DC Medical Malpractice & Patient Safety Blog

Since the 1970’s, gynecologists would generally advise women who are hysterectomy candidates to also have their ovaries removed, along with the uterus. The idea was to prevent ovarian cancer, which is difficult to detect but often deadly. However, Roni Rabin reports in a New York Times story that a new study finds compelling reasons for women to keep their ovaries.

The study, published in the May issue of the journal Obstetrics & Gynecology, tracked almost 30,000 women over the span of 24 years. It found that women who had their ovaries removed were at a greater risk for heart disease and lung cancer, and were more likely to die of cancer than those who left their ovaries untouched. For women who had their uterus and ovaries removed before they turned 50 and did not take estrogen, these risks were even higher. Scientists believe the continued production of estrogen may be the reason why women who kept their ovaries tended to live longer.

The lead author of the study, Dr. William H. Parker of the John Wayne Cancer Institute in Santa Monica, CA, explained why women should consider keeping their ovaries because although ovarian cancer is difficult to detect and treat, it is much rarer than heart diseases. Every year, heart diseases kill more than 20 times the number of women than ovarian cancer.

Of course, there are women who will benefit from removing their ovaries, especially those who are at high risks of getting ovarian or breast cancer. A patient with strong family history of either cancer should definitely consult with their doctor to decide the best course to take.

Getting a loved one home from the hospital is always a relief for both patient and family, but the weeks immediately after hospital discharge are fraught with peril, as many families don't discover until the patient has to be readmitted for a new problem. This is especially common with Medicare patients: an alarming one in five Medicare patients are back in the hospital within thirty days, and one in three are readmitted within ninety days. Fully half of the non-surgical patients who have to be readmitted in the first month after going home had no followup visit with any doctor during that same month. That means the patients were basically set adrift to fend for themselves. These numbers come from an analysis published in the New England Journal of Medicine, as reported in an editorial in the New York Times.

Leaders in the health care field freely admit that hospital readmissions come about from poor discharge planning and inadequate communication with family members about what they need to do to keep the patient healthy. The president of the American Hospital Association said in a letter to The Times about the editorial: "Most unplanned readmissions can be traced back to our fragmented delivery system, and to the lack of social support programs for many elderly and sick patients."

What is the answer?

Family members who are assigned by hospitals to take care of a loved one at home need to be very clear on what they are supposed to do. Do not let a family member be dumped on your lap without a clear, written list of everything they need, including medications, therapies, and appointments for return visits. Family members need a lifeline they can call on when things don't seem to be going right.

The leaders of our health care system are talking about extending Medicare benefits so that nurse managers can coordinate the transition from hospital to home, or teams of caregivers can conduct house calls on recently discharged patients. These are promising ideas, but what is needed right now is for anyone who has a family member coming home from the hospital to speak up and insist on clear instructions and advice. Being forceful and clear can help the caregivers help you to make sure there is a well thought out plan and that you can realistically carry it out.

Patrick Malone's new book, The Life You Save: Nine Steps to Finding the Best Medical Care -- and Avoiding the Worst, has a chapter on how family members can become effective patient advocates when they have someone in the hospital. The chapter includes a list of key checkoff points that you need to understand when a loved one is discharged to your care. You need to have at a minimum:

* A written set of discharge instructions.

* A specific appointment with the doctor in charge for a followup visit.

* A list of bad things to watch out for, and the contact person to relay this information to.

* Written lists of all medications that need to be taken, when and how; plus all therapies that need to be done with similar detailed instructions.

In a newly released Thomson Reuters survey, one in five respondents say they have delayed medical care, and one in four of those who did listed financial cost as the primary reason, reports Maggie Fox of Reuters. The survey also predicted that in the next three months, one in every five adults in America will have difficulty paying for health insurance or health care.

The data show a significantly higher number of Americans putting off healthcare than in 2006, when the same question was asked in a survey. Leaders of the study associate this increase with growing number of Americans losing employer-sponsored health insurance.

The study leader Gary Pickens predicted that America’s “collective well-being” will be hurt if people continue to delay necessary treatments.

If you find yourself unable to afford healthcare or health insurance, check with your state and local agencies to see if you are eligible for Medicaid or other forms of financial assistance. Pharmaceutical companies often have programs for uninsured patients. Additional resources may be available: Walgreens, for example, recently announced that its Take Care program will offer free routine clinic services for the uninsured and unemployed.

One of the true pioneers of modern medicine is Dr. Thomas Sarzl, who performed the first liver transplant and who developed many of the procedures that have made transplantation a safe lifesaving treatment for thousands of people.

Dr. Sarzl is still active at age 83. He was interviewed recently by another transplant surgeon, Dr. Pauline Chen, for her column in the New York Times.

From his many years of experience, Dr. Starzl gave three nuggets of advice to patients, which I am reprinting because I think he is right on target:

"As for the patients," he told Dr. Chen, "I would give this advice — I followed it myself. That is to get a practitioner of general medicine to take care of you, somebody who is not a narrow specialist. And have that person take care of yourself and the people you care for most, your family. The second is to be constantly learning so you can be informed and have some judgment about advice you are given. And then the third item would be to get a second opinion if some really significant thing happens that requires drastic therapy. Those decisions are so important that I think you should get a second opinion if you come to a point where you need the treatment required for cancer or transplantation or catastrophic indications."

My new book, "The Life You Save: Nine Steps to Finding the Best Medical Care -- and Avoiding the Worst," makes some of these same points. For example, Step Three of my "nine steps" says: "Team up with the best primary care doctor you can find." And Chapter 9 is titled: "The Second Opinion: Always Your First Choice."

Everybody knows that close friendships can be wonderful, and medical researchers are now coming up with tangible evidence that friendship can pay off in longer and healthier lives as well.

"Friendship has a bigger impact on our psychological well-being than family relationships," says sociologist Rebecca Adams of the University of North Carolina, Greensboro. She was quoted in an article by Tara Parker-Pope in the New York Times.

Ms. Parker-Pope's article was inspired by a book, "The Girls from Ames: A Story of Women and a 40-Year Friendship." Author Jeffrey Zaslow documents how eleven childhood friends from Iowa continued to nurture and sustain each other, including two of them who recently learned they had breast cancer.

Researchers have found that friendship has an even greater effect on health than being married or having family members nearby. No one is quite sure what it is about friendship that sustains people, but perhaps what we all take heart from is the idea that "we're all in this together."

Victims of medical malpractice won a big victory in a Maryland court this week when a judge refused to reduce a jury's verdict in a wrongful death case to the artificial "cap" on damages set by the legislature.

The case is Semsker vs. Lockshin, in which Patrick Malone and Associates represents the family of a Montgomery County, Maryland attorney who died at age 47 from a highly curable skin cancer. Treatment of the cancer was delayed for years because of the combined negligence of Mr. Semsker's doctors. Click here for more case details and a link to Mr. Malone's closing argument in the trial, which was held in November 2008.

Four years ago, the Maryland General Assembly passed a statute under pressure from the medical lobby which cut in half the amount of money that a malpractice victim could recover in a wrongful death lawsuit from a doctor or hospital in "non-economic" damages. Those are general damages for the victim's suffering and the family's loss of companionship with their deceased loved one.

Now the judge who presided at the Semsker vs. Lockshin trial has ruled that the "plain meaning" of the statute as worded eliminated the cap from all cases except those in which the parties had arbitrated the case before suit was filed. Read more about the judge's decision in the Maryland Daily Record article.

This case is very significant for Maryland victims of medical malpractice, who are freed by this ruling from the onerous and unfair damage “cap” that acts as a regressive tax on the most injured patients.

Patrick Malone commented: “On the same day as the judge’s ruling, a report was released that shows Maryland ranks 45th among the 50 states in its rate of disciplining doctors who harm patients. Rather than trying to win special protection from the legislature to shield doctors and hospitals from accountability for the injuries they cause, the medical leaders of Maryland should clean up the disciplinary process so that the truly dangerous doctors are weeded out.”

The report Malone referred to was the annual ranking published by Public Citizen of physician license disciplinary boards. It can be accessed here.

If you are pregnant and experiencing fatigue, dry skin, sleep loss, or weight loss, it may be worthwhile to find out whether you are a candidate for a thyroid test – these symptoms, while common in pregnant women, may be caused by underactivity (hypothyroidism) or overactivity (hyperthyroidism) of the thyroid gland.

If untreated during pregnancy, both conditions have been shown to result in higher risks for miscarriage, premature birth, preeclampsia, and even impaired intelligence in the child (in the case of hypothyroidism). But does such risk necessarily warrant a universal recommendation for thyroid tests in pregnant women? Ingfei Chen explores an ongoing debate on this issue in a New York Times article.

The thyroid gland produces hormones that regulate many important aspects of our bodies, including metabolism, body weight and heart rate. When there is too much of this thyroid-stimulating hormone (TSH), the pregnant woman suffers from hyperthyroidism and experience poor sleep, weight loss, and nervousness after giving birth. On the other hand, when the thyroid gland is underactive, the resulting hypothyroidism causes fatigue, weight gain and dry skin. Both conditions are manifested in very subtle symptoms but are risk factors for dangerous pregnancy complications.

While both an overactive and an underactive thyroid spell trouble for pregnant women, hypothyroidism is the more common and worrisome condition. Hypothyroidism, affecting 10 to 20% of women of childbearing age, is often undiagnosed but hampers fetal brain development. A study done 10 years ago reports that 19% of children born to women with untreated hypothyroidism had an IQ of 85 or lower, whereas the same measure was only 5% for those born to mothers with a healthy thyroid.

Although risks of an imbalanced level of TSH are known, the medical field is currently split on whether there is sufficient existing evidence for the benefits of treating the condition, and subsequently, of recommending universal screening. Studies are underway to track pregnant women with healthy and underactive thyroids, and their children will be tested for IQ. Until scientists arrive at conclusive results, the general clinical policy is to recommend a thyroid test to high-risk women (for example, a woman with family history of thyroid problems). However, more doctors have begun recommending the test to normal-risk expecting mothers, and many think that evidence for universal screening will soon be available, according to Dr. Stagnaro-Green, an endocrinologist at Touro University College of Medicine in New Jersey.

Many people nowadays have never seen a bed bug, a blood-sucking insect assumed to exist only in underdeveloped countries and impoverished neighborhoods. However, more and more Americans are now finding themselves aghast with the sight of real bed bugs infesting their homes. An article published in the Journal of American Medical Association in April discusses the consequences of bed bug bites, and ways to prevent them, Jane Brody writes in the New York Times.

Authors of the newly published article attribute the resurgence of bed bugs in developed countries to “international travel, immigration, changes in pest control practices, and insecticide resistance.” The critters hitchhike with travelers from continent to continent, resulting in significantly higher numbers of infestations in the United States, Canada, and Australia in recent years.

While most victims of bed bugs do not react, about 30 percent of those bitten will have “small, pink, itchy bumps” that resemble mosquito bites. These bumps can be treated with oral or topical anti-itch product, such as antihistamine or calamine lotion. More sensitive people may develop intense itching and infections. Other more extreme reactions include asthma, generalized hives and a life-threatening allergy that should be treated immediately.

So how should we prevent these bugs from entering our homes? Authors of the article suggest careful inspection before buying second-handed mattresses, sofas, cushioned chairs and similar furnishings. They also advise against picking up discarded furnitures. And if you must take the clothes left out by your neighbors, you should wash them immediately in hot water or have them dry cleaned. Travelers should also be vigilant when packing and unpacking, searching for bugs that may have climbed into their luggages.

Lastly, if your home has already been infested by bed bugs, it’s recommended that you hire a professional exterminator, which costs more than home remedies but is much more effective in warding off the pests.

As if there is not already a multitude of problems awaiting those who lead an inactive lifestyle, researchers recently found yet another inactivity-related condition that threatens human health, a condition called non-alcoholic fatty liver disease (NAFLD), according to Medical News Today.

In an article published in The Journal of Physiology, Dr. John Thyfault of the University of Missouri reports his research group’s findings that established a link between low aerobic fitness level and fatty liver disease. His group carefully bred two groups of rats of different levels of intrinsic aerobic capacity, so that after 17 generations the rats in the “fit” group can run 1500 meters, whereas the “unfit” rats can undertake only 200 meters.

Rats in the “fit” group normally live healthy lives, even though they are not more active than those in the unfit group. However, those in the “unfit” group often display clear symptoms of NAFLD, including fibrosis, which is a form of liver damage seen in alcohol abuse patients.

Fatty liver disease causes fat deposit in patients’ livers and elevated levels of fat in their blood. The “unfit” rats in Thyfault’s study also were found to have poor fat processing power. These effects together result in high fat retention in patients, making them prone to obesity and its related risks of heart disease, strokes and diabetes.

Widely hailed for saving lives through early detection of breast cancer, mammography may in fact “do more harm than good,” writes Roni Rabin of the New York Times. Rabin reports that British health care advocates and experts complained in a letter to The Times of London that candidates for mammography receive informational fliers that exaggerate the exam’s benefits and neglect to advise patients of potential harms.

Mammography detects cancers indiscriminatingly, picking up aggressive tumors as well as those so slow-growing that they present no health risks for women who have them. As a result, for every woman saved from deadly breast cancer by routine mammography, at least one other woman would have her life unnecessarily disrupted by overtreatment of a slow-growing cancer that’s not life-threatening.

Mammograms also often result in "false positive" reports which scare women who think the test has shown they have a deadly cancer when further testing shows they have no disease. This is particularly a problem when mammograms are used in low-risk groups like women under age 50.

Further, early detection of the deadly form of breast cancer may not necessarily be life-saving, says Dr. Ned Calonge, chairman of the United States Preventive Services Task Force, which writes consensus reports on all sorts of screening tests, because the cancers are too aggressive to treat even when found early.

In addition to unnecessary emotional distress and extraneous treatment and related costs, other potential harms of mammography include exposure to radiation during the exam.

On the other hand, many doctors, including the director of cancer screening for the American Cancer Society, still believe mammography should be recommended to women of normal risks for breast cancer (e.g. over 50 years of age, family history of the cancer), preferring overdiagnosis to delayed diagnosis.

Before a more definite conclusion is reached within the scientific community, patients should educate themselves about the benefits and harms of mammography, because the ultimate decision of whether to be screened is in their own hands.

Salmonella, which causes serious gastrointestinal illnesses that can be life-threatening, was found in pistachios last week, according to the Los Angeles Times. The FDA has issued warnings for consumers to stop eating all foods containing pistachios, while investigations are underway.

Although salmonella contamination in pistachios is yet to be confirmed, Setton Pistachio of Terra Bella Inc., the nation’s second-largest pistachio processor, has voluntarily recalled more than 2 million pounds of nuts that it shipped out last fall. Kraft Foods Inc. and Kroger have also recalled some of their pistachio products.

Consumers are advised to stop eating pistachio products and monitor the investigations as more reports become available.