WhiteCoat

Healthcare Update — 01-23-2012

See more medical news from around the web over at the Satellite Edition of this week’s Update at ER Stories.

The story of “Dr. Douchebag” and why morale is declining in many of this country’s emergency departments. Even if you say “thank you, sir” for the abuse, your job may still be threatened because of bad Press Ganey scores.

More than 80% of medical mistakes go unreported by hospitals. Let’s just get this out of the way: Doctors kill every single patient that they treat and plaintiff attorneys should be paid even more money to sue our way to better health care. That should do it.

Indiana woman awarded $1.5 million after surgeon did not operate on abdomen soon enough. Two days after initial presentation, she required emergency surgery for ischemic bowel requiring that a large portion of her intestines be removed.

Sorry, Grandma, I know that your bone cancer is causing you excruciating pain, but you can’t have any more pain medication. As Florida cracks down on doctors who treat chronic pain patients, the patients are having more difficulty getting their medications. Where do the patients end up? In the emergency departments.
When pill abusing patients go to the emergency department and don’t get their medications, some become abusive and violent.
Now some Florida hospitals are implementing a “chronic pain management plan” which requires doctors to “help educate patients about the dangers of abusing prescription drugs and addiction.” Got that, Granny? You have bone cancer and you have six months to live, but abusing oxycontin is dangerous and can kill you.
As part of the “plan,” emergency physicians then will “refer the patient to a primary care physician” – who has already been “cracked down upon” and who won’t prescribe the pain medications, either.
End result? In an attempt to curb abuse by criminalizing the prescription of pain medications, Florida is now affecting the ability of patients who are legitimately in pain to receive necessary treatment. Cancer pain patients in Florida now more likely to get bounced around the system and die in pain.
And people blame the physicians instead of the legislators.

Why let a little thing like a gangrenous appendix get between you and your wedding? Ceremony held in hospital. Both bride and groom wear “gowns.”

New York jury awards 18 year old patient $3 million for delay in c-section at birth that allegedly caused patient’s cerebral palsy.

Patients gone wild in Pennsylvania. Woman gives medical staff hard time in ED, pulls out IV, threatens to infect everyone around her with HIV, kicks a security guard in the cha-chas when trying to escape, then is wheeled out of the hospital by police kicking and screaming in a wheelchair. Initially charged with three felonies, but those charges were dropped by persecutors er, um prosecutors. Of course, if the security guard was an off duty police officer, the patient would be doing 20 to life in Leavenworth.

Patients gone wild then … police gone wild? Patient becomes combative in emergency department. Police called, then allegedly “strike the patient, place him in a headlock, pull and twist his head and forced handcuffs on him with force and violence.” Another officer allegedly “pushed the handcuffed man over a metal chair arm with the force of his weight pressing upon him.” The officers could face jail time and fines if found guilty.

Patients gone wild — Twilight Edition. Toledo woman allegedly tries to steal baby from hospital. When ED nurse approaches her, the woman turns around and bites her. Then she hisses, turns into a bat, and flies away.

The Medical Marijuana Advocates create even more safety policies. Now they’re recommending that health care organizations assess “fatigue risks” and develop a “fatigue management plan” which includes “strategic caffeine consumption.”
My kid kept me up last night. I’m a little fatigued. I want to come to work and sleep, then when I wake up, I want free double mocha lattes. OK, nanny?
The problem is that “fatigue” is determined in a retrospective manner and the Marijuana Advocates don’t tell anyone how to determine fatigue prospectively. Make people afraid of it and tell people who’s to blame for it. That’s how you win elections.
Of course, it didn’t take the plaintiff’s attorneys much time to jump on how providing services while “fatigued” is negligent and will kill people.

While many patients can’t afford health care at all, some hospitals cater to the ultra-rich, charging them between $450 and $4,500 per day in order to have a butler, swank hospital rooms, and an exclusive menu. Meanwhile, other patients wait in the emergency department for days before a hospital bed opens up. Oh, and medical residents aren’t allowed on the units, either — only attending physicians.

Kevin Pho from Kevin, MD wrote an article in USA Today providing some suggestions on how to reduce malpractice lawsuits. Some people commenting on the article demanded that physicians’ hours be cut back so that they aren’t overworked while trying to pay for their “expensive houses, cars, and boats” (see comments section).
I say “be careful what you wish for.”
In other countries, people are demanding that physicians work more hours because patients can’t get the care they need when the doctors work banker’s hours.

21 Responses to “Healthcare Update — 01-23-2012”

  1. Matt says:

    “because patients can’t get the care they need when the doctors work banker’s hours.”

    We are getting ready to find out what exactly “need” means in terms of medical care in this country. That’s the biggest question we face in that area.

    “Doctors kill every single patient that they treat and plaintiff attorneys should be paid even more money to sue our way to better health care.”

    If anyone is missing a strawman, WC has one for you there. You can use it – he’s got multiple copies.

    • WhiteCoat says:

      Point #1 I agree with you upon. The pendulum is going to swing the other way and there will be a lot of patients who are unable to obtain “necessary” care by today’s standards.

      Point #2 First of all, use your little friend Google again and look up the term “hyperbole.” Never mind. I’ll make it easier for you. Just click this link.
      Second, if you believe that the argument is so specious then why don’t you provide us all with some examples of bad patient outcomes that lawyers haven’t tried to blame on physicians. I know the list is long, but just a few examples will suffice.

      • Matt says:

        “Second, if you believe that the argument is so specious then why don’t you provide us all with some examples of bad patient outcomes that lawyers haven’t tried to blame on physicians.”

        Sure, let me give you an example from my own life. My brother was grievously injured in a construction accident. We were lucky he survived initially, and we were all thankful for the physicians’ hard work in relieving the pressure on his brain. Shortly after surgery, it was noted that he had a blood clot in his leg. After several months, he was transferred to rehab, where he was progressing well under a physician’s care. Ultimately, however, in rehab he died of a pulmonary embolism which no one saw coming. A terribly bad outcome for all, especially his family and young children. No one in his family blamed this bad patient outcome on physicians. No one even mentioned it.

        Now, there are numerous other examples, because malpractice lawyers see bad outcomes every day. They turn away far more cases than they accept, many with terrible outcomes. Often they are turned away because the physician’s actions simply weren’t negligent. It’s just a bad outcome. You don’t know this because of a little thing called attorney-client privilege. You just see the ones that are pursued. Your lack of perspective, lack of understanding of privilege, and your desire to spew a line of attack keep you from understanding or even believing this is how it happens. But you not believing it doesn’t make it true.

        And then finally, there are thousands of cases of actual negligence that no attorney ever sees. As your original link illustrates.

        It’s interesting you call it hyperbole but then request proof that it is not true.

      • WhiteCoat says:

        Sorry to hear about your brother.

        A search on your old friend Google shows more than 1.6 million hits for the search string “doctor sued for pulmonary embolism.” I’m sure there would be even more hits if we tweaked the search terms a little.
        Want to try another bad patient outcome where lawyers haven’t alleged that physicians are to blame?

        The “hyperbole” is that doctors “kill every single patient.” Kind of like “this bag weighs a ton” – it doesn’t really weigh a ton, it is just quite heavy. Doctors don’t really “kill every single patient” – but malpractice attorneys and regulatory agencies (whose sole reason for existence is to combat “medical errors”) just keep trying to up the ante about how many patient deaths are due to medical errors.
        When all you have is a hammer, everything starts to look like a nail.

      • Matt says:

        I guess I misunderstood your question. Are you asking me if there is any possible procedure where a physician hasn’t wen sued as a result? That I don’t know. I assume all cases are unique because the patient is unique. Am I wrong? That wasn’t what you originally asked me, so are you now changing the question?

        How is it “upping the ante” to acknowledge the results of a study?. You do the same thing with statistics with equal or less rigor behind them.

        You just added some more hyperbole with what you allege attorneys and regulatory agencies claim. Your stance on public policy issues would be more believable if you’d ease up on the broad statements.

  2. doc99 says:

    After the IOM reports on Adverse Events aka Medical Errors, a Bumper Sticker is in order –
    “Guns Don’t Kill People – Doctors Kill People.”

  3. ThorMD says:

    I disagree with your point about Grandma dying in pain. I currently work in an ED with a “chronic pain management policy”. We say no to prescriptions for Percocet, refills for anyone with a chronic painful condition, narcs for dental pain, fibromyalgia, migraines, chronic abdominal pain, and chronic back pain. Consequently, these patient don’t come to our ED anymore and go to the candy store up the street. We decided as a group that if we all enforced it, then everyone would take the short-term Press Ganey hit equally. And now that they don’t come anymore, Press Ganey’s have gone back up and we are all happier.

    However, cancer pain is not on our list and isn’t of any of the policies of other ED’s we reviewed before we implemented ours. We still treat acute pain and cancer pain.

    • Liz says:

      Agreed. In my (unofficial) opinion, cancer pain, especially TERMINAL cancer pain, =/= chronic pain.

    • WhiteCoat says:

      If your policy works with your ED and the admins can tolerate the satisfaction issues, then there isn’t a problem.
      The policy at the Orange County hospitals requires counseling and referral to a family physician – at least according to the article. Perhaps their definition of “chronic pain” doesn’t include cancer patients, but that wasn’t stated in the article.
      My example illustrates what happens when legislators start painting with too wide of a paintbrush.
      Why not have the database spit out the names of the patients receiving excess prescriptions and go after them instead of harassing physicians.
      Did you see what the article says is the next recommendation? Requiring physicians and pharmacists to check Florida’s new drug-monitoring database. Like we don’t have enough to do without spending a few more minutes x 30 patients per shift = 90 minutes per shift tracking down potential drug seekers.

      • ThorMD says:

        You make good points. A couple of comments based on my experiences working with this policy. First, we get VERY FEW drug seekers and chronic pain patients because our policy is well known in the community and they have stopped trying. So if I get one per shift, it’s no skin off my back to check our database.

        Second, when I say “no”, it’s nice to say “I’m sorry, I wish I could help you, but we are not allowed to do this because of our policy. They won’t let us”. It takes the argument away from Me vs Patient. We can be caring and compassionate when we say no.

        For what it’s worth, our ED’s have PG’s routinely >97%. Occasionally we dip to the mid 90’s, but that’s rare.

      • WhiteCoat says:

        I just wonder what will happen when all of the hospitals in your area adopt a similar policy leaving drug-seeking patients with nowhere to reliably get their medications. Do they then return with a vengeance?
        If you’re *required* to check the database on every patient – which is what the recommendation is – it would eat into your time.
        You’re lucky that everyone is on board with your plan. Can’t pull that in our ED because the patients will come back with “Yeah, well Dr. So-and-so did it, why won’t you?”

  4. Hueydoc says:

    Sorry I’ve been out but after 30 years, I’ve left the ER and am now ensconced in a regular practice.
    Gee- I go to bed everynight, don’t work weekends or holidays anymore, eat lunch everyday, don’t deal with violent psychs or bogus MVA’s anymore.
    I’ll visit here from time to time to see what I am no longer missing.
    Oh- did I mention that I refuse to accept lawyers as patients ?

  5. C. says:

    Temporarily under the care of pain management after a MVA in which my neck and back were broken. Nothing seems to even touch the pain; cant take narcs or narc type pain meds during the day so I can be effective with clients. At night some controlled substances are taken but rarely help. I am drug tested EVERY time I go to the pain dr so my drug level can be evaluated. Im afraid to ask for something stronger as I dont want to be pegged a drug seeker. What are real pain patients supposed to do? A poster on my docs wall says “If you have run out of pain meds and the office is closed go to the er.”

    If I happened to go to the ER complaining of pain in my neck and back do I have to carry around my MRI report showing evidence of the injuries?

    • Hueydoc says:

      Thank the government and the lawyers !

    • WhiteCoat says:

      If you’re seeing a pain specialist and the medications don’t help, I don’t think I’d be too concerned with asking the doctor for stronger medications. Or perhaps nerve blocks may be of some help.
      You’re also not going to be questioned about drug seeking behavior if you’re up front with the ED nurse/doc and you’re not there so much that the post office starts forwarding your mail.
      Bringing the MRI report probably isn’t a bad idea.
      As for what patients in legitimate pain are supposed to do, it puts everyone in a bind. Patients/primary care docs/ED docs. Thank the drug seekers for getting that ball rolling.

  6. midwest woman says:

    Boyfriend’s coworker had GI complaints for one year. Pain nausea. Got blown off. No endo no colonsocopy. Nada nothing. Colon ca mets to liver stage 4. Oh well shit happens right?
    He will leave 2 small children and a young wife.
    Looks like a nail to me.

    • WhiteCoat says:

      Regardless of how it happened, the outcome sucks. And from what you describe it is a nail.

      Some of the cases I’ve been involved with:
      – Doctor sued for wrongful death of a patient when the doctor was on vacation in Europe during the patient’s entire admission and did not even know the patient
      – Doctor sued for failing to diagnose an MI in the ED when the patient had a normal EKG and no symptoms until 6 hours after reaching the medical floor.
      – Doctor sued for failing to diagnose a patient with a stroke when the patient didn’t have a stroke
      – Doctor sued for giving a patient the wrong dose of medicine when patient got “anxious” after receiving it but had no other “injuries.”
      – Doctor sued for missing mesenteric ischemia on a patient that he saw for 10 minutes before shift change, ordered labs to get the workup started, and signed the patient out to the oncoming physician. Oncoming physician wasn’t named in the lawsuit.
      – Doctor successfully sued when patient died of an MI. Patient signed out of the hospital AMA, refused follow up recommendations, refused to get a stress test, and died three weeks later. Multimillion dollar judgment because doctor didn’t call patient to see whether the patient had done the stress test.

      Are these nails, too?

      Obviously, there are cases of bad outcomes due to misdiagnoses. I believe that they are a lot less than what trial lawyers would have us believe.

      Goes back to the question I posed to Matt. What are bad outcomes for which physicians should not be sued?

      • Hueydoc says:

        My wife has been sued twice for patients she has never even seen !

      • Matt says:

        “What are bad outcomes for which physicians should not be sued?”

        Your question is unanswerable for two reasons. One, you or I can “sue” someone for living on the moon. If you pay your filing fee, and take it down to the clerk, they will take your money, stamp it, and you can serve it. You have now sued someone. There is no way to put a prohibition on that without empowering clerks to review all suits filed and make determinations on validity.

        The other reason is that you’re asking to say what outcome is never the result of negligence. That is simply impossible, at least for a layman. You’re the doctor – can you think of any outcome where it is simply impossible that negligence can cause it. Can the outcome of death be caused by negligence? Sure. Can the outcome of loss of say, vision, be caused by negligence? Sure. We can go on like this for a long time.

        Do YOU know any outcomes that absolutely, positively can’t be the result, under any circumstances, of negligence? You see far more outcomes than I.

        “I believe that they are a lot less than what trial lawyers would have us believe.”

        How many are trial lawyers trying to make you believe there are? And how many do you believe there actually are? And while we’re at it, how many of those result in a claim? Now your answers to those questions would be quite interesting.

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