Lawyers are hardworking people. That’s for sure. Take this lawyer from Ohio who billed long hours for court-appointed cases. For instance, he billed for 21, 21.5, 23 and 29 hours of work for 4 different days. His lawyer said he did the work but was simply a poor record keeper.
Right.
Not to be outdone, a lawyer from Iowa billed for more than 24 hours of work in a day on 80 …
Recently, I underwent surgery for what proved to be an extensive tear of my right rotator cuff.
I have never had a major operation before. Here is how it went down.
Back in July, I felt a sharp pain in my right shoulder while playing tennis. Of course, I continued to play that day and for two more weeks. When the pain finally prevented me from playing, I saw an orthopedist who …
You have no idea how important your arm is until you can’t use it
There was some recent buzz on Twitter about a proposal from a retired plastic surgeon in San Diego who has developed a plan to retrain retired specialists as family practitioners. The idea is that this could alleviate the shortage of primary care physicians that exists now and is predicted to worsen as more people become insured.
The 15 module course created by some faculty at the University of California at San …
Can we solve the primary care shortage with retired specialists?
Medical errors are a real problem. I won’t deny that.
It was bad enough when the often-quoted Institute of Medicine figure that 98,000 deaths per year in the US are caused by medical errors was in vogue, but now a paper in the Journal of Patient Safety states that adverse medical events result in 210,000 to 400,000 deaths per year and 10 to 20 times those numbers of serious …
Not all adverse events are preventable
An anesthesiologist at a California hospital pasted stickers simulating a mustache and teardrops on the face of a hospital employee while she was having surgery on a finger.
According to the Los Angeles Times, the doctor said, “I thought she would think this is funny and she would appreciate it.”
And if that wasn’t bad enough, a “nursing attendant” took a photograph.
The patient, who said she had to quit her job …
The OR is not a good place for a prank
An orthopedic surgeon from New York reportedly has 261 malpractice suits against him. He has been accused of performing “phantom” and unnecessary operations. In one case, he supposedly performed a knee reconstruction, and the patient died of a pulmonary embolism the same day. A post-mortem examination allegedly showed no evidence of a reconstructed knee.
There is also said to be evidence showing that in one day he was doing as many …
3 stories of surgeons that I find disturbing
If you are interested in patient safety and medical errors and haven’t read the story in the Texas Observer about a spectacularly incompetent neurosurgeon, you should. It is long but worth it. It will make you cringe.
The story includes many details about operations done poorly and patients suffering paralysis and death at the hands of Dr. Christopher D. Duntsch.
The Texas Medical Board is over-worked, slow to act and …
Lawyers are a big impediment to disciplining bad doctors
A recent article on American Medical News titled “Medical charting errors can drive patient liability suits” led with a case involving a bad outcome after coronary artery bypass surgery. The plaintiff’s attorney alleged that the doctors did not review the patient’s lab results or x-rays because they did not specific say so in the medical record.
The article quoted a defense attorney who said, “By the time [the doctors] are deposed, …
A concept that has been percolating in the medical literature boiled over into the mainstream as the New York Times published this story, “Chicago’s Intern ‘Boot Camp’ is a rehearsal for life or death medical issues.”
The article describes a new internal medicine intern having to deal with a simulated patient who is critically ill and has alarms going off.
Another intern had to tell a “patient” played by an actor …
Should intern boot camps be mandatory after medical school?
On June 10, 2013 a 32-year-old pregnant woman was reported to have died after having an ovary removed instead of her inflamed appendix. As the infected appendix festered, she became septic and succumbed to multiple organ failure. This tragedy occurred in the UK in late 2011, but has just come to light.
How could this have happened?
Let me count the ways.
The surgery was performed by two trainee surgeons. Their …
An ovary removed instead of an inflamed appendix: What happened?
A paper in JAMA Surgery noted that patient satisfaction ratings have very little to do with the quality of care provided by a hospital. The study analyzed data from 31 hospitals that participated in patient satisfaction surveys, the CMS Surgical Care Improvement Project (SCIP), and employee safety attitudes questionnaires. They found that patient satisfaction did not correlate at all with the rates of hospital compliance with SCIP process measures nor …
A doctor guilty of fraud has great patient satisfaction scores
Dr. Sam Ko says resident work hours should be limited to 40 per week. Via Twitter, I warned him that I would rebut his assertion.
Without any data or references except a tangential one, he bases his opinion on four premises.
1. Residents will be happier and nicer to patients because they will be less stressed. There is no proof that this is so. In fact, a recent Read more…
Should medical resident training be limited to 40 hours per week?
If you’ve read my reviews of the new medical TV show Monday Mornings, you’ll know I’ve been critical of many things about it. I was particularly disappointed with the way the show handled one of its central themes: the morbidity and mortality (M&M) conference.
I thought it might be useful to tell you how most real M&M conferences are run. M&M conferences generally take place at hospitals with residency training …
What really happens in a morbidity and mortality conference
New York City’s Health and Hospitals Corporation (HHC), which runs 11 hospitals in four of the five boroughs of New York, is negotiating a new deal with the union representing some 3,300 salaried physicians. The corporation wants to base MD pay raises on 13 quality indicators.
The New York Times article that broke the story does not list all of the indicators but mentioned the following: how well patients …
The problem of basing physician pay on quality indicators
Despite the fact that many papers have identified the problem, inappropriate blood transfusions continue in hospitals across the nation.
This topic was featured at the recent Patient Safety Science and Technology Summit that was held in Orange County, California.
Transfusion of packed red blood cells is very common. Over 2 million patients or 5.8% to 10% of inpatients are transfused every year with some …
Inappropriate blood transfusions: Surgeons should lead the way
I’m involved in a protracted and good-natured (I hope) debate about the merits of robotic surgery with a University of Pittsburgh urologist named Ben Davies. Today he tweeted the following (with translation for the Twitter averse):
“I would love for a $ISRG [stock symbol for Intuitive, makers of the robot] MD hater (like @Skepticscalpel) to actually watch 10 open RRPs [radical retropubic prostatectomies] …
Robotic prostatectomy: A debate with a urologist
Not long ago, I blogged about a plastic surgeon who aggressively pursues patients who refuse to pay her bills. The state is suing her to make her stop and also considering lifting her medical license. The central theme is that she makes patients who she sees in the ED to sign a form stating that they will pay her. It is unlikely that the patients are aware of …
Should we expect patients to think about costs?
The September 2012 issue of the AARP Bulletin has a story about a woman who sued an elder-law attorney for legal malpractice. Bear with me. It’s an interesting tale.
In 2004, a man consulted an elder-law attorney to set up a trust that would distribute his assets fairly. He had a daughter from his previous marriage and his wife had five children from her previous marriage. The story is …
Are hospitals learning from the lawyers?
The recent hurricane in New York City and the closures of some hospitals requiring the transfer of a large number of patients reminded me of something that happened on 9/11/2001.
I was working at a hospital near New York. You may recall that among the many problems that day was a breakdown in communications. Reliable information on the number of casualties and extent of injuries was hard to determine.
Late on the …
Why can’t we be more proactive in discharging patients?
As predictable as the leaves falling this time of year, another paper on the subject of unnecessary preoperative laboratory testing has appeared.
A group from the University of Texas Medical Branch looked at more than 73,000 elective hernia repairs in the National Surgical Quality Improvement Project (NSQIP) database. Almost 2/3 of the patients had preoperative laboratory tests. Of that group, 58.6% had a CBC, 53.5% had electrolytes, 23.7% had …
Stopping extensive pre-op testing requires malpractice reform
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