DC Medical Malpractice & Patient Safety Blog

The U.S. government is launching an ad campaign to promote a website where consumers can check to see how good their hospitals are, measured by such things as patient satisfaction and cooperation with recommended care guidelines. The website, called Hospital Compare, can be found here.

But the federal government is not the only such purveyor of such information: Zagat Survey (the same people who publish the restaurant guide) also rates doctors, for example.

These efforts are limited, however, by the lack of common standards. From the article:

While ratings efforts can be useful, they also can be confusing and limited in scope, says Robert Berenson, a senior fellow with the Urban Institute, a Washington, D.C., think tank that studies policy issues.

"If I were a consumer looking at these reports, I would be bewildered by the variations that show up across different rating systems," says Berenson, who says there is not enough information available to shop for health care the way people shop for cars or televisions.

However, some organizations are making efforts to address this problem:

Last month, the Consumer-Purchaser Disclosure Project, a coalition of groups representing consumers, employers and unions, agreed to develop a national set of standards to measure doctor performance.

A recent New York Times article discusses how doctors, patients and lawyers are discovering that apologizing for medical errors often helps both doctor and patient. The patient gets closure and a sense of acknowledgment, and will receive a settlement more quickly. The doctor does not have to suffer the psychological pressure of denying any wrongdoing or cutting off contact with the patient and can avoid a lawsuit.

As the article notes, conventional wisdom has long held that a doctor should say absolutely nothing in the event of a medical error. Disclosure, it was believed, would only make the doctor and the hospital liable. But empirical evidence suggests otherwise:

Despite some projections that disclosure would prompt a flood of lawsuits, hospitals are reporting decreases in their caseloads and savings in legal costs. Malpractice premiums have declined in some instances, though market forces may be partly responsible.

At the University of Michigan Health System, one of the first to experiment with full disclosure, existing claims and lawsuits dropped to 83 in August 2007 from 262 in August 2001, said Richard C. Boothman, the medical center’s chief risk officer.

“Improving patient safety and patient communication is more likely to cure the malpractice crisis than defensiveness and denial,” Mr. Boothman said.

What most patients want in these cases is not the largest settlement possible but some sort of acknowledgment, honesty and respect. And doctors, hospitals and patients all want to settle these matters quickly without long, drawn-out courtroom battles. Full disclosure policies are a promising new way of achieving these goals.

President Jimmy Carter's former chief of staff, Hamilton Jordan, died this week of mesothelioma after 24 years of fighting and surviving cancer four different forms of cancer. His memoirs include a top ten list of recommendations for cancer patients.

The whole list is worth reading, but in principle it could be boiled down to the first item:

No. 1: Be an active partner in the medical decisions that are made about your life. Don’t be passive. Learn about your disease, and participate in the decisions that are made….For example with my lymphoma, if I would have accepted the first treatment offered, I’d be dead today. It was assumed that I only had a mass in my chest. I later learned that the lymphoma was all through my body.

All of the other items on the list elaborate on this one, which is the most basic and the most important.

Tara Parker-Pope discusses a Tower Cancer Research Foundation survey of 500 cancer survivors that showed more than half of them delaying treatment for two months or more after having symptoms. Fifteen percent delayed treatment for one to five years.

Some delayed treatment because of lack of medical insurance, or insufficiency of coverage.

But others had emotional reasons for the delay: a third of them put it down to procrastination, and the most commonly cited reason was that they were hoping the symptoms would just go away. Fear also played a role. Many patients simply did not want to be told the worst. These feelings are obviously natural, but acting on them can prevent the early diagnosis and treatment that saves the lives of so many cancer patients.

Many doctors believe that the recent sharp increase in drug advertising has altered the doctor-patient relationship for the worse.

From the article:

Like many doctors, Ron Ben-Ari thinks ads on TV for prescription drugs frequently go too far in touting a particular pill's benefits without adequately presenting the risks.

But Ben-Ari, who has a practice at USC's Health Sciences Campus in East L.A., accepts that the ads have fundamentally altered the doctor-patient relationship. He's found that it can be fruitless to try to talk a patient out of seeking some name-brand medication, even when a cheaper alternative is available.

"If it's an appropriate medicine for the person, I'd probably prescribe it," said Ben-Ari, who also teaches at County-USC Medical Center. "We're in an era of information. We have to evolve with it."

This highlights the fact that a little information can be a dangerous thing, since a little information is often incomplete information. If patients come into a doctor's office wanting a certain drug because they're aware of cherry-picked facts gleaned from ads designed to put a drug in the best light, and refuse to be talked out of it, then their health will obviously suffer.

It's good for patients to be informed about drugs even before they walk into a doctor's office, but that information needs to come from reliable sources. If a drug looks good to you based on what you see in an advertisement, it's a wise idea to do some independent research and ask your doctor's opinion before becoming set on it.

After his newborn twins were given near-fatal doses of the blood-thinner heparin, actor Dennis Quaid testified in front of Congress defending consumers' rights to file suit against pharmaceutical companies.

From the article:

Beginning with the Bush administration, the Food and Drug Administration has stepped into suits on the side of defendant pharmaceutical companies, arguing that federal regulation of drugs pre-empts state suits.

The article also reminds us that thousands of people die each year from medical errors. Lawsuits like the one Quaid is filing against Baxter Healthcare Inc. (the maker of the heparin) are one way of holding those who make these errors accountable.

Tara Parker-Pope of the NY Times has an article on how more than half of the writers of the DSM-IV--the Diagnostic and Statisical Manual of Mental Disorders--have financial links to the drug industry.

The DSM is the most commonly used handbook of psychiatric disorders. Clearly these financial links suggest a conflict of interest.

From the article:

It’s not the first time the D.S.M. has been linked to the drug industry. Tufts University researchers in 2006 reported that 95 — or 56 percent — of 170 experts who worked on the 1994 edition of the manual had at least one monetary relationship with a drug maker in the years from 1989 to 2004. The percentage was higher — 100 percent in some cases — for experts who worked on sections of the manual devoted to severe mental illnesses, like schizophrenia, the study found.

There is a growing industry of hired patient advocates. Patients are hiring people to defend their interests when they go to the hospital.

The impetus from this comes from the huge number of patients who die because of medical error, and the growing consensus that going into a hospital as a patient alone is one of the most dangerous things you could do.

From the article:

It is a trend emerging here and across the country, though it's not without controversy — and a hefty price tag. But it may be offering a vital, even lifesaving service in a severely overburdened medical system plagued by a shortage of nurses, doctors and hospital beds. Arizona — with the nation's longest ER wait time and an extreme shortage of doctors and nurses — should prove fertile for the fledgling business. "We have seen so many patients — including my own father and mother — nearly die in the hospital because of mistakes or neglect, we realized somebody had to do something," said Alice Milton, a Tucson attorney now working for Patient Care Advocates, a company launched two years ago in Tucson — first to provide home care services, expanding to hospital patient advocacy in recent months. "This idea was born of personal trauma, of seeing firsthand what kind of fight you have to wage to get decent care for someone you love. And of seeing patients who are absolutely terrified to go to the hospital, because they are certain they will die there," Milton said. "The need for this is huge — great enough to actually earn a living doing it."

Of course, savvy family members and other loved ones can also serve as your "advocate," with the added benefit that they will probably do it for free. But the idea is essentially the same: when you go to a hospital, it is comforting and may even be life-saving to have back-up with you.

Lasik is a popular laser surgery done on the eyes to correct vision. However, last week Lasik patients went to Washington D.C. to speak to the Food and Drug Administration on harmful side-effects that they experienced as a result of the surgery, including the following:

(1) Severe eye pain

(2) Dry eye

(3) Blurred vision

The effects of intense chronic pain can have a devastating effect on people's lives. One case was particularly extreme. From the article:

Colin Dorrian was in law school when dry eye made his contact lenses so intolerable that he sought Lasik, even though a doctor noted his pupils were pretty large. Both the dry eye and pupil size should have disqualified Dorrian, but he received Lasik anyway -- and his father described six years of eye pain and fuzzy vision before the suburban Philadelphia man killed himself last year.

"As soon as my eyes went bad, I fell into a deeper depression than I'd ever experienced, and I couldn't get out," Gerard Dorrian read from his son's suicide note.

One quoted patient said he was considered a "success" by doctors despite experiencing terrible after-effects:

Matt Kotsovolos, who worked for the Duke Eye Center when he had a more sophisticated Lasik procedure in 2006, said doctors classify him as a success because he now has 20-20 vision. But he said, "For the last two years I have suffered debilitating and unremitting eye pain."

These patients are demanding clearer standards for who can qualify for Lasik, as well as better information from the FDA on how many patients suffer these various side-effects.