Physicians writing on KevinMD about being sued and about making mistakes: the summons, the deposition, and the verdict that does not feel like winning, whether damage caps and safe harbors work, frivolous claims argued from both sides, expert witnesses, nuclear verdicts and premiums, apology laws, and how physicians say errors happen and what it is like to make one. Two maintained records draw on this archive: Medical malpractice: what physicians say, in their own words and Medical errors: what physicians say, in their own words.

Heart catheterization worries that every cardiologist face

Physician
June 18, 2010

Malpractice and heart catheterization have been in the news recently.

A spicy concoction for sure. An epidemiological study published in an online subsidiary of Circulation addresses the role of three major medical issues facing cardiologists today: malpractice, heart catheterization, and medical costs.

It is hard to get more controversial.

Heart catheterization, the invasive assessment of the coronary artery lumen, has always been a hot-potato topic. The “percent-normal” was the buzz word when I …

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Heart catheterization worries that every cardiologist face

Peer review may require random over-reads

Conditions and Diseases
June 9, 2010

“Let’s kill all the lawyers.” It’s every doctor’s favorite Shakespeare quote. And if you’re giving a talk to doctors there’s no better way to get the audience on your side than by starting with a lawyer joke.

But perhaps we shouldn’t be too hasty about killing all those lawyers. As recent commentary about the Mark Midei case makes clear, modern medicine doesn’t know how to police itself. And until medicine does …

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Peer review may require random over-reads

Interruptions in the emergency department can lead to errors

Physician
June 8, 2010

by Nancy Walsh

Busy clinicians in the emergency department reduce the time they spend on clinical tasks when interrupted, working faster and possibly cutting corners, a prospective observational study found.

Overall, clinicians were interrupted 6.6 times per hour, and 11% of all tasks were interrupted, according to Johanna I. Westbrook, PhD, of the University of Sydney, in Australia, and colleagues.

The mean “time on task” for uninterrupted tasks was 1 minute and 26 …

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Interruptions in the emergency department can lead to errors

Why patients file medical malpractice lawsuits

Physician
June 7, 2010

Time to turn our attention to an unpleasant topic: Lawsuits.

Who files them?

Why? And what actually happens?

There have been oceans of ink spilled about medical malpractice. An oversimplification of the various positions on malpractice and malpractice reform goes something like this:

  1. (+) Malpractice suits are good. They keep healthcare professionals and hospitals on their toes; if the threat of a big payout improves safety and quality, then lawsuits provide an important regulatory …

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Why patients file medical malpractice lawsuits

Tort reform for doctors in exchange for less salary

Health Policy
June 7, 2010

Matt Steinglass at The Economist has interesting take on tort reform, specifically that limiting physician liability for adverse patient outcomes must come with an equable cost to doctors.

In Europe, the costs accrued due to medical errors are covered by the wide-ranging social safety net; the lottery system of massive medical malmalpractice judgments is virtually absent.

It’s part of the social contract: doctors accept limited salaries in exchange for limited liability; …

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Tort reform for doctors in exchange for less salary

Defensive medicine starts early in residency training

Physician
May 19, 2010

Part of a resident’s job is to learn the ropes in preparing for independent practice. While you’re a resident, you get the benefit of having someone looking over your shoulder to critique you as you determine how you are going to manage patients.

I frequently tell residents that different attending physicians practice medicine in different ways. Some practice defensive medicine more than others, some prescribe antibiotics more than others and some …

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Defensive medicine starts early in residency training

Patient wants an apology, not money, after medical malpractice

Physician
May 16, 2010

by Tricia Pil, MD

This is the true story of a hospitalization as told from three points of view: first, the recollections of the patient (who happens to be a physician); second, events as recorded in the medical charts by doctors and nurses; and third, the version put forth by the hospital.

FRIDAY

Patient:
It is fall 2005, and I am nine months pregnant. A healthy 33-year-old pediatrician, I am a longtime patient of …

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Patient wants an apology, not money, after medical malpractice

Children with fever may not receive antibiotics in the ER

Physician
May 10, 2010

by John Gever

Up to one-third of children with febrile bacterial infections failed to receive antibiotics in a large emergency department, while 20% of youngsters without such infections received antibiotics unnecessarily, Australian researchers said.

A computer algorithm based on standard test results could do a better job of assigning feverish children to the correct treatment sooner, Jonathan C. Craig, MBChB, PhD, of the University of Sydney, and colleagues reported online in BMJ.

Although …

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Children with fever may not receive antibiotics in the ER

False patient contact information worsens emergency care

Physician
May 10, 2010

One of the biggest emergency room problems is contacting patients after they leave.

Patients sometimes leave false contact information — which makes it difficult for the emergency room staff should problems arise after the visit.

The issue was illustrated in a piece from msnbc.com. Many times, results like blood cultures or x-ray findings take time to return. And if there’s something that needs to be acted upon, contacting the …

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False patient contact information worsens emergency care

Medical malpractice deposition survival tips for doctors

Physician
May 9, 2010

An excerpt from How to Survive a Medical Malpractice Lawsuit: The Physician’s Roadmap for Success.

by Ilene R. Brenner, MD

The most important part of your case is upon you: the pretrial deposition. If you do a poor job, you can ruin your case and make a defensible lawsuit become indefensible.

So what is a deposition? It is the sworn testimony of a witness taken before trial, in a location …

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Medical malpractice deposition survival tips for doctors

Malpractice fears influence cardiology decisions

Physician
May 4, 2010

by Charles Bankhead

For nearly a quarter of cardiologist respondents, malpractice concerns influenced their decisions to order tests or treatment for hypothetical cases included in a national survey.

Almost 30% of cardiologists acknowledged ordering cardiac catheterization because colleagues did so in the same situation, according to an article published online in Circulation: Cardiovascular Quality Outcomes.

Concerns about malpractice had a significant association with regional use of tests and treatment, Frances Lee Lucas, PhD, …

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Malpractice fears influence cardiology decisions

Defensive medicine worsens patient care and raises costs

Physician
May 3, 2010

Health care in the United States costs too much, and it doesn’t look like that’s going to change. Recent health care reform legislation doesn’t take any meaningful steps towards reducing or controlling costs. In fact, it explicitly forbids states from trying to curtail the costs of malpractice litigation in any way that would reduce lawyers’ fees.

How does a fear of lawsuits increase costs? The most direct way is …

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Defensive medicine worsens patient care and raises costs

C-section rates and its association with lawsuits

Physician
April 25, 2010

The National Center for Health Statistics recently released a new report, Recent Trends in Cesarean Delivery in the United States. The report is most notable for a startling statistic; the C-section rate has reached the astronomical level of 32%, an increase of more than 50% since 1996. This is disturbing news.

Why is the C-section rate sky high?

The pervasive nature of the increase may hold some clues. The increase has …

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C-section rates and its association with lawsuits

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Checklists help reduce hospital deaths

Physician
April 15, 2010

by Michael Smith

The use of treatment checklists for 13 common diagnoses was associated with a dramatic reduction in patient deaths at three London hospitals, researchers said.

The year the checklists were introduced, the three facilities in the North West London Hospitals NHS Trust registered 255 fewer deaths than the previous year, according to Brian Jarman, PhD, of Imperial College London, and colleagues.

The targeted diagnoses accounted for 174 fewer deaths than the …

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Checklists help reduce hospital deaths

iPhone medical apps may be medical malpractice targets

Health Technology
April 11, 2010

Medical practice is a big business. Conservative estimates put the total cost of medical malpractice at nearly $35 billion annually and, according to a Kaiser Family Foundation report, nearly $5 billion is paid in claims each year. With an average claims payment of about $300,000 and up to 50% of that going to the lawyers representing the patient, its not surprising that practically every show on cable television has at …

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iPhone medical apps may be medical malpractice targets

Teaching patient safety starts in medical school

Physician
March 31, 2010

Ten years after the release of the IOM report To Err is Human, which documented the toll taken by medical errors in this country, the question remains: What can be done to reverse the trend of ever-increasing morbidity and mortality due to medical errors?

Last December, a look back over the decade since the release of To Err is Human — and a steady medical error death rate of about …

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Teaching patient safety starts in medical school

Never events in hospitals depend on patient risk

Health Policy
February 25, 2010

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

Occurrence of some so-called “never events” in hospitals may depend partly on unmodifiable risk factors such as patient characteristics, undermining the rationale for denying Medicare payment for their treatment, researchers said.

Analysis of some 890,000 surgeries performed in 1,368 hospitals showed that patient age and pre-existing conditions such as weight …

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Never events in hospitals depend on patient risk

Why is President Obama ignoring the doctors when it comes to health reform?

Health Policy
February 15, 2010

by Ernesto Gutierrez, MD

There is a lot of discussion about what Obama did right and wrong in managing the politics of passing health insurance reform. What strikes me as the most obvious is the failure to engage physicians. Sure there was support from the AMA, ACP, and AAFP, but the support was lukewarm at best. The position letters sent out to society members outlining their support seemed forced …

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Why is President Obama ignoring the doctors when it comes to health reform?

Doctors are responsible for a minority of medical mistakes in radiation therapy

Physician
February 11, 2010

The New York Times recently featured a disturbing expose of serious medical errors associated with the newest forms of high tech radiation treatment, entitled, Radiation Offers New Cures, and Ways to Do Harm. The piece is an example of excellent medical journalism, compelling stories of two individuals who sustained truly horrifying injuries as the result of treatment errors framed a detailed investigation of similar errors that have occurred in New …

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Doctors are responsible for a minority of medical mistakes in radiation therapy

When doctors are at greatest risk of making a mistake

Physician
February 5, 2010

Early in my training as a glider pilot my instructor showed me an excellent but simple analogy for ensuring my safe performance as a pilot. I have always remembered this lesson, which he called the ‘accident slope’, and have tried to apply it to my method of practicing medicine, as well as the other ‘dangerous’ activities for which I have an affinity.

“Accidents and mistakes are seldom the result of one …

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When doctors are at greatest risk of making a mistake

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