Perspective: Acute MI: “Yes” or “No” – Still more art than science
By Charles A. Pilcher MD FACEP
August, 2015
Body et al. published a study in BMJ’s “Emergency Medicine Journal in which they asked: “Can emergency physicians ‘rule in’ and ‘rule out’ acute myocardial infarction with clinical judgement?” The fascinating aspect of the study was the coverage the article got touting the value of a new “highly-sensitive troponin t test” that would give a doctor 100% certainty in ruling out a myocardial infarction. A closer look at the data suggests that we must all remain skeptical when we see the words “certainty,” “breakthrough,” “game changer,” or “foolproof” when applied to medicine. Though based on science, medicine still has a major component of “art.” And doctors should never forget: There’s more to a chest pain evaluation than simply ruling in or ruling out an MI. To read how physicians might use – or misuse – the new troponin test, continue reading here ->
Has tort reform made a difference? Apparently not.
The New England Journal published a study last fall to find out if physicians practice differently in states establishing major tort reforms, states where even the definition of “deviation from the ‘standard of care’ has been changed.” The answer is “No.” Doctors still order as many tests, still admit as many patients, and still fear getting sued as much as ever. It turns out that “tort reform” is likely to be less of an issue than the internal culture of medical training, one of “never miss ” and “professional embarrassment,” a culture that almost forces over-utilization. MedPage Today summarizes the study nicely. Tort reform, at least in Texas, Georgia and South Carolina, has had little impact.
Apologize for mistakes? The pros and cons for physicians
An article in the June 10 issue of Medical Economics by Debra Beaulieu-Volk addresses the issue of how and when a physician should apologize to a patient and/or family for a medical error. It’s a really worthwhile read and includes a summary of “apology laws” in the various states. Apologizing for an error is a process, not an event. Doug Wojcieszak founder of Sorry Works, says that the first step should be “When something bad happens, you just need to be a grief counselor. You need to sit with them and hold their hand. The next patient can wait.” Full disclosure can occur later as more information is developed. You can find the article on page 52 of Medical Economics. [Editor’s Note: See also “Nice Doctors Don’t Get Sued,” a Perspective essay in the June, 2015, issue of MMB.]