Medical Malpractice Bulletin – November/December, 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 to substantiate the magnitude of the problem with actual numbers. To learn more about the significance of this issue, read this month’s “Perspective.” 

Beneficence versus autonomy: When a physician’s legal duty and ethical duty conflict
Dr. Robert Solomon’s recent column in ACEP News discussed the two principles of beneficence (the duty to help the patient) and autonomy (the patient’s right to make his own decisions about what happens to him). Using as an example a recent New York case in which an intoxicated patient was seriously injured after eloping from the emergency department, he addresses the pivotal issue of “decisional capacity” and illustrates the importance of documenting that when treating a patient whose plan of care is contrary to that of the physician. Dr. Solomon concludes with these words: “While I consider it important to avoid violating the law in my practice of medicine, I consider it even more important to avoid violating principles of biomedical ethics. If I obey the law but violate professional ethics … that will not help me to sleep at night if there is a tragic outcome.” It’s a worthwhile 2-3 minute read. If interested, click here.

 What doctors are reading about “Apology Laws.”
To say “I’m sorry” or not to say “I’m sorry.” That is the question when doctors make a mistake. This recent article in Medical Economics is an example of what doctors are reading about “Apology Laws.” Decide for yourself if physicians who have their “knickers in a twist” over the issue are worried appropriately or not.

“Attorneys Gone Wild:” Postmenopausal women, Lipitor and diabetes
Google “postmenopausal,” “Lipitor,” and “diabetes,” and half the hits on page 1 will be law firms suing Pfizer and other statin manufacturers, claiming Lipitor and other statins cause postmenopausal women to have a “48% increased risk of diabetes.” Actually, the data in the article in Archives of Internal Medicine show that 9.93% of women taking Lipitor develop diabetes, but 6.41% of women not taking Lipitor also develop diabetes. This is a relative difference of 55%, but an absolute difference of only 3.52%. Bottom line: Only 3.5 more women out of 100 will get diabetes if they take a statin. Since lawsuits usually require that an act or agent must be causative on a “more probable than not” basis, how does 3.52% meet the burden of proof? A previous “Perspective” on “absolute” versus “relative” risk can be found here. This is of special interest since statins have now been recommended to be used by nearly everyone with a pulse. Here’s a great cartoon  summarizing that November news.

FDA lifts restrictions on rosiglitazone
More on relative v. absolute risk… From the “I told you so” department, the FDA has removed restrictions on GlaxoSmithKline’s diabetes medication Avandia (rosiglitazone). This Bulletin previously covered the topic of relative versus absolute risk using  Avandia as an example when the restrictions first came out. Allegations were that the drug caused an incremental increase in heart attacks. Now, additional studies confirm that restrictions on the drug were premature.

 

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