In October 2011, the Centers for Disease Control and Prevention reported a 60% increase in “emergency department visits for sports– and recreation–related traumatic brain injuries, including concussions, among children and adolescents” over the past decade. That’s good news: as the CDC’s press release said, they believe the increase was due in part to “growing awareness among parents and coaches, and the public as a whole, about the need for individuals with a suspected ...
Posts tagged Malpractice
The fear of malpractice will always be in the back of my mind
“I wouldn’t hesitate to sue you.”I’m sorry, what?That is what I heard from the mother of one of my patients. I was evaluating a high school athlete who had recurrent stingers (nerve injury that affects an upper limb, usually resolves with time) and a possible episode of transient quadriparesis (affecting all limbs this time). I wasn’t on the sidelines for these injuries, so I had to go on the reports ...
Patients will understand an honest mistake if the doctor tells the truth
It was 1976 and I was a junior resident in urology at Baylor College of Medicine in Houston, Texas. I was assigned to a rotation in pathology where my job was to process specimens taken at surgery, dictate a gross description of the specimen and then place the specimens into the cassettes that would be used to make the permanent sections. I was transferring a prostate biopsy, approximately 0.5mm x ...
Solving distracted doctoring from smartphones and tablets
Imagine that your neurosurgeon, during surgery, was talking on his cellphone using a headset.Unthinkable?Well, no. A recent article in the New York Times cites a case where a patient was left paralyzed and the neurosurgeon was sued, in part, for being distracted. He made 10 personal calls during the operation.The proliferation of portable electronic devices, smartphones, tablets, and ...
Health reform that offers relief from fear and greed
What if we had considered the following items within health care reform?What if physicians were able to practice medicine with reduced fear of malpractice litigation? Some estimates believe the cost of defensive medicine approaches 30%.What if patients were to be offered a different process for conflict resolution before litigation, one that is partially driven by greed? What if this process provided a remedy which met all our future financial and ...
The culture of medicine needs to change
I’ve been involved in clinical medicine for more than 20 years and during this time I’ve come across numerous situations that created stress, or emotional upheaval within myself, and even times of burnout. At one point, I came close to permanently leaving my chosen profession. The culture of medicine is not geared towards allowing health care providers to de-stress, acquire emotional support, or discuss in an encouraging environment various conflictive ...
Protecting patients from medical apology programs
To deal with the aftermath of medical errors, an increasing number of providers are encouraging injured patients to participate in "medical apology programs." The idea, proponents say, is for patients to meet with facility representatives to learn what happened and why. It gives the patient a chance to ask questions and it gives providers a chance to apologize, and as appropriate, offer compensation. These programs are promoted as humanitarian, and, ...
A few more minutes with Andy Rooney
"I died last week, just a month after I said goodbye to you all from this very desk. I had a long and happy life - well, as happy as a cranky old guy could ever be. 92. Not bad. And gotta say, seeing my Margie, and Walter, and all my old friends again is great.But then I read what killed me: 'serious complications following minor surgery.'Now what the heck ...
The malpractice risk of high deductibles
As the cost of health insurance rises, patient deductibles are getting bigger.More doctors are reporting that patients are coming in less frequently for chronic care followups, skipping medication refills, or balking at the out of pocket costs for various tests.Sometimes, however, this can get physicians into trouble.I was reading through a copy of Massachusetts Medical Law Report, and saw ...
When doctors have to be reminded how to act like human beings
It’s a sad commentary when human beings have to be reminded how to act like human beings, especially when they’re in the helping profession.Loni Hildebrandt was a 29-year old certified nursing assistant who was pregnant with her first baby. Make that two babies because she was pregnant with twins. Hildebrandt considered her pregnancy miraculous because she had infertility and was a diabetic since the age of one. Together, she and ...
A nationwide system to collect adverse events from anesthesia
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.Anesthesiologists have been at the forefront of the patient safety movement. Over the past 25 years, anesthesia-related deaths have declined from two deaths per 10,000 anesthetics administered to one death per 200,000 to 300,000 anesthetics administered, due to improvements in patient safety and innovative research ...
Physicians who cash in on a woman’s desire to be beautiful
Three young mothers under the age of 40 are dead because they wanted to be beautiful. Kellee Lee-Howard wanted a slimmer body. Ditto Maria Shortall and Rohie Kah-Orukatan. Shortall worked as a housekeeper; Lee-Howard was the mother of six kids and Kah-Orukotan died at the same place where she received manicures. What do these women have in common besides being minorities? They had liposuction procedures performed by men who offered ...
It’s time for a VBAC court
We understand the problem: the VBAC (vaginal birth after cesarean) rate is too low. It's time for a bold solution. We need a "VBAC Court."VBAC is a safe option for most women, and almost 3/4 of women who opt a VBAC will deliver vaginally and avoid another C-section. But we also know that approximately 0.8% of women attempting VBAC will end up with a ruptured uterus, a catastrophic complication ...
Tort reform and integrated systems in health reform
Here are my next two principles of affordable healthcare reform.First, healthcare reform cannot occur without tort reform. Anything less is akin to a drunk leaning up against a lamppost for support but insisting it is for illumination.It is well known that fear of malpractice suits accounts for defensive medicine; e.g., performing tests and procedures and making unnecessary referrals to assure staying out of the court room. We are all ...
Lawsuits are more of an emotional issue than a financial one
Doctors love to talk about tort reform – states passing laws to put limits on awards such as non-economic damages for harms such as pain and suffering, and on the legal process of suing a doctor for malpractice. They speak of defensive medicine – the practice of ordering extra tests, treatments, and days in a hospital to cover their medical-legal butts.Texas passed a comprehensive tort reform law in 2003 ...
Progressive health reformers need doctors to change the health system
Doctors order too many tests.That's not a surprise for regular readers of this site, but even the physicians themselves think so.A recent survey reported that, "42% of the 627 respondents believed the patients in their own practice were getting too much care. Just 6% of doctors believed their patients were getting too little care ... And 28% of ...
Patients generally seek attorneys out of anger rather than greed
Patients often pursue litigation simply to obtain information that has not been forthcoming. Research shows that the three things patients want most in the face of medical error are: information about what happened; a sincere apology; and measures to prevent the error from happening to someone else. Financial compensation is lower on the list. Patients generally seek attorneys out of anger rather than greed. When unanticipated adverse outcomes occur, error ...
Legal weaknesses of an electronic medical record
Over the past several months I have read several online discussions and comment threads on the medical-legal issues raised by EMR, including an HIMSS brochure on the subject. Most of these discussions miss what I consider to be the most important legal weaknesses of an electronic medical record. I finally came across an online discussion that comes closer to covering what I consider to be the ...
Patients lose if physicians are expected to practice perfect medicine
I discussed whether or not ambulances should be required to add equipment costing $12,000 in order to be able to transport 850 pound patients recently, so I won’t belabor the point here. Providing medical care to morbidly obese patients presents multiple challenges.Then I read an article in the Florida Sun Sentinel about how some obstetrician-gynecologists in South Florida are refusing to provide medical care to obese women. ...
How a doctor reviews cases for both plaintiff and defense attorneys
Early in my career, a local defense attorney working with my hospital would occasionally ask me to review a case in which another physician client of her firm was the defendant. As Medical Director of Evergreen Hospital Emergency Department, I was comfortable with hospital records, knowing where to look in a record for information – both recorded and not recorded – that either helps or hurts a case. I found ...
