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Tag Archives: News Commentary

ERP Makes the News

ERP, who guest posts on this very blog, got interviewed for an article about how to get treated “better” and “faster” in the emergency department published on AOL today. Congrats! The comment section to the article has some er, um … interesting reactions … and misperceptions about patients using emergency departments. All in all, the article isn’t bad and gives some decent suggestions like bringing a list of medications and recent tests with you and also bringing along an advocate. But the reporter calls us emergency “room” docs. Grrrr.

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Drug Testing Welfare Recipients

From the steamy comment section of Nurse K’s blog comes IglooDoc’s link to an article showing how a state agency in Arizona is heading in the right direction in the war on drugs. Effective Tuesday, the Arizona Department of Economic Security started performing urine drug testing on individuals whom officials had “reasonable cause” to suspect were using illegal drugs. Get caught using and you’ll lose your welfare check for a year. Before you start applauding, the requirement has a lot of loopholes: The test only happens when you reapply for assistance — it is not a random test. When you do reapply, apparently “reasonable cause” is determined by peoples’ answers to a three question questionnaire. I’m bubbling over with anticipation to see how many people will answer “yes” to the “do you use illegal drugs” question. If you are one of the unfortunate few to be selected to take the urine drug test, you have to submit your sample within ten days – by which time it is likely that, if you can control your habit for that long, most drugs will be out of your system anyway. So the Arizona requirement is largely toothless, but at least it is a step in the right direction. There was an e-mail going around not too long ago saying that if working people are subject to random drug tests while earning money at work, people who are earning money from welfare should be subject to the same random drug testing. Don’t want to give up your civil liberties and privacy to the contents of your bodily secretions? Then don’t take the money. Now if only more state governments would get the hint.

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Unnecessary Medical Testing

The topic of unnecessary medical testing comes up all the time in the health care reform debate and is a recurrent theme in news headlines. Study finds that unnecessary tests ordered in 43 percent of checkups – CBS News $700 billion each year is spent on unnecessary medical tests – Healthcare Economist Why doctors order unnecessary tests – KevinMD (with some excellent insights) Millions squandered in unnecessary tests ordered in routine doctor visits – Medical News Today The Cost Conundrum – New Yorker article by Atul Gawande Even this month’s Night Shift column in EP Monthly details a family discussion about unnecessary medical testing and health care reform. The term “unnecessary testing” is on its way to becoming the new “death panel” of the health care reform debate. But just as the term “death panel” was disingenuous, the term “unnecessary testing” is ambiguous. What exactly is an “unnecessary test”? Perhaps an unnecessary test is a stress test that has little predictive value in determining death from heart disease. A study of 25,000 men who underwent stress testing showed that in ten years only 158 men died from heart disease. Stress testing was normal in 40% of the men who died. Is stress testing “unnecessary”? Perhaps an unnecessary test is one that has a low likelihood of showing a positive result. Spontaneous carotid artery dissections occur less than 1 in 34,000 individuals. Maybe we shouldn’t be performing all those expensive magnetic resonance angiograms on patients who have headaches or neck pain. After all, a vast majority of the tests will be normal. Personally, I think that the term “unnecessary testing” is a misnomer. To me, the term “unnecessary” means that there is absolutely no likelihood that a test will find or exclude a disease process and that there is absolutely no likelihood the test results will change the patient’s proposed treatment — like performing saliva screening for food particles. A majority of tests aren’t really “unnecessary,” they just don’t show abnormalities very often. Everyone is quick to criticize the necessity of a negative test after it has been performed. What about a prospective look at the testing? A more appropriate term for testing considered by some to be “wasteful” should be “low-yield testing.” Sure a vast majority of “low yield” tests will be normal, but if you perform enough low yield tests, you will eventually find something wrong. The outside chance that patients may have an uncommon disease picked up by an “unnecessary test” is one of the biggest reasons why low yield testing is performed. Failure to perform low yield testing serves as the basis for many medical malpractice lawsuits. Regardless of how rare the disease is, a common question raised by malpractice plaintiff attorneys is “What would it have hurt to just do the test?” That question is followed by some iteration of the statement that “if only that horribly negligent doctor had just ordered the simple test on this patient, Little Johnny wouldn’t be an orphan.” During closing arguments, some attorneys can even channel voices from beyond to prove their point. If we all agree that “unnecessary testing” is such a bad thing, what tests are we all going to agree that doctors should stop ordering? Give me a list of unnecessary tests that I should no longer perform and I’ll follow it. No more wasteful MRIs for back pain? Sign me up. No more¬† CT scans for the patient with chronic abdominal pain? I’m all for it. PET scans? Outta here. Maybe we could use percentages instead. If a test has less than a “Y” percent chance ...

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Legal Malpractice Insurance in Texas? GASP!

Texas attorneys are up in arms because the Texas Supreme Court is again considering whether or not to require Texas attorneys to disclose their malpractice insurance status to their clients. The measure apparently was previously vetoed by a state Supreme Court task force. The Texas Bar Blog is soliciting comments from attorneys. So far, there are nearly 100 comments such as … I think it is a bad idea. All attorneys have clients who are never satisfied even when they have reached a good settlement to their case. Mentioning liability insurance to this sort of client will only encourage malpractice suits for them to see what else they can get. and I think it is a bad idea. Clients could simply inquire about it if necessary. Clients come to us for litigious reasons in the first place, to make this disclosure offers them another avenue of recourse – against the attorney. In other words, we would just be planting a seed in their minds. Plus, smaller offices may not have the insurance for financial reasons and to force the disclosure carries a sense of not being a good lawyer. and Malpractice insurance breeds claims. and Being forced to let the clients know that we have a deep pocket if they want to get some money “without hurting anyone but the insurance company” will also make grievances in support of the malpractice case more prevalent. and Let me get this straight. We cannot tell a jury that a defendant has insurance because the assumption is that they will award a run-away verdict, knowing that the insurance company will have to pay the judgment. Why do lawyers not deserve the same privilege against said disclosure? Have any of the Supreme Court justices ever paid a malpractice premium for themselves, or was it paid by some firm administrator in their ivory tower? I could go on cutting and pasting, but I’m getting all choked up. [Sniff] Of course, if we changed the operative subject in the article from “attorney” to “doctor”, you know they’d all be whistling a different tune about what a good idea it is for patients to have recourse against all the incompetent medical practitioners in Texas. Hat Tip to Examiner.com

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Healthcare Update 10-17-2009

Myth or no myth? Does a full moon cause more ED visits? I don’t care what the studies say. On nights of a full moon, the freaks are out in full force. Why do you think they call it lunacy? Suck it up, America! Why are doctors becoming slaves to patient satisfaction scores? Great discovery request, there Perry Mason. Michael J. Trentalange, a Florida medical malpractice lawyer, requested 75 years of incident reports before having his colonoscopy performed at Florida’s St. Joseph Hospital. He wanted to know “how many people [at the hospital] get perforated colons during colonoscopy” before having his own procedure done. Oh, and by the way, he’s also representing someone who died from sepsis after sustaining a perforated colon. He didn’t limit his request to just colonoscopies, though. He wanted every single incident report in the hospital. Why? His response: “I could have a family member contemplating another procedure.” The hospital sued him over his request. More doctors and hospitals need to fight back against BS like this. And people wonder why lawyers get a bad rap. Phil Howard from Common Good scores an article in the Wall Street Journal about “Why Medical Malpractice is Off Limits” in the health care reform debate. Does it have anything to do with the fact that trial lawyers are “amoung the largest contributors to the Democratic Party”? One interesting quote: Trial lawyers also suggest they alone are the bulwark against ineffective care, citing a 1999 study by the Institute of Medicine that “over 98,000 people are killed every year by preventable medical errors.” But the same study found that distrust of the justice system contributes to these errors by chilling interaction between doctors and patients. Trials lawyers haven’t reduced the errors. They’ve caused the fear. We can’t sue our way to better health care. Another interesting tidbit from the upcoming book “Architects of Ruin” regarding why tort reform isn’t part of health care reform. Several trial lawyers filed a class action suit against Citibank for rejecting a black woman’s loan application. The basis of the suit was that “racial bigotry, not poor credit histories, explained high rejection rates among minorities applying for mortgages.” Four years later, the case settled. The plaintiff received $60,000. The lawyers received $950,000 – more than 15 times as much money as the plaintiff. Among the lawyers receiving those fees was a young gent named Barack H. Obama. Paging Dr. Scumbag … An emergency department physician steals a Presidential Rolex watch off the wrist of a patient who had just died from a heart attack. Busted by hospital security cameras and fired on the spot. Also indicted by a grand jury for the theft. Who is at fault? A patient gets sedated for brain surgery and waits on the table for the neurosurgeon … who is out of town attending to an “urgent family situation.” The head of the department refused to do the surgery in his place. Among the things that the hospital and doctors are getting cited by JCAHO for is “the doctors operating did not pause to stop and check that they were operating on the right part of the body.” Was there some transrectal approach to brain surgery that I didn’t learn about? Insurance doesn’t equal access. Another study out about the Massachusetts “insurance for all” program shows that “unless access to health care improves, many people will continue to treat emergency rooms as a substitute for a primary care doctor” and that “access problems in the community may play a significant role in ED use in Massachusetts.” Sounds like a plan. ...

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The Germiest Profession Is …

According to a post in the Wall Street Journal’s Health Blog, a study from the University of Arizona’s Department of Soil, Water and Environmental Sciences shows that the job exposing people to the most germs is … a school teacher. Surfaces regularly used by teachers had 10 times more bacteria per square inch when compared with other professions. So kudos to all you school teachers for not only raising our next generation of good citizens, but also for being able to put up with 30+ out of control kids at the same time and for having some damn fine immune systems to boot. Want to cut the number of germs at work? Use disinfectants. People who said they used disinfectants dropped the bacteria counts in their work areas by more than 75%. By the way, know what the “least germiest” profession is? Lawyers. Really. Check the link above. I’m not kidding. Probably a professional courtesy from the other germs. Bwwwaaaaaahahahaha

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