Perspective: “Guidelines” are of little value
The Institute of Medicine has been an advocate for clinical guidelines for many years. Although the true value of guidelines has never been established, both clinicians and medical malpractice attorneys often want to ascribe greater credibility to them than they deserve. The issue was raised again in the past few months and I review it briefly here. The authors conclude that, because of the disarray found in guidelines, many clinicians (appropriately) do not use them.
Nor, in this editor’s opinion, should malpractice attorneys (either plaintiff or defense) hang their hats on them.
We aren’t getting what we’re paying for at high-priced hospitals
According to an article in Health Affairs, researchers have found that high-priced hospitals may fare worse on standard quality measures. “Variations [in care] occur not only from region to region, but also from hospital to hospital in cities around the country.” Investigators “looked at how much hospitals billed Medicare for caring for chronically ill patients during the last two years of life,” and “compared how much the hospitals charged with how well they fared on some of the…quality measures described on the federal Hospital Compare website.” The result: “Hospitals that charge more fare worse on standard quality measures.”
“Loss of chance” doctrine in Massachusetts
In a May 8 article in Medical Economics, S. Allan Adelman, JD, analyzes the impact of a recent ruling in Massachusetts that modifies the “loss of chance” doctrine there. In the case of Matsuyama v. Birnbaum, Massachusetts has now joined 20 other states in applying what is called the “loss of chance” doctrine, which provides that even if a patient had less than a 50-50 chance of a full recovery at the time of a physician’s negligent act, it is a compensible injury if that negligence deprived the patient of any chance of recovery.
New TIA Guidelines
For those following developments in evaluation, treatment and outcome of TIA and stroke , a recent article in Stroke summarizes current thinking on this issue. Key point: An ABCD2 score of 3 or greater seems to be the cutoff that predicts stroke following TIA. Three previous posts on this have been published in Medical Malpractice Bulletin and can be found under “Perspectives” on the left of the page.
Neurologists, National Quality Forum at odds over 45 minute CT scan rule in stroke
The Wall Street Journal (4/21, Burton) reports that neurologists disagree with the recent decision of the National Quality Forum NOT to mandate that a CT scan be done within 45 minutes of arrival in suspected stroke patients. A CT scan is the key test to determine if a patient is a candidate for “clot buster” therapy. The Forum felt that vague wording created more questions than answers. Many hospitals are ill equipped for compliance with such a mandate, citing cost of 24/7 availability as one obstacle. Stroke neurologists say the rejection “threatens to compromise stroke care nationwide,” and the Forum says it is “willing to reconsider the stroke-treatment guideline.”
More on templates and EMRs
I am still advocating a “go slow” approach on the Electronic Medical/Health Record (EMR or EHR). Those of you with clients using a charting system based on mouse-clicks probably understand what I am talking about. These create a huge opportunity for error and contain no “color” or “flavor” of a doctor-patient interaction, and often little of the thought process of the physician. Note that an EMR is still better than illegible or insufficient handwriting, but not as good as a combination of hand-written notes and a complete dictated/transcribed record. More on this is available in an interesting blog post here.
Suing chiropractors for malpractice
LawyersAndSettlements.com (March 25, Craig) has a report on DC attorney Michael Abelson’s experience in dealing with cases involving chiropractic malpractice. Bottom line: Manipulation has a sketchy, if any, scientific basis and is fraught with danger such as stroke, especially when the neck is manipulated.