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Healthcare Update — 10-03-2011

More medical news from around the web at the Satellite Edition of this week’s update on ER Stories

Australian emergency physician punches and slaps restrained patient who spat in his face. He was terminated from his position. A court held that the termination was unfair. Australian doctors considered going on strike after learning how the doctor was treated after the incident.
When you read the comments section of articles describing patients who assault emergency department staff, many people seem to think that staff should accept abusive behavior due as being “part of the job.” Shouldn’t patients therefore accept abusive behavior from medical staff as being “part of the visit”?

A view of medical malpractice reform misconceptions from physician-attorney William Sage. I disagree with several of his premises. For example, one question Dr. Sage asks “How likely is it, really, that ‘sinister forces’ outside [of medicine] are the reason why tens of millions of Americans lack access to services, or why even those who can afford it often get mediocre care at inflated prices?”
Ask physicians who don’t provide care to patients with certain government insurance plans and who stop taking emergency call or stop performing certain procedures (such as brain neurosurgery) due to liability concerns. Ask doctors who won’t or can’t prescribe medications that are safe through billions of prescriptions because the FDA issues a black box warning that the drugs might have caused adverse reaction in one millionth of a percent of the people receiving them. Then ask patients who can’t afford to purchase certain drugs such as albuterol, colchicine, or (soon to be) Primatene Mist because drug companies jacked up their prices based upon a governmental technicality in approving the medications.
Nah. No “sinister forces” here.

Recent Massachusetts Medical Society survey shows many interesting findings. Specialties in critical short supply included internal medicine, urology and psychiatry. Primary care specialties had severe shortages for 6 straight years. More than half of physicians would be unwilling to participate voluntarily in either global payment programs or accountable care organizations. Oh – and “the fear of being sued continues to be a substantial negative influence on the practice of medicine, affecting access to and availability of physician services.”
Nah. No “sinister forces” here, either.

Another timely rebuttal to some assertions in Dr. Sage’s article. Study in Archives of Internal Medicine shows that 42% of physicians believe that their patients are receiving too much care. Guess what factor contributed to more aggressive care in 76% of cases. Click this link to find out. Hint: “Sinister force” alert.

CMS coming out with bundled payment plans for 2012. Look for the pendulum of clinical care and testing to swing the other way. And look for more people to accuse “greedy doctors and hospitals” of limiting care in order to make more money when, in reality, the government is limiting care through underpayments to providers.

Another reason that getting a ZeePack for your cough might not be a good idea (aside from the fact that it won’t work) … it might cause you to get Crohns disease or ulcerative colitis. Twelve percent of patients diagnosed with Crohns or UC had been prescribed three or more doses of antibiotics in the two years prior to their diagnosis. Only 7% of patients who had developed Crohns or UC had not been prescribed antibiotics. In other words, people prescribed frequent antibiotics were up to 50 percent more likely to get Crohn’s disease or ulcerative colitis within next two to five years. My guess is that they were more likely to get MRSA and C. difficile as well. Study abstract here.

More Florida shenanigans. Physicians Regional Medical Center in Naples, FL has tells specialists that they have to take call for the emergency department in both the system’s hospitals or resign. Many doctors call the hospital’s bluff and resign or change to inactive status. Now emergency patients have less access to specialist care. The comments section has many people blaming “greedy doctors” for the problem.

This case was from last year, but still surprised me. A physician was sued and settled for $500,000 after failing to recommend a pneumococcal vaccination.

Excellent post over at ACP Internist about the costs of medical malpractice.

LA Times reporter gets a glimpse of an evening in one of the busiest emergency departments in the country. Read her story here. Then read the comments section for insight into how “illegal aliens” are causing the problem. The multimedia presentation also has some great pictures.

$4.9 million awarded to patient who suffered brain injury in hospital.

$4 million verdict against emergency physician who diagnosed a 42-year-old patient with “chest pain of unclear cause and bronchitis.” Patient found unresponsive at home 11 days later. Jury decided that a more thorough examination in the emergency department “would have revealed warning signs of an impending heart attack.”

Finally, if you want to learn a more about evidence based medicine, go check out Graham Walker and company’s site at TheNNT.com (the number needed to treat). Lots of new studies and interesting information that is in an easy to understand format for physicians and patients.

10 Responses to “Healthcare Update — 10-03-2011”

  1. ThorMD says:

    thennt.com website is awesome!!

  2. throckmorton says:

    Its not just in Florida where medical systems try to make physicians cover all the systems hospitals ERs. We are seeing it as well. The specific problem in our area is that all the smaller hospitals are essentially turfing as much as they can out except that for which they can at least break even. As a result, even if you are not on call for one of these hospitals, the system will transfer it to the hospital you are at under the guise of EMTALA. This has led to an even more adverse relationship between the docs and the administration. The solution that has come around is that if the system does this to you, they need to pay for it otherwise the Docs just migrate to other medical systems. When the Orthopods at CT surgeons walk out, it seems to get the attention of the suits in the adminostratosphere.

  3. Anonymous says:

    I’m in agreement with firing the doctor who punches a RESTRAINED FEMALE patient. Put a spit mask on her head and have the cops charge her with assault. But responding with an assault of your own is wholly inappropriate and unprofessional. Period.

    • KT says:

      I have to agree…I work in a department in which we deal with many aggressive patients, and have never seen a staff member assault a patient or even consider it. One warning about foul/threatening language, then call security. Nobody should be accepting abusive behaviour, but these issues are easily resolved. Tell the patient once, call security, make sure the patient is safe and can be observed by staff, stay away until they calm down.

      • KT says:

        Easily resolved isn’t the right phrase…perhaps it would be better to say “Easy to stop from escalating.”

  4. ERdocJaded says:

    re: the 3rd article about medmalpractice:

    “or why even those who can afford it often get mediocre care at inflated prices? ”

    Is he speaking about his own care that he provides? give me a break, already.

  5. doc99 says:

    Dr. Sack’s story and many like it have the feel of PTSD accounts. WC, has this been looked into?

  6. […] Talking back to the “malpractice litigation is no big deal, docs should grin and bear it” theorists [David Sack, ACP via White Coat] […]

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