Wednesday, May 31, 2006

A family holds vigil for wrong patient

Tragic:
An American family stood vigil for weeks at the hospital bedside of a severely injured woman they thought was their daughter before realising she was really the girl's classmate and that their own child was dead and already buried.

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What's the average length of stay in the ER?

3.7 hours, according the a recent survey.

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Duke closes its family practice residency

This may be start of a trend as medical students, heavily in debt, realize that family medicine is a dead end.

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Stories from a single payer world

The next in a continuing series:
A herniated disc kept Thomas Dobson flat on his back all winter and now he can't find a doctor to sign his application for disability benefits.

"The problem is I need a doctor," said Dobson. "I've called every number in the book."

Dobson had no success because there are no physicians taking new patients and no walk-in clinics in the city.

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Flights are introducing on-board telemedicine

I wonder if this will catch on:
Tempus uses the satellite technology that operates Virgin Atlantic’s onboard telephone system to transmit medical information such as pulse rate and blood pressure readings as well as video images to medical experts at the MedAire Centre in Phoenix, Arizona. The ground-based doctors can then diagnose the problem and advise the crew on the next course of action, enabling crew to use their medical training to assist the passenger.
(via Medgadget)

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Using Google to beat bird flu

US poultry experts are using Google Earth:
Since the beginning of the year, experts have also been using Google Earth , which combines satellite imagery, maps and the company's search engine to span the globe. It gives extra details including the location of buildings, schools and roads near large chicken and turkey farms and production facilities.

"Twenty years ago we had to drive around the countryside and find the chicken farm that reported a disease, but now everything is on a mapping system," Davison told Reuters in a recent interview.

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How a blood draw can lead to debilitating injury

The NY Times profiles an unusual case.

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Some interesting data about the uninsured

Here's one tidbit:
Nearly 60 percent of uninsured hospital stays originated in the emergency department, compared with 31.8 percent for the privately insured and 39.3 percent for Medicaid patients.

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When normal people become patients

The Washington Post looks at disease-mongering:
Shy people have "social phobia," requiring psychotropic drugs. High-strung boys have attention deficit disorder and need amphetamines. Baby boomers with slightly elevated blood pressure have "pre-hypertension" and line up for beta blockers. A few nights of restlessness calls for sleeping pills.

"The ordinary experiences of life become a diagnosis, which makes healthy people feel like they're sick," Schwartz said.

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The controversies of pill splitting

Expect drug companies to adjust pricing as this practice becomes widespread.

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How does a baby grow three arms?

ABC News takes a look.

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Tuesday, May 30, 2006

Problems at Medlogs?

GruntDoc and others can't get their feed published at Medlogs. As it gets fixed, one option to stay up to date would be to use the feeds page here.

I'd like to keep it as updated as possible (i.e. including only regularly updated blogs), since I use it to steal find the links I blog about throughout the day. Contact me if you want your blog to be considered for addition. (via Grand Rounds)

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EMRs: Where more is less

Doctor comments on JAMA's recent EMR commentary:
Moreover, EMR encourages everyone to copy-and-paste the notes of everyone else so that notes become the same from author to author as well as from day to day. Even consultants are assimilated into the oneness of the EMR Borg. A cardiology consultant recently copied-and-pasted the intern's note into his own, even including "consult cardiology in AM" in his recommendations. Perhaps he meant consult a more thoughtful cardiologist.
Pages of history, physical exam templates and review of systems can be generated with a single keystroke. Again, reimbursement is the driving factor. Essentially, more comprehensive notes = higher coding = higher reimbursement. (via Grand Rounds)

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Is the food police going too far?

This NY Times article thinks so:
I fear there's something else at work -— a fear borne out by a flier my fifth grader brought home saying that at the monthly pizza hot lunch, no child would be allowed to buy a second slice of pizza. The district says the new ruling is to avoid bad feelings caused by "inequities": if everyone can't have extra helpings, no one can.

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Brilliant anti-smoking marketing

From the Singapore Cancer Society.

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Chris Rangel wonders about fast-food outpatient medicine

Welcome to primary care in the USA:
To use the same fast food analogy, imagine a situation where price was no longer an issue (because of insurance) and the hungry masses started demanding the best burgers in the world . . . . but they wanted to wait no longer than they did for the regular "McDonaldized" burger. The problem is that the amount of money that the restaurant gets from the "burger insurance company" is little more than what they got from the customer when the meal was paid for directly. So the burger guys are stuck.

Unlike the gourmet burger place across the street that accepts only cash (or plastic), the "fast food" burger guys (who only take burger insurance) can't increase their prices. If they could then they could serve fewer customers and concentrate on quality while trying to hold down wait times. What to do? There are only two choices. 1. Close up shop or 2. Serve the crappiest burgers as possible so that wait times can be as short as possible, cash flow is kept stable to maintain profitability and cover overhead, and hope that nobody notices.

Oh, but Dr. Rangel, you're not suggesting that the quality of American health care is being kept low by the current physician reimbursement rates, are you? Oh yea. You bet your ass I am.
Until reimbursement is properly fixed, or at least delinked to quantity, this is only going to continue.

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On-call, 24-style

Orac takes us through a call night of an academic surgeon.

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UnitedHealth again shows why it is so profitable

It shirks its payments and now picks on hospitals serving the poor:
The trouble began in 2004 when Oxford agreed to a new contract that increased the rates it paid the hospital, then continued to pay the old rates for more than a year, according to both Jamaica and the New York State Department Center.

That cost the hospital tens of millions of dollars, but the loss is minor compared with the harm that an abrupt cancellation of its contract would cause, said David P. Rosen, president of Jamaica and its parent company, MediSys Health Network. "What Oxford did was use a nuclear weapon" in what ought to have been a minor skirmish, he said.
(via The Health Care Blog)

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A doctor sues his own hospital

This must put him in an awkward position:
According to the lawsuit, Patty Phillips went to the hospital's emergency room March 19 with extreme abdominal pain. Her husband said he was certain it indicated a serious intestinal problem that required immediate surgery.

Instead, he asserted in the lawsuit, she spent hours in a bed without standard monitoring machines in a storage area outside the hospital's radiology unit before she died. An autopsy revealed she had 20 inches of damaged intestine.

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The baby with three arms



Having such as fully-developed third arm is rare:
Neither of the boy's two left arms is fully functional and tests have so far been unable to determine which was more developed, said Dr. Chen Bochang, head of the orthopedics department at Shanghai Children's Medical Center.

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Grand rounds is up

KidneyNotes hosts the weekly best in the medical blogosphere.

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Monday, May 29, 2006

"The trial bar needs unpredictability"

It is because of the jury's unpredictability that leads to payouts and settlements:
The trial bar desperately wants the unpredictable nature of a jury to remain in the equation. Even though most cases that make it to court are won by the physician, the unpredictability of the outcome encourages physicians and their insurers to agree to a payment for an alleged error, even though in some cases the physician knows that none occurred.

As we have said for years, a system in which 75 percent of cases that make it to court are won by the doctor suggests that some or them never should have made it that far; a system in which only a few of those injured by malpractice ever receive compensation does not offer justice.

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Can architecture improve patient care?

Hospitals seem to think so.

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Meet the family of 20-year old doctors

And I thought I was young when I graduated medical school. Not compare to these siblings:
When Sugar Land siblings Shilpa, Shinil and Shiwan Shah moved across country for medical school, they were just 16 and 17 years old. Their mom came along, cooking meals and caring for them while they studied at the University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine.

The three graduated this week and will return to the Houston area this summer to start their residencies.

Twins Shilpa and Shinil are only 20 years old -— but they could be your doctors. Shiwan is 21.

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A doctor successfully countersues . . . with support from the trial lawyers

Must be read to be believed:
Four times, Dr. Frank Bonnarens was sued for malpractice, and four times, the lawsuits were dismissed.

So after a fifth suit was filed and later dropped, the Louisville orthopedic surgeon fought back -- filing his own suit against the moonlighting state government attorney who had sued him in the fifth case . . .

. . . But the president of the Kentucky Academy of Trial Attorneys, Steve Downey, hailed the verdict, which he said shows that doctors have a remedy from frivolous suits without so-called tort reform.

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$5 million for loss of sexual function

Think the lawyers were tugging on any heartstrings?
Given her condition since the 2000 procedure, the woman offered her husband a divorce -- a man she met on a blind date, just a day before he left for the Vietnam War.

She told him she'd understand if her husband of 35 years, the father of their two children, the one who sent "Love Is ..." cartoons with all his war letters, wanted to leave her for someone else.

But love, he told her, is forever.

"He said 'I'd rather be with you than without you'," attorney Brian Hurst recalled. "And then he told her 'I don't ever want to hear you say that again.' I mean, these are the two most in-love people I have ever seen in my life."

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Finally, some good advice from Forbes

I've ragged on Forbes before for their health "advice", but here's a good one:
Here's another tip: If you don't require emergency care, make an appointment with your doctor. Using the emergency room for routine medical care is a good way to start sinking into debt.

"You might get charged $1,000 for walking in the door," Cecere cautioned.

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Is that what "natural healing" is?

Meet John E. Curran: "Curran claimed to be a physician and 'natural healer,' a doctor who treats diseases with natural agents like air, water or sunshine."

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Friday, May 26, 2006

A surgeon halts surgery to donate blood

Amazing story:
A top New York heart surgeon who was doing a mercy-mission operation on an 8-year-old boy in El Salvador had to scrub out in the middle of the procedure so he could donate his own rare-type blood to the patient.

Dr. Samuel Weinstein said he had his blood drawn, ate a Pop-Tart, returned to the operating table and watched as his blood helped the boy survive the complex surgery.

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Six habits of highly effective healthcare bloggers

Healthcare blogger analyst Fard Johnmar gives his take. Thanks for the shout out.

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"A malpractice trial is like a diagnostic test"

Sailorman rebuts my thoughts on the recent Studdert malpractice study:
A trial is much like a diagnostic test, actually. In general use, you don't do a test because you KNOW there is something wrong, you do a test because you WANT TO KNOW if there is something wrong, or because you THINK there is something wrong.

Similarly, you usually don't sue when you know all the facts of the case. You sue because there's some important stuff--REALLY important stuff--in dispute. Was the procedure done right? Was a mistake made? Was the drug prescribed correctly? And so on. One person thinks yes, the other thinks no. Only the judge (or jury) can decide.
Nice points. So, let's assume the reason we go to trial is to find the "truth" (i.e. whether medical error lead to the injury). We "test" with a malpractice trial. It has a false positive rate of 37 percent according to Studdert. This leaves us a test with a 63 percent specificity. Furthermore, the costs of performing this test are ridiculously high, which everyone agrees on:
. . . a LOT of expense in medmal comes from the requirement to prove what SHOULD have happened. A lot of cases progress because people think something should have happened that didn't happen (or that something happened which should not have happened). This is really expensive. You need experts. You need experts to fight with the experts. You need lawyers to talk to them all. You can have days of debate about what the "proper" procedure is to treat X, and why Y is (or is not) as good or better.
So, all I ask - is this the best we can do? An expensive test with 63 percent specificity? Some may think so. I happen to think we can do better.

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Another tort reform success story

Arkansas has a $1 million cap: "A lot of cases that use to get filed that didn't have merit simply have not been filed."

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Denied by the state Supreme Court, a woman wants to sue a hospital again

A tragic outcome, but the need to blame someone has got to end. The hospital is not responsible. The court agreed. The risk of HIV and other viruses are on the informed consent sheet before any blood transfusion.

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WellPoint is the worst at shirking payments

Or, as Matthew Holt point out, the best as protecting profits:
Insurance companies make money off the float—always have. So it’s in their interest to be at the bottom of the list until either they get fined by the state (as happened to United in Arizona lately) or they get sued by medical associations.
Shameful.

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Turning the tables: A woman is ordered to pay a doctor $2.8 million

She made up the allegations about sexual misconduct:
A woman who accused her doctor of molesting her and having his identical twin impersonate him to assault her must pay the doctor $2.8 million because she fabricated the allegations, a judge ruled . . .

. . . "The contradictions and inconsistencies in Ms. Saldivar's testimony were some of the most pronounced this court has ever seen," Stolz wrote Wednesday.
The lawyer was in on it as well:
The judge also fined Saldivar's lawyer $300,000. Stolz called Harish Bharti of Seattle a knowing participant in the falsehoods against the Momah brothers, and also ordered him to post her decision on his Web site for at least a year or as long as it contains reference to the brothers.

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It just takes one cigarette

The so-called "sleeper effect" in kids:
Children who light up just once are twice as likely to become steady smokers later.

British researchers report that, among 11-year-olds, the desire to smoke can lie dormant for more than three years after trying just one cigarette.

The researchers call this a "sleeper effect," and it doubles the risk that a child who smokes just one cigarette will become a regular smoker, according to their report in the July issue of Tobacco Control.

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Spreading the news of the cervical cancer vaccine

Most will learn this important public health information from the drug company:
The scientists and researchers who made and tested these incredibly promising vaccines will probably not be deciding the best way to educate men and women about cervical cancer, or how to plan for affordable global distribution that is now, more than ever, the right thing to do.

Regrettably, some of those decisions have already been made — in pharmaceutical company boardrooms — and we can now see the opening act of another sophisticated "ask your doctor" advertising campaign on the evening news. This one begins with a well-dressed, hip young woman who reflects, while contemplating the middle distance: "There's a common virus that can cause cancer? I didn't know that!"

Maybe she didn't. But here, where public health was born, and where the knowledge that HPV causes cancer has been around for almost two decades, it's a crying shame she has to learn it from a drug company.

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1% of Americans account for 22% of health care spending

Striking numbers. Also, the top 5 percent of the population accounted for 49 percent of health care expenditures.

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Botox - the new wonder drug

Indications for use are expending daily:
Overactive bladder, diabetic nerve pain, excessive sweating, migraine headaches, voice tremors — these are just a few of the conditions that the drug Botox can treat.

This week came the news that yet another condition might be alleviated by Botox — benign prostatic hypertrophy, or prostate enlargement.

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Thursday, May 25, 2006

La Jolla Digital - Complete Practice Management Solutions



Please welcome La Jolla Digital as the newest sponsor to Kevin, M.D. From the website:
For years physicians have been in search of a product to effectively, easily, and reasonably manage their practices. Today, La Jolla Digital has an affordable solution for physician practices looking to enhance their services with the latest in practice management technology. La Jolla Digital's products were designed from ground level with the HIPAA regulations in mind, so our customers are compliant right from the start.

La Jolla Digital's solution is an integrated suite of clinical information management solutions for physician practices. La Jolla Digital's web-based practice management and patient management solutions automate the primary areas of a medical practice. They provide physicians and patients with a modern, affordable, easy-to-use solution for managing clinical and patient information.
Learn more here.

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A physician is sued for disclosing HIV information

The patient was denied a promotion once his boss found out:
A man who tested positive for HIV is suing his Charlotte doctor, saying he was denied a promotion at work after the doctor faxed confidential medical records to his office.

The man says his boss found the report, and he experienced discrimination at work.

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Dr. Charles defeated by breast implants

The latest, hilarious, slice of Dr. Charles' life.

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A doctor was "driven to shoplift"

She cites considerable family stress.

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Surgeons warming up with video games

No surprise with the increased gadgetry in surgery:
Surgeons who warmed up by playing video games like "Super Monkey Ball" for 20 minutes immediately prior to performing surgical drills were faster and made fewer errors than those who did not, said Dr. James "Butch" Rosser, lead investigator on the study, slated for release Wednesday.

The research involved 303 surgeons participating in a medical training course that included video games and was focused on laparoscopic surgical procedures--which use a tiny video camera and long, slender instruments inserted through small incisions.

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Medicaid enrollees to sign a "personal resonsibility contract"

Great idea, but there's no way to enforce this:
West Virginia families served by Medicaid could face a reduction in benefits if they refuse to sign contracts promising to show up for doctors' appointments and to use the emergency room only for emergencies.

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How delays in payments increase medical costs

Well, that's what happens when profits takes precidence:
Tardiness or refusal to pay what doctors consider legitimate medical claims may add as much as 15 to 20 percent in overhead costs for physicians, forcing them to pursue those claims or pass along the costs to other patients.

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Wednesday, May 24, 2006

Meet the world's most soothing robot



It has been shown to help with Alzheimer's disease:
Named the world's most soothing robot by Guinness World Records, the robot can express emotions and react sensitively to humans by cooing, moving delicately and opening and closing its eyes. It looks happy when patted on the head and gets angry when ignored. Paro has been shown to help people suffering from Alzheimer's disease and mental disorders by reducing stress, activating the immune system and stabilizing heart rate and blood pressure.

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I love how the media is making David Studdert look like an idiot

I was reading this piece in the Boston Globe about a new malpractice proposal. Of course, Studdert's malpractice findings are trotted out:
A study released by the Harvard School of Public Health earlier this month found that about 40 percent of the medical malpractice cases filed in the United States are groundless. Many of the lawsuits analyzed contained no evidence that a medical error was committed or that the patient suffered any injury, the researchers reported.

The vast majority of those dubious cases were dismissed with no payout to the patient. However, groundless lawsuits still accounted for 15 percent of the money paid out in settlements or verdicts.
A 40 percent groundless case rate and a 15 percent chance of a payday in these baseless cases - sounds pretty broken to me. But here's the next paragraph:
The study's lead researcher, David Studdert of the Harvard School of Public Health, said the findings challenge the view among tort reform supporters that the legal system is riddled with frivolous claims that lead to exorbitant payouts.
Huh? Again, Studdert's biased conclusions completely go against the results of his own study.

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The AMA is proud of boosting membership . . .

. . . to almost 30 percent of practicing physicians. Want to boost membership? How about reducing the ridiculously high annual fee, or making AMNews free again. You're welcome - no charge for that advice.

Posted by Kevin |