Medical Malpractice Bulletin – February, 2016

February, 2016

In this issue:

Perspective: Posterior circulation stroke – why is this diagnosis missed?
By Charles A. Pilcher MD FACEP
February, 2016

In the November, 2015, issue of Medical Malpractice Bulletin, the “Perspective” covered the issue of missed aortic dissections. This month I cover missed posterior circulation strokes. In both cases a narrow focus and “anchoring bias” is the most common cause of diagnostic error. Confidently ruling out an MI (serious) in a chest pain patient while missing the aortic dissection (equally serious) is just as dangerous as confidently ruling in labyrinthitis or benign positional vertigo (not serious) while missing the posterior circulation stroke (serious). In both cases a broad differential diagnosis and critical thinking is necessary to avoid error. Continue reading ->

UPDATE: Spinal epidural abscess
Since last month’s “Perspective” on the epidemic of missed spinal epidural abscesses, I have learned of 2 more cases, bringing the total to 10 in the past 4 1/2 years, with 8 of those here in the State of Washington. I also received the following feedback from attorney readers (edited for brevity):

  • Regarding confidential settlements the only “cure” for that disease is legislation that forbids it. Doctors always want it and even though plaintiffs’ attorneys hate it, the client’s wishes always prevail.
  • We have often negotiated “confidential” agreements that allow us to share the **facts** of the case and even the amount paid – but not the identity of the health care provider. That helps a bit in getting out the facts.
  • Keep it up Dr. Pilcher. You’re on the side of right, justice, and better medicine.
  • Fantastic write up! Unbelievable this is so prevalent, and you nailed it. If any of your readers need help with such cases, have them call me. As you know “I have the book.”
    And my own thought: How would the 8 Washington State patients feel if each was invited to meet – in their wheelchairs – with the other seven?

Diverticulitis: Another surgical disease goes medical
Diverticulitis has been a surgical disease for decades, one of the bread-and-butter procedures done by general surgeons. But according to new guidelines published by the American Gastroenterological Association, selected patients with acute diverticulitis often do not need surgery. Of course, the devil is in the details, just as it was when appendicitis was found to be amenable to medical rather than surgical treatment as earlier discussed here.

  • There is a nice video analysis of this situation by Dr. David A. Johnson here.
  • An abstract of the new “Guidelines on the management of acute diverticulitis” can be found here.
  • An abstract of the technical review on the management of acute diverticulitis can be found here.

Why radiologists get sued
Medscape’s excellent Malpractice Report 2015: Why Radiologists Get Sued by Carol Peckham, January 22, 2016, contains 29 fascinating slides and is a quick read. Slides include such items as:

  • How do radiologist feel about plaintiff lawyers?
  • When I hear that a lawsuit involved real errors, I think…

US health system: Great care if you can get it
Every year the Commonwealth Fund publishes a report comparing the health systems of developed countries around the world in terms of quality and cost. And every year, while the players may shuffle places a bit, the US – contrary to prevailing wisdom – ranks low in quality (particularly for chronic conditions, obesity and infant mortality) and high in cost (about 50% higher). The basic problem is access to preventive care. While the US has great care and great outcomes when people are severely ill, we have too little access to care that would keep our citizens from needing the expensive services of so many specialists, To paraphrase Ella Fitzgerald “Nice care if you can get it, and you can get it if you try.” But it’s too often too little care early and too much care late. The report is heavy on graphics and a quick read.

About this publication:
This post is an archive of a newsletter sent to attorneys with whom I have had prior contact on a matter of personal injury or medical malpractice. I consult with both plaintiff and defense attorneys in the fields of emergency medicine, urgent care, personal injury, and hospital practice. If you would like to subscribe to Medical Malpractice Bulletin, or if I can assist you in any way, please contact me. For additional information and to view more archives of this Bulletin, please visit
Charles A. Pilcher MD FACEP

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