Evan Murray was a 17-year-old high school senior, honor student, and three-sport athlete who died recently as a direct result of injuries sustained playing quarterback for his school football team. On the last play of his life, he got drilled by a defender with a clean hit to the midsection. He gathered himself, rose, and walked off the field on his own. Shortly thereafter, however, he collapsed on the sideline …
Like many practicing general surgeons I read with interest the recent Finnish paper published in JAMA that attempted to challenge the long held surgical dogma that the best treatment of acute appendicitis is cold hard steel. The paper itself, in terms of design, was beautiful. This was no retrospective review of a series of case studies. This was a …
With much hype and fanfare, the independent investigative journalism outfit, ProPublica recently released their Surgeon Scorecard, assessing individual specialist surgeons who perform elective knee and hip replacements, spinal surgery, prostate surgery, and gallbladder removal surgery.
I had blogged about the impending release. My trepidation about the idea of a non-medical, non-scientific organization analyzing complex surgical data concerned issues such as …
Quintessential Messi. One moment he is standing over the ball, in a seemingly harmless position at midfield, the next thing you know you are picking the ball out of the back of the net. How did this come to pass? How did things change so rapidly? When you watch it the first time, it’s disorienting. It makes no sense. How does …
JAMA published an opinion piece about the controversial issue of patients secretly recording their physicians during encounters. We live in the era of the smartphone. Everyone has one — soccer moms, teenagers, young kids who can’t even read yet, elderly nursing home patients who can’t safely feed themselves. Everyone. And these devices have amazing powers of audiovisual capability. We all know this. …
A few months ago, I was seeing an elderly man in the hospital with a sigmoid mass seen on his colonoscopy that day. He had presented to the hospital with fatigue and anemia, and the long meandering workup eventually zeroed in on this malignant appearing mass as the source. His daughter was in the room while I discussed the results, the …
Aaron Carroll, a pediatrician who blogs at the Incidental Economist, had a piece published a few weeks ago in the New York Times concluding that adolescents and college kids would be better off — given a choice of illicit substances — opting for marijuana over alcohol. Of course, he would prefer that his kids chose neither. But he is a …
Like most of my age cohort, I was brought up to believe that the great Satan threatening to undermine the bloated American health care system was our broken-down, antiquated, self-interested model of reimbursement for care provided called “fee-for-service.” Being a professional who, to the best of my ability, tries to maximize the value of the care I provide to my patients, I subscribed wholly to the notion that the cause …
One of the obligations of a medical or surgical specialist is to communicate with the referring primary care provider. This can take many forms: a phone call, texting via smartphone, email, messages sent via EMR, and dictated letters. The format is pretty standard no matter what medium is chosen. You thank the referring doc for the consult request, you give some brief background info about the patient in question, and …
Recently, Ohio became the 20th state to pass a law mandating that hospitals and clinics performing mammography screening to notify a patient in writing if results suggest something known as “dense breast tissue.” Standard mammography creates a 2-D image of breast tissue. In general, this is sufficient for screening purposes. However, especially in younger patients, the presence of dense breast parenchyma can lead to higher false negative readings and …
From my interview with Andrew Thompson the other day, the issue of a medical malpractice crisis was raised. Mr. Thompson averred that such a concept is pure myth, a spook story older docs tell young interns around the campfire at night. And he may be right.
In a paper from the Journal of Healthcare Quality, researchers at Johns Hopkins demonstrated, using data from the National Practitioner Data …
My interview series continues, this time with local litigation attorney Andrew Thompson, Esq. The topic this time is medical malpractice. I asked him a bunch of questions. He answered. See what you think.
1. In your opinion, is there a medical malpractice crisis in this country?
No. This is not even a close issue. The concept of a “crisis” or dramatic increase in the number of medical malpractice cases is a fabrication …
Wrong site surgery is never acceptable. A surgeon ought never to find himself in a situation where he has to inform the family that he just operated on the wrong body part. It is embarrassing, unprofessional, and an egregious violation of the patient/physician covenant.
That being said, we have allowed this issue to be defined entirely in terms of “systems management”. And hence the …
Former White House physician Connie Mariano, MD, set off a firestorm recently by stating the patently obvious fact that New Jersey governor Chris Christie ought to address his morbid obesity prior to entertaining thoughts of running for the presidency in 2016.
“It’s almost like a time bomb waiting to happen unless he addresses those issues before he runs for office,” Mariano …
The weakest aspect to Obamacare is in its cost control strategies, or lack thereof. The predicted savings from converting to electronic medical records (EMR) have failed to materialize. And the Rube Goldberg-esque plan to save money by penalizing hospitals and doctors for having poor HCAHPS scores has reaped its own set of unforeseen complications.
HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is the Press-Ganey …
From the Economist in October 2012 was an article on physician assisted suicide. In the United States, terminally ill patients can apply for permission to end their lives with the guidance of a doctor in Oregon and Washington state. Several safeguards are in place to prevent this from becoming the default death pathway (only 0.2% of total Oregonian deaths). Also, I had no idea that Holland, Switzerland, and Belgium allow assisted suicide …
The American Journal of Surgery had a nice little (38 patient cohort) study from the VA database that tried to determine the process by which patients make informed decisions on elective surgery. The results were rather surprising, at first glance.
Sixty-nine percent of patients decided to have surgery before meeting their surgeon, and 47% stated that the surgeon did not influence their decision. Although the surgeon was an important source of information …
Junior Seau had CTE, chronic traumatic encephalopathy, the degenerative brain disease known to afflict individuals who have sustained repeated head injuries over time.
Junior Seau played football his whole life and was never officially diagnosed with a concussion. Last May he sat down one day and shot himself in the heart. Dave Duerson, the former Bears safety, did this too, as a way to …
A buddy of mine sent along an interesting link by a physician named Ben Brown that makes an argument that doctors actually aren’t all that well off. Salaries are down. Education costs can exceed $300,000 over the course of college, medical school, and residency. By the time you take that first job, you’re on the wrong side of 30 and Wells Fargo is demanding $1800 a month for all your student loans. It’s a topic …
The events in Newtown, Connecticut will hopefully jump start a national conversation. That’s about the only solace I can take from the senseless murder of 20 schoolchildren in a classroom.
This conversation ought to transcend minutiae like the specifics of gun laws and gun show loopholes (although there will be a time for redressing these inanities). I don’t want to hear about …
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