Kevin, M.D. - Medical Weblog

Jackpot: Lawyers receive more than the victim in a malpractice win
"Circuit Judge Debra S. Nelson approved a settlement payout that gives her lawyers more money than her family.

Under its terms, the family would receive about $4.6 million. The lawyers, from Leesfield Leighton & Rubio of Miami, would receive more than $5 million." (via Common Good)

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One in four adults between the ages of 50 and 64 said that they had failed to fill a prescription, visit a physician when needed or receive a medical test or follow-up treatment because of cost concerns

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Indian doctors continue to take verbal abuse in Australia
"When Indian-trained GP Viney Joshi arrived in Townsville the first question he faced was: 'Are you Doctor Death?'

After a busy day Dr Joshi headed for the taxi rank and was shocked when his cabbie decided he must be Dr. Death."

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This study says that health-related e-mail spam can prod people to a healthier lifestyle
I still hate spam.

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Reassurance: Men worried about having a small penis are usually pretty average, but have a false idea of what the normal size is
"This best way to reassure men with penile concerns is to educate them, the author of the report says. Men should know that a normal-sized penis is 1.6 inches or more when flaccid or 2.76 inches when stretched out."

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Multi-tasking: A toilet can measure blood pressure, analyze urine, and dispense medical advice



"Users begin their toilet-room medical at the built-in urine analyzer, which collects five cubic centimeters (0.15 fluid ounces) of urine before analyzing sugar levels. The device cleans itself automatically after the one-minute long test.

Users then move to the blood pressure monitor, within arm's reach of the toilet, then weigh themselves on a set of scales in front of the basin and measure their body mass index (BMI) after washing their hands . . .

. . . Advice about diet and exercise is then dispensed, without any human intervention."

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Female doctors kill themselves at a rate 130 percent higher than other adult women, while the rate among male physicians is 40 percent higher than men in general
"The fraternity of medicine, mental health specialists said, is populated by hard-charging professionals taught to pursue perfection and abhor weakness. It's a high-stress profession. And it is a field uniquely positioned to have access to the tools of suicide -- and the knowledge of how to use them."

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Money talks: Doctors outspent lawyers by 40 percent in their political contributions during the last election
"Rios opened his checkbook to Republicans promising to limit lawsuits. So did many colleagues: In the 2004 elections, doctors almost doubled their political contributions compared with four years earlier. And, in another milestone, they outspent trial lawyers, who are opposed to curbs on litigation, by 40 percent, a reversal of the 2000 campaign."

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Grand rounds is up
Come get the weekly best of the medical blogosphere.

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The annual physical is useless - but we still do them
"Even though a panel of experts has thrown cold water on the automatic need to get an annual checkup, physicians and their patients haven't always gotten the message, a new survey says.

The survey, published Monday, found that while there's no evidence annual physicals for healthy people are useful, 65 percent of primary care doctors think they are necessary and nearly 9 out of 10 said they perform the exams."

I read the article from the Archives of Internal Medicine yesterday. Some say that both physicians and patients use the annual physical as an opportunity to get to know one another - where the opportunity isn't available during a focused visit.

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Vitamin C does nothing for colds
The vitamins are taking a beating the last few years. It has also been recently reported that vitamin E does nothing to prevent heart disease.

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"I practiced defensive medicine today" 6

The next part of this continuing series. A look at how defensive medicine hurts patients as well:

I am not a doctor, but a patient. But I thought I'd write to you about how my recent ectopic pregnancy has driven up the cost of treatment for every single patient at my IVF clinic, most of whom self-pay due to limited insurance coverage for infertility.

Last fall, I had an IVF cycle, and 13 days past ovulation I had a Beta HCG pregnancy test. The result was 5.9. I was informed this essentially negative; that a chemical pregnancy had perhaps started but the number was far too low to be viable and most likely would resolve itself. I was instructed to wait 3 days and if I did not receive my period to return for another blood draw. Sure enough, I received my period within 2 days and thus did not go in for a second Beta.

Over a month later, a 9 week ectopic pregnancy was discovered that must have been the result of the IVF cycle (no sexual activity that month) but had gone undiscovered, with Beta HCG levels around 4800. I was treated with Methotrexate. Beta HCG levels dropped 20% within a week, but 8 days after the shot the ectopic ruptured. Within an hour I lost 2.5 liters of blood, and was saved by my IVF clinic's doctors via an emergency salpingectomy and a blood transfusion.

I should mention that prior to this, I had several risk factors for ectopic pregnancy, including one prior ectopic pregnancy in 2003, in-utero DES exposure, previous abdominal surgery, and IVF.

My doctors were obviously quite concerned that they had not detected the ectopic earlier. By the extreme amount of attention and concern I received, I could tell they were worried I would sue. While I would never sue them - I did feel properly informed of the risks and besides that I owed them my very life - I was peturbed to later discover that in my chart's operative report the attending physician wrote "patient chose Methotrexate shot in lieu of surgery, against advice" because this was totally not true. Prior to the rupture, another physician at the clinic (a fellow) accurately informed me of the risks of each course of action, and deliberately told me she was not supposed to make a recommendation, that it was up to me. But after I chose the shot, the IVF fellow told me she thought my decision was a good one.

Anyway, as the result of my case, my IVF clinic has instituted a new policy. Starting 13 days past ovulation, each patient must return every 2-3 days for a Beta HCG until levels are less than 1 or an intrauterine pregnancy is confirmed via ultrasound. This applies to all patients. These blood tests cost each patient $150 each; patients with normal pregnancies now must pay for 4 or 5 blood tests prior to confirming the pregnancy via ultrasound.

While I can understand instituting such a policy for women with multiple risk factors for ectopic pregnancy, such as myself, I feel very badly that my case has increased the cost of cycling by up to $600 for women who only have a 2-5% chance of having an ectopic.

Anyway, just wanted to sum up by pointing out that defensive medicine doesn't always increase costs for the "system", but directly increases the costs for other patients. But I do wonder how common it is for physicians to try to CYA by entering inaccurate information into medical charts. I adore my doctors and are so thankful to them, but my trust in them has eroded some as a result.

Defensive medicine is one of the leading factors in driving up health care costs today. The purpose of this series is to breathe some real-life examples into the numbers, and to provide some insight into how the threat of malpractice litigation pervades medical decision making.

Please e-mail me your stories of "how you practiced defensive medicine today", and it will be posted anonymously as part of this continuing series.

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Get ready for the Dr. Death movie
Any suggestions for a tagline?

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The American Medical Association is launching a $60 million public relations campaign that includes heartstring-tugging ads that portray doctors as "everyday heroes"
"The AMA is losing out on market share. An internal AMA report reported the AMA lost members in 2004 for the fifth straight year, and only can count one in four doctors and medical students nationwide as members. At one time, the AMA represented nearly 70% of the nation's doctors and medical students."

Isolationist moves like making AMA News "members only" only further threatens their membership. I'm not sure who's making the public-relations decisions over there.

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More education is needed: Many still believe cancer myths
"The authors found only one in four (25 percent) of participants correctly identified all five misconceptions as false. Four in ten (41 percent) of the respondents believed that surgical treatment actually spread cancer in the body and 13 percent said they were unsure whether this was true. Twenty-seven percent believed that there is a cure for cancer available being withheld by the healthcare industry and an additional 14 percent were uncertain. Nineteen percent believed that pain medications were ineffective in treating cancer pain with another 13 percent saying they did not know. Nine in ten (89 percent) correctly disagreed with the statement that "all you need to beat cancer is a positive attitude," but more than one in ten (11 percent) either thought is was true or did not know. A similar percentage (87 percent) correctly disagreed that "cancer is something that cannot be effectively treated," but again, about one in eight (13 percent) either agreed or did not know."

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Some say a federal ban to cover Viagra can put lives at risk
"Erectile dysfunction drugs are not 'lifestyle' drugs to prostate cancer patients . . . Men already have a great reluctance when it comes to paying attention to their health - significantly downsizing access to the opportunity to fight side-effects of life-saving treatments gives them another excuse."

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One third of residents in their final or next-to-last year of residency planned to leave Pennsylvania because of the lack of availability of affordable malpractice coverage
"An environment of mounting liability costs in Pennsylvania appears to have dissuaded substantial numbers of residents in high-risk specialties from locating their clinical practices in the state. The impact of decreased resident retention on the future availability of specialist services in high-cost states merits close monitoring." (via PointofLaw.com)

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Looking at the "July myth": Is June 30th more dangerous than July 1st?
"One can argue that June, rather than July, is the worst time to be a patient. I don’t mind a young doctor who is scared but eager to learn, but I do very much mind that same doctor 11 months later when his knowledge base has increased o­nly modestly compared with his fatigue and false confidence.We have taken great pains to come up with comparison between the July 1st vs. June 30th housestaff to see just which is more dangerous." (via The "Future" of Medicine)

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"You can trust any generic drug as much as you trust its brand name equivalent."
Agreed. Generic drugs often do not receive as much publicity.

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The Center for Nursing Advocacy doesn't like the way House, M.D. portrays nurses
"The show itself is a damaging lie: that a team composed entirely of physicians would rove the hospital providing all significant care to desperately ill patients as the few nurses and other professionals stand silently in the background or simply disappear."

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Can EMTs be sued for malpractice?
"The wife of a man whose death came under investigation after a San Francisco Fire Department ambulance crew failed to take him to the hospital said Tuesday that rather than helping her husband, the crew had talked him out of getting treatment.

'He was complaining about his heart,' Sheila Narcisse Potter said of her husband, Elissa Potter Jr., 59. 'They kept saying, 'Well, it's pretty busy right now. If we were to take you, you would have to wait three to four hours to see a doctor.' They said it was really busy, and most of the hospitals were full.'" (via Subaqua Sternal Rubs)

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"I practiced defensive medicine today" 5

The next part of this continuing series. I'm sure that many can relate to this story. A reader writes:

A 30-year old woman comes into her PCP's office with a complaint of chest pain for the past couple weeks. It is described as sharp and pricking along the left sternal border. It hurts when you press on it and does not radiate. It does not change with position, exertion or food. It lasts hours at a time.

She is otherwise healthy and does not take medications. There is no family history of heart disease. Vital signs are stable and the physical exam is only revealing for reproducible chest tenderness. The EKG and cholesterol panel are normal. We now pick up the conversation:

Doctor
Based on your symptoms, the chest pain is unlikely to be heart-related in origin. Your EKG, blood pressure and cholesterol are normal, and you do not have a family history of heart disease. I believe that your chest pain is musculoskeletal in origin, since this is the most common cause of chest pain.

Patient
I want to be 100% sure this isn't my heart.

Doctor
Well, there are no absolutes in medicine. But from my experience and your history and physical, I can be reasonably sure that this isn't cardiac in origin.

Patient
I'm just really nervous. I've heard some stories of young adults dropping dead of a heart attack, and I really don't want that to happen to me. I heard you can run on a treadmill to see if your arteries are blocked.

Doctor
It's called an exercise stress test. In my opinion, this test will be of low yield in your case.

Patient
What percentage of heart disease does this test pick up?

Doctor
Well, the estimated sensitivity of the test is between 65-70% - meaning that a negative test result will miss about 30-35% of coronary heart disease.

Patient
That doesn't sound very accurate. Isn't there anything better?

Doctor
There are stress tests with imaging, like an echocardiogram or nuclear scan, that can push the sensitivity up to 85-90%.

Patient
That sounds good - it would be make me feel a lot better if we went that route. I understand that it's likely going to be negative, but I just don't want to be that 1 in a million case where someone like me can have heart disease.

Doctor
Ok, I'll go ahead and order that test for you - just to be on the safe side.

Cost of ordering an imaging stress test in this low-yield patient: several hundred dollars.

Cost of knowing that there will be zero chance of being sued for this visit: priceless.

Defensive medicine is one of the leading factors in driving up health care costs today. The purpose of this series is to breathe some real-life examples into the numbers, and to provide some insight into how the threat of malpractice litigation pervades medical decision making.

Please e-mail me your stories of "how you practiced defensive medicine today", and it will be posted anonymously as part of this continuing series.

(Disclaimer: Any pictures shown are not of the patient. All identifying features, including race, age, gender and ethnicity have been modified significantly or fictionalized.)

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One has to remember that "the first drug geared towards blacks" is really not a new medication
This is simply repackaged hydralazine and a nitrate, which was used before the ace-inhibitor era for heart failure. More has been written about this previously.

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A physician lost a case for $2.6 million for following instructions
"Alexander Mitchell, 16, of Conway, N.H., died after swallowing nearly 300 aspirin pills. Alexander, a student at Proctor Academy in Andover, was depressed over a relationship.

The Mitchells alleged that Christopher Occhino, a visiting doctor filling in at Franklin Hospital, did not order their son transferred to Dartmouth-Hitchcock Medical Center soon enough for more specialized treatment. Occhino now practices in New York.

Occhino's lawyer, Christopher Nyhan, said Occhino had consulted with a Dartmouth-Hitchcock expert soon after Alexander Mitchell arrived in Franklin, but was told to do additional tests before transferring the boy. When Occhino did the tests and made a follow-up call to Dartmouth-Hitchcock, staff there recommended transferring Mitchell, Nyhan said.

'Occhino agreed, and the transfer was undertaken,' Nyhan said.

Nyhan said jurors concluded that because the overdose had been so unusually large, the doctor should have known to transfer Mitchell much sooner."

Perhaps if the physician did an earlier "defensive transfer" to a tertiary care facility, he would not have been sued.

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retired doc wonders if there will be general internists in the future
"Tremendous growth and development of the subspecialist domains of expertise has changed the landscape. Cardiologists are now called in to treat coronary syndromes, pulmonary docs for respiratory failure, etc etc. Oncologists take care of the cancers, kidney doctors the ESRD cases and it is the rheumatologists now giving the disease modifying treatments for rheumatoid arthritis. In short, the areas in which the internist was the expert have largely disappeared and the experts are the IM subspecialists."

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More defensive medicine: Malpractice fears leads to mammography overreads
"An article in the July issue of Radiology suggests that this anxiety may be the reason for the large number of false positives and recalls in the United States.

Dr. Joann Elmore of the University of Washington medical school, said that this caution does not necessarily make women safer and does increase their anxiety about breast cancer.

'The majority of women who are called back for additional testing after a screening mammogram do not have any evidence of breast cancer on subsequent evaluation,' she said.

Elmore and her colleagues surveyed 124 radiologists who regularly screen mammograms. They found that 76.4 percent are concerned about the effect of medical malpractice suits on mammography, 58.5 percent said that makes them more likely to recommend breast biopsies and 72.4 percent said it increased their recommendations for diagnostic mammography or ultrasound."

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More "dirt" on Dr. Death
"India-born surgeon Jayant Patel, dubbed 'Dr Death', refused to wash his hands between operations and was responsible for a high rate of complications among renal unit patients at the Australian hospital where he worked, an inquiry has heard."

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The BMJ suggests ways to re-invent office practice
"If we can change the financing so that doctors are paid by the patient instead of by the visit, or if health plans would begin to reimburse for on-line and group care, all kinds of new care models could be supported. The key insight is the willingness to abandon the individual doctor-patient visit as the standard unit of care. The Internet and e-mail, along with group visits, enable asynchronous and/or more efficient and tailored communications between physician and patient."

Kind of stating the obvious isn't it? These changes certainly are necessary, but it's easier said than done my friend.

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Antibiotics do not help healthy individuals with bronchitis
"In the study, coughing lasted an average of 11 days after patients saw their doctors, whether they got antibiotics or not. Other symptoms, such as phlegm and shortness of breath, were reduced by less than a day for people treated with amoxicillin or erythromycin."

The abstract can be found here.

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A patient punches a doctor for trying to do a physical exam for a hip injury
"Winston seemed to think Dhananjayan would X-ray his leg. When the doctor explained that a physical examination was required first, Winston flew into a rage and accused the doctor of 'wanting to touch his sexual organs,' the police said."

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No balls: The AMA can't make up its mind about DTC advertising, so it plays it safe and votes for further study

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Overseas Trained Doctors (OTDs) are facing racial abuse in Australia in light of the continuing Dr. Death scandal
A follow-up to this story.

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Why is it so difficult to e-mail your doctor?
Liability and reimbursement are two big reasons.

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A drug rep took a physician to a strip club
"About four evenings a week, L.J. Twyner, a Newton physician, enjoys dinner paid for by drug companies. Other perks have included trips to bars and in at least one instance a visit to a club featuring nude dancers."

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Wyeth is cutting back on drug rep visits to physician offices
"Wyeth spokesman Doug Petkus said his company is cutting back on repeat visits to the same general practitioners and internists because of the costs and also the growing unwillingness of busy doctors to endure so many sales calls."

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Grand rounds 1:39 is up
Everybody's favorite blogging surgeon is hosting this week. Come get the weekly best of the medical blogosphere.

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Some are facing difficult decisions about removing their recalled heart defibrillators
"Each assessment on surgery, doctors say, will be a personal one, based on a patient's age and health, how dependent the patient is on the device and the patient's attitudes toward risk."

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"Dr. Patel screamed at patient's wife not to cry."
The NY Times writes about Australia's Dr. Death.

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Bristol-Myers Squibb is the first major drug firm to forgo advertising new drugs to consumers in a product's first year on the market
I applaud the move. Not quite a ban on DTC advertising, but it's a start.

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Medical residents are on strike in a hospital in India, leading to a standstill
"Two more patients died and more than two dozen patients sought discharge from the King George’s Medical University, as junior doctor’s strike entered the second day on Tuesday.

The hospital wore a deserted look as patients started leaving the hospital for private nursing homes and other government hospitals. In the general body meeting held during the day, Junior Doctors’ Association (JDA) decided to continue to strike till their demands were fulfilled . . ."

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A neurosurgeon quits brain surgery to do hair transplants
"'Basically I was working over 100 hours a week just to pay a malpractice premium (of) about $135,000 a year,' he says.

He was reimbursed between 25 and 40 percent of his surgical fees, and his income had already plummeted 60 percent.

Now, Dr. Ballon says he's operating on the same place, but he just doesn't go as deep. And he had the same operation himself." (via Common Good)

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"I'm writing on behalf of the more than 60 people who took my advice and posted pictures of their illnesses and injuries . . . in the hopes that Dr. Frist might be able to diagnose us over the Internet."
Dr. Frist is coming under fire for his internet diagnosis from the LA Times and Chris Rangel.

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Despite all the complaining that doctors do, this physician puts it in perspective
"Personally, I think we complain too much. All businesses have become more difficult in today's economy. My brother-in-law - in management for an automobile company - has had to work out-of-state 10 days out of 12 for the past six months. A computer company downsizes its workforce and everyone left picks up the slack. A well-respected editor is let go when the company that acquired his publication decides his position is expendable. This is the reality of our modern day world. Yet it seems we believe that because we're doctors, we should be immune."

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Low blood sugar can now be used as a defense in court
"The Colorado Supreme Court has ruled that low blood sugar meets the legal definition of ?involuntary intoxication.?

The court ruling gives legal standing to something diabetics and medical authorities have known for a long time, low blood sugar can have serious affects on the way people act." (via bookofjoe)

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A UK hospital told a patient she would have to wait 18 months for an MRI brain scan, but she could get the scan privately in two weeks

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A cancer-stricken man has a new penis constructed
"In October 2004, the patient had skin removed from the inside of his mouth, which Bird then rolled into a tube to create a new, longer urethra. The patient was given six months to heal.

Ten days ago, doctors selected a relatively hairless part of the man's outer thigh to make the shaft of the penis . . .

. . . But leaving the blood vessels attached presented another challenge - how to get the skin from the thigh to the groin area without snipping its tethers.

To do this, the doctors made a tunnel under the skin and fed the piece of flesh through to the groin area. There it was rolled into the shape of a shaft and connected to the artificial urethra.

From there, Lee worked to reattach the nerves to the stump of the man's former penis and sculpt a passable head for it."

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John Stossel wonders why the best sunscreen is being blocked by the FDA
"But even though dermatologists say Mexoryl is the best, you cannot legally buy it in the United States. It's illegal, because the Food and Drug Administration won't approve it. They won't even say why. The FDA is charged with making sure no drug is sold unless the government is convinced it's safe and effective. Dermatologists think it's just stuck in the bureaucracy. It routinely takes 12 to 15 years for a drug to get approval . . .

. . . But is there no common sense here? All drugs have risks as well as benefits. Mexoryl has been in use in other countries for 13 years. It's passed many safety tests. Why won't our FDA even talk about it?"

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Equating the competence of older physicians with older firefighters
"The sad truth was that some of the more experienced firefighters had let their skills and training lapse, feeling certain that they would continue to coast along to retirement on grass fires. Some failed to follow important safety protocols. Some positioned themselves and their equipment poorly. A few were temporarily paralyzed by fear.

The "old guys" weren't so physically or mentally diminished that they couldn't do the job well. They had simply become complacent about the need to vigorously engage in ongoing training." (via MSSPNexus Blog)

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A surgical resident rotated through four Massachusetts hospitals with active TB
"The memo states that once the woman's potential TB infection was identified by a skin test in 2004, Boston Medical Center referred her for a chest X-ray to a TB clinic run by the Boston Public Health Commission. The X-ray, which is one of the tests typically performed to ascertain whether a patient has an infectious case of TB, was scheduled for July 15, 2004, but, the document states, the doctor did not show up for the appointment."

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A woman survives a rare internal decapitation
"A near-fatal car accident this past January ended a lifelong career as a musician when the ligaments connecting the base of Greitzer's skull to her backbone were severed, internally decapitating her.

Miraculously, even though Greitzer's injuries were so severe, tests revealed that her organs and spinal cord were still intact."

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The paper trail from a simple doctor's visit can be so labyrinthine that some people simply wait for an envelope from a collection agency before cutting a check
"The sequence of events goes something like this: You go to the doctor, pay the $10 or $20 co-pay on your way out, and shove the carbon copy receipt into the bottom of your purse or pocket. Later, you get an envelope with a piece of paper in it that says, "This is not a bill." It mentions that a bill is coming, but this isn't it, so you ignore it. Ditto for the second non-bill that says -- seemingly-- the exact same thing. Then a bill shows up that says that you don't have to pay it yet because the insurance company might pay some or all of it. Next, the "explanation of benefits" bill that says "this actually is a bill" arrives, and you ignore it, too, because, well, maybe they're kidding. Once the sixth or seventh envelope arrives, you figure it might be time to pay the bill (or send a "This is not a payment" payment just to be cheeky).

Repeat this cycle for every lab test, radiologist report, dermatological exam, and nurse practitioner appointment, and it's no wonder you have no idea what you're shelling out to keep your brood healthy."

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A psychiatry resident talks about Tom Cruise, Scientology and its anti-psychiatric stance
Maria over at intueri: to contemplate has a wonderful blog. She writes:

If Tom Cruise has not ever personally suffered from mental illness, it is my sincere hope that he is grateful for that blessing. His faith in Scientology is steadfast, but his proselytization of the merits of his faith, particularly in the realm of (anti) psychiatry, only reveals his ignorance and lack of empathy for those who do not share in his good fortune and blessings.

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What can you treat over the phone?

The most recent story in the defensive medicine series led to the following comment:

Why would a physician even consider prescribing anything other than say, birth control, over the phone? That doesn't sound like defensive medicine, it sounds like common sense.

This begs the question: Are there any diseases that can be treated over the phone?

The answer is yes. Go to your local drug store, and you will find many OTC medications that patients can simply pick up without even talking to a physician. Prilosec OTC for GERD or Claritin for allergic rhinitis. Both of these medications used to be prescription-only.

In the UK, antibacterial eyedrops for conjunctivitis and statins for hypercholesterolemia are now being sold OTC, further examples where patients can self-diagnose without a physician visit.

How about a UTI? Studies have shown that a history alone (without physical exam or laboratory testing) can diagnose some 90 percent of cases.

Do you call a physician every time you have a headache? Most would simply take a Tylenol and call it a day. Today, if you call a doctor about a headache, there is a good chance you'll be told to come in for an office visit and walk out with an order for a head CT.

So no, not every complaint needs to be seen. Back when defensive medicine was less prevalent, many of these minor complaints could be treated over the phone. Patients were happy at the convenience. Physicians were happy because they did not drive up the cost of health care with unnecessary office visits. Emergency rooms were happy because they were not deluged with minor, non-emergent issues.

This scenario no longer exists today. Defensive medicine has diminished the role telephone medicine. Every patient needs to be seen without exception. After-hours, patients are directed to the emergency room for every complaint, further promoting ER overcrowding. Any refusal is documented in the chart. The consequences of not doing so are too great.

By the way, the comment above eluded to the "safety" of prescribing birth control over the phone. Try prescribing an oral contraceptive to a women with an unbeknownst elevated level of antiphospholipid antibodies over the phone. Note the pulmonary embolus that she received from her 2.3 times increased risk of venous thromboembolism. See the physician who prescribed the oral contraceptive over the phone get sued.

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Tort reform is causing some malpractice lawyers to leave the field
"Attorneys say they have been forced to turn low-income clients away because those individuals cannot generate enough in the way of economic damages, which are not capped, to justify going to court.

Losing that business might have negative consequences for some attorneys. Several attorneys said they have heard grumbling from colleagues who are insisting they will need to leave the medical malpractice field entirely."

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Patients in Australia are canceling surgery from doctors with ethnic names amid a patient backlash over the "Dr Death" scandal
"As the scandal unfolds, the Australian Divisions of General Practice has received reports of mounting concern among patients about the quality and qualifications of overseas-trained doctors.

It has reached a point interstate where patients are cancelling surgery due to the 'ethnic inflection' of surgeons' surnames, according to ADGP chairman Dr Rob Walters."

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Grand Rounds 1:38 is up
Come get your weekly best of the medical blogosphere.

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