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The CMG Voice

Poll – some doctors think lying to protect colleague is justified

Posted Monday, May 1, 2017 by Tyler Goldberg-Hoss

It is common in my practice to hear stories from potential clients about how their memory of a conversation with a doctor, or of the medical care in particular, is very different than what is written in the medical chart. It is difficult, absent extenuating circumstances, to take case that is built on a jury finding that the patient’s version is true, versus the medical record. I’ve tried and lost such a case.

Still, I will admit my bias, likely caused in part by all of the injured patients I speak with: in the context of litigation I get the feeling doctors do “misremember” things in a way that may not be overtly lying, but may not be entirely truthful. It is also likely true that patients who have been hurt and want to be compensated probably do the same thing.

Apparently, colleagues of defendant doctors do similar things to support their own. Recently an article came out highlighting a recent poll about doctors, nurses and lying. The poll, through Medscape, found that as many of 43% of doctors felt like lying to protect a colleague would be ok in certain circumstances. Only 18% of nurses, on the other hand, felt that way.

With respect to doctors, 38% felt like lying to protect a fellow doctor would be ok so long as the patient wasn’t harmed, while 5% said lying could be justified even if sometimes it was not in the best interest of the patient.

It was unclear from the poll what “not in the best interest of the patient” meant. Certainly in active litigation, “not in the best interest of the patient” means testifying in such a way as to defend fellow health care providers. Again, this may not be overt lying, but it may involve selective memory.

Another question in the poll asked whether the respondent had ever lied to protect a colleague. Almost one fourth of doctors (24%) said they had, while 14% of nurses said they had.

An unidentified doctor was quoted in the article as saying that lying was “medicine’s dirty little secret.” I don’t know about that; I’m not a health care provider. But the numbers in this poll are eye-opening.

You can read the Medscape article detailing the results of this poll here:

[Poll: 43% of Doctors Say Lying for Colleague Could Be Justified](http:// http://www.medscape.com/viewarticle/877290)

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Virtual Reality In The Hospital?

Posted Thursday, April 27, 2017 by Gene Moen

It was bound to happen. Technology and the computer age have already infiltrated our health care system in many ways, but a new one may be the use of virtual reality. Cedar-Sinai Medical Center in Los Angeles issued a study (a randomized controlled trial) on inpatient virtual reality use. The trials were in three areas: eating disorders, rehabilitation (motor and cognitive), and pain management.

In general, the trials showed clinical efficacy, although the small sizes of the samples made it difficult to reach far-reaching conclusions. Inpatient pain management was the most successful. As one report asked, “have you ever lain down on a hospital bed counting the days until you are released?” The report described how the team at Cedars-Sinai “introduced VR worlds to their patients to help them release stress and reduce pain.” Using the special goggles, they could ignore the four walls of the hospital and the impact of hospital routine while visiting amazing landscapes in Iceland, participating in the work of an art studio, or swimming together with whales in the deep blue ocean.

Other studies have investigated the use of virtual reality with traumatic brain injury patients, and another looked at stroke rehab with virtual reality. The “brain-body” connection has new meaning when your virtual reality brain can take you to far-away places.

The use of this device can have major impact on children in hospitals. “The experience in a hospital is even more stressful and mentally burdening for small children who miss their parents, their best buddies, their favorite blanket and generally, the soothing environment called home.”

But a Dutch study has found that a smart-phone and virtual glasses can make live contact possible with a 360 degree camera at the patient’s home, school or special occasions such as a birthday celebration or a football game. Though hospitalized, young patients can relax and still enjoy their lives.

Looking forward to your next stay in a hospital? Stay tuned as technology keeps developing new ways to change your ordinary reality, however depressing, to a more interesting one.

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Are Strokes In Younger People Increasing Or Are Classification Systems Changing?

Posted Tuesday, April 25, 2017 by Gene Moen

We usually think of strokes being associated with old age. But studies of stroke trends have indicated that there have been sharp increases among younger people. For example, there were 30,000 more hospitalizations for acute ischemic stroke in people under 65 in 2012 as compared to 2003. Among men ages 18-34, the rates have almost doubled. The increase in stroke prevalence in younger adults seems to mirror an increase in hypertension and hyperlipidemia in this population. Other factors that are related to strokes, such as diabetes and obesity, also increased in that group.

These increases have led stroke specialists to emphasize the importance of focusing on prevention in younger adults. But others question whether the increase is more a function of diagnostic classification systems and coding. Some observers think that similar diagnostic and coding factors may be involved in calculations of both stroke incidence and risk factor prevalence.

It has been noted that other factors that may account for the increases, including greater use of MRI imaging and changes in the definitions of TIA (temporary ischemic attack) and ischemic strokes. Some events diagnosed as TIA in 2003 would likely be diagnosed as ischemic stroke in 2012.

The difficulties in deciding whether there has been an actual increase, as opposed to changes in classification and coding factors, are frustrating for those who study stroke trends. According to James Burke, MD and Lesli Skolarus, MD, of the University of Michigan, “it is startling that in a country that spends almost 20% of [GDP] on healthcare, we cannot say with confidence whether the fifth leading cause of death in the United States is increasing or decreasing in the young.”

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New prostate cancer screening guidelines gain acceptance, if not clarity

Posted Friday, April 21, 2017 by Tyler Goldberg-Hoss

The US Preventive Services Task Force has recently updated its guidelines for screening men for prostate cancer using the prostate-specific antigen (PSA) lab test. Although the guidelines are a little muddier than they were the last time they were changed (in 2012), at least now there is consensus among other physician associations.

The current guidelines go like this: if you are a man older than 70 or younger than 55, the advice is don’t get screened. If you are 55-69 years old, talk with your doctor about the plusses and minuses of screening.

Luckily, both the American Cancer Society and the American Urological Association are mostly in agreement with these recommendations (there are slight differences in when men are recommended to talk with their doctor about PSA testing).

For men older than 70 and younger than 55, the Task Force has concluded that the risks outweigh the potential benefits. There are too many false positives, which lead to too many procedures that can cause real problems, including urinary incontinence and sexual dysfunction.

For those in the 55-69 age bracket, the Task Force felt the risks and benefits were such that it is worthwhile for each man to make the decision with his doctor.

There is a handy graphic here that shows this demographic, and in particular what happens when 1000 of these men are tested. 240 of those 1000 get a positive result, which leads to a biopsy. The biopsy confirms only 100 have cancer. Of those, 20%-50% of them have cancer that never grows, spreads or harms them.

Of those 100, 80 will choose surgery or radiation. These procedures come with serious possible complications discussed above.

Of those, only 3 will have avoided the cancer spreading, and 1 or 2 of those will have avoided a death from prostate cancer.

The rest either have cancer that never grows, spreads or harms them.

So men in this age bracket are doing some (hopefully) well-informed gambling. Do you want to be screened, knowing that it’s much more likely that it will result in urinary incontinence or sexual impotence (about 6%) instead of preventing death (.1%-.2%)?

For medical negligence attorneys, these new guidelines make it very difficult, absent extenuating circumstances, to argue that a client with metastatic prostate cancer should have been screened. The doctor can easily point to these recommendations as indications that it is not the standard of care to screen such patients.

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Physician Orders Under Electronic Records Systems

Posted Wednesday, April 19, 2017 by Gene Moen

In the old pre-computer days, physicians caring for patients in the hospital would order medications for their patients in a fairly simple way: just tell the nurse or write it into the order sheet. With the advent of entirely computerized record keeping, that simplicity is a thing of the past. Whether it improves patient care of safety, however, is not so clear.

At the present time, orders are made through a “Computerized Physician Order Entry” (CPOE). Physician orders, whether for medications, laboratory, radiology, or other purposes, now require the physician to go to the nearest computer, log in, and then use a password to get into the system. No more can the doctor tell the nurse or unit secretary, on the fly as he is passes by, “give the patient 600 mg of tylenol q 4 hours PRN.”

The doctor now has to enter this into the computer, thus interrupting what he or she was doing. It’s not a lot of time, but it adds up if this occurs dozens of times a day. And all of the time used in entering a computer order is time not spent with the patient. As one patient said about computers in the hospital: “I see the back of my doctor’s head more than I see his face.”

A recent article advocates development of an app that would allow voice commands to be placed via a smart phone. The nurse calls the physician asking for a medication order, and the physician dictates the patient’s name, which then pulls up the patient information on the phone. The physician would dictate the medication order and click “order.” In an age when almost anything can now be done via your smart phone, and the advent of voice recognition software, developing that app doesn’t seem like an insurmountable task. After all, anyone can now order their favorite pizza via their iPhone and dictating what they want before pushing a button or two. Computerized medicine is here to stay, and there should be a major effort to make it work faster and better and more safely.

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