Sunday, April 30, 2006
Malpractice in West Virginia
Tough malpractice reforms are putting plaintiff lawyers under pressure, and reducing malpractice rates. In other words, it's working:Sensabaugh said the caps have allowed cases to be settled quickly and reasonably, and have provided stability for medical insurance carriers.
That stability, said David Rader, president and chief executive of West Virginia Physicians Mutual Insurance Co., enabled the company to cut its premiums by 5 percent on Jan. 1.
"I anticipate that we can do the same next year and the year after," he said.
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The 2006 Bitter Pill Awards
This year, Bitter Pill Awards were presented in four categories to drug companies engaging in over-zealous and questionable marketing practices. The drug industry’s national lobbying group, PhRMA, received two awards, and the remaining three awards were shared among makers of five of the nation’s most well-known drugs: Lunesta, Ambien/AmbienCR, Lipitor, Crestor and Strattera.(via PharmaGossip)
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"Demand to be tested"
A radiation oncologist is giving this tidbit of advice to patients exposed to polluted water in Massachusetts:Sacher urged people exposed to Nyanza to get regular checkups and seek medical care whenever they have symptoms that seem unusual or last longer than expected, like a cold or respiratory problem lasting more than a week. They should also demand tests if they are worried, even if a doctor doesn't think it is necessary, Sacher said.
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"Too posh to push"
C-sections are up in the UK as well:Last year the government introduced a new coding system that classifies caesareans as either elective or emergency. Preliminary figures show that, last year, 45% were elective, compared with 55% classified as emergency procedures. This compares with an estimated 7.5% elective sections in 1998.
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The new standard of defensive medicine
64-slice CT scanners. Expect most who enter the ER with chest pain to receive these scans soon:At this point, most doctors agree that the new scanners should not be used to look for problems in healthy people. In addition to the radiation risk, CT scans may pick up tiny spots of plaque on artery walls that, in the absence of symptoms, are hard for doctors to interpret. They may not know whether the plaque poses a heart attack risk to the patient and requires treatment such as clot-busting medications or a stent to widen the vessel. Inevitably, many such patients probably would get treatment anyway, because it's hard for doctors to do nothing, especially given the fear of lawsuits.
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DEA and pain
The DEA investigates a pain specialist and suspends his prescription writing privileges. It's been over a year and the physician still hasn't been charged with anything. In the meantime, the physician is forced to practice alternative pain treatments.
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Reducing the jackpot
These physicians should have settled, using the retrospectoscope:Lawyers for the gynecologist hit with that $28 million medical malpractice award two weeks ago have asked a Sanford judge to reduce it to less than $300,000. Attorneys for Dr. Robert Bowles say that's what the victim asked for in pre-trial settlement talks.
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Saturday, April 29, 2006
Cover the Uninsured Week
May 1-7th brings attention to this health crisis:The Problem
Nearly 46 million Americans, including more than 8 million children, are living without health insurance - forced to gamble every day that they won't get sick or injured. That's a risk no one should have to take. Uninsured Americans live sicker and die younger than those with health insurance. Just one serious illness or injury can wipe out an uninsured family's bank account, and the problem is getting worse.
The Response
That's why the Robert Wood Johnson Foundation and some of the most influential organizations in the country are again organizing Cover the Uninsured Week. This year's effort will mobilize thousands of individuals and organizations from many sectors of society to plan activities to tell Congress that health care coverage must be their top priority.
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Welcome to Canada
Where private health-care is a growing reality.
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Fed up
More are becoming fed up with rushed, harried doctors, and turning to holistic care:Walking around Victoria, I saw signs of this new two-tier health care everywhere I went: yoga studios on every corner, organic cafes, Ayurvedic health centres where people are encouraged to try healing the herbal, holistic way. Maybe it sounds flaky, but you can't argue with results.
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Legal and medical evidence
There's a good discussion going on at DB's discussing how lawyers and physicians define what acceptable evidence is:We who favor special health courts believe that this story provides a classic example of poor definitions of evidence. We expect the same definition of evidence for our medical practice and any judgment of malpractice. Having a son in law school, I understand (because he has explained this clearly) that the legal definitions of acceptable evidence are very different from the medical definitions.
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Medblogger interview
Clinical Cases and Images is interviewed by a medical librarian.
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MRSA
A women is infected with MRSA after getting her eyebrows waxed.
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Orlistat
GSK is hoping OTC Xenical (Orlistat) will be a blockbuster. Don't expect miracles however. From UptoDate, here is the results of a meta-analysis of the prescription version:Almost two-thirds of the subjects completed the first year of treatment. Weight loss at one year varied from 5.5 to 6.6 percent of initial body weight in the placebo groups and 8.5 to 10.2 percent in the orlistat groups.
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Mumps
The recent epidemic has left the efficacy of the vaccine in question:Even among those given both shots, 10 percent are left unprotected against mumps. The failure rate for measles and rubella is only 1 percent. For those who skip the second shot, 20 percent have no mumps protection, with 6 percent to 8 percent remaining vulnerable to measles and rubella.
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Celebrex ads
With patents for Lipitor and Norvasc expiring soon, Pfizer is revving up the Celebrex ad machine:The ads for the Pfizer painkiller Celebrex feature a man holding a boy's hand as they walk up a stadium staircase. "52 steps won't keep you from taking him out to the ballgame," they say.AdJab comments:
But a heart attack would.
Each ad includes a boldface warning that begins, "Important Information: Celebrex may increase the chance of a heart attack or stroke that can lead to death."
While Pfizer was holding off on advertising Celebrex sales dropped dramatically. As the article states, that's a strong lesson in how much the pharmaceutical companies are now reliant on direct-to-consumer advertising. Pfizer obviously thinks restarting DTC ads is important enough to risk the ire of critics and potential backlash that could come from the tactic. The company has not yet made a decision whether or not to expand the renewed campaign to television, where it would likely really start to feel the heat.
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A mother with 4 autistic children
The BBC investigates the link between autism and sleep disorders:Although Jacqui's family's situation is so severe, studies have shown that of the 500,000 people on the autistic spectrum in the UK most have some sort of sleep problems.
Over a third of them suffer from serious sleep problems that are debilitating for their families, partners and careers.
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Friday, April 28, 2006
An FP in Washington State learned this the hard way when he failed to notice, until a follow-up visit, that a patient's PSA was elevated. "I referred him to a urologist, who successfully treated him for prostate cancer," says the FP, who requested anonymity. "The delay in diagnosis had no negative effect, but I told the patient because I felt he had a right to know. He responded by suing me. In retrospect, I still feel that I did the right thing. It would have been nice if the patient had done the right thing, too, but he didn't."
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As most medicos know, legalities are only as binding as a judge sees fit... especially with the long shadow cast over the health business by the Health Insurance Portability and Accountability Act (HIPAA).(via a reader tip)
Not only has the Act made it really hard to stay out of a courtroom, but health pros are having more and more trouble keeping up with HIPAA's requirements.
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GruntDoc is not dead
He is simply a victim of the DOS attack on Hosting Matters. I was affected for a brief time this morning as well - but at least my blog survived (so far). GruntDoc will return soon.Update:
He's back up.
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Nurse practitioners are gaining broader acceptance by health insurers and medical regulators. In Iowa, Oregon and a dozen other states, nurse practitioners can operate without doctors' collaboration or supervision. Most states allow the nurses to prescribe the vast majority of drugs, with the exception of controlled substances such as narcotics.
Medicare, the U.S. insurance program for the elderly and disabled, reimburses nurse practitioners who bill independently at 85 percent of the amounts paid to doctors, a limitation set by Congress. In New York, Medicaid, the state-federal program for the poor, pays the nurses 100 percent of M.D. fees.
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"Blink", chest pain, and the Goldman algorithm
During my time off, I read Malcolm Gladwell's fascinating Blink. One chapter deals with Chicago's Cook County Hospital, and it's adherence to Goldman's algorithm for diagnosing chest pain. Gladwell writes:
One of the stories I tell in "Blink" is about the Emergency Room doctors at Cook County Hospital in Chicago. That's the big public hospital in Chicago, and a few years ago they changed the way they diagnosed heart attacks. They instructed their doctors to gather less information on their patients: they encouraged them to zero in on just a few critical pieces of information about patients suffering from chest pain--like blood pressure and the ECG--while ignoring everything else, like the patient's age and weight and medical history. And what happened? Cook County is now one of the best places in the United States at diagnosing chest pain.Can this "less is more" philosophy be practiced realistically? Perhaps, but old habits are hard to break. ER docs that practice defensively will have a tough time with this.
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James Greco claims Vest failed to provide anticoagulant therapy to his wife on April 30, 2004, failed to warn her of the risk she had for the development of deep vein thrombosis, and failed to consult with a specialist in vascular surgery or disease and/or radiologic expertise to evaluate and treat Tamara.
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Thanks to the guest bloggers
Much appreciation goes out to Clinical Cases and Images and This Makes Me Sick for keeping the blog fresh in my absence.
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Thursday, April 27, 2006
"There's a lot of money to be made from telling healthy people they're sick.
Some forms of medicalising ordinary life may now be better described as disease mongering: widening the boundaries of treatable illness in order to expand markets for those who sell and deliver treatments."
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Wednesday, April 26, 2006
We Don't Even Know Where to Begin
1) More than a dozen more ear-stapling businesses have been told to shut down by the Mississippi Medical Licensure Board because they aren’t licensed. The small, stainless steel staples are supposed to apply pressure to points that control appetite and cravings for nicotine. Do people sue if they keep eating? Read [Clarion Ledger] 2) This happened in Canada, but we couldn’t let it go. A hospital had to cancel 17 elective surgeries after six doctors were suspended because they were not completing patients’ charts. Oh, yeah, the slackin’ docs had 28 days to take care of this huge liability risk. Read
3) A New Jersey woman with a history of beating her son laid a real swift kick to his neck in 2003. The boy died from internal bleeding and heart failure several hours after being admitted to a hospital. Now, three medical experts say it was Pascack Valley Hospital’s shoddy care--not mom's footwork--that caused the boy’s death. So mom was found guilty of assault instead of murder. Even if the facts are what they are, the whole thing just sickens us. Read [Bergen Record]
Read more news that MakesUsSick here and here. And contact us if you have some news that MakesYouSick.
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JAMA Audio Commentary by the Editor-in-Chief
JAMA is the third journal from the group of "big five" in medical publishing to feature audio summary of content. NEJM and Lancet have their own versions of weekly audio summaries.You can listen to the MP3 files directly or subscribe via iTunes.
It is a matter of time before almost all major journals feature audio summaries.
In the meantime, you can always use text-to-speech to convert text from your favorite journal to mp3 files you can listen to on the go.
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Tuesday, April 25, 2006
Philip Howard and the crew at Common Good are helping bring special health courts to states across the nation. Howard wrote a powerful piece about hospitals’ fear of lawsuits helping allow a nurse, Charles Cullen, to kill at least 29 patients in New Jersey and Pennsylvania. Read
Doug Wojcieszak first asked when he joined the TMMS squad: "What if you could lower lawsuits and litigation costs without any politics?" Read
Dr. Eric Novack started the first of his many guest columns by flatly stating: “Solving the medical liability crisis will require medicine embracing the legal system. That sounds like complete heresy coming from an actively practicing surgeon!” Read
We got the real political deal of trying to clean up the medical liability mess from U.S. Congressman Mac Thornberry. He watched the wind blowing the special health court sails disappear like magic as a fellow congressman’s support for the solution vanished: “the Association of Trial Lawyers caught wind of his interest in the bill and they quickly changed his mind by threatening to cut off all campaign contributions.” Read
Muriel in Seattle, an 87-year old grandmother, detailed the nonsense of having to sign liability wavier after wavier while facing a frightening hospital stay over Thanksgiving in 2005: "They stick it right in front of you." WatchWe bet you have something to say. Maybe a sad or chilling experience from the frontlines. A solution that might help ease the liability mess. Or maybe just your two cents. Let it out, here.
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He was attacked by a bear and had a partial face transplant during a 15-hour operation earlier this month.
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In one study, the systolic blood pressure was on average 16 points lower after patients waited in a chair for 5 minutes.
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"Tell me more about that." "That must have been very difficult for you." "I hear what you are saying." "Your story moves me."
We are getting closer to the 7-minute-Jiffy-Lube-visit every day... The "lubricating comments" will surely help.
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"I noticed at least a couple of changes since I hosted #40 almost a year ago. First, the pre-Rounds writeup on Medscape (thanks Nick) and second, the sheer number of submissions.
Now, let's get started..."
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The Other Foot Myth, So Sorry, and More Liability News
1) While surgery on the wrong patient or wrong body part often makes headlines, a new study that looked at 20 years of data from a malpractice insurance provider found that cases of "wrong-site surgery" are rare. Read [Forbes]2) British Columbia is considering "The Apology Act," which could become the greatest Canadian export since hockey. Read [Press Telegram]
3) A doc with a new book about a 'Broken Medical System' says she laments having "to order an MRI just to prove they don’t have a brain tumor, even though we know they don’t." Read [Beverly Citizen]
4) Philipsburg Area Hospital in Pennsylvania battled to stay in business. But difficulties in recruiting doctors hurt and the rising cost of malpractice insurance "hit like a lead balloon." Read [Centre Daily Times]
5) Conservative estimates say doctors and lawyers will invest over $1 million in this year's races for the Tennessee General Assembly. One writer noted an interesting sight at the state capital: "hallways filled with physicians, clad in white coats, earnestly confronting lawmakers." We're sure lawyers in bespoke suits were lurking, as well. Sigh. Read [The Tennessean]
Read more from ThisMakesMeSick's Medical Liability News
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Monday, April 24, 2006
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Bloodless Open Heart Surgery? It's Possible
Associated Press reports that Pennsylvania Hospital, a part of The University of Pennsylvania Health System is able to offer "bloodless surgery" to 90 percent of its patients who want it:"Transfusions are like getting a transplant; they can be risky and should be a last resort."
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"Where else but in medicine do you find men and women who never admit a mistake?
Who talk more than they listen and feel entitled to withhold crucial information?"
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Google Calendar for Patients
"Google Calendar can potentially be useful for monitoring the progress of patients with chronic conditions like asthma: daily symptoms, use of PRN inhalers, symptoms during the night, etc.It is not difficult to imagine diabetic patients using the calendar to monitor their blood glucose, hypertensive patients recording their blood pressure and so on."
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"It is considered bad form in the Baltics to refuse the offer of a drink or not to finish a bottle of liquor once it has been opened. The person who finishes a bottle is expected to buy another one."
This is one of the reason why doctors do not recommend drinking alcohol to increase low HDL levels: you never know who will overdo it.
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Vioxx scandal is the latest one that shows why such legislation is necessary.
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Thanks to Kevin, M.D., for letting us guest blog in his absence. We like the serious medical forum he has built.ThisMakesMeSick has been exposing the nation's medical liability crisis since Fall 2005 with news nuggets, esteemed guest bloggers, editorial cartoons and juicy comments and astronomical financial costs. Note: we're not docs OR lawyers. But we've got something to say.
We’ve called attention to emergency room hemorrhaging and treating the uninsured here, celebrities getting burned by malpractice and winning lawsuits here, a judge’s overflowing docket because of malpractice lawsuit here, the promise of special health courts here, debated med-mal caps here, and noted a doc in Jersey offering free reconstructive surgery to needy kids only to get the boot from a lawsuit fearing hospital here. Needless to say the liability crisis breeds plenty on which to write.
Read up. Speak out. Tell us WhatMakesYouSick being a doc, a patient, a lawyer or an insurance agent in this maddening environment. The only way a system is changed is if people demand it. Contact us--david@ted.com
Today, we note the new TIME mag cover that tells us what scares doc. The answer: being a patient. We understand the idea behind the headline. But it still brings a chuckle.
More to come this week.
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Sunday, April 23, 2006
"I got through medical school only by riding a combination of fear, uncertainty and well-concealed rage at the whole process.
I left general practice after two years because I was bored to tears and devastated each night when I got home, a combination of emotional fatigue and (short-term, I hope) brain damage resulting from listening to 30 depressed people a day tell me the somatic manifestations of their misery.
But guess what?
Every single practice I worked at during that two-year run-up to beginning my anesthesiology residency (which I absolutely loved every minute of, by the way) begged me to stay and become full-time.
They loved me."
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The articles claims that, for example, doctors are uneasy about becoming patients in July:
"The average major teaching hospital typically sees a 4 percent jump in its risk-adjusted mortality rate in the summer, according to the National Bureau of Economic Research."
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New Diagnosis: Boomeritis
NYTimes describes the health problems of aging baby boomers who continue to exercise: osteoarthritis which needs "knee and hip replacements, surgery for cartilage and ligament damage, and treatment for tendinitis, arthritis, bursitis and stress fractures."Some doctors call this phenomenon "boomeritis" or "Generation Ouch."
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Saturday, April 22, 2006
"Regardless of which cleaning/disinfecting solution used, wearers may want to consider performing a "rub and rinse" lens cleaning method, rather than a no rub method, in order to minimize the number of germs and reduce the chances of infection."
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