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The CMG Voice

Deception in Medicine

Posted Friday, February 21, 2014 by Tyler Goldberg-Hoss

Taking a proper clinical history is one of the most important things doctors do when they treat their patients. Unfortunately, that communication isn’t always ideal. Patients aren’t always the best reporters of their symptoms, doctors don’t always ask the right questions, and sometimes actual deception is involved.

So says Dr. Sandeep Jauhar in an Op Ed for the New Your Times. Read it here:

The Lies That Doctors and Patients Tell

Certainly, deception can have its place in medicine. Think of the cancer doctors who aren’t entirely upfront with a patient’s prognosis. Hope can help fight disease.

And it’s understandable in the example that Dr. Jauhar uses – an elderly woman he is convinced he can save with more treatment.

But it’s not understandable when deception is used to perform surgeries and other treatments that have questionable value, especially when the patient isn’t fully informed about the possibilities that such treatment will work.

A good example can be found in recent studies that show a huge increase in the number of lumbar spine fusions being done on older patients with chronic low back pain. It is uncommon for the patient to experience a significant improvement, and worse outcomes occur on a frequent basis. The operations are also expensive, but Medicare pays for them without advance approval. That may be a factor in the willingness of surgeons to recommend the procedures. Hospitals also benefit from the facility and other costs associated with the hospital stay required for the surgeries.

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“Sloppy and paste” charting in electronic medical records dangerous for patients.

Posted Monday, February 17, 2014 by Tyler Goldberg-Hoss

“Sloppy and paste” charting in electronic medical records is dangerous for patients.

A recent study in Critical Care Medicine found that physicians and residents often used the cut and paste feature to more quickly chart patient notes into the electronic health records (EHR) system.

You can read a review of the study from the Washington Academy of Family Physicians website here:

“Sloppy and paste” endures despite patient safety risk

The study found that 82% of all residents’ and 74% of all attending notes contained at least 20% copied information. Doctors and residents argue that without copying and pasting, there is simply not enough time to chart on patients.

But copying and pasting also has the potential to cause serious harm to patients. The article relates a story about a patient who was supposed to get an anticoagulant medication, and the chart note stated the patient “would” receive it. Unfortunately, the same chart note was copied and pasted four days in a row, the woman was discharged without getting the medication, and was later re-hospitalized after suffering a life threatening pulmonary embolism.

In our own practice, it is common for us to review records that show the same language in successive chart notes.

It’s unclear whether physicians need more time to responsibly chart, or the system somehow needs fixing to prevent this problem. What is clear is that patients can suffer serious harm when “sloppy and paste” occurs.

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What's Wrong with Our Hospitals?

Posted Thursday, February 13, 2014 by Gene Moen

A recent op-ed in the Orange County Register, by Joel Hay, a profession at the USC Schaeffer Center for Health Policy and Economics, outlines the dismal history of care in U.S. hospitals.

Find the article here: What’s wrong with American hospitals?

He states that a recent study now indicates that as many as 440,000 people die each year from preventable hospital errors. This is the equivalent of two daily jumbo jet crashes. Hospitals have risen from the sixth- to the third-leading cause of death in the U.S.! The phrase “preventable error” does not mean the same as “medical malpractice,” but many of those errors probably do occur because of substandard care. There is no outrage expressed in the media, and certainly not in Congress, about this phenomenon. Instead, some in Congress argue that erecting barriers to medical malpractice cases would actually lower healthcare costs.

Professor Hay also points out that hospitals do not have a financial incentive to give better or less-expensive care. In fact, the average hospital netted a median profit of $18,900 per surgery, but when complications arise the hospital’s average profit rises to $49,400. If the patient was covered by Medicare, the profit increase was doubled, and if the patient had private insurance it tripled.

He does not imply that there is intentional bad care to increase profits, but he contends that the financial incentives should be reversed, to reward better care. “Since hospitals and their CEOs are financially rewarded for providing poor quality and expensive care, it is not surprising that they do just that.”

There is no doubt that hospital malpractice is a leading cause of deaths in the U.S. Only a small percentage of those cases result in a medical malpractice lawsuit. Reducing the number of lawsuits would restrict one of the few ways in which a patient or a patient’s family can not only obtain compensation but also achieve some accountability for the mistakes that were made. Without such accountability, the incentives for bad care will continue.

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The State of Malpractice in America

Posted Wednesday, January 8, 2014 by Tyler Goldberg-Hoss

Medscape recently published an article on the state of Medical Malpractice in America.

You can find the full, five-part article here:

Malpractice in America: Is Anything Getting Better?

Certainly, the tone of the article is meant to sympathize with its expected readers: doctors and other healthcare providers. But if you sift through the rhetoric and focus on the data, you see the future of litigation looks increasingly better for health care providers.

The article certainly contains a lot of rhetoric. It cites the “problem of lawsuits,” the continued “tremendous uncertainty” of the future of litigation in medical care, the “unconscionably high number of claims,” and the “plaintiff bar’s parasitic form of venture capitalism.” That last one in particular hurts.

But when the article focuses on the data and facts, the report reads downright rosy for health care providers. Recoveries for injured patients continue to decline, and liability insurance costs remain flat. Defendant doctors win nearly 90% of the cases that result in a verdict, and 82% of the cases overall.

Tort reform efforts continue to show success on the state level, limiting and sometimes barring an injured patient’s right to recover through caps on damages, certificate of merit requirements, 90 day notice requirements, and other laws.

It is unfortunate that the discussion of medical malpractice is at times so polarizing. There may be attorneys in the United States who bring frivolous medical malpractice lawsuits. I don’t see them filed, and I don’t file them myself, because I’d prefer to stay in business. In fact, the opposite is likely true: given the climate of tort reform and our predisposition to like and trust our doctors and nurses, it’s likely that many meritorious claims are not brought.

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When limited harms mean no viable case

Posted Monday, January 6, 2014 by Tyler Goldberg-Hoss

Often potential medical malpractice clients call with compelling stories about the medical errors they have suffered from, but with harms and losses that are relatively minor. These cases must be considered carefully due to the limited potential recovery for both client and attorney.

A new study from Emory University School of Law found that 95 percent of patient who seek a medical malpractice attorney are shut out of the legal system, primarily for this economic reason.

Find a link to the story here:

Patient Harm: When An Attorney Won’t Take Your Case

In Washington, we are fortunate to have no caps on damage amounts which may further limit the amount of claims that are viable. And contrary to this article, we don’t shy away from some of the smaller cases. When there is obvious and overt negligence, we are successful obtaining recoveries for our clients, even if the recoveries are limited.

Still, this article is accurate explaining the process by which malpractice attorneys decide whether or not to take on a client’s case. Considering the amount of money necessary to evaluate - let alone take the case to trial - is often prohibitive when considering the amount of potential recovery. It makes no sense to spend $50,000 to recover $50,000. Then nobody wins.

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