CONTENTS:
- Perspective: Stroke, Part 2: Stroke/TIA evaluation and treatment both a medical and legal quagmire
- PSA test is not the standard of care. Discussing it with patients is.
- Does a patient near death as the result of suicide qualify as “terminally ill?”
- Medical bloggers lack quality control
- Seattle/King County still the worst place to try to die
Perspective: Stroke, Part 2: Stroke/TIA evaluation and treatment both a medical and legal quagmire
Stroke evaluation, diagnosis and treatment was briefly addressed in last issue’s “Perspective” titled “Is thrombolytic therapy for stroke the standard of care?” Recent articles highlight the need for more information for attorneys on this subject.
PSA test is not the standard of care. Discussing it with patients is.
A urologist was successfully sued for delayed diagnosis of prostate cancer, not for failing to order a PSA test, the value of which is controversial, but for failing to discuss the option of the test with his patient.
Does a patient near death as the result of suicide qualify as “terminally ill?”
That’s the question being asked of a Nevada court in the case of an elderly patient who took an overdose of pills. In Nevada and 20 other states, physicians can make the determination of terminal illness when the patient has voiced a refusal of life-sustaining care. Physicians can risk a claim of battery should they not honor the patient’s request, but can be accused of negligence if they do.
Medical bloggers lack quality control
Blogs are a growing part of the public face of the health professions. They offer physicians and nurses the opportunity to share their narratives. They also risk revealing confidential information or, in their tone or content, risk reflecting poorly on the blog authors and their professions. Over half (56.8%) of blog authors provided sufficient information in text or image to reveal their identities. Of blogs that described interactions with individual patients, 45 (16.6%) included sufficient information for patients to identify their doctors or themselves. An AMA News article on this is available here.
Seattle/King County still the worst place to try to die
Two articles and an editorial in JAMA, September 24, 2008, once again illustrate the success of Seattle/King County’s Medic I program. In this area 16.3% of patients with cardiac arrest survive to discharge. In the case of ventricular fibrillation, the figure is 39.9%. Both are the highest in a study of 10 North American communities, and as much as 4 times better than the lowest performers. Portland and Vancouver, B.C., both fared well also.