Perspective: Practice guidelines always help your case – maybe not
By Charles A. Pilcher MD FACEP
David O’Dell MD JD has written a nice summary of the topic of guidelines and their value in medical malpractice cases in the January 10 edition of Medical Economics. This newsletter discussed the value of “Guidelines” in an earlier “Perspective. Key takeaway: Use guidelines cautiously, whether pressing or defending an allegation of medical malpractice. Read MORE ->
But… they’re ba-a-a-a-a-c-k – New clinical guidelines on tonsillectomies in children published.
Just because they aren’t always reliable doesn’t mean guidelines aren’t still being published almost weekly. For the latest more stringent guidelines on tonsillectomies, click here.
Studies question whether tPA benefits mild stroke patients.
Patients with minor or rapidly improving stroke symptoms have historically been excluded from treatment with tPA because evidence from the original NINDS trial suggested the risks were greater than the benefits. Now that assumption is being questioned. An article by Jeffrey in Medscape February 24 highlights the findings of a study presented at the AHA/ASA International Stroke conference. [Editor’s Note: I have 2 questions related to this: 1) Little is said about the NNH (number needed to harm) and 2) The authors quote a potential “savings” of $200 million and reduction in disability in 3700 patients as if treated patients would never again become sick or die.]
Antibiotic administration followed by immediate surgery may be best treatment for ruptured appendix.
In recommending early surgery for a ruptured appendix, the author of this study in the Archives of Surgery compares “early” (<24 hours) surgery with delayed surgery (6+ weeks) plus antibiotics. The key point in this article is “24 hours.” The other point is that there are many pediatric surgeons who still believe antibiotics and delayed appendectomy are the best approach in kids. The reader is referred to this publication’s previous “Perspective” essay asking if a ruptured appendix is evidence of malpractice. The average delay in return to normal activities with the delayed-surgery approach was 5.6 days.
TASERS: Asymptomatic individuals require no medical check after use of conductive energy weapons
Tasers and other conductive energy weapons (CEWs) are used daily by law enforcement, and patients are often brought to an emergency department (ED) for medical clearance. This review indicates that no studies need be done on otherwise asymptomatic patients. MORE->
Do “unnecessary” c-sections reduce malpractice suits? Check out the “Unnecesarean”
A very well-written blogger posts regularly on the “Unnecesarean.” A recent post entitled “Myths of malpractice in American obstetrics” claims that the threat of a malpractice suit has caused the spike in C-sections. While the C-section rate has climbed to over 30%, the rate of OB related malpractice lawsuits has remained stable. The blog includes exceptionally high quality comments, among them one that astutely observes that the increase in C-sections has had the desired effect: a stabilization in the apparent incidence of both birth injury and malpractice suits. In a similar vein, Ob/Gyn Dr. Amy Tuteur blogs as “skepticalob” about other birth related issues. In a spinoff essay, Dr. Tuteur addresses society’s quest for zero risk the role of the patient in promoting defensive medicine. Dr. Tuteur also weighs in on “cameras in the delivery room” [above] in a NY Times article.
Scalpel….ZZZZ…Scissors….ZZZZZ….Hemostat….ZZZZ…: Surgeons shouldn’t operate after a night of call
In an article in NEJM, physicians themselves support barring a surgeon from performing elective surgery if he/she were on call the night before. “Absent such policies, sleep deprived doctors should at a minimum tell their patients about their sleep status prior to performing any elective surgery, and offer those patients the opportunity to postpone the procedure or select a different surgeon,” suggest the 3 physicians.