Perspective: Acute MI: “Yes” or “No” – Still more art than science

By Charles A. Pilcher MD FACEP
August, 2015

Body et al. published a study in BMJ’s “Emergency Medicine Journal in which they asked: “Can emergency physicians ‘rule in’ and ‘rule out’ acute myocardial infarction with clinical judgement?” The fascinating aspect of the study was the coverage the article got touting the value of a new “highly-sensitive troponin t test” that would give a doctor 100% certainty in ruling out a myocardial infarction. A closer look at the data suggests that we must all remain skeptical when we see the words “certainty,” “breakthrough,” “game changer,” or “foolproof” when applied to medicine. Though based on science, medicine still has a major component of “art.” And doctors should never forget: There’s more to a chest pain evaluation than simply ruling in or ruling out an MI. To read how physicians might use – or misuse – the new troponin test, continue reading here ->

Has tort reform made a difference? Apparently not.

The New England Journal published a study last fall to find out if physicians practice differently in states establishing major tort reforms, states where even the definition of “deviation from the ‘standard of care’ has been changed.” The answer is “No.” Doctors still order as many tests, still admit as many patients, and still fear getting sued as much as ever. It turns out that “tort reform” is likely to be less of an issue than the internal culture of medical training, one of “never miss ” and “professional embarrassment,” a culture that almost forces over-utilization. MedPage Today summarizes the study nicely. Tort reform, at least in Texas, Georgia and South Carolina, has had little impact.

Apologize for mistakes? The pros and cons for physicians

An article in the June 10 issue of Medical Economics by Debra Beaulieu-Volk addresses the issue of how and when a physician should apologize to a patient and/or family for a medical error. It’s a really worthwhile read and includes a summary of “apology laws” in the various states. Apologizing for an error is a process, not an event. Doug Wojcieszak founder of Sorry Works, says that the first step should be “When something bad happens, you just need to be a grief counselor. You need to sit with them and hold their hand. The next patient can wait.” Full disclosure can occur later as more information is developed. You can find the article on page 52 of Medical Economics. [Editor’s Note: See also “Nice Doctors Don’t Get Sued,” a Perspective essay in the June, 2015, issue of MMB.]

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Perspective: Acute MI “Yes” or “No”- Still more art than science

August 19, 2015

By Charles A. Pilcher MD FACEP August, 2015 A recent article in BMJ Emergency Medicine got considerable press suggesting a new “high-sensitivity troponin T” test would predict who is and who is not having a heart attack – with 100% certainty. Hopefully our skepticism rises whenever we see “100% certainty,” “foolproof,” “game-changer,” “breakthrough” or other […]

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July, 2015 – Medical Malpractice Bulletin

July 17, 2015

Perspective: Pursue? Defend? Settle? Drop? The value of a “case viability analysis” By Charles A. Pilcher MD FACEP July, 2015 Every malpractice case demands thorough review to determine whether it should be pursued/dropped (plaintiff) or defended/settled (defense). In order to determine the best course of action, attorneys do a thorough analysis. In this “Perspective” the […]

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Pursue? Defend? Settle? Drop?

July 17, 2015

Case viability analysis crucial to prevent costly decision errors By Charles A. Pilcher MD FACEP July, 2015 “Charles, making decisions is easy. It’s getting the information that’s hard.” These words from my father have stuck with me since I first heard them decades ago at a crucial decision point in my own life. They are particularly appropriate when […]

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Medical Malpractice Bulletin – June, 2015

June 4, 2015

Perspective: If you’re a “nice” doctor, you won’t get sued By Ryan Padgett MD FACEP & Charles A. Pilcher MD FACEP June, 2015 Do hospital ratings matter? Is a “nice” physician with good behavior less likely to get sued than others? Physicians have long been skeptical of the value of patient satisfaction ratings but a recent study […]

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“Nice” doctors don’t get sued (as often)

June 3, 2015

Ryan Padgett MD FACEP and Charles Pilcher MD FACEP June, 2015 “Patient satisfaction scores for your department dropped last quarter. What are your plans to bring them up?” asks a hospital CEO of his ER director. This question irritates physicians more than the patient with an “emergency” wart at 3 AM. Press-Ganey, Healthgrades, Leapfrog, US News, RateMD.com […]

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Medical Malpractice Bulletin – April, 2015

April 28, 2015

Perspective: Why physicians make mistakes – deja vu all over again By Charles A. Pilcher MD FACEP April, 2015 This newsletter has frequently posted articles and “Perspectives” on what leads to physician error. Now a fascinating JAMA editorial on physician mistakes sheds light on the progress we are making (or not making) in improving patient […]

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Why physicians err – deja vu

April 26, 2015

Why physicians err – Deja vu By Charles A. Pilcher MD FACEP April, 2015 Over 100 years ago Dr. Richard Cabot reported that autopsies showed a remarkable lack of correlation between the pre-mortem diagnosis and the actual cause of death. The findings were shocking and embarrassing, but the house of medicine anticipated that they would lead to improvements in […]

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March, 2015 – Medical Malpractice Bulletin

March 10, 2015

Perspective: Physicians are learning nothing from med mal lawsuits. Time for a change. By  Charles A. Pilcher MD FACEP I am upset that physicians (other than defendants) are learning nothing from medical malpractice lawsuits. In this month’s “Perspective” I share my strong feelings on this issue and describe a project that I have begun to change that and improve […]

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Can we work together to improve patient safety?

March 10, 2015

By Charles A. Pilcher MD FACEP March, 2015 DISCLAIMER: In the January “Perspective” I presented Medical Malpractice Insights, a new publication for physicians which helps them learn from medical malpractice lawsuits. Because this is so important, I am continuing my “rant” in this post and seeking your involvement. I expect differences of opinion and am interested in your […]

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January, 2015 – Medical Malpractice Bulletin

January 4, 2015

Perspective: It’s time for doctors to LEARN from malpractice suits By Charles A. Pilcher MD FACEP January, 2015 After 35 years of working as an expert in medical malpractice, I continue to see presumably competent colleagues make the same mistakes over and over and over again. We docs are learning nothing from the unfortunate experiences/mistakes […]

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Medical Malpractice Insights – Learning from Lawsuits

January 4, 2015

By Charles A. Pilcher MD FACEP January, 2015 New Publication: Medical Malpractice Insights – Learning From Lawsuits Physicians are learning nothing from the outcome of medical malpractice lawsuits. That must change. Now. Seeing the same mistakes being made again and again by presumably competent physicians is frustrating. We physicians don’t have a clue – unless we […]

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Medical Malpractice Bulletin – November, 2014

November 3, 2014

Perspective: Interruptions lead to mistakes in patient care The ER is a busy place. So is the office of almost any physician. Having  uninterrupted time to address a patient’s problem is critical. Eliminating as many sources of interruption as possible is key to achieving that goal. Interruptions can lead to a lack of focus, a […]

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Perspective: Interruptions put patients at risk

November 3, 2014

By Charles A. Pilcher MD FACEP November, 2014 Last February in Emergency Physicians Monthly Dr. Jeremy Tucker wrote a column titled “The No-Interruption Zone.” Dr. Tucker, a busy ED physician at MEP/St. Mary’s Hospital in Leonardtown, Maryland, talked about the effects of physician interruptions on  patient flow and safety, and the ways in which interruptions lead to […]

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Medical Malpractice Bulletin – September/October, 2014

September 29, 2014

Perspective: Alert fatigue – a pitfall of the EMR By Ryan Padgett MD FACEP [Editor’s Note: This month’s “Perspective” is contributed by my colleague, Dr. Ryan Padgett, who provides services as a Consulting Expert with PilcherMD.com. / CP] As experience with EMRs increases, new challenges are discovered. One of the most critical is “alert fatigue,” an […]

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Perspective: Alert fatigue – a pitfall of the EMR

September 29, 2014

By Ryan G. Padgett MD FACEP September, 2014 [Editor’s Note: This month’s “Perspective” is contributed by my colleague, Dr. Ryan Padgett, who provides services as a Consulting Expert with PilcherMD.com. / CP] Mention the word “EMR” (Electronic Medical Record, aka EHR for Electronic Health Record) to a health professional and you can expect a strong […]

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Medical Malpractice Bulletin – August, 2014

August 25, 2014

Perspective: “Black Box” drugs raise red flags By Charles A. Pilcher MD FACEP “Black Box Drugs” are those that require the strongest available warning used by the FDA for an approved drug, because they carry “a significant risk of serious or even life-threatening adverse effects.” The warning is placed at the top of the PDR […]

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Perspective: Black box drugs raise red flags

August 25, 2014

By Charles A. Pilcher MD FACEP August, 2014 “Black Box” drugs: Open the box with care In the past few years I have been involved with 3 cases related to drugs with a “black box warning.” All 3 involved the accidental arterial injection of a low pH medication that caused severe vasospasm, arterial and arteriolar […]

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Medical Malpractice Bulletin – July, 2014

July 15, 2014

In this issue: Perspective: Is a “draft” report the “final” report? Canadians say “Yes.” Jumping to conclusions: Little time spent in differential diagnosis Vertebral Artery Dissection May Initially Cause No Noticeable Symptoms The other side of the stethoscope: Injured ED doc finds treatment lacking Malpractice claim may be modified after medical panel decision Must I […]

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Perspective: Is an expert’s “draft” report final?

July 15, 2014

By Charles A. Pilcher MD FACEP July, 2014 As an expert witness, I am occasionally asked to write a report, affidavit or declaration for an attorney client. When I do so, must my initial draft be the only and final say on the matter? May my attorney client accept it as a “draft” and suggest […]

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Medical Malpractice Bulletin – June, 2014

June 5, 2014

In this issue: Perspective: More tests ≠ “standard of care” Opportunities and challenges for attorneys in the ACA 1 in 20 outpatients misdiagnosed Alabama: Brand drug manufacturers liable for claims of generic knockoffs The fraudulent medical record: Anonymous ED scribe admits to over-documentation, over-billing Perspective: More tests ≠ “standard of care” By Charles A. Pilcher MD FACEP […]

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Perspective: More tests ≠ “standard of care”

June 5, 2014

By Charles A. Pilcher MD FACEP June, 2014 Sometimes doing nothing is the best care. There is an increasing body of medical literature illustrating the limits – and dangers – of excessive testing. Too often our legal system assumes that if a doctor had done just “one more test,” the outcome would have been different. Yes, […]

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Medical Malpractice Bulletin – February, 2014

February 23, 2014

Perspective: Can plaintiff attorneys prevail in stroke cases? By Charles A. Pilcher MD FACEP This newsletter assiduously monitors the medical literature on the subject of stroke, as well as news of malpractice suits resulting from the care of stroke patients. In the past 3-4 years there has been almost zero news about lawsuits for failure […]

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Perspective: Can plaintiffs prevail in stroke cases?

February 23, 2014

By Charles A. Pilcher MD FACEP February, 2014 This newsletter has published 4 previous “Perspective” essays on the standard of care for management of acute stroke. One of those standards is the use of tPA (alteplase, or tissue plasminogen activator), the “clot-buster drug,” in those patients presenting within the (now) 4 1/2 hour window from […]

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Medical Malpractice Bulletin – January, 2014

January 6, 2014

Perspective: How do I find a good doctor? By Charles A Pilcher MD FACEP January, 2014 One of the toughest challenges for any health care provider is being asked by a friend or family member with a medical problem, “Who should I see for this?” I have an answer. My fellow physicians have an answer. […]

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Perspective: Finding a doctor – I know. You know. But the patient doesn’t have a clue.

January 6, 2014

By Charles A Pilcher MD FACEP January, 2014 One of the toughest challenges for any health care provider is being asked “Who should I see for…?” by a friend or family member. I have an answer. My fellow physicians have an answer. My nurse colleagues have an answer. Attorneys involved in medical malpractice, both plaintiff […]

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Medical Malpractice Bulletin – November/December, 2013

November 29, 2013

Perspective: How busy was the doc? Overwork can lead to errors By Charles A. Pilcher MD FACEP November/December, 2013 The harder and faster one works, the more prone one becomes to mistakes. That’s no different for physicians than for anyone else. And it matters to med mal attorneys. An increasing body of research is beginning […]

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Perspective: How busy was the doc? Physician workload impacts patient care, leads to mistakes

November 28, 2013

By Charles A. Pilcher MD FACEP November, 2013 The harder and faster one works, the more prone one becomes to mistakes. That’s no different for physicians than for anyone else. And an increasing body of research is beginning to substantiate the magnitude of the problem with actual numbers. This became an issue over a decade […]

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Perspective: Stop! Think! Listen! “Cognitive pause” will reduce medical errors

October 12, 2013

By Charles A. Pilcher MD FACEP October, 2013 What kind of medical error accounts for most malpractice payments: Surgical mistakes? Overdoses? Obstetrical errors? No, no and no. The most common cause of paid claims for malpractice is diagnostic error, accounting for 28.6% of claims and 35.2% of payouts, according to a 25 year summary of […]

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Perspective: Stroke and tPA – ACEP’s Clinical Policy Fuels The Debate

September 10, 2013

By Charles A. Pilcher MD FACEP September, 2013 I am often asked to evaluate the medical records of stroke patients, almost always to address the issue of whether or not the provision of tPA, the “clot-busting drug,” would have provided a patient with a demonstrably better chance of an improved outcome following a stroke. There […]

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Medical Malpractice Bulletin – October, 2013

July 30, 2013

Perspective: Stop! Think! Listen! “Cognitvie Pause” can reduce medical error By Charles A. Pilcher MD FACEP October, 2013 Most medical errors are caused not by lack of knowledge or an obvious mistake, but rather by thinking errors. These result in mis-interpreting the patient’s presentation as something more common, when unusual symptoms should give the physician […]

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Medical Malpractice Bulletin – July/August 2013

July 29, 2013

Perspective:  Electronic Health Records (EHRs): Can we trust them? Media, government and most of organized medicine view the EHR as the answer to much of what is wrong with medical care in America. In part, that may be true. But the past year has seen a flurry of studies and articles pointing out that there […]

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Perspective: Electronic Health Records (EHRs): Can we trust them?

July 29, 2013

July/August, 2013 By Charles A. Pilcher MD FACEP We’ve all seen the hoopla about the benefits of the EHR: standardization, easy communication between providers, reduction in paper, no need to re-enter the same data, better tracking of medications, etc. The EMR or EHR (as the Department of Health and Human Services prefers) has become the standard […]

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Medical Malpractice Bulletin – June, 2013

June 9, 2013

Perspective: Consults and Handoffs Part II: Handoffs By Charles A. Pilcher MD FACEP June, 2013 As introduced in the last issue of this newsletter, all too often the responsibility for a patient becomes unclear when an emergency physician requests a consult or transfers care to another doctor, i.e., a “handoff.” Both “handoffs” and “consults” – if […]

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Medical Malpractice Bulletin – September, 2013

May 6, 2013

Perspective: The Role of tPA in Stroke – ACEP’s Clinical Policy Fuels Ongoing Debate By Charles A. Pilcher MD FACEP September, 2013 How valuable is tPA in stroke? While tPA has become the standard of care for patients who qualify, the numbers are less than impressive and the benefit marginal. Studies generally show that patients […]

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Medical Malpractice Bulletin – May, 2013

May 5, 2013

Perspective: Handoffs And Consults: Who’s In Charge? By Charles A. Pilcher MD FACEP During transitions in patient care, a lot can go wrong. Almost all of the potential risk in these situations is the result of poor communication. But why is the communication so poor? Much of it is the result of misplaced assumptions, unrealistic […]

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Handoffs and Consults: Who’s in charge? Part II

May 5, 2013

Part II: Handoffs By Charles A. Pilcher MD FACEP June, 2013 As introduced in the last issue of this newsletter, all too often the responsibility for a patient becomes unclear when an emergency physician requests a consult or transfers care to another doctor, resulting in potential catastrophe for the patient and physician. In last month’s […]

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Handoffs and Consults: Who’s in charge? Part I

May 4, 2013

By Charles A. Pilcher MD FACEP May, 2013 Part I: Consults [Editor’s Note: This “Perspective” covers “Consults.” Part II on “Handoffs” will appear in the next issue of Medical Malpractice Bulletin. All too often the responsibility for a patient becomes unclear when an emergency physician requests a consult or transfers care to another doctor. The […]

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Medical Malpractice Bulletin – March/April, 2013

March 30, 2013

Perspective: 1/3 of physicians miss test results Charles A. Pilcher MD FACEP One third of physicians surveyed admit to missing a test result because of information overload linked to their Electronic Health Record (EHR). It’s called “Alert Fatigue,” and it’s a growing challenge. Most EHRs have built in alerts, designed to keep physicians from making […]

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Perspective: 1/3 of physicians miss test results

March 30, 2013

Charles A. Pilcher MD FACEP March/April, 2013 One third of physicians surveyed admit to missing a test result because of information overload linked to their Electronic Health Record (EHR). It’s called “Alert Fatigue,” and it’s a growing challenge. Most EHRs have built in alerts, designed to keep physicians from making mistakes: Examples: “Patient due for […]

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Perspective: Why do doctors make mistakes? Part II

March 30, 2013

Charles A. Pilcher MD FACEP March/April, 2013 A study published in JAMA Internal Medicine reveals that the most common causes of medical error resulting in delayed diagnosis and patient harm are “cognitive errors” completely within the physician’s control. Problems with doctor-patient encounter cause most primary care diagnosis errors. On retrospective review of patients requiring an […]

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Medical Malpractice Bulletin – December, 2012

December 20, 2012

Perspective: Must physicians do a lumbar puncture on every suspected subarachnoid hemorrhage? Charles A. Pilcher MD FACEP Classic medical training has been to do a lumbar puncture (LP) on every patient with a new, sudden onset headache if a CT scan does not show a suspected subarachnoid hemorrhage (SAH), usually from a ruptured cerebral aneurysm. […]

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Perspective: Must physicians do a lumbar puncture on every suspected subarachnoid hemorrhage?

December 20, 2012

December, 2012 Charles A. Pilcher MD FACEP At the 2012 ACEP Scientific Assembly, Dr. Ashley Shreves and Dr. David Newman presented statistics showing the number of lumbar punctures (LP) that must be done to find a single subarachnoid hemorrhage (SAH) in a CT negative patient with sudden onset of headache. The answer: 700. Emergency physicians […]

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Medical Malpractice Bulletin – July, 2012

July 22, 2012

Perspective: The chart is my witness. Make sure it tells the story. Guest Authors: Andrew Koslow, MD, JD, and Diana Nordlund, DO The medical record can become a missed opportunity for communication between providers and  a dangerous medico-legal pitfall. Physicians should be certain that it communicates an encounter clearly. EMRs and template charts are particularly […]

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Perspective: The chart is my witness

July 22, 2012

July, 2012 Guest Perspective, by Andrew Koslow, MD, JD, and Diana Nordlund, DO [Editor’s Note: This article first appeared in ACEP News June 5, 2012, and is reprinted from the original with permission of Dr. Koslow] “Doctor, let me see if I understand what you’re saying. You just told the court that Melanie was febrile, […]

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Medical Malpractice Bulletin – May, 2012

May 28, 2012

Perspective: Cauda equina lawsuits: Gambling or litigating? By Charles A. Pilcher MD FACEP May, 2012 Pursuing or defending a case of cauda equina syndrome (CES) is as much a matter for the daring gambler as the skilled litigator. If it were your nerves being pinched off by a herniated disk, would you want to wait […]

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Cauda Equina Syndrome: Gambling or litigating?

May 28, 2012

Perspective: Cauda equina lawsuits: Gambling or litigating? By Charles A. Pilcher MD FACEP May 2012 The March issue of the journal Orthopedics presents a study by Daniels et al on the outcome of litigation for cauda equina syndrome (CES). The study was retrospective and used Lexis Nexus reports from 1983-2010. [Editor’s Note: One must be […]

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Medical Malpractice Bulletin – March 2012

March 22, 2012

Perspective: What is a “reasonable and prudent” physician? It seems such a simple question: Given a specific set of facts concerning the presentation of a patient in the ED, what would the prudent and reasonable physician do? In this month’s guest “Perspective,” Dr. Mark Plaster takes a look at why the “best” care need not […]

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Perspective: What is a “prudent and reasonable physician”?

March 22, 2012

March, 2012 [Editor’s Note: This month’s “Perspective” comes from Mark Plaster MD, Editor of Emergency Physicians Monthly. It was first published December 5, 2011, and is edited for brevity.] It seems such a simple question: Given a specific set of facts concerning the presentation of a patient in the ED, what would the prudent and […]

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Medical Malpractice Bulletin – January, 2012

January 17, 2012

As we begin a new year, I want to thank each you for your encouragement and support of the Medical Malpractice Bulletin, now entering its 4th year. I have enjoyed sharing this information with you and look forward to continuing to assist you in resolving issues related to medical malpractice and personal injury. Charles A. […]

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Perspective: Who’s to blame when bad things happen?

January 17, 2012

This month’s guest “Perspective” is by Mark Plaster, MD, and was first published in Emergency Physicians Monthly, June 14, 2011. It is edited and reprinted with permission. The opinions expressed are those of Dr. Plaster and reflect his experience with a specific case example. Generalization is discouraged./CP Over the years I’ve gotten many calls like […]

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Medical Malpractice Bulletin – September/October, 2011

October 10, 2011

Perspective: Door-to-needle times for tPA in stroke hard to meet By Charles A. Pilcher MD FACEP September/October, 2011 Under current guidelines from the American Stroke Association, tissue plasminogen activator (tPA, commonly known as a “clot buster” drug) should be administered within 3-4.5 hours of “last seen normal” – and 1 hour of patient arrival – […]

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Medical Malpractice Bulletin – July/August, 2011

August 20, 2011

Perspective: Emergency Department discharge instructions: “Sign right here and your good to go.” ———- By Charles A. Pilcher MD FACEP So you’re not having a heart attack like your wife thought. That’s the good news. But what **is** wrong, what **did** cause that pain, and what should you do from here on out? That’s the […]

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Medical Malpractice Bulletin – June, 2011

June 16, 2011

You receive this newsletter because I have had prior contact with you or a member of your firm on a matter of personal injury or medical malpractice. If you wish to subscribe to or be removed from the mailing list, please call 206-915-8593 or email me. I consult with both plaintiff and defense attorneys in […]

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Medical Malpractice Bulletin – May, 2011

June 16, 2011

Perspective: Black, white or gray: Post-hoc knowledge alters opinions of care quality By Charles A. Pilcher MD FACEP Medical malpractice is a field where opinion matters. That’s why attorneys hire experts. But how valid are those opinions? On what are they based? Does one’s opinion of the quality of care change when one knows the […]

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Are you getting “value” from your experts?

June 16, 2011

June, 2011 By Charles A. Pilcher MD FACEP What is value? Based on the repeat business I get from numerous defense and plaintiff attorneys, I must be providing you with value. “Value” is defined as quality divided by cost. When I read depositions, it’s apparent that attorneys are not always getting uniform value from their […]

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Perspective: Black, white or gray: Does post-hoc knowledge alter opinion of care quality?

May 30, 2011

May 30, 2011 By Charles A. Pilcher MD FACEP Medical malpractice is a field where opinion matters. That’s why attorneys hire experts. But how valid are those opinions? On what are they based? Does one’s opinion of the quality of care change when one knows the outcome of the case? This is the question asked […]

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Perspective: Door-to-needle times for tPA in stroke hard to meet

May 5, 2011

By Charles A. Pilcher MD FACEP September/October, 2011 Under current guidelines from the American Stroke Association, tissue plasminogen activator (tPA, commonly known as a “clot buster” drug) should be administered within 3-4.5 hours of “last seen normal” – and 1 hour of patient arrival – to potentially ameliorate a new onset stroke.  (“Last seen normal” […]

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Perspective: Emergency Department discharge instructions: “Sign right here and your good to go.”

May 5, 2011

By Charles A. Pilcher MD FACEP August, 2011 So you’re not having a heart attack like your wife thought. That’s the good news. But what is wrong, what did cause that pain, and what should you do from here on out? That’s the purpose of discharge instructions, and it’s not enough for the ED staff […]

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Medical Malpractice Bulletin – April, 2011

April 26, 2011

Proximate cause: No harm, no foul? By Charles A. Pilcher MD FACEP In the course of nearly 3 decades of reviewing medical records for both plaintiff and defense attorneys, I find the most challenging of the 4 elements necessary for a successful malpractice lawsuit to be “proximate cause” or “causation.” This is often the Achilles […]

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Proximate cause: No harm, no foul?

April 26, 2011

By Charles A. Pilcher MD FACEP In the course of nearly 3 decades of reviewing medical records for both plaintiff and defense attorneys, I find the most challenging of the 4 elements necessary for a successful malpractice lawsuit to be “proximate cause” or “causation.” This is often the Achilles heel of malpractice for the plaintiff […]

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Medical Malpractice Bulletin – February/March, 2011

February 27, 2011

Perspective: Practice guidelines always help your case – maybe not By Charles A. Pilcher MD FACEP David O’Dell MD JD has written a nice summary of the topic of guidelines and their value in medical malpractice cases in the January 10 edition of Medical Economics. This newsletter  discussed the value of “Guidelines” in an earlier […]

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Perspective: Practice guidelines, Part II – Who do “guidelines” actually guide?

February 27, 2011

By Charles A. Pilcher MD FACEP Related to this newsletter’s earlier “Perspectives” essay on the value of “Guidelines,” David O’Dell MD JD writes his own nice summary of the topic in Medical Economics, January 10 edition. He discusses the relationship between malpractice claims and “guidelines.” Dr. O’Dell agrees that most guidelines carry little weight in […]

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Medical Malpractice Bulletin – January, 2011

January 3, 2011

In this issue: Expert medical review services – 2011 rate increase Perspective: OOPS! Why do doctors make diagnostic errors? Surgical errors still occurring “far too often” despite protocols Washington state hospitals post surgical infection rates Patients trust a CT scan 4 times more than they trust the doctor “Handoffs:” Reducing the error of a high-risk […]

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Perspective: OOPS! Why do doctors make diagnostic errors?

January 3, 2011

By Charles A. Pilcher MD FACEP American Medical News published an informative essay by Kevin B. O’Reilly on December 13, 2010, about errors in diagnosis and why doctors make them. According to Gordon Schiff, MD, associate director of the Center for Patient Safety Research and Practice at Brigham and Women’s Hospital, “The problem of diagnostic […]

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Medical Malpractice Bulletin – November, 2010

November 14, 2010

In this issue: Perspective: Health reform & why we vote the way we do, by Leo Greenawalt, CEO, Washington State Hospital Association OK to delay surgery for appendicitis Dangerous jawbone condition rare side effect of Fosamax Death rate from strokes in US hospitals falls 26%… REALLY??? ABCD3-I Score May Improve Risk Stratification After Transient Ischemic […]

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Perspective – US Health Care: Quality? Availability? Price? [PICK 1]

November 13, 2010

Charles A. Pilcher MD FACEP, Editor Editor’s Note: This month’s guest“Perspective” comes from Leo Greenawalt, CEO of the Washington State Hospital Association, and appeared in a WSHA newsletter November 10. It is republished with his permission. For further reading, I recommend “The Healing of America” by TR Reid. The first two chapters claim that the […]

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Medical Malpractice Bulletin – October, 2010

October 13, 2010

Perspective: Medical Malpractice and Healthcare Reform By Charles A. Pilcher MD FACEP Over the past year I have been involved in many discussions with doctors, healthcare executives, elected officials, plaintiff and defense attorneys and others about healthcare reform. At a recent Swedish Hospital 100th Birthday Symposium on “Innovation in the Age of Reform,” an array […]

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Perspective: Medical Malpractice and Healthcare Reform

October 13, 2010

By Charles A. Pilcher MD FACEP Over the past year I have been involved in many discussions with doctors, healthcare executives, elected officials, plaintiff and defense attorneys and others about healthcare reform. Bottom line: There is no consensus what the future holds. There is no question that reform is necessary to avoid absolutely bankrupting the […]

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Medical Malpractice Bulletin – September, 2010

September 14, 2010

In this issue: Perspective: Should consent to life-saving procedures have a “sunset clause?” Neutral radiologists fail to detect x-ray abnormalities found by “experts” What specialty is a doctor practicing? Michigan Court of Appeals sides with plaintiff, says Urgent Care doctor was practicing Emergency Medicine Two rulings from New Jersey support arbitration agreements Disclosing errors reduces […]

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Perspective: Should consent to life-saving procedures have a “sunset clause?”

September 14, 2010

By Charles A. Pilcher MD FACEP Your 88 year old mother has just been admitted to the ER with a severe stroke. The doctor comes out of the resuscitation room, explains the gravity of the situation, and says that because of brain swelling, an endotracheal tube and artificial ventilation is needed. He asks for your […]

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Medical Malpractice Bulletin, July/August, 2010

July 27, 2010

In this issue: Perspective: Avandia – What’s the risk? Washington dumps notice for malpractice lawsuits Conflict of interest: Can a defense attorney’s former client testify as a plaintiff expert in a later case he is defending? Prostate cancer and PSA: If and when to test The “how” matters when gauging risk after suicide attempt Calling […]

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Perspective: Avandia – What's the risk?

July 27, 2010

Rosiglitazone (Avandia – GSK), an oral hypoglycemic agent (OHA) used in treating diabetes, has been in the news recently because of concern that it is associated with an excessive number of adverse events in users of the drug. After a week of media hype with headlines such as “Avandia users experience 30% more heart attacks,” […]

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Medical Malpractice Bulletin June, 2010

June 15, 2010

In this issue: Perspective: Is a ruptured appendix evidence of malpractice? Do you have issues? Suggest a topic for “Perspectives” Florida ruling jeopardizes EMS services nationwide Diagnostic or screening mammogram? Whose call is it? Is a plaintiff expert necessary? Kentucky Supreme Courts says “Yes” — but barely. X-Rays of hip and pelvis miss 1/3 of […]

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Is a ruptured appendix evidence of malpractice?

June 15, 2010

Charles A. Pilcher MD FACEP Appendicitis is the most common acute abdominal surgical condition in medicine, yet there is probably not a single physician in practice today who hasn’t missed the diagnosis at least once. Often that results in “simple” appendicitis becoming a “ruptured” or “perforated” appendix. I have reviewed several such cases which have […]

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Medical Malpractice Bulletin May, 2010

May 19, 2010

Perspective: Tell your expert the whole story Medical staff is not a separate entity from the hospital Can associate of plaintiff’s new physician testify for the defense? Court says “no.” Does improving patient safety reduce malpractice claims? Rand Corporation study says “yes.” Database on stroke treatments incomplete due to non-published trials tPA for stroke: Give […]

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Perspective: Tell your expert the whole story

May 18, 2010

Charles A. Pilcher MD FACEP A few years ago I was asked to review a case involving a death that occurred less than 24 hours after hospital discharge. In a phone call with the attorney, the case seemed to have merit. I agreed to take a look at the records and was sent a brief […]

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Medical Malpractice Bulletin April, 2010

April 9, 2010

Perspective: Strolling blissfully down the garden path… “What is an emergency physician’s duty?” Medical Economics: Plaintiff Attorney gives advice Autism lends itself to questionable medical practices VBAC (Vaginal Birth After Caesarean Section) is safe State Supreme Court Rules on Corporate Practice of Medicine Case Nurses cleared in whistleblowing case in TX Georgia Supreme Court: One […]

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Perspective: Strolling blissfully down the garden path…

April 9, 2010

“Always trust your first impression.” We’ve all heard it time and time again, but is it really true? Especially in medicine, should it ever be true? In my review of malpractice cases over the years, one of the most common errors seen is “falling in love with one’s first impression.” It’s called “anchoring,” and can […]

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Medical Malpractice Bulletin, February, 2010

February 22, 2010

In this issue: Perspective: The IME: Does time heal all wounds? FDA issues warning on long-acting asthma meds Texas nurse cleared of charges after reporting physician for unsafe practices. “Medical Mafia” case in Las Vegas coming to a close What are the chances? Explaining risk to patients Good Samaritan defense depends on the circumstances Emotional […]

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The IME: Does time heal all wounds?

February 22, 2010

By Charles A. Pilcher MD FACEP Wham!!! Jim’s head snapped back as the Hummer hit the back of his Subaru Forester, totaling the Forester but leaving little more than scratches on the Hummer’s sturdy bumper. Jim had no idea how fast the Hummer was traveling. All he knew was that he had just stopped quickly […]

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Medical Malpractice Bulletin – January, 2010

January 15, 2010

Perspective: Would “no fault” be a better way? By Charles A. Pilcher MD FACEP Last month I reported on the defense verdict in the case of a Bellingham woman left with brain damage as a result of a surgical complication. The case bothers me. The patient’s injuries were major and her family devastated. Future expenses […]

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Perspective: Would “No Fault” be a better way?

January 15, 2010

By Charles A. Pilcher MD FACEP January, 2010 Last month I reported on the defense verdict in the case of a Bellingham woman left with brain damage as a result of a surgical complication. The case bothers me, and for the past few weeks I’ve been asking myself “Isn’t there a better way?” Medicine is […]

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Medical Malpractice Bulletin for Nov/Dec, 2009

December 16, 2009

In this issue: Perspective: I got elected. Now what? Woman with DNR order given 20 mg IV morphine, dies. Family wins $3 million. Defense verdict in Bellingham brain injury trial Feedback to hospitals on performance fails to improve quality of cardiac care Plaintiff attorney may advertise for patients similar to his client. Georgia high court […]

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Perspective: I got elected. Now what?

December 16, 2009

It’s been a real honor working with the readers of this newsletter during the past few years. I look forward to continuing our relationship and wish all of you a happy and prosperous new year. As I mentioned in the last issue, I believe in community service. In June area leaders approached me to challenge […]

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Medical Malpractice Bulletin for October, 2009

October 26, 2009

In this issue: Perspective: Certificate of merit overturned. Now what? Health insurer can’t recover medical costs paid if settlement is only for pain and suffering. Law firm can’t read their own retainer agreement, sues own client – unsuccessfully. Do as I do, not as I say: Defense expert’s personal practice supports plaintiff’s claim Social Media: […]

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Perspective: Certificate of merit requirement overturned

October 26, 2009

By Charles A. Pilcher MD FACEP As most Malpractice Bulletin readers have undoubtedly heard by now, the requirement that a plaintiff must have a “certificate of merit” to file a malpractice lawsuit was overturned by the Washington State Supreme Court on September 17, 2009. The requirement was ruled to unfairly discriminate against a specific class […]

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Medical Malpractice Bulletin for August/September, 2009

September 13, 2009

Perspective: Service Service. My parents exemplified it and passed the value down to me. Since my first job delivering newspapers in Federal Way for the Seattle Times, I have enjoyed serving others. On rainy days it was important to me that the papers I delivered did not get wet. “Any job worth doing is a […]

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Perspective: Service

September 13, 2009

Service. My parents exemplified it and passed the value down to me. Since my first job delivering newspapers in Federal Way for the Seattle Times, I have enjoyed serving others. On rainy days it was important to me that the papers I delivered did not get wet. “Any job worth doing is a job worth […]

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Medical Malpractice Bulletin for July, 2009

June 18, 2009

Perspective: What did Obama tell the AMA about malpractice reform? On Monday, June 15, President Obama spoke to physicians assembled in Chicago for the annual AMA convention. His subject: health care reform. I listened to most of the speech on the radio and have read the reviews. What I heard and what I read seem […]

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Perspective: What did Obama tell the AMA about malpractice reform?

June 18, 2009

On Monday, June 15, President Obama spoke to physicians assembled in Chicago for the annual AMA convention. His subject: health care reform. I listened to most of the speech on the radio and have read the reviews. What I heard and what I read seem divergent. What I heard was a detailed, well-presented, thoughtful speech […]

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Medical Malpractice Bulletin for May, 2009

May 25, 2009

Perspective: “Guidelines” are of little value The Institute of Medicine has been an advocate for clinical guidelines for many years. Although the true value of guidelines has never been established, both clinicians and medical malpractice attorneys often want to ascribe greater credibility to them than they deserve. The issue was raised again in the past […]

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Perspective: "Guidelines" are of little value

May 24, 2009

The Institute of Medicine has been an advocate for clinical guidelines for many years. Although the value of guidelines has never really been established, both clinicians and medical malpractice attorneys often want to ascribe greater credibility to them than they deserve. The issue was raised again in the past few months and I review it […]

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Medical Malpractice Bulletin for April, 2009

April 18, 2009

Contents: Perspective: Good case/bad case Darvon and Darvocet: How much truth in the allegations? Still innocent till proven guilty: Ohio doctor cleared of criminal conduct for alleged over-prescribing of pain meds Woman loses arms and legs. Was there malpractice? AZ legislator reintroduces malpractice bill Waste is destroying the American health care system; reform needed U.S. […]

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Perspective: Good case/bad case

April 18, 2009

Whenever there is an initial allegation of malpractice, the goal of each party is different, but an honest opinion of the merits of a case is important to both. Plaintiff attorneys want to know if their client has a case. Defense attorneys want to know if their client is at risk. This requires an appraisal […]

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Medical Malpractice Bulletin for March, 2009

March 26, 2009

CONTENTS: Perspective: Money doesn’t buy health Wyeth v. Levine: FDA approval does not protect against lawsuits. Arizona Supreme Court allows legislature to define an “expert witness” “This is no more an expert report than my son’s tricycle is a Harley” Questions to ask. Questions you might be asked. Depends on which side you’re on. More […]

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Perspective: Money doesn't buy health

March 26, 2009

A recent report indicates that the cost-benefit of healthcare in the US falls behind our leading economic competitors. The Business Roundtable concludes that “America’s healthcare system has become a liability in a global economy.” Spending on healthcare per person is about 2 ½ times more than any other advanced country such as Canada, Japan, Germany, […]

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Medical Malpractice Bulletin for February, 2009

February 22, 2009

CONTENTS: Perspective: Stroke, Part III:  What is the standard of care? Radiologist can’t give films to defense expert without authorization. Another instance of “How to win a malpractice case even if you lose.” Gynecologist sued. Non-gynecologist expert’s testimony challenged. CMS “Never Events” Why can non-compliant patients still sue their practitioner? Enough fishy stuff here to […]

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Perspective: Strokes, Part III: What is the standard of care?

February 22, 2009

Despite two previous Perspective pieces on the topic of stroke last year [“Is thrombolytic therapy for stroke the standard of care?” and “Stroke/TIA evaluation and treatment both a medical and legal quagmire“], both patients and attorneys continue to have questions about treatment standards for this often devastating condition.  In an effort to make this as […]

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Medical Malpractice Bulletin for January, 2009

January 21, 2009

CONTENTS: Perspective: Futility Medicare wants its money back Must doctors also be prophets? Georgia Supreme Court to rule More on judgment and hindsight Flaps – check. Brakes – check. Airspeed – check. Can surgeons learn something from pilots? Unlike in church, confession doesn’t necessarily lead to absolution in the world of medicine. “Informal” consults can […]

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