Perspective: The chart is my witness. Make sure it tells the story.
Guest Authors: Andrew Koslow, MD, JD, and Diana Nordlund, DO
The medical record can become a missed opportunity for communication between providers and a dangerous medico-legal pitfall. Physicians should be certain that it communicates an encounter clearly. EMRs and template charts are particularly prone to poor communication. Physicians should be certain that their chart tells the real story. More ->
Also in this issue:
- A picture’s worth 1000 words. Child’s drawing illustrates demise of doctor-patient relationship
- IST-3: Latest stroke trial results in more spin than a top
- Stroke case? Here’s three articles of interest:
- What causes emergency physician discharge errors?
- Study: Tasers do not cause cardiac dysrhythmia deaths
- Wrongly sued? Physicians have alternatives
- New Hampshire Governor vetoes novel “early offer” program
A picture’s worth 1000 words. Child’s drawing illustrates demise of doctor-patient relationship
The June 20 issue of JAMA has a revealing essay about the damage that the EMR is doing to the doctor-patient relationship. Caring for the computer has preempted caring for the patient. Click here to see how it looks from the perspective of a 7 year old with some crayons and time on her hands.
IST-3: Latest stroke trial results in more spin than a top
Depending on one’s perspective, the recently published Third International Stroke Trial (IST-3) either showed the value of tPA for stroke, even in an extended window of time, or proved once and for all that the science of “clot busting” therapy for stroke is fatally flawed. While tPA is clearly the standard of care within the 3 hour time window from “Last Seen Normal,” the ratio of benefit to harm is among the lowest of any available medical treatment. Judicious use is mandatory. Emergency Physicians Monthly and the SmartEM blog both have negative reviews. On the other hand, a Canadian emergency physician suggests the trial was carried out so poorly that the results are meaningless. Even the American Stroke Association spun this positively, yet even the average reader should be able to see that this article is clearly no “breakthrough.”
[On another stroke related note, the New England Journal recently published a trial comparing tenecteplase versus alteplase in acute ischemic stroke. The study found that very carefully selected patients actually do benefit from thrombolysis, with TNK much better (72% no disability versus 40% no disability at 90 days)].
Stroke? Here’s three more articles of interest:
- Neurologists more comfortable with using tPA for stroke.
- Advanced imaging (beyond simple CT) for stroke remains blurry
- ABCD2 scores for TIA fail to predict likelihood of stroke
What causes emergency physician discharge errors?
A study in Annals of Emergency Medicine found the following were the most common causes of emergency physicians discharge errors:
- improper triage
- wrong diagnosis
- poor communication
- location in the ED of the patient assessment, and
- ED crowding
Study: Tasers do not cause cardiac dysrhythmia deaths
A survey of 1201 incidents in which law enforcement used conducted electrical weapons (CEW), commonly known as Tasers, found no deaths that could be linked to cardiac dysrhythmias as a result of the electrical pulse delivered by these devices. The survey results were published in the June 2012 issue of the Journal of Emergency Medicine.
Wrongly sued? Physicians have alternatives
Medical Economics recently published an article discussing alternatives for physicians who feel they have been wrongly sued for malpractice. Countersuits are expensive and generally non-productive. A report to the state bar association may help. While the article mentions such things as “dishonest lawyering” and “bogus” expert witness testimony, those appear to be relatively rare in Washington State.
New Hampshire Governor vetoes novel “early offer” program
New Hampshire Governor John Lynch vetoed SB 406 which provided for the nation’s first “early offer” program as an alternative to a malpractice lawsuit. The Democratic governor, married to a physician, points out several problems with the proposal, which this editor agrees was well-intentioned but poorly crafted. His veto statement seems fair and reasonable. (In a separate matter, the confidentiality of findings of New Hampshire’s “Screening Panels” is also being evaluated by the NH courts.)