WhiteCoat

Healthcare Update Satellite – 08-06-2013

Look for more updates at my other blog at Dr.Whitecoat.com

Naked West Virginia patient steals ambulance from emergency department parking lot, goes on joy ride and then crashes into three vehicles – requiring more ambulances to take injured patients to the hospital. Hopefully this time they locked the ambulance doors. And I’m not sure I’d be wanting to sit on the driver’s seat without a plastic cover until after the seat gets washed down.

Use of chest x-rays in asthma patients increasing between 1995 and 2009. According to a 2005 study cited within the post, most xrays in children with asthma are deemed “unnecessary.” I don’t have access to the full article, but if it doesn’t have prospective criteria for what are considered necessary tests in wheezing or dyspneic children, then the results are suspect. Remember, kids don’t come to the emergency department saying “treat my asthma.” Kids come to the emergency department with trouble breathing, with wheezing, and with coughing. If the researchers are saying retrospectively, based on a normal CXR, that the kids had asthma and didn’t need an x-ray, that’s classic hindsight bias.

What’s that? You have an ingrown toenail? Well, you’re getting tested for HIV. Why? Because some study says so. Who’s paying for it? Who cares? The study says there’s a benefit. Out of 9,572 patients offered testing, 40% agreed and they found SIX new HIV cases. But don’t you dare call that an “unnecessary test,” dammit. Tests are only unnecessary when doctors do them for … well …
Oh nevermind. Carry on.

How good are emergency physicians at diagnosing Bell’s Palsy in the emergency department? Greater than 99% accurate by this study. Just hope that your patient isn’t one of the less than one percent who ends up having a brain bleed, stroke, or meningitis instead. Those outcomes are more likely in the elderly, in diabetics, and in blacks, with black race being the largest risk for patients having a diagnosis other than Bell’s Palsy.
Would be interesting to see how many of the misdiagnosed patients developed bad outcomes and sued for failure to diagnose.
Failing to perform testing that would have made the alternative diagnosis is seen as a negligent event while performing testing in the exact same patient when no alternative disease is present is considered “unnecessary,” “greedy,” and “wasteful”.

Study by Safe Kids Worldwide (.pdf file) shows that there were more than 1.3 million visits to the emergency department for sports injuries in 2012. Of those visits, 163,000 were for concussions meaning about one concussion every three minutes. That’s a lot of damaged neurons.

Nothing new in this study. Health Affairs study shows that physicians with higher concern for medical malpractice are more likely to practice ‘defensive medicine” than those with lower concerns for medical malpractice. Scenarios presented to physicians included patients coming to a medical office with chest pain and patients complaining of a headache. Those physicians with higher levels of malpractice concern were more likely to send the chest pain patients to the ED and were more likely to obtain imaging on the headache patients.
And if, using our magical retrospectoscope, we truly believe that patients with those complaints shouldn’t go to the emergency departments and shouldn’t obtain advanced imaging, then we need to change the system to reflect those values. Maybe we make “failure to diagnose” an exception to medical malpractice suits.

Any of you medical professionals want to help your fellow Americans when a disaster hits? Stay away from Missouri. After the devastation from the Joplin, MO tornado, charities sent medical care to the area but weren’t allowed to help because of Missouri laws. State legislatures saw the problem and created legislation that would have permitted licensed health professionals from other states to provide free care in Missouri and would have protected them from medical malpractice. Missouri Governor Jay Nixon vetoed the bill, stating that it was “unnecessary” because Missouri already has a system that encourages volunteers.”
Wonder if all the people in Joplin who needed medical care after the last tornado felt the same way.

Another example of the WhiteCoat Effect. Bert Fish Medical Center in … Florida … puts out creative ad with picture of surf board and shark bite taken out of the top using the caption that it has “emergency care when you need us.” New Smyrna, Florida’s public information officer takes offense at the ad, stating that the ad “doesn’t help us to market the safety of our beaches.” Well, when your beaches have the most shark bites in 2012 in the WORLD according to one study, maybe you should stop throwing chum in the surf, then, lady. Now even more people are going to know how New Smyrna, Florida is the shark bite capitol of the planet and how people could be taking their lives into their stumps … er … um … hands … by setting stump … er … um … foot … on the beach there.

4 Responses to “Healthcare Update Satellite – 08-06-2013”

  1. The aim of Progressive, government-provided medical care is to adjust medical spending and guidelines to produce the greatest good for the greatest number, namely the most votes for the money spent.

    Preventive testing is promoted as good, and it does achieve better outcomes at a higher cost compared to waiting for clear symptoms to appear.

    Testing in response to symptoms is criticized because it produces better outcomes but at a higher cost.

    Why the difference? The generally younger, healthy people who get free preventive testing see a benefit from their government and are happy to get good test results. The generally older people presenting with symptoms may only see a benefit from expensive testing for say 3% of that population. The situation is ambiguous, and 3% of that population is not significant for elections. Why spend the extra money?

  2. Matt says:

    “Maybe we make “failure to diagnose” an exception to medical malpractice suits.”

    I thought damage caps were going to reduce “defensive medicine”. Then a bunch of states enacted them and guess what – the cost of medicine didn’t decline. Now we need some new immunity it seems. I’m sure healthcare costs will positively plummet if you get it.

  3. Leslie Klug says:

    It’s New Smyrna Beach, not New Smyrna. And yes, they have more than their fair share of shark bites but they are not great whites, they’re small sharks and only eat a little ;-)

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