Medical Malpractice Bulletin – March, 2016

Perspective: I removed the spleen! What do you mean it was a kidney?!
More transparency needed in medicine

By Charles A. Pilcher MD FACEP
March, 2016

What if we didn’t have the NTSB to investigate plane crashes? The medical profession experiences the equivalent of multiple “plane crashes” every day, but what do we do to prevent recurrences? Why does the airline industry learn from its mistakes but the medical profession does not? Read this example showing why we need more transparency in med mal settlements.

Why hospitalists get sued
The Doctors Company, one of the nations largest malpractice insurers (78,000 insureds), published a study by Ranum et al. examining why hospitalists get sued. The study by Ranum et al. looked at 464 closed claims from 2007-2014 against over 2100 hospitalists insured by the company. Not unexpectedly, 78% of claims were allegations of misdiagnosis, improper treatment or medication error. In addition to the usual metrics, the study includes analysis by experts who discuss how certain aspects of care can lead to patient harm and ways that hospitalists can mitigate risks. Missed spinal epidural abscesses, a frequent subject of concern in Medical Malpractice Bulletin, are specifically singled out for discussion in a summary of the study.

Is it just abdominal pain – or an aortic aneurysm?
The Journal of the American Academy of Physician Assistants published a nice short summary on abdominal aortic aneurysms (AAA) and how not to miss the diagnosis. It is geared to family practitioners but applies to anyone evaluating patients with abdominal pain. The most common condition confused with AAA is renal colic. This is especially true if the patient has a prior history of kidney stones. As is the case so often in medicine, we have the tension between “Occam’s Razor” and “Hickam’s Dictum.” While Occam says that “No problem should be made more complicated than it appears” (i.e., renal colic is presumed), Hickam says that “Patients can have as many problems as they damn well please.” When an AAA suddenly distends or ruptures, the presentation can be very similar to that of a kidney stone. Read the study here ->

EHRs in the ED: Concerns Emerge About Medical Errors

Shefali Luthra wrote a nice summary in Kaiser Health News last month regarding problems with EHR’s, particularly “technology mismatch between “boutique” EHR’s and a hospital’s mainframe or legacy EHR system. While EHR’s have made many aspects of care better, e.g., physician handwriting and medical record access, other issues have increased mis-communication regarding orders, medications, patient history or even patient identification. Pointing and clicking is easy, sometimes too easy, and is leading to new types of mistakes. See the full article in KHN here. [Editor’s Note: This Bulletin has published “Perspectives” on this issue before. Click here for one of them.]

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