Chemnick | Moen | Greenstreet

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The CMG Voice

Quantifying pain with science – how new technologies may be able to show jurors the pain an injured person is experiencing

Posted Thursday, June 22, 2017 by Tyler Goldberg-Hoss

Every one of our clients has suffered some harm giving rise to a claim. Some harm is easier to quantify than others. In particular, if one can show that the injured person cannot do the work that she used to do because of the negligence of the defendant, she may be entitled to money to replace the wages she has lost. Similarly, if medical and other bills have been paid or likely will need to be paid in the future, money can pay those bills.

However, most of my clients also have “pain and suffering” damages, harm that cannot easily be quantified by calculating wages lost or medical bills to be incurred. This often includes harm in the form of actual, day-to-day, pain. Pain is a difficult thing for many people to understand sufficient to feel comfortable translating it into a figure that will adequately compensate the person for having to endure it.

Recently, there is an emerging trend in personal injury litigation to make more concrete this pain by using neuroscience. In particular, some doctors and researchers are using fMRI technology (“Functional magnetic resonance imaging”) to actually show the locations in the brain that become active with pain. The thought is that, by standardizing the pain a person has (as opposed to amorphous and subjective 1-10 scales), juries will be more likely to understand, accept, and more easily allow for money damages to compensate for the pain.

An article describing these new efforts can be found here:

Personal injury lawyers turn to neuroscience to back claims of chronic pain

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Is Medicine Based On Science? The Example of Cardiac Stenting

Posted Monday, June 19, 2017 by Gene Moen

Over the centuries, medicine has evolved from a “black art” to one that is based on provable scientific principles. Or at least that is the assumption. An essay in The Atlantic magazine questions how far medicine has actually advanced (“When Evidence Say No, But Doctors Say Yes”). A key example in the article is the practice of stenting cardiac vessels to prevent heart attacks.

As the article points out, interventional cardiologists participate in a major industry focused on opening up a blocked cardiac artery without surgery. This is done by inserting a thin device up through the vessel to the narrowed area and stretching it open. Sometimes the area is then kept open by placing a stent inside the vessel. It all seems intuitive to anyone who thinks of the body as, in part, a vascular plumbing system. If the pipe is narrowed, open it up, and then prop it open.

Studies have shown, however, that few patients who are otherwise stable benefit from this procedure. Putting a piece of metal in an artery carries the risk of major complications, even death. Despite this knowledge and the evidence upon which it is based, invasive cardiologists continue to make this a mainstay of their medical practices. Apart from the obvious fact that this makes a lot of money for such cardiologists, a major reason may be social and cultural, rather than scientific.

“Evidence-based medicine” has become a slogan for the “new” scientific medicine. Yet there is a dearth of solid proof of benefit for many of the medical practices that make up much of what a doctor does. The remedies are often a result of habit and custom. Other doctors do them, and they are talked about at medical meetings, so this must be what should be done.

But evidence-based medicine only works for things for which we have solid evidence. A review of the article in The Atlantic contained the following: “But for those things for which we only have intuition and sometimes guesswork it is often best to remember the famous formulation of Loeb’s laws. Many times it is best to go by this dictum when tempted for forge ahead into the mist: ‘Don’t just do something, stand there.’”

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Are Teaching Hospitals Better?

Posted Friday, June 16, 2017 by Gene Moen

There are many assumptions about both teaching hospitals and community hospitals. The latter are thought to have lesser quality physicians and medical staff, while the former have better educated and well-published experts. However, with teaching hospitals patients worry about medical interns or residents doing the actual medical work, while the attending physicians are in their ivory towers writing peer-reviewed articles to advance their academic careers. There are also the horror stories about the July 1 shift for new residents each year. Do you want your emergency intubation being done by a resident who just started his residency?

A recent study, published in the Journal of the American Medical Association, tries to measure the difference between the two kinds of hospital by looking at objective data. The study found that there are significant differences in outcome, and this generally reflects better care in teaching hospitals. The authors looked at 21 million hospitalization records from Medicare data. They were looking for risk-adjusted 30-day mortality. The study focused on 15 diagnosis groups and 6 common surgical procedures.

Except for stroke and sepsis, teaching hospital patients did better by every measure. For more complex procedures, like abdominal aortic aneurysm repairs, teaching hospitals had a mortality rate that was 5% lower than their community hospital counterparts. There was also a substantial gap — favoring teaching hospitals — for respiratory disease treatment. Since teaching hospitals often get referrals of patients who have more complex problems, the gap in favor of teaching hospitals may be even larger.

One of the reasons for this gap is probably that “practice makes perfect” – or at least better. As noted, major teaching hospitals are often the hospitals to which complex cases are referred, so the average doctor there may do similar procedures many more times than would a community hospital physician. There have been other studies that show that the more of a particular procedure, like aortic valve replacements, performed by an individual doctor, the fewer complications or bad outcomes.

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Reduce your chances of post-surgical infection by going under the knife in winter

Posted Monday, June 12, 2017 by Tyler Goldberg-Hoss

We routinely receive calls from potential clients injured due to postoperative infections. Often times it is difficult to make a claim that a health care provider – be it the surgeon or other person involved in the surgery – was negligent and caused the infection to occur. More often claims can be made in a failure by the health care provider to reasonably and carefully diagnose and treat the infection when it does occur.

Often times in such situations there are possible arguments to be made that something the patient did or failed to do caused or contributed to the infection, or in the delay in treating it.

A new study put out in Infection Control & Hospital Epidemiology gives patients an additional tool in preventing such infections from occurring – schedule your surgery for when the weather is colder.

The new study looked at every adult hospitalization with a surgical site infection from 1998 to 2011, and found that “for every five-degree Fahrenheit increase in average monthly temperature, the risk of hospital admission for a surgical site infection increased by 2.1 percent.”

You can read an article on the findings of this study here:

Warmer Weather Brings More Infections After Surgery

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Virginia Mason latest hospital to tell its patients that their surgeons may be overlapping surgeries

Posted Thursday, June 8, 2017 by Tyler Goldberg-Hoss

After the recent discovery at Swedish Medical Center of surgeons performing multiple surgeries at the same time, Virginia Mason joins the University of Washington in confirming that the practice exists outside of Swedish, and that they are revising their informed consent forms to address it.

Prior to this, most informed consent forms for surgery talked vaguely the patient’s “care team” being involved in the surgery. Knowing that alone, one might be led to think that the care provided is going to be even better than with just a lone surgeon. However, those words in fact often meant that providers other than the surgeon were involved in many parts of the surgery. And it certainly wasn’t conveyed to a patient that their surgeon would in fact be in other operating rooms during surgery.

The new Virginia informational sheet (you can read it here) describes how the surgeon will always be in the operating room for the “critical portions” of your surgery, but may not be in the room for noncritical parts. Further, your surgeon will not perform any “critical portions” of another person’s surgery while your surgery is occurring.

The term “critical portions” is undefined in the information sheet. However, it appears that the hospital is attempting to allay fears in their patients that their surgeon will be unavailable to them if something goes wrong. Still, who gets to decide what are the “critical portions” of a surgery is unknown. Further, complications from surgeries necessitating competent surgeons occur both in “critical” and “noncritical” portions of surgery. While this updated policy may reduce the risk of your surgeon being unavailable while working on another patient, it does not appear to eliminate it.

To fully eliminate this problem, institutions like Virginia Mason, UW, and Swedish could just eliminate the practice of overlapping surgeries. We are left to wonder why they don’t.

You can read another excellent Seattle Times article on this here:

Virginia Mason to inform patients about overlapping surgeries

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Chemnick | Moen | Greenstreet
115 NE 100th St #220, Seattle, WA 98125 US
Phone: 206-443-8600
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