Medical Malpractice Bulletin – June, 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 poorly managed – can result in catastrophe for the patient and physician. To read this month’s “Perspective” on “Handoffs,” click here ->.

In other news:

Lidocaine, amiodarone or neither: Which works best in VF/VT?
The question of which drug, if any, is most helpful in cardiac arrest due to ventricular fibrillation or tachycardia has been an issue in Advanced Life Support for about 2 decades. Some question whether amiodarone or lidocaine even works at all. A new study, considered “the most important drug trial in cardiac arrest ever to be performed,” will answer the question once and for all. The University of Washington, Seattle, is providing primary oversight of the study.

Over-treatment also kills
In med mal cases, we are usually dealing with omissions resulting in mis-diagnosis or failure to treat. But patients can also die from over-diagnosis, over-treatment or provision of unnecessary treatment. An article under “Medical Ethics” in Emergency Physicians Monthly, May, 2013, discusses this in some detail.

Even physicians are mis-diagnosed
“It’s just a sore throat,” doctors told Dr. Itzhak Brook, a pediatric infectious disease specialist at Georgetown University School of Medicine. Now, following a laryngectomy for cancer, Dr. Brook knows that even physicians can be victim of misdiagnosis. More ->. Check out previous “Perspectives” on misdiagnosis here and here.

Debate rages on regarding endovascular treatment for stroke
An article referenced last month indicated endovascular interventions after tPA for stroke added nothing to the outcome. Now, another article suggests that primary endovascular intervention may be better than tPA. In the latest study, published in JAMA Neurology, investigators found that, “among 203 patients with intracranial large-vessel occlusions (ILVOs), those with NIH Stroke Scale (NIHSS) scores of 14 or higher at presentation and occlusions located in the more proximal segment of the middle cerebral artery had significantly better outcomes… when treated with endovascular therapy, also known as intra-artery therapy.” [Editor’s Note: When so many differing opinions are available, one must wonder “Does anything really make a difference?”]

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