January, 2015 – Medical Malpractice Bulletin

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 of others. That frustrates me, and I plan to do what I can to change that. So beginning this month, I am publishing a new newsletter, Medical Malpractice Insights – Learning from Lawsuits. This electronic bi-weekly publication for physicians will provide short case summaries and “Takeaway Points” from lawsuits to improve patient safety, educate physicians, reduce the cost and stress of litigation and honor those patients who expected that their lawsuit would “keep this from happening to someone else.” If only they knew! To read more about this project and see an early draft of the publication, continue here->

Aortic dissection survival improved, still kills 25-37% of victims
Aortic dissection remains a common theme in medical malpractice. Early diagnosis and treatment is critical, as death rates are high. An October report by Mody et al. from Yale indicates that survival has improved over a 10 year period. The 30 day mortality improved from 32% to 25% and 1 year mortality from 43% to 37%, still a very high rate. The authors attribute the decline to improvements in surgical technique, but one has to wonder if earlier inclusion of dissection in the differential diagnosis of chest pain could be playing a role. MedPage Today covered the story in lay language. The original study was reported in Circulation: Cardiovascular Quality and Outcomes, November, 2014.

50% of patients prescribed narcotics for 30 days still using them 3 years later.
The headline says it all. Express Scripts published a report entitled A Nation in Pain. They found that nearly half of the patients who were prescribed an opioid medication (Vicodin/hydrocodone, Percocet/oxycodone, et al.) for 30 days were still taking the drug 3 years later. This occurs most often in post-surgical (often orthopedics) patients and those with back pain. These drugs are intended for short term use only, yet too many physicians prescribe boatloads of such drugs for patients who have no idea of their addictive potential – so they continue to take them when an OTC medicines or lifestyle modifications would be equally effective. While the USA has only 5% of the world’s population, we consume 75% of all opioid medications, i.e., we want “pills for our ills.” With 46 people a day dying of overdoses of prescription opioids. (usually combined with anti-anxiety medications or sleeping pills), it’s time to reflect. This was well-reported by Time magazine.

Intra-arterial mechanical intervention a stroke “breakthrough”? Maybe. Maybe not.
The “MR CLEAN” trial published in NEJM in December, 2014, found a benefit in treating stroke patients with intra-arterial alteplase with or without mechanical intervention. Lauded as a “breakthrough” by some, close analysis by others suggests the results may not be what they seem. In particular, the study patients in the non-intervention arm had worse outcomes than in other stroke studies, making the intervention arm look much better. The reason for that is unclear, but suggests that the jury continues to be taking an exceptionally long look at all interventions for stroke. Three skeptics weigh in on the issue:

Dr. Spiegel concludes nicely with these words: “It would be frustratingly tragic to once again be forced to practice with continual doubt because we halted all further investigations out of the fear of discovering that reality is not as promising as the false-truth gained from interpreting only the data that pleases us.”

Booze makes men smile
Now that the holidays are over, guess what: Alcohol makes men smile, according to an article in Clinical Psychological Science. Oddly, it does not seem to have the same effect on women. An easy to read summary can be found here. Draw your own conclusions.

Happy New Year 2015!

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