Contents:
- Perspective: Good case/bad case
- Darvon and Darvocet: How much truth in the allegations?
- Woman loses arms and legs. Was there malpractice?
- Waste is destroying the American health care system; reform needed
- The problem with EHRs and coding
Perspective: Good case/bad case
Whenever there is an initial allegation of malpractice, the goal of each party is different, but an honest opinion of the merits of a case is important to both. Plaintiff attorneys want to know if their client has a case. Defense attorneys want to know if their client is at risk. This requires an appraisal of the facts of the case and a knowledge of current practice standards.
Both parties need an honest assessment of the situation, both of them to minimize financial risk. The plaintiff attorney wants not to waste time and resources pursuing a case with little or no chance of recovery, i.e., a case that is readily defensible despite what may appear to be errors in care. The defense attorney wants to know up front if the standard of care was violated to the point that the plaintiff is likely to recover damages, and to minimize those damages for his/her client. More ->
Darvon and Darvocet: How much truth in the allegations?
A recent NY Times article cast the drugs Darvon and Darvocet (generic: propoxyphene) in a highly negative light, allegedly based on recent reports by the FDA. However, perusing those reports, one by the manufacturer and one of which has no apparent industry ties, shows the alleged danger of the drugs to me much less clear. On further investigation, it appears that the NYT was reporting less on the results of the FDA investigation and more on the results of a consumer watchdog agency with a somewhat checkerd history and an agenda to pursue. How this all shakes out is yet to be seen. It’s a bit premature, in this physician’s opinion, to be taking sides.
Woman loses arms and legs. Was there malpractice?
Woman with pain from an obstructing kidney stone developed sepsis and presents to the ER. During evaluation, she developed septic shock before a diagnosis can be made. Exploratory surgery was done, and nothing found. Dopamine was used to keep her BP up and heart pumping, but caused loss of limbs.
Here’s a case of severe injury, a young disabled victim who makes a great witness, and reasonable questions regarding care… yet the jury found for the defendant ER team whose diagnosis was made too late. While I don’t generally report on specific cases, this one struck me as unusual.
Waste is destroying the American health care system; reform needed
Philip K. Howard, an attorney and legal reformer, writes in a New York Times op-ed piece April 1, 2009, about the major reforms that he feels are needed to provide Americans with an equitable and affordable health care system. Waste, resulting from both patient demand and fear of lawsuits, is rampant in the current system, according to Mr. Howard. Health courts would bring more equity to the legal process. To read the entirety of his comments, click here.
The problem with EHRs and coding
I have been uniformly unimpressed with the quality of records that I review when that record has been produced electronically or via a “template chart.” These methods of documentation give no sense of a physician’s thought process or consideration of options. They give no “color,” no humanity, to the doctor-patient exchange. They result in huge amounts of data being stored and immense difficulty in “separating the wheat from the chaff.” And they are prone to abuse, because the “copy/paste” option is so tempting and much easier than actually performing a complete new history and exam.
Deborah Grider et al. provice an excellent summary of this problem in Medical Economics, April 3, 2009. They quote an April, 2008, study in NEJM that found that ” Such charts may satisfy the demands of third-party payers, but they are the product of a word processor, not of physicians’ thoughtful review and analysis. Another records expert says that such charts are easily open to criticism by plaintiff attorneys and experts.