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 practice
- On the light side: “Fecal transplantation” and “Exploding flatus”
Please note: Expert medical review services – 2011 rate increase
On January 1, 2011, I raised my rate for expert medical review services for the first time in over 10 years to $xxx.00 per hour to all clients. This fee remains below that charged by most attorneys and other medical experts.
I understand that your client is the one paying for my services, and keep that in mind in giving you an honest and timely opinion. The initial telephone discussion is free. Thereafter, a preliminary assessment of the viability of a case usually takes about 2 hours of chart review, after which further evaluation is at your discretion.
As I described in my first “Perspective” in “Medical Malpractice Bulletin” nearly 3 years ago, I enjoy the work I do for you and trust that you will continue to find value in the information I provide.
Charles A. Pilcher MD FACEP
Perspective: OOPS! Why do doctors make diagnostic errors?
By Charles A. Pilcher MD FACEP
Error occurs. About 5% of autopsies find clinically significant conditions that were missed and could have affected the patient’s survival. And 40% of malpractice suits are for “failure to diagnose.” These aren’t “system errors,” but “thinking errors.” 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. The article focused on “thinking mistakes” and was both refreshingly honest and depressingly true. The biggest problem is getting too focused too soon. Read more ->
Surgical errors still occurring “far too often” despite protocols.
While the above “Perspective” discusses how “thinking errors” lead to diagnostic errors, an article in Archives of Surgery indicates that despite all our efforts we are making little headway with “system errors” either. While standardized protocols are designed to prevent surgical errors, mistakes like wrong-site or wrong-patient operations continue to occur, and may in fact be on the increase. The paper’s lead author, Dr. Philip F. Stahel, called the findings “shocking.” [Editor’s note: Reminds me of the pilot who landed with the wheels up and excused the mistake with the words “But the checklist was complete!”]
Washington state hospitals post surgical infection rates.
The Seattle Times reports that the Washington State Hospital Association is now posting online data on surgical infections for member hospitals, with a goal of “helping consumers find the best place for their surgery and to assist hospitals in improving their safety records.” The website “also lists whether a hospital follows proven infection prevention safeguards like keeping a close watch on antibiotic dosing.” According to Cassie Sauer of WSHA, “Airing these numbers isn’t always comfortable for the hospitals, but they believe such transparency and the ability to compare themselves with others around the state will help them all improve.” The website also includes the rates of ventilator-associated infection and central-line infection, which have been reported since 2007.
Patients trust a CT scan 4 times more than they trust the doctor.
Every physician today feels that patients trust technology more than they trust their doctor. This is by far the #1 reason for the astronomical rise in health care costs. An example appears in a December article in the online version of Annals of Emergency Medicine. The authors report that ED patients with acute abdominal pain are four times more confident that doctors have correctly diagnosed their conditions after a CT imaging study than a diagnosis based on history and physical alone. In a study of 1168 patients, the confidence level of patients rose from 20% to 90% following a CT scan and blood work. Of note is that of 75% of the patients surveyed underestimated the risk of the radiation associated with a CT scan.
“Handoffs:” Reducing the error of a high-risk practice
A “handoff” (the transfer of care from one physician to another) is a high-risk event. Most ED’s in the Pacific Northwest use the “handoff” rarely, meaning that each ED physician admits or discharges all patients he/she started. However, there are always situations where a doctor begins a workup at the end of a shift out of courtesy to the patient and oncoming doc, or in event of life-threatening emergency. When that happens, a transfer of care to a second physician – aka a “sign-out” or “handoff” – occurs. In order to minimize the risk in such situations, a standardized handoff protocol is recommended by the authors of an article in the December issue of Annals of Emergency Medicine.
On the light side…
1) Not quite FOS? Try a “fecal transplantation” When reading abdominal films, physicians (especially radiologists) are fond of using the term “FOS,” a crude acronym for constipation. But being “FOS” may actually be an answer to the problem caused by clostridium difficile, a superbug associated with severe diarrhea following antibiotic use. In a disgustingly ingenious approach to restoring normal gut bacterial populations diminished by the antibiotics, doctors are infusing good bacteria into patients by means of a “stool transplant.” According to one expert, “there’s very good reason to think this fecal transplantation, or bacteriotherapy, might work.” [Editor’s note: Let’s not argue about which among us is a qualified donor.]
2) “Fire in the hole.” Related to the above, you may recall the 2005 malpractice case in which a Boston woman sued her surgeon when her bottom “caught fire” in the OR. She claimed that during her hemorrhoid surgery she passed gas which was then ignited by an electrical spark The defense prevailed. [Editor’s note: Didn’t we see that in college?]
