January 3rd, 2011 by KevinMD in Better Health Network, Research
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I’ve written in the past that more medicine and tests do not necessarily reflect better care.
There is no test that is 100 percent specific or sensitive. That means tests may be positive, when, in fact, there is no disease (“false positive”), or tests may be negative in the presence of disease (“false negative”).
It’s the latter that often gets the most media attention, often trumpeted as missed diagnoses. But false positives can be just as dangerous. Consider this frightening case report from the Archives of Internal Medicine:
A 52-year-old woman presented to a community hospital with atypical chest pain. Her low-density lipoprotein cholesterol and high-sensitivity C-reactive protein levels were not elevated. She underwent cardiac computed tomography angiography, which showed both calcified and noncalcified coronary plaques in several locations. Her physicians subsequently performed coronary angiography, which was complicated by dissection of the left main coronary artery, requiring emergency coronary artery bypass graft surgery. Her subsequent clinical course was complicated, but eventually she required orthotropic heart transplantation for refractory heart failure. This case illustrates the hazards of the inappropriate use of cardiac computed tomography angiography in low-risk patients and emphasizes the need for restraint in applying this new technology to the evaluation of patients with atypical chest pain. Read more »
*This blog post was originally published at KevinMD.com*
December 29th, 2010 by KevinMD in Better Health Network, Opinion, True Stories
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Primary care physicians often have to see patients with a litany of issues — often within a span of a 15-minute office visit.
This places the doctor in the middle of a tension: Spend more time with the patient to address all of the concerns, but risk the wrath of patients scheduled afterwards, who are then forced to wait. And in some cases, it’s simply impossible to adequately address every patient question during a given visit.
It’s a situation that internist Danielle Ofri wrote recently about in the New York Times. In her essay, she describes a patient, who she initially classified as the “worried well” type:
… a thin, 50-year-old educated woman with a long litany of nonspecific, unrelated complaints and tight worry lines carved into her face. She unfolded a sheet of paper on that Thursday morning in my office with a brisk snap, and my heart sank as I saw 30 lines of hand-printed concerns.
Ms. W. told me that she had recently started smoking again, after her elderly mother became ill, and she was up to a pack a day now. She had headaches, eye pain, pounding in her ears, shortness of breath and dizziness. Her throat felt dry when she swallowed, and she had needling sensations in her chest and tightness in her gut. She couldn’t fall asleep at night. And she really, really wanted a cigarette, she told me, nervously eying the door.
This is the kind of patient who makes me feel as though I’m drowning.
Dr. Ofri did as many doctors do: She listened appropriately, went over the patient’s history and physical, reviewed prior tests, and concluded that many of her symptoms were due to anxiety. Except, in this case, they weren’t. The patient eventually had a pulmonary embolus, and hospitalized. Read more »
*This blog post was originally published at KevinMD.com*
December 17th, 2010 by KevinMD in Better Health Network, Health Policy, News, Opinion, Research
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Mediation has been cited as a way to lower the cost of litigation and compensate injured patients without going through the ordeal of a trial. In a post from the WSJ Health Blog, the problem is that few doctors are participating.
That’s a problem. A study from a law journal looked at 31 cases that went to mediation and found that,
of those cases, 16 were settled at mediation, 5 settled afterward and 10 weren’t settled. While defense attorneys were less likely to agree to mediation than plaintiff attorneys, lawyers who did participate reported satisfaction with the process, as did “plaintiffs, hospital representatives and insurers,” the study finds.
The authors write that in no cases did physicians participate in the mediation.
Many times, patients resort to suing their physicians simply to find out what happened. In a recent post here, attorney Brian Nash provided perspective from the legal standpoint, and in the comments (now 150+ strong), you can see the dissonance between the malpractice viewpoints of the physician, attorney, and patient. Read more »
*This blog post was originally published at KevinMD.com*
October 21st, 2010 by Stanley Feld, M.D. in Better Health Network, Health Policy, News, Opinion, Research
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It is important to listen to what physicians are saying. An article appeared in SERMO, a physicians’ social network, which expressed a physician’s frustration. It is appropriate to publish some of that physician’s thoughts:
“I first heard this statement over twenty years ago, when I was an intern in general surgery, struggling to find my professional self.”
“My chief resident said; “The patient owns the disease,” “You’re not trying to make them suffer, you’re trying to help. They’re sick, you’re not.”
“The human body is unpredictable. Disease complications happen.”
The author thought his chief resident was heartless and callous. In a way, he was but he was getting at the heart of the matter. What is the patient’s responsibility in the evolution of disease? Read more »
*This blog post was originally published at Repairing the Healthcare System*
October 11th, 2010 by GruntDoc in Better Health Network, Health Policy, News, Opinion
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According to the Standard of Care Project at EP Monthly:
The Power of Agreement
We can stop baseless malpractice suits before they get started. How? By having a majority of practicing emergency physicians go on record as to the baseline “standard of care,” beneath which is negligence.
This has been rolling for a while, and I’ve been late to blog it. That does not in any way mean I’m not 100 percent FOR it.
The idea is beautifully simple: The standard of care in emergency medicine (EM) should be set by practicing EM physicians, not case-by case in courts before lay juries with battling experts. (AAEM had the “remarkable testimony” series as a retrospective attempt to shame “experts” who gave, well, remarkable statements under oath, which to date has two cases in it.)
This has the very real advantage of being a clear, concise peer statement that this is/is not the standard of care.
I voted (while at ACEP). If you’re an emergency physician (and you have to cough up some information to determine your bona-fides before you can vote), go to the Standard of Care Project and cast your vote. They’ve set the bar at 30,000 votes, which is ambitious. It’s also worth it.
*This blog post was originally published at GruntDoc*
