
* Only unanimous decisions by the panel are admissible in any future trial.
* Pre-trial screening panels encourage quicker settlements. 80% of med mal cases in Maine are resolved before a panel meets.
* The 20-year, positive experience in Maine indicates that pre-trial screening panels benefit the patient because average awards are not reduced: plaintiffs receive more money, sooner.
* System costs are lower for both plaintiffs and defendants because very few cases end up in an actual trial.
* SB 214 includes an important oversight committee that will study med mal premium rates, claims data and the effect of the panel system.
* HB 702 is worse than the voluntary and inadmissible pre-trial screening law (RSA 519-A) that is currently on the books in NH.
* HB 702 mandates pre-trial screening by a single judge - no panel and no medical expertise.
* Under HB 702, only the plaintiff presents evidence (one-sided approach).
* If a case is not dropped or settled, HB 702 requires mediation within 45 days. The legal community has indicated that forced mediation in such a short time frame is not realistic for med mal cases.
* The judges decision is not admissible in a future trial. NH already has an inadmissible, ineffective panel law. Admissibility of a screening decision is the "incentive" that encourages settlements.
* HB 702 prohibits confidential settlements which will result in more cases going to trial and will consequently cost more money in legal fees.
Posted by Kevin |
link
| Comments (5)
| 
Turning the tables: Doctors are now suing the insurance companies
"Local doctors claim greed has overtaken the health industry, and that insurance companies are making decisions of life and death instead of physicians. Now thousands of doctors are suing insurance providers."
The insurance company's ironic response: "We believe the class-action lawsuits ... are baseless and frivolous."
"Local doctors claim greed has overtaken the health industry, and that insurance companies are making decisions of life and death instead of physicians. Now thousands of doctors are suing insurance providers."
The insurance company's ironic response: "We believe the class-action lawsuits ... are baseless and frivolous."
Posted by Kevin |
link
| Comments (5)
|
A man who was declared dead and had life support withdrawn was actually alive
"The doctor on duty had removed the life support systems and was making arrangements for sending the patient for postmortem when the family doctor of the patient, who happened to be there, noticed that the pulse was still beating."
"The doctor on duty had removed the life support systems and was making arrangements for sending the patient for postmortem when the family doctor of the patient, who happened to be there, noticed that the pulse was still beating."
Posted by Kevin |
link
| Comments (0)
|
9 and 10-year old children are receiving Epivir and AZT after being exposed to HIV
"Some students already have begun taking a combination of medicines - 100 milligrams of Retrovir (or AZT, an HIV treatment) and 150 milligrams of Epivir (an HIV and hepatitis treatment), in addition to a stomach protector - to prevent the onset of the virus. One poking victim, George Whitaker, 10, reported having felt dizzy from the medication, and another, Jonathan Rodriguez, also 10, said he had vomited after taking it."
Although probably a good idea, the data supporting post-exposure prophylaxis is scarce. Most of the data comes from maternal-infant transmission of HIV:
The recommended treatment course is 4 weeks, but the optimal duration has not been studied. HIV testing should be done at baseline, six weeks, twelve weeks and 6 months after the exposure. Side effects occur in 50 percent of patients and consist mostly of nausea and fatigue; headache, vomiting, and diarrhea.
"Some students already have begun taking a combination of medicines - 100 milligrams of Retrovir (or AZT, an HIV treatment) and 150 milligrams of Epivir (an HIV and hepatitis treatment), in addition to a stomach protector - to prevent the onset of the virus. One poking victim, George Whitaker, 10, reported having felt dizzy from the medication, and another, Jonathan Rodriguez, also 10, said he had vomited after taking it."
Although probably a good idea, the data supporting post-exposure prophylaxis is scarce. Most of the data comes from maternal-infant transmission of HIV:
The benefit of ZDV in reducing maternal-infant transmission of HIV from 25.5 to 8.3 percent in the AIDS Clinical Trial Group Protocol 076 suggests that ZDV could also have a beneficial role in PEP (post-exposure prophylaxis). In a case-control study of needlestick injuries, HCWs who received ZDV prophylaxis were at lower risk for HIV transmission (odds ratio 0.19).The case-control study mentioned an odds ratio of 0.19, meaning those who received prophylaxis had a 1/5th chance of contracting HIV from a needlestick.
The recommended treatment course is 4 weeks, but the optimal duration has not been studied. HIV testing should be done at baseline, six weeks, twelve weeks and 6 months after the exposure. Side effects occur in 50 percent of patients and consist mostly of nausea and fatigue; headache, vomiting, and diarrhea.
Posted by Kevin |
link
| Comments (0)
|
A pregnant 13-year-old girl in Florida has been told she cannot have an abortion because she lacks the maturity to make such a decision
"Florida's department of children and families intervened and took the matter to court, arguing the teenager, who is under the care of the state, is too young and immature to make an informed medical decision. Judge Ronald Alvarez in Palm Beach accepted that argument and has granted a temporary injunction and psychological evaluation, which effectively blocks her from terminating the pregnancy."
"Florida's department of children and families intervened and took the matter to court, arguing the teenager, who is under the care of the state, is too young and immature to make an informed medical decision. Judge Ronald Alvarez in Palm Beach accepted that argument and has granted a temporary injunction and psychological evaluation, which effectively blocks her from terminating the pregnancy."
Posted by Kevin |
link
| Comments (1)
|
Money talks: The UK is paying physicians to have better access
Using cash as an incentive to promote open-access scheduling. Crude, but that's one way to reduce wait times.
Using cash as an incentive to promote open-access scheduling. Crude, but that's one way to reduce wait times.
Posted by Kevin |
link
| Comments (0)
|
Friday, April 29, 2005
"It's our malpractice system and its reliance on fault that are responsible for increasing damage awards and costly defensive medicine on the part of physicians."
"The American malpractice system relies on fault. It requires the injured victim and their attorney to allege fault and to accuse the medical provider of substandard medicine. The system requires the medical provider and their attorney to defend against these charges -- which, in turn, motivates the provider to conceal rather than document mistakes -- and to practice defensive medicine. Having providers conceal their errors is antithetical to quality improvement programs, which require the diligent identification of individual and system errors to establish proper corrective actions. The provider's practice of defensive medicine is not only costly; it exposes patients to medically unnecessary treatment."
Sounds like no-fault insurance would be the ideal solution. CodeBlueNow! has come out with a malpractice fact sheet as well. Worthwhile reading.
"The American malpractice system relies on fault. It requires the injured victim and their attorney to allege fault and to accuse the medical provider of substandard medicine. The system requires the medical provider and their attorney to defend against these charges -- which, in turn, motivates the provider to conceal rather than document mistakes -- and to practice defensive medicine. Having providers conceal their errors is antithetical to quality improvement programs, which require the diligent identification of individual and system errors to establish proper corrective actions. The provider's practice of defensive medicine is not only costly; it exposes patients to medically unnecessary treatment."
Sounds like no-fault insurance would be the ideal solution. CodeBlueNow! has come out with a malpractice fact sheet as well. Worthwhile reading.
Posted by Kevin |
link
| Comments (1)
|
The patients lose again: In the crusade against pain physicians, those in real pain are left hanging
"Since the doctor's arrest, KETV NewsWatch 7 has heard from several of his patients, telling stories similar to Hook's. Hook is a nurse, and describes Rosario as a good physician. She said Rosario did not push pills, and instead, often prescribed therapy for her."
As treating chronic pain is becoming a low-reward, high-risk field, fewer physicians are going to take the risk of prescribing chronic narcotics.
"Since the doctor's arrest, KETV NewsWatch 7 has heard from several of his patients, telling stories similar to Hook's. Hook is a nurse, and describes Rosario as a good physician. She said Rosario did not push pills, and instead, often prescribed therapy for her."
As treating chronic pain is becoming a low-reward, high-risk field, fewer physicians are going to take the risk of prescribing chronic narcotics.
Posted by Kevin |
link
| Comments (2)
|
A 2-year old died in his father's arms while waiting to be seen in the emergency room
"The Toronto Sun reported yesterday that the child was brought to the hospital by his parents around 5:30 Monday morning. He had reportedly vomited and had diarrhea the day before, and when his condition did not improve his parents tried to have him seen by an emergency room doctor.
They told the Sun that they waited for an hour without being seen by a doctor. Then, their son stopped breathing."
"The Toronto Sun reported yesterday that the child was brought to the hospital by his parents around 5:30 Monday morning. He had reportedly vomited and had diarrhea the day before, and when his condition did not improve his parents tried to have him seen by an emergency room doctor.
They told the Sun that they waited for an hour without being seen by a doctor. Then, their son stopped breathing."
Posted by Kevin |
link
| Comments (5)
|
Even for those with health insurance, medical costs are bankrupting families
"Families are paying more and more for health insurance that covers them less and less."
"Families are paying more and more for health insurance that covers them less and less."
Posted by Kevin |
link
| Comments (0)
|
Thursday, April 28, 2005
An Ohio judge has formally sanctioned an attorney who brought a frivolous suit against a physician
"The plaintiff's attorney pressed her case even after her own expert witness could offer no evidence that the doctor hadn't met the prevailing standard of care. The judge ordered her to pay the physician $6,000 plus interest, to cover the expenses he incurred defending himself. Moreover, the judge specified that the plaintiffs themselves wouldn't be liable for any part of that award. The attorney is appealing."
"The plaintiff's attorney pressed her case even after her own expert witness could offer no evidence that the doctor hadn't met the prevailing standard of care. The judge ordered her to pay the physician $6,000 plus interest, to cover the expenses he incurred defending himself. Moreover, the judge specified that the plaintiffs themselves wouldn't be liable for any part of that award. The attorney is appealing."
Posted by Kevin |
link
| Comments (0)
|
An 86 year-old woman goes on a hunger strike protesting staffing shortages at her nursing home
"We need help desperately. Two people looking after 17 is not enough." (via Cuppa News)
"We need help desperately. Two people looking after 17 is not enough." (via Cuppa News)
Posted by Kevin |
link
| Comments (0)
|
Shifting care from physicians to nurse practitioners do not result in any cost savings
"Because nurses spent more time with each patient, however, they saw fewer patients per hour. In four of five studies on nurse-led urgent care, lower salary costs were offset by this so-called 'lower productivity' and increased use of resources."
Mid-level providers, such as PA's and NP's generally spend more time with patients which more likely results in greater patient satisfaction. There is no doubt that many are qualified to do most primary-care tasks.
However, medicine today is all about reimbursement and productivity. Practices are going to find out that when replacing physicians with mid-level providers, the lower cost of employing mid-levels will be offset by a decline in revenue. This study shows that the end result is little, if any, cost savings.
"Because nurses spent more time with each patient, however, they saw fewer patients per hour. In four of five studies on nurse-led urgent care, lower salary costs were offset by this so-called 'lower productivity' and increased use of resources."
Mid-level providers, such as PA's and NP's generally spend more time with patients which more likely results in greater patient satisfaction. There is no doubt that many are qualified to do most primary-care tasks.
However, medicine today is all about reimbursement and productivity. Practices are going to find out that when replacing physicians with mid-level providers, the lower cost of employing mid-levels will be offset by a decline in revenue. This study shows that the end result is little, if any, cost savings.
Posted by Kevin |
link
| Comments (5)
|
More than two-thirds of U.S. adults think that the law should allow medical euthanasia for dying patients in severe distress who ask to have their lives ended
Posted by Kevin |
link
| Comments (0)
|
According to a Gallup poll, the most frequently recommended occupation is medicine
Posted by Kevin |
link
| Comments (0)
|
A surgeon is sued when a patient developed arterial blood clots after ankle surgery
The case ended in a mistrial. An arterial blood clot is uncommon: "The defense, however, argued that Horrell's particular complication after her surgery was utterly unheard of and that Fugate could not have been reasonably expected to discern it."
Perhaps the patient had some underlying heart disease that led to arterial emboli:
The case ended in a mistrial. An arterial blood clot is uncommon: "The defense, however, argued that Horrell's particular complication after her surgery was utterly unheard of and that Fugate could not have been reasonably expected to discern it."
Perhaps the patient had some underlying heart disease that led to arterial emboli:
The majority of these emboli occur in patients with significant underlying cardiac disease; the severity of the patient's underlying cardiac condition may increase the risk of surgery, and limit the options available for restoring blood flow to the ischemic extremity.
Potential sources of emboli from the heart include left ventricular thrombus formation following myocardial infarction, and atrial thrombus in patients with atrial fibrillation. Up to 75 percent of patients with emboli to the lower extremities have a history of recent myocardial infarction or atrial fibrillation.
Posted by Kevin |
link
| Comments (0)
|
They found Legionnaries' disease in a teaching hospital in NYC
"Legionnaires' disease is a bacterial infection with pneumonia-like symptoms that first became widely known after a 1976 outbreak killed 34 people attending an American Legion convention in Philadelphia. According to the Centers for Disease Control and Prevention, 8,000 to 18,000 people contract the disease each year in the United States, and it is rarely fatal except for people with weakened immune systems."
It's one of those diseases that you study about in medical school, but rarely see in real life.
"Legionnaires' disease is a bacterial infection with pneumonia-like symptoms that first became widely known after a 1976 outbreak killed 34 people attending an American Legion convention in Philadelphia. According to the Centers for Disease Control and Prevention, 8,000 to 18,000 people contract the disease each year in the United States, and it is rarely fatal except for people with weakened immune systems."
It's one of those diseases that you study about in medical school, but rarely see in real life.
Posted by Kevin |
link
| Comments (1)
|
A mother dying of ALS is recording her wisdom for her children and pleading with the government to control health care costs
"Her other battle was making people realize that health care's oppressive costs can be a drain on those around you. Her family spends at least $20,000 a month for round-the-clock care, therapists, aides and medicines.
'We did everything you're supposed to do. We had savings in the bank, we were in a good position,' she said. 'This is bankrupting us.'"
"Her other battle was making people realize that health care's oppressive costs can be a drain on those around you. Her family spends at least $20,000 a month for round-the-clock care, therapists, aides and medicines.
'We did everything you're supposed to do. We had savings in the bank, we were in a good position,' she said. 'This is bankrupting us.'"
Posted by Kevin |
link
| Comments (1)
|
Wednesday, April 27, 2005
Are the number of uninsured overstated?
"The number of US residents without health insurance may be overstated by as much as nine million people, according to two new analyses of census data, the Los Angeles Times reports."
"The number of US residents without health insurance may be overstated by as much as nine million people, according to two new analyses of census data, the Los Angeles Times reports."
Posted by Kevin |
link
| Comments (1)
|
DrTony gives his inner monologue during an ED visit
Update:
Part 2 is here.
Update:
Part 2 is here.
Posted by Kevin |
link
| Comments (0)
|
The New Hampshire legislature is debating real screening panels vs half-assed screening
"The House Judiciary Committee took more than five hours of testimony Tuesday on the legislation (SB 214), which the Senate approved earlier this month.
The measure would require that all cases go through a panel consisting of a lawyer, doctor and retired judge. Any unanimous decision of the cases merit could be introduced at trial. Last month, the House approved a competing measure (HB 702) that calls for only a retired judge to preside at an early stage and decide if the doctor was liable or the damage was an unfortunate but defensible medical result."
Having a single judge weed though complex medical cases makes as much sense as a sole doctor making decisions on legal malpractice. Like I said, stick to what you know.
As for the lawyers' arguments that proper screening "takes too much time" - well they should. Malpractice cases are complex and deserve to be carefully considered from both a medical and legal standpoint (i.e. by an impartial doctor, lawyer, and judge). Time should not supercede proper screening when it comes to medical malpractice cases.
"The House Judiciary Committee took more than five hours of testimony Tuesday on the legislation (SB 214), which the Senate approved earlier this month.
The measure would require that all cases go through a panel consisting of a lawyer, doctor and retired judge. Any unanimous decision of the cases merit could be introduced at trial. Last month, the House approved a competing measure (HB 702) that calls for only a retired judge to preside at an early stage and decide if the doctor was liable or the damage was an unfortunate but defensible medical result."
Having a single judge weed though complex medical cases makes as much sense as a sole doctor making decisions on legal malpractice. Like I said, stick to what you know.
As for the lawyers' arguments that proper screening "takes too much time" - well they should. Malpractice cases are complex and deserve to be carefully considered from both a medical and legal standpoint (i.e. by an impartial doctor, lawyer, and judge). Time should not supercede proper screening when it comes to medical malpractice cases.
Posted by Kevin |
link
| Comments (0)
|
News flash: Drug ads work
"To conduct the study, Richard Kravitz, director of primary-care research at the University of California, Davis, in Sacramento, Calif., hired a group of women actors to mimic different forms of depression and to make various requests of physicians during unscheduled visits.
The actors made a total of 298 visits to 152 doctors' offices in Rochester, N.Y., San Francisco and Sacramento.
When they made a general request for drugs, saying they had seen a TV segment on depression, the pretend patients left the office with a prescription for their feigned condition 76 per cent of the time. When they asked for the heavily advertised antidepressant Paxil by name, they were prescribed that specific drug 53 per cent of the time. And when the mock patients made no request for drugs, they were nonetheless prescribed an antidepressant 31 per cent of the time."
No surprise here. Consider a common scenario: you are a primary-care physician that has appointments every 15 minutes. You running behind schedule and patients in the waiting room are starting to complain. There are 20 messages on your desk that have yet to be seen. Phones are ringing off the hook - the hospital is calling for you for another admission. Your next patient comes in and says "I have depression and want Paxil". Now you have two options:
1) Discuss with the patient how psychotherapy and counseling can be as effective as medication. If medication is needed, you can further discuss that generic fluoxetine or citalopram is just as good. After 20 minutes of discussion, the patient leaves angry at not getting what they saw on TV and leaves. Most likely, they will find another physician who will prescribe what they want. The doctor has now lost a patient, feels that all that time was wasted, and falls further behind schedule. Patients in the waiting room start to leave because of the wait.
2) Screen the patient for depression. Give Paxil. Move on to the next patient on time. Patient is happy. Doctor is happy.
This may seem extreme, but believe me these are the two choices that physicians face every day. Option two looks pretty good most of the time.
"To conduct the study, Richard Kravitz, director of primary-care research at the University of California, Davis, in Sacramento, Calif., hired a group of women actors to mimic different forms of depression and to make various requests of physicians during unscheduled visits.
The actors made a total of 298 visits to 152 doctors' offices in Rochester, N.Y., San Francisco and Sacramento.
When they made a general request for drugs, saying they had seen a TV segment on depression, the pretend patients left the office with a prescription for their feigned condition 76 per cent of the time. When they asked for the heavily advertised antidepressant Paxil by name, they were prescribed that specific drug 53 per cent of the time. And when the mock patients made no request for drugs, they were nonetheless prescribed an antidepressant 31 per cent of the time."
No surprise here. Consider a common scenario: you are a primary-care physician that has appointments every 15 minutes. You running behind schedule and patients in the waiting room are starting to complain. There are 20 messages on your desk that have yet to be seen. Phones are ringing off the hook - the hospital is calling for you for another admission. Your next patient comes in and says "I have depression and want Paxil". Now you have two options:
1) Discuss with the patient how psychotherapy and counseling can be as effective as medication. If medication is needed, you can further discuss that generic fluoxetine or citalopram is just as good. After 20 minutes of discussion, the patient leaves angry at not getting what they saw on TV and leaves. Most likely, they will find another physician who will prescribe what they want. The doctor has now lost a patient, feels that all that time was wasted, and falls further behind schedule. Patients in the waiting room start to leave because of the wait.
2) Screen the patient for depression. Give Paxil. Move on to the next patient on time. Patient is happy. Doctor is happy.
This may seem extreme, but believe me these are the two choices that physicians face every day. Option two looks pretty good most of the time.
Posted by Kevin |
link
| Comments (3)
|
Tuesday, April 26, 2005
Women are waiting weeks for a mammogram
"Women had to wait between 1 and 4 weeks for diagnostic mammography, designed to investigate a possible problem. For regular screening mammograms, women waited up to 8 weeks for an appointment.
Study author Dr. Carl D'Orsi of Emory University in Atlanta, Georgia said that he believed that over time, women might have an even harder time getting an appointment for a mammogram. And if women have to wait even longer for a mammogram, they may not get one at all, he said."
Hmm . . . perhaps this is because reading mammograms is a low-reward, high-risk field:
"Women had to wait between 1 and 4 weeks for diagnostic mammography, designed to investigate a possible problem. For regular screening mammograms, women waited up to 8 weeks for an appointment.
Study author Dr. Carl D'Orsi of Emory University in Atlanta, Georgia said that he believed that over time, women might have an even harder time getting an appointment for a mammogram. And if women have to wait even longer for a mammogram, they may not get one at all, he said."
Hmm . . . perhaps this is because reading mammograms is a low-reward, high-risk field:
A mammogram is an inherently limited study with relatively low sensitivity and specificity. Unfortunately, the public does not understand these limitations because the exam has been oversold as a diagnostic modality (We are told this is for the public’s “own good”). As a result, people have a difficult time understanding why breast abnormalities are “missed” or “misinterpreted” during routine mammography. Personal injury lawyers ruthlessly take advantage of this dilemma by scavenging mammograms involved in breast cancer cases. They prey on this ignorance by holding radiologists to impossible standards bolstered with retrospective analyses of mammograms done by venal physicians in their stable of experts. As a result, mammography is the single highest liability risk for radiologists (and the second highest risk in all of medicine). For a $15 reading fee, radiologists can face multi-million dollar lawsuits.
Posted by Kevin |
link
| Comments (4)
|
Nashua Medical Group is featured as an A4 Health Systems case study
Look hard and you can find a picture of me.
Look hard and you can find a picture of me.
Posted by Kevin |
link
| Comments (0)
|
A man in South Africa had his testicles removed instead of his prostate
"In his letter of complaint, the patient claims the wrong operation was performed on him and that the removal of his testicles was not the operation about which he had been informed and for which he was prepared.
According to the letter, after the man's testicles had been removed, one doctor - not the one who did the operation - said to him they had performed the wrong operation on him.
The doctor who performed the operation is charged with, among other things, not consulting with Professor S Reif, who had referred the patient for a prostate operation, when there was confusion about what the correct procedure would be.
When cross-examined on Monday, the patient said the doctor did tell him before the operation what the removal of his testicles entailed and what the side effects would be.
He said that, at that stage, he was satisfied with the doctor's explanation that it was a new technique to first remove the testicles and afterwards the prostrate, if there was not an improvement."
"In his letter of complaint, the patient claims the wrong operation was performed on him and that the removal of his testicles was not the operation about which he had been informed and for which he was prepared.
According to the letter, after the man's testicles had been removed, one doctor - not the one who did the operation - said to him they had performed the wrong operation on him.
The doctor who performed the operation is charged with, among other things, not consulting with Professor S Reif, who had referred the patient for a prostate operation, when there was confusion about what the correct procedure would be.
When cross-examined on Monday, the patient said the doctor did tell him before the operation what the removal of his testicles entailed and what the side effects would be.
He said that, at that stage, he was satisfied with the doctor's explanation that it was a new technique to first remove the testicles and afterwards the prostrate, if there was not an improvement."
Posted by Kevin |
link
| Comments (2)
|
Sounds like drug companies are starting to rein in their sales force
"Nonetheless, cost-cutting is now in vogue in the pharmaceutical industry. Pfizer, for instance, is trimming its sales force, and other drug makers are expected to follow suit. While sampling may play an important role, experts say a little auditing may be in order."
"Nonetheless, cost-cutting is now in vogue in the pharmaceutical industry. Pfizer, for instance, is trimming its sales force, and other drug makers are expected to follow suit. While sampling may play an important role, experts say a little auditing may be in order."
Posted by Kevin |
link
| Comments (1)
|
The NY Times on DTC marketing
"Doctors afraid to disappoint patients can also be negatively influenced by drug advertisements. The doctor may recommend that other approaches - like changing habits to lower blood pressure or controlling high cholesterol - are preferable to taking drugs. But patients hoping for prescriptions may pressure their doctors to write them."
"Doctors afraid to disappoint patients can also be negatively influenced by drug advertisements. The doctor may recommend that other approaches - like changing habits to lower blood pressure or controlling high cholesterol - are preferable to taking drugs. But patients hoping for prescriptions may pressure their doctors to write them."
Posted by Kevin |
link
| Comments (0)
|
Arizona signs some common-sense malpractice reforms
"The new law says expert witnesses in these cases must practice in the same area as the physician being sued. And if the defendant is 'board certified' in a specialty, the witnesses also must be certified by the same board . . .
. . . Napolitano had no problem with another part of the legislation, which will permit a doctor to apologize for a mistake without having that statement used in court."
"The new law says expert witnesses in these cases must practice in the same area as the physician being sued. And if the defendant is 'board certified' in a specialty, the witnesses also must be certified by the same board . . .
. . . Napolitano had no problem with another part of the legislation, which will permit a doctor to apologize for a mistake without having that statement used in court."
Posted by Kevin |
link
| Comments (2)
|
Math + Medicine = Confusion
"Why do so many people have trouble with the notion of probability and chance? Mathematicians chalk it up to innumeracy, the arithmetic equivalent of illiteracy. Simply put, people are uncomfortable with mathematical concepts like probability because they never learned them in the first place.
Innumeracy explains much of the public's confusion about the risks of various drugs and medical treatments. But not all of it. In a classic 1966 study, a group of subjects was told that a man had parked his car on a hill and that the car had rolled back into a hydrant after the man had left. The subjects were sympathetic to the man.
But a second group of subjects, told that the car had rolled into another person after the man walked away, held him responsible, even though the cause was the same.
People might chalk up a minor mishap to chance, but they are reluctant to blame a serious event on bad luck. Someone or something has to be held responsible."
I can say something relating this to medical malpractice, but I won't.
The article states that dealing with probability and chance does not come naturally. People like absolute yes/no answers - and medicine often does not come prepackaged that way. One of my favorite sayings is that "the only absolute in medicine is that there are no absolutes".
I often watch law shows on TV where the physician witness is being hositally cross-examined: "Is it possible that [xxx] can happen?". The answer is always yes! Anything is possible. It's also possible that I can win the lottery or find the cure for cancer, but the chances are slim. A better question that lawyers should consider: "Is it probable that [xxx] can happen?" Of course, that makes too much sense, and thus, won't happen. (via shrinkette)
"Why do so many people have trouble with the notion of probability and chance? Mathematicians chalk it up to innumeracy, the arithmetic equivalent of illiteracy. Simply put, people are uncomfortable with mathematical concepts like probability because they never learned them in the first place.
Innumeracy explains much of the public's confusion about the risks of various drugs and medical treatments. But not all of it. In a classic 1966 study, a group of subjects was told that a man had parked his car on a hill and that the car had rolled back into a hydrant after the man had left. The subjects were sympathetic to the man.
But a second group of subjects, told that the car had rolled into another person after the man walked away, held him responsible, even though the cause was the same.
People might chalk up a minor mishap to chance, but they are reluctant to blame a serious event on bad luck. Someone or something has to be held responsible."
I can say something relating this to medical malpractice, but I won't.
The article states that dealing with probability and chance does not come naturally. People like absolute yes/no answers - and medicine often does not come prepackaged that way. One of my favorite sayings is that "the only absolute in medicine is that there are no absolutes".
I often watch law shows on TV where the physician witness is being hositally cross-examined: "Is it possible that [xxx] can happen?". The answer is always yes! Anything is possible. It's also possible that I can win the lottery or find the cure for cancer, but the chances are slim. A better question that lawyers should consider: "Is it probable that [xxx] can happen?" Of course, that makes too much sense, and thus, won't happen. (via shrinkette)
Posted by Kevin |
link
| Comments (6)
|
Grand Rounds XXXI, brought to you by DrTony
Come get the weekly best of the medical blogosphere.
Come get the weekly best of the medical blogosphere.
Posted by Kevin |
link
| Comments (0)
|
Some docs don't get it
"Ontario's doctor shortage 'can't be a mitigating factor' for a Sault Ste. Marie physician who breached an order not to examine female patients except in the presence of a female nurse . . .
. . . Dr. DeLuco was first suspended from practice last January 11 after the college learned he had seen two women patients, and performed a breast examination on one, in what the panel described as "a deliberate and flagrant" violation of the earlier order.
Earlier this month, Dr. DeLuco, the chair of the Ontario Medical Association's general and family practice section, pleaded guilty to seeing the two patients without a female monitor."
"Ontario's doctor shortage 'can't be a mitigating factor' for a Sault Ste. Marie physician who breached an order not to examine female patients except in the presence of a female nurse . . .
. . . Dr. DeLuco was first suspended from practice last January 11 after the college learned he had seen two women patients, and performed a breast examination on one, in what the panel described as "a deliberate and flagrant" violation of the earlier order.
Earlier this month, Dr. DeLuco, the chair of the Ontario Medical Association's general and family practice section, pleaded guilty to seeing the two patients without a female monitor."
Posted by Kevin |
link
| Comments (0)
|
Monday, April 25, 2005
Orac talks about a case where a brain-dead 13-year old boy is being kept alive on a respirator
"Even worse is that a lawyer would file such an outrageous motion. Although I rarely agree with hospital flacks, in this case, I have to agree with Montefiore's spokesman, who said: 'The case and what this lawyer is doing is atrocious and a disservice to this family.' Indeed. The family has just endured a horrific tragedy. They can be certainly be excused if they are not thinking objectively or are unable to understand brain death. The lawyer cannot be excused for pursuing court action in a case like this."
"Even worse is that a lawyer would file such an outrageous motion. Although I rarely agree with hospital flacks, in this case, I have to agree with Montefiore's spokesman, who said: 'The case and what this lawyer is doing is atrocious and a disservice to this family.' Indeed. The family has just endured a horrific tragedy. They can be certainly be excused if they are not thinking objectively or are unable to understand brain death. The lawyer cannot be excused for pursuing court action in a case like this."
Posted by Kevin |
link
| Comments (5)
|
Oregon is considering a bill forcing pharmaceutical companies to disclose gifts to physicians
"In Oregon, Rep. Carolyn Tomei, D-Milwaukie, has introduced a bill requiring public disclosure of the value and purpose of any gifts given to health-care providers.
Tomei learned of the practice several years ago while looking into causes of high health-care costs. She says she was surprised to find that pharmaceutical companies spend more on advertising than on researching and developing new drugs."
"In Oregon, Rep. Carolyn Tomei, D-Milwaukie, has introduced a bill requiring public disclosure of the value and purpose of any gifts given to health-care providers.
Tomei learned of the practice several years ago while looking into causes of high health-care costs. She says she was surprised to find that pharmaceutical companies spend more on advertising than on researching and developing new drugs."
Posted by Kevin |
link
| Comments (0)
|
A patient in the UK died after a DIY home detox program from heroin
Posted by Kevin |
link
| Comments (0)
|
Sunday, April 24, 2005
A local man dies of neuroleptic malignant syndrome at a psychiatric hospital
"According to medical records, Shiv began showing symptoms of NMS on March 17, including fever, muscle stiffness, altered consciousness, increased heart rate, profuse sweating and drooling. He refused food and water and became agitated and verbally abusive.
Two days later, according to a Massachusetts Department of Mental Health report, Shiv was growing weaker, stiffer and couldn't walk without help.
It was the weekend, and a doctor was called in to examine Shiv. According to medical records, the doctor determined Shiv was dehydrated, but didn't order a blood test, which can help identify NMS, the symptoms of which include dehydration, dramatic changes in blood pressure, fever, agitation and many of the other symptoms Shiv displayed. The doctor also didn't order intravenous fluids to treat Shivs dehydration.
However, Shiv was given two shots of Haldol, another antipsychotic drug thats also known to cause and exacerbate NMS.
By the next day, Shiv was taken into a shower by hospital staff. Afterward, he remained in a weakened, dehydrated state. Another medical examination was ordered. But by the time the doctor arrived, Shiv was dead."
Nicely written article from my local paper. Neuroleptic malignant syndrome (NMS) is an uncommon reaction to some antipsychotic medications. In this case, clozaril was the culprit, with NMS occurring in less than 1% of patients.
From UptoDate, here are the clinical manifestations:
Needless to say, if NMS was suspected, the clozaril should have been stopped. Instead, because the patient was agitated in a psychiatric setting, haldol was given - which likely would have worsened the NMS. Medical treatment like dantrolene and bromocriptine are the current mainstays of treatment.
"According to medical records, Shiv began showing symptoms of NMS on March 17, including fever, muscle stiffness, altered consciousness, increased heart rate, profuse sweating and drooling. He refused food and water and became agitated and verbally abusive.
Two days later, according to a Massachusetts Department of Mental Health report, Shiv was growing weaker, stiffer and couldn't walk without help.
It was the weekend, and a doctor was called in to examine Shiv. According to medical records, the doctor determined Shiv was dehydrated, but didn't order a blood test, which can help identify NMS, the symptoms of which include dehydration, dramatic changes in blood pressure, fever, agitation and many of the other symptoms Shiv displayed. The doctor also didn't order intravenous fluids to treat Shivs dehydration.
However, Shiv was given two shots of Haldol, another antipsychotic drug thats also known to cause and exacerbate NMS.
By the next day, Shiv was taken into a shower by hospital staff. Afterward, he remained in a weakened, dehydrated state. Another medical examination was ordered. But by the time the doctor arrived, Shiv was dead."
Nicely written article from my local paper. Neuroleptic malignant syndrome (NMS) is an uncommon reaction to some antipsychotic medications. In this case, clozaril was the culprit, with NMS occurring in less than 1% of patients.
From UptoDate, here are the clinical manifestations:
NMS is also characterized by "lead pipe" muscle rigidity, altered mental status, choreoathetosis, tremors, and evidence of autonomic dysfunction, such as diaphoresis, labile blood pressure, and dysrhythmias. Complications include myocardial infarction, aspiration pneumonitis, thromboembolism, respiratory failure, mixed respiratory and lactic acidosis, rhabdomyolysis, and renal failure.In a psychiatric setting, NMS needs to be clinically suspected. Blood tests looking at the renal function, and tests for rhabdomyolysis should be done.
Needless to say, if NMS was suspected, the clozaril should have been stopped. Instead, because the patient was agitated in a psychiatric setting, haldol was given - which likely would have worsened the NMS. Medical treatment like dantrolene and bromocriptine are the current mainstays of treatment.
Posted by Kevin |
link
| Comments (3)
|
A disgruntled former Kaiser employee directed visitors to protected health information on her blog
"Cooper had posted links on her blog to three other Web sites that had the names, addresses, telephone numbers, medical record numbers, and in some cases, laboratory test results belonging to approximately 140 Kaiser health plan members, according to the lawsuit Kaiser filed last month against her. Kaiser had the sites taken down last month before the injunction was imposed on Cooper."
"Cooper had posted links on her blog to three other Web sites that had the names, addresses, telephone numbers, medical record numbers, and in some cases, laboratory test results belonging to approximately 140 Kaiser health plan members, according to the lawsuit Kaiser filed last month against her. Kaiser had the sites taken down last month before the injunction was imposed on Cooper."
Posted by Kevin |
link
| Comments (0)
|
A doc uses our highly litigious society to his advantage
"Gary Ordog was trained in emergency medicine. He spent the first 17 years of his career patching up knife and gunshot wounds at Martin Luther King/Drew Medical Center in the tough Compton neighborhood of Los Angeles. Then he found a more lucrative specialty. For $9,800 up front (plus $975 an hour) Dr. Ordog appears as an expert witness in lawsuits to testify that mold can cause a terrifying array of diseases, from lung cancer to cirrhosis of the liver."
This physician takes the "if you can't beat 'em, join 'em" approach. (via symtym)
"Gary Ordog was trained in emergency medicine. He spent the first 17 years of his career patching up knife and gunshot wounds at Martin Luther King/Drew Medical Center in the tough Compton neighborhood of Los Angeles. Then he found a more lucrative specialty. For $9,800 up front (plus $975 an hour) Dr. Ordog appears as an expert witness in lawsuits to testify that mold can cause a terrifying array of diseases, from lung cancer to cirrhosis of the liver."
This physician takes the "if you can't beat 'em, join 'em" approach. (via symtym)
Posted by Kevin |
link
| Comments (8)
|
Surgery on the cheap: 60 Minutes reports on the growing medical tourism trend
Posted by Kevin |
link
| Comments (0)
|
Sticker shock: A couple from Australia learns the hard way about life without health insurance
"A week later we saw an orthopedic specialist for a follow-up examination. That appointment, which included X-rays, cost $US480 ($615).
Then came the bad news. The wrist would need to be operated on. They could do it next week, but first, a check-up by a 'primary care physician' was needed.
This 'internist', as he was called, asked a few standard questions about medical history and allergies, got the stethoscope out, looked into the mouth and ears, and took some blood. That would be $US450 please. If he saw 12 patients a day, that would be $US5000 per day. Allowing a day each week for golf, that worked out as an annual income of $US1.25 million.
That was an expensive day for us (or our insurers), but not as expensive as it would become. The day before the operation, the surgeon's office rang to tell us what it would cost.
The surgeon's fees would be 'more than $US8000' and the hospital fees would be $US9443. An anaesthetist would be extra.
The day we returned to the hospital for the operation we entered via the front door, on Fifth Avenue. Patients are greeted in the 12-storey atrium by a woman who accompanies you to the reception desk. Before you get to see a doctor, you sit down with a clerk: 'What insurance do you have?'
Since then we have had follow-up visits to the orthopedic surgeon (included in his original fee) and twice-weekly rounds of physiotherapy. The first visit was $300.43. Don't forget the 43 cents.
We have since had other encounters with the US health system. To start children in American schools, they need a physical examination - $US300 please."
"A week later we saw an orthopedic specialist for a follow-up examination. That appointment, which included X-rays, cost $US480 ($615).
Then came the bad news. The wrist would need to be operated on. They could do it next week, but first, a check-up by a 'primary care physician' was needed.
This 'internist', as he was called, asked a few standard questions about medical history and allergies, got the stethoscope out, looked into the mouth and ears, and took some blood. That would be $US450 please. If he saw 12 patients a day, that would be $US5000 per day. Allowing a day each week for golf, that worked out as an annual income of $US1.25 million.
That was an expensive day for us (or our insurers), but not as expensive as it would become. The day before the operation, the surgeon's office rang to tell us what it would cost.
The surgeon's fees would be 'more than $US8000' and the hospital fees would be $US9443. An anaesthetist would be extra.
The day we returned to the hospital for the operation we entered via the front door, on Fifth Avenue. Patients are greeted in the 12-storey atrium by a woman who accompanies you to the reception desk. Before you get to see a doctor, you sit down with a clerk: 'What insurance do you have?'
Since then we have had follow-up visits to the orthopedic surgeon (included in his original fee) and twice-weekly rounds of physiotherapy. The first visit was $300.43. Don't forget the 43 cents.
We have since had other encounters with the US health system. To start children in American schools, they need a physical examination - $US300 please."
Posted by Kevin |
link
| Comments (0)
|
As radiology is being outsourced, I wonder how hard it is to sue them
"When patients needed urgent CT scans, MRIs and ultrasounds late at night at St. Mary's Hospital in Waterbury, Conn., emergency room workers used to rouse a bleary-eyed staff radiologist from his bed to read the images. Not anymore.
The work now goes to Arjun Kalyanpur -- 8,000 miles away in Bangalore, India. When it is the middle of the night in Connecticut, Kalyanpur is in the middle of his day, handling calls from St. Mary's and dozens of other American hospitals that transmit pictures to him electronically so he can quickly assess them and advise their doctors."
Previously mentioned here, outsourcing radiology is a growing trend. The issue of accountability has been raised:
"When patients needed urgent CT scans, MRIs and ultrasounds late at night at St. Mary's Hospital in Waterbury, Conn., emergency room workers used to rouse a bleary-eyed staff radiologist from his bed to read the images. Not anymore.
The work now goes to Arjun Kalyanpur -- 8,000 miles away in Bangalore, India. When it is the middle of the night in Connecticut, Kalyanpur is in the middle of his day, handling calls from St. Mary's and dozens of other American hospitals that transmit pictures to him electronically so he can quickly assess them and advise their doctors."
Previously mentioned here, outsourcing radiology is a growing trend. The issue of accountability has been raised:
Some also worry about what will happen when mistakes occur. Will a radiologist on another continent be as easily held liable? Could a physician in Bangalore or Beirut be compelled to come to the United States for court proceedings?
"If your radiologist is in Australia or India, I'm not so sure how easy it would be to hold them accountable," said Dennis F. O'Brien of the Maryland Trial Lawyers Association.
Companies offering the services say they have the same malpractice insurance as any U.S.-based radiologist, and such cases would be handled no differently.
"It would be very much in their interest to return to the United States to participate in any proceedings," said Sean Casey, chief executive of Virtual Radiologic Consultants of Eden Prairie, Minn. "This is where their livelihood is. They're not going to risk losing their licenses."
Posted by Kevin |
link
| Comments (0)
|
Saturday, April 23, 2005
Teaching hospitals in Florida are looking for $150,000 liability caps
"The effect would essentially be to immunize teaching hospitals in Florida from medical malpractice lawsuits. The Miami Herald reports that the bill is likely to pass; if so, it will create an interesting experiment in the effect of malpractice liability on healthcare costs and results, since there will be two regimes side-by-side in the state, one for teaching hospitals and one for regular hospitals." (via PointofLaw.com)
"The effect would essentially be to immunize teaching hospitals in Florida from medical malpractice lawsuits. The Miami Herald reports that the bill is likely to pass; if so, it will create an interesting experiment in the effect of malpractice liability on healthcare costs and results, since there will be two regimes side-by-side in the state, one for teaching hospitals and one for regular hospitals." (via PointofLaw.com)
Posted by Kevin |
link
| Comments (2)
|
The 100K Lives Campaign is designed to reduce preventable medical errors
"The 100,000 Lives Campaign is a nationwide initiative of the Institute for Healthcare Improvement (IHI) to radically reduce morbidity and mortality in American health care. Building on the successful work of health care providers all over the world, we will introduce proven best practices across the country to extend or save as many as 100,000 lives. IHI and its partners in this work believe it’s possible to achieve this by June 2006 — with your help."
The AMA editorializes on the campaign.
"The 100,000 Lives Campaign is a nationwide initiative of the Institute for Healthcare Improvement (IHI) to radically reduce morbidity and mortality in American health care. Building on the successful work of health care providers all over the world, we will introduce proven best practices across the country to extend or save as many as 100,000 lives. IHI and its partners in this work believe it’s possible to achieve this by June 2006 — with your help."
The AMA editorializes on the campaign.
Posted by Kevin |
link
| Comments (1)
|
This physician truly runs a solo practice
Relying heavily on technology, he has zero support staff.
Relying heavily on technology, he has zero support staff.
Posted by Kevin |
link
| Comments (0)
|
A patient wins a malpractice suit, but won't collect since the doctor filed for bankruptcy
"A sweeping federal bankruptcy act the president signed into law last week will still allow doctors to file bankruptcy to avoid paying medical malpractice suits, according to Jeffrey Morris, scholar for the American Bankruptcy Institute in Alexandria, Va., and chair-in-law at the University of Dayton School of Law in Ohio.
Medical malpractice debts are not considered as being due to a 'willful and malicious injury,' and are therefore able to be discharged, or canceled, under Chapter 11 or 13 after a certain period of time, such five years, of bankruptcy payments, Morris said, citing a case in Hawaii involving a negligent doctor."
"A sweeping federal bankruptcy act the president signed into law last week will still allow doctors to file bankruptcy to avoid paying medical malpractice suits, according to Jeffrey Morris, scholar for the American Bankruptcy Institute in Alexandria, Va., and chair-in-law at the University of Dayton School of Law in Ohio.
Medical malpractice debts are not considered as being due to a 'willful and malicious injury,' and are therefore able to be discharged, or canceled, under Chapter 11 or 13 after a certain period of time, such five years, of bankruptcy payments, Morris said, citing a case in Hawaii involving a negligent doctor."
Posted by Kevin |
link
| Comments (2)
|
Friday, April 22, 2005
Doctors gone wild: A physician was fired for assaulting his boss
"'He don't talk to them [patients] like a doctor, he talks to them like
a brother and a friend,' said Marvin Johnson, one of the protesters.
'He say, You my dog, I'll hook you up,' ' to a patient who asks for a
new prescription, said Johnson. 'He's earthy and gutty and they [the
clinic] don't like that.'"
"'He don't talk to them [patients] like a doctor, he talks to them like
a brother and a friend,' said Marvin Johnson, one of the protesters.
'He say, You my dog, I'll hook you up,' ' to a patient who asks for a
new prescription, said Johnson. 'He's earthy and gutty and they [the
clinic] don't like that.'"
Posted by Kevin |
link
| Comments (0)
|
The story of a famed Tampa surgeon being sued for a surgical complication
This isn't a case of weeding out bad doctors. From all accounts, this was one of the top surgeons in the area. Nor is this frivolous - the patient has suffered a terrible complication. Unfortunately, complications occur despite the best intentions.
I harken back to a previous quote: "Most of the problem is that medicine is by nature something less than an exact science - and our society can't deal with that."
Update:
The physician was cleared of malpractice. Now, there is no doubt that the patient suffered because of a bad medical outcome. This is where the no-fault concept would have come in handy.
This isn't a case of weeding out bad doctors. From all accounts, this was one of the top surgeons in the area. Nor is this frivolous - the patient has suffered a terrible complication. Unfortunately, complications occur despite the best intentions.
I harken back to a previous quote: "Most of the problem is that medicine is by nature something less than an exact science - and our society can't deal with that."
Update:
The physician was cleared of malpractice. Now, there is no doubt that the patient suffered because of a bad medical outcome. This is where the no-fault concept would have come in handy.
Posted by Kevin |
link
| Comments (12)
|
A plastic surgeon has been reprimanded after he left a patient in the middle of an operation to perform surgery down the street at another hospital
Posted by Kevin |
link
| Comments (0)
|
Thursday, April 21, 2005
"The unimpeded increase in litigation leads one to question whether the rule of law that our society is supposedly based on has become the tyranny of lawyers."
Posted by Kevin |
link
| Comments (3)
|
A doctor was liable for a patient he didn't even see
Risk-management principle: "Advice given over the telephone is a high-risk gamble and should be treated with considerable caution. Any such advice should be recorded in the patients chart. Unless the physician is in the office with the chart in front of him, however, this recommendation may be unrealistic. One physician (who has successfully defended several lawsuits) carries a pocket tape recorder with him and makes a record of every encounter, no matter how informal, for later transcription to the office chart. These notes have been extremely useful in defending delayed lawsuits, which often hinge upon who said what and when."
That is why we send everyone to the ER after-hours. Facing a lawsuit like this is not worth the risk.
Risk-management principle: "Advice given over the telephone is a high-risk gamble and should be treated with considerable caution. Any such advice should be recorded in the patients chart. Unless the physician is in the office with the chart in front of him, however, this recommendation may be unrealistic. One physician (who has successfully defended several lawsuits) carries a pocket tape recorder with him and makes a record of every encounter, no matter how informal, for later transcription to the office chart. These notes have been extremely useful in defending delayed lawsuits, which often hinge upon who said what and when."
That is why we send everyone to the ER after-hours. Facing a lawsuit like this is not worth the risk.
Posted by Kevin |
link
| Comments (9)
|
Italians have the longest penises
What a study: "A group of scientists in Hong Kong spent five months from October last year measuring 148 ethnic Chinese volunteers aged between 23 and 93.
The average length of their flaccid penises was 8.46 centimeters (3.4 inches), which compared favorably with similar studies on other men overseas.
Germans have average lengths of about 8.6 centimeters, Israelis 8.3, Turks 7.8 and Filipinos 7.35. Italians were the longest at 9 centimeters and Americans averaged 8.8."
What a study: "A group of scientists in Hong Kong spent five months from October last year measuring 148 ethnic Chinese volunteers aged between 23 and 93.
The average length of their flaccid penises was 8.46 centimeters (3.4 inches), which compared favorably with similar studies on other men overseas.
Germans have average lengths of about 8.6 centimeters, Israelis 8.3, Turks 7.8 and Filipinos 7.35. Italians were the longest at 9 centimeters and Americans averaged 8.8."
Posted by Kevin |
link
| Comments (1)
|
An ER nurse tells us how she really feels
A tirade for the ages. I'll quote one part that rings true (expletives censored by me):
A tirade for the ages. I'll quote one part that rings true (expletives censored by me):
Do not believe that because your doctor told you to come right to the ER that you have a right to be seen right away. Let us discuss why he really said that; LIABILITY. Your doctor doesnt give a rat's ass about little Johnny's sniffles as long as he's out of the clinic before 5:00. Filling up his over-booked appointment calendar could have an adverse affect on that, but sending them right away to the ER wont! AND no one can ever sue him for bad advice or irresponsible behavior because he TOLD them to go the ER Right away for the Highest level of care. Gotta keep those malpractice premiums down! . . .She's right. The fear of liability is why we send so many people to the ED. But don't take it out on the advice nurses, they are simply doing what the docs are instructing. And that means sending everyone in question to the ER to be evaluated as a cya measure. You can see the pressures of defensive medicine has gotten to this nurse in particular. (via GruntDoc and code: theWebSocket;)
. . . 2) Advice nurses are the bane of our existence. Sure they cant tell everything over the phone, sure people are generally bad communicators, sure the clinics and doctors are over-booked, sure its 2-6 weeks out to even see a doctor, sure my cheap-ass HMO added another 90,000 new members last month but no infrastructure to deal with them, but the solution for this is not Not NOT to go to the ER right away where they will fill the fantasies that our unscrupulous marketing department has instilled in you. **** off. I love getting advice nurses for patients. They must know because they are reluctant to mention it. We hate them all and feel no shame in railing against them while they suffer (off the clock) in their sick and/or injured misery.
Posted by Kevin |
link
| Comments (10)
|
Several hundred physicians rallied at the Capitol yesterday for malpractice reform
"Dr. Steven Fletcher, a general and vascular surgeon at St. Barnabas Medical Center in Livingston, N.J., said lawsuit reform would reduce the amount of defensive medicine he performs.
About 70 percent of the blood-clot checks he conducts are not are not medically necessary, but 'we have to do them just in case,' Dr. Fletcher said.
Defensive medicine, including medical tests and procedures performed mainly to protect a doctor from a lawsuit, costs an estimated $60 billion annually, Department of Health and Human Services data show."
"Dr. Steven Fletcher, a general and vascular surgeon at St. Barnabas Medical Center in Livingston, N.J., said lawsuit reform would reduce the amount of defensive medicine he performs.
About 70 percent of the blood-clot checks he conducts are not are not medically necessary, but 'we have to do them just in case,' Dr. Fletcher said.
Defensive medicine, including medical tests and procedures performed mainly to protect a doctor from a lawsuit, costs an estimated $60 billion annually, Department of Health and Human Services data show."
Posted by Kevin |
link
| Comments (1)
|
A doc goes cold turkey from drug reps
"We doctors see these folks, let them stroke our egos and accept their largesse. Some of us do this reluctantly, with unspoken reservations; a few do it eagerly and even try to shake down the reps for more and bigger freebies.
Many of us just play the game without thinking. Drug reps have been part of the medical scene since the early years of the 20th century, and most of us have never considered what medicine would be like without them."
"We doctors see these folks, let them stroke our egos and accept their largesse. Some of us do this reluctantly, with unspoken reservations; a few do it eagerly and even try to shake down the reps for more and bigger freebies.
Many of us just play the game without thinking. Drug reps have been part of the medical scene since the early years of the 20th century, and most of us have never considered what medicine would be like without them."
Posted by Kevin |
link
| Comments (3)
|