WhiteCoat

Healthcare Update — 07-24-2014

Busier may be better* … at least for for patients with life-threatening medical emergencies. When comparing very high volume emergency departments with very low volume emergency departments, a study in Annals of Emergency Medicine shows that patients with medical emergencies were about 0.4% less likely to die when they were treated at the nation’s busiest emergency departments. These statistics reportedly translate into about 24,000 lives saved each year if patients received the kind of care that was provided in the nation’s busiest emergency departments.
* A small disclaimer is in order, though. The study was performed by University of Michigan medical school. University of Michigan Hospital’s ED has more than 80,000 visits per year and is considered high volume.
I think a good idea for a similar study would be to compare mortalities in communities before and after the closure of emergency departments in the areas. This study might suggest that mega-hospital care is better, but is immediate care in small volume emergency departments better than delays in care during travel to a mega-hospital … or no care at all because patients can’t get there?

This may explain why doctors are so good at practicing defensive medicine. During their careers, doctors spend more time in the courtroom than in the classroom.
The headline is misleading since during a lawsuit, doctors aren’t in the courtroom 40 hours per week as they are during medical school. The point is that for 11% of their careers, an average physician has a lawsuit hanging over his or her head.

Johns Hopkins gynecologist admits to secretly recording patients during gyne exams. Police search home and find computer servers with naked pictures and videos of up to 8000 patients. Doctor then commits suicide.
Johns Hopkins has just agreed to a $190 million settlement with the involved patients.
If the lawyers get 30% of the settlement, they’ll net $63 million. If the remaining funds are divided equally among the affected patients, they’ll each receive about $16,000.

Kourtney Kardashian’s boyfriend can’t handle his liquor and has to go to the emergency department for alcohol poisoning. Not sure why this is news, but now you can click the link and gouge your eyes out, too.

There may be some truth to the statement from patients with chronic back pain who say “that sh*t doesn’t work with me.” Study published in the Lancet shows that there is no difference in time to resolution of symptoms between patients using Tylenol and patients using sugar pill placebos. There was also no difference between the groups in pain, disability, symptom changes or quality of life. And the strange thing is that 75% of patients were happy with their treatment regardless of whether they took Tylenol or a sugar pill placebo.

Oakland police repeatedly beat Occupy protester and Army Ranger Veteran with a nightstick, then throw him in a cell and ignore his complaints for help. When he begins vomiting, one officer told him to stop using heroin. Another officer videotaped him. Friends finally bail him out and bring him to the hospital … where he underwent surgery for a lacerated spleen.
Why does it seem like the names of public citizens accused of crimes are published in newspapers but the names of law enforcement officials who commit crimes against the public are kept hidden?

Understaffing in British Columbia hospitals frustrates patients who had to wait 4.5 hours in emergency department before they could get treatment for their infant son’s severed finger. Waiting room was packed with dozens of patients and only two doctors were on duty. Called several other hospitals that also had long waits in their emergency departments.
But at least the care is free.

9 year old patient with history of congenital heart defect and prior endocarditis goes to emergency department for a fever and “seeming sick.” Doctors give him motrin and discharge him without performing testing after he appears better. Returns two days later and diagnosed with endocarditis. Develops complications during surgery and ends up paralyzed on the left side of his body, blind in the left eye, and with garbled speech. Jury awards patient $17 million.

Laparoscopic hysterectomy begins uneventfully, then bleeding from the uterine artery is noted and the procedure is immediately converted to an open procedure. Towels packed into the abdomen to stop the bleeding and the patient’s life was saved. A month later, the patient has fever, discharge, and abdominal pain. Repeat operation showed that one of the towels had been left inside the patient. Patient required several additional surgeries and later sued. Jurors award $7.2 million. Important point in the case is that the defendants began pointing fingers at each other. The surgical techs blamed the surgeon and the surgeon blamed the surgical techs. As the author of the article noted, “once jurors see “dueling defendants” they most often assume the worst happened and find blame all around”

Jury finds that Alabama doctor and nurse midwife were not liable for birth injuries to an infant who was born a quadriplegic. Case gets overturned after attorneys discover that, when questioned about a potential deadlock, the judge sent jurors a note to “please keep deliberating” — without informing the attorneys or parties.

For a completely non-medical link that had me both appalled and laughing at the same time, check out this model citizen who became upset because McDonalds didn’t serve chicken nuggets in the morning.
Even though this video was posted last year, according to TSG, the event occurred in 2010.
A little more searching showed that the original video had no audio and that the audio was dubbed in later for amusement purposes.
And I just kept thinking that this is the type of patient whose low Press Ganey satisfaction survey scores would be the source of a monthly meeting because the emergency department staff isn’t meeting all of its patients’ needs.

5 Responses to “Healthcare Update — 07-24-2014”

  1. Rick says:

    Saw a similar endocarditis case as an intern. Guy died. Lack of situational awareness as well as I bet ER doc did med school and residency tat non-Children Hospital affiliated program. If you never see pts with congenital heart disease, tough to appreciate the implications of fever ect. Sad

  2. Matt says:

    I’m sensing we may have another malpractice “crisis” coming given the strident nature of WC’s posts on the subject.

    Get your lobbyist “crisis” maps and damage caps talking points dusted off, and let’s go suspend logic and factual analysis!

  3. markps2 says:

    “towels had been left inside the patient” is incompetence of whoever looks after the operating room.
    I would not expect the surgeon to count the towels being used.
    They should have told the surgeon when he/she was closing up that there was a problem with the number of towels.

    • markps2 says:

      Just read the article and it looks like only ONE towel was used. Right. Lost track of one towel.

      • markps2 says:

        The Joke
        Article says “The surgeon claimed that…the towel’s…had prevented the patient from bleeding to death.”

        Forgets who made the bleed.

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