Chemnick | Moen | Greenstreet

Medical Malpractice. It's All We Do. 206-443-8600

The CMG Voice

Some Stroke Patients May Have an Extended Chance at Thrombectomy

Posted Monday, February 25, 2019 by Morgan Cartwright

A stroke occurs when a patient has had restricted blood flow (normally due to a blood clot) to the brain and the neurons in the brain start dying. A thrombectomy is a surgical procedure in which a doctor removes a blood clot from a blood vessel/artery. Thereafter, the blood flow is restored to the brain and hopefully minimizes significant brain injury.

Over the past few decades, a number of clinical trials have tested the time frame in which a thrombectomy can be performed after the stroke started. It used to be that there were only a few hours into a stroke in which you could perform a thrombectomy that would result in any benefit to the patient. However, recent clinical trials, DAWN (24 hr range) and DEFUSE 3 (6-16hr range), have shown a possible benefit for thrombectomy of up to 24 hours after the onset of symptoms.

Unfortunately, the extended time frames are only available to a small percentage of patient groups depending on the area of the blood clot and the patient’s anatomy. So for now, it’s imperative that all stroke patients are identified for potential thrombectomy as soon as possible to avoid tragic outcomes.

The Window of Opportunity Widens: Thrombectomy’s Practice-Changing Implications in Stroke

Permalink to this entry

Communication between Technicians and Radiologists is Key

Posted Friday, February 22, 2019 by Morgan Cartwright

When taking imaging of a patient, the radiology technologist is typically the provider who sees the patient. The radiologist – the physician who interprets the images taken – rarely interacts with the patient. This means that communication between the technician and radiologist is often important to ensure the radiologist is guided in their interpretations and patients are provided optimal care.

For example, sometimes a technologist might see that a patient is particularly ill, in which case the technologist may be able to expedite the exam. In such a scenario, communicating that to the radiologist may key her or him into a critical finding on an image, or a clue that further imaging needs to be done.

Equally as important is the ability of the radiologist to communicate back to the technician regarding the images. If the technician takes images in a certain way but they aren’t showing something, the radiologist has the ability to suggest different images be taken. This symbiotic relationship of obtaining the correct images is critical to ensuring the patient is being treated properly.

While this communication furthers patient care, it also serves to foster a connection between the technician and radiologist. This allows both providers to start to develop awareness into information that is important to each other so they can do their jobs at their peak ability. Most importantly, this increased communication between the technician and radiologist leads to higher quality care and more patient safety.

A Good Tech-rad Relationship Is Vital to Patient Care

Permalink to this entry

Language Barriers in Medicine

Posted Monday, February 11, 2019 by Morgan Cartwright

The United States is becoming more and more diverse, with people immigrating here from every part of the globe. Currently, there are over 25 million people in the United States who have limited English proficiency.

Doctors who provide care to these people must recognize this and provide adequate language services to ensure a mutual understanding with the patient. Most of the time this requires the doctor obtaining a professional translator. This is most often a translator with expertise in translating in the medical field, rather than someone who just happens to speak the language of the patient. The difference can be enormous in the ability to communicate the medical terms necessary for the patient to understand care. Furthermore, when patients have questions, they must have an interpreter who is competent enough to get a complete answer.

Doctors who fail to recognize these language differences may risk performing procedures or making decisions about health care against the wishes of those with limited English proficiency.

This can open the physician up to liability. In a study of 35 malpractice cases involving translators, 32 had to do with a failure to use competent interpreters. Twelve involved failure to translate important documents, and twelve involved using family members to translate.

This population is particularly vulnerable because they may be less able to get help after they have been injured. They may not understand the legal system to take action or may have other fears of the legal system. We can only hope that as the diversity increases in this country, doctors will realize the importance of overcoming language barriers in Medicine with competent translators.

Your Legal Risks When Patients Don’t Speak English Well

Permalink to this entry

Artificial Intelligence continues making inroads into medicine by interpreting x-rays

Posted Monday, February 4, 2019 by Tyler Goldberg-Hoss

Followers of this blog may recall a recent post on how Artificial Intelligence (AI) was being used to screen patients for the eye disease diabetic retinopathy.

Mere months later, more data has come out about the algorithm “CheXNeXt”, created by researchers at Stanford. It was created to review chest x-rays for 14 different medical conditions.

Recently, it was “trained” with over 100,000 x-rays, after which it was tested against a panel of three trained (human) radiologists. CheXNeXt and each of the radiologists reviewed 420 x-rays one by one. The results were encouraging (for AI): for 11 of the 14 diseases, CheXNeXt was as good or better than the radiologists at catching the disease.

Not only is CheXNeXt’s accuracy similar to board certified radiologists, it comes with the added advantage of being very fast. While each of the radiologists reviewing the 420 images did so in about three hours, it took CheXNeXt 90 seconds.

This has some practice advantages. First, it may be used in underserved parts of the world where skill radiologists are lacking. Second, it can be used as a triage tool. For example, if a patient came in to the ER and his physical exam and lab results were consistent with pneumonia, the ER doc could use CheXNeXt to read the patient’s x-ray quicker than waiting for the radiologist to read it. In such a circumstance, the confidence in the diagnosis would be high, and antibiotics could be given the patient more quickly. However, if CheXNeXt came up with a different diagnosis, then a radiologist could review the images and consult with the ER doctor as needed.

Additionally, it might also serve as a quality control, scanning the images interpreted by radiologists during the day, and making sure that there were no “missed” diagnoses.

Forecasting the future, as much as this article makes efforts to not conclude the jobs of radiologists may be at stake, one cannot help but make that conclusion. From a medical negligence perspective, it will be interesting how claims involving radiology “misses” are dealt with in the setting of an algorithm essentially making the diagnosis. If there is no human health care provider, did anyone commit malpractice?

It may be that claims such as these in the future focus on either the manufacturer of the algorithm, or on how it is implemented. Either way, the future of medicine – and accountability for harms resulting from negligence care – looks to be changing. And quickly.

You can read more here:

Artificial intelligence rivals radiologists in screening X-rays for certain diseases

Permalink to this entry

The Physical Examination is Critical for Proper Care

Posted Monday, December 31, 2018 by Morgan Cartwright

It’s estimated that hospitalists and internal medicine interns spend less than 18% and 12%, respectively, of their time in direct patient care. Most of this is due to an increased reliance on diagnostic technology, lack of bedside teaching, and decreased interest in physical examination due to time limitations. As a result, patients’ care may be mismanaged, sometimes leading to significant risk of harm.

In one case study, the doctor describes a patient who goes to the emergency department for left-sided facial paralysis. The doctor ordered a CT that offered no diagnostic clues, and the patient was diagnosed with bells palsy. The next day, the patient returned with arm weakness. A thorough physical examination at that time discovered the patient’s forehead muscles were unaffected, making the diagnosis of bells palsy less likely.

Furthermore, the doctors were able to get at the issue by getting the patient to admit to daily heroin injections, despite having previously denied it. At this point specialists were able to evaluate him with an echocardiogram, which showed vegetation on his mitral valve. He then underwent emergent mitral valve replacement surgery to prevent recurrent embolic strokes.

This case illustrates that the initial examination on the first day should have been more thorough to prevent later complications.

While technology certainly has its place in the modern diagnosis of a patient, a thorough physical examination is also important. The advantages of being thorough include positive physician-patient relationship, improved patient safety, fewer diagnostic errors, and lower financial costs.

Importance Of Thorough Physical Examination: A Lost Art

Permalink to this entry

Chemnick | Moen | Greenstreet
115 NE 100th St #220, Seattle, WA 98125 US
Phone: 206-443-8600
Fax: 206-443-6904