DC Medical Malpractice & Patient Safety Blog

Two new books take up patient safety and quality of care issues from opposite perspectives, one a physician's, the other a patient's, and both have compelling lessons.

Lisa Sanders, MD is the New York Times Magazine "Diagnosis" columnist. Her book, "Every Patient Tells a Story -- Medical Mysteries and the Art of Diagnosis," starts with puzzles of sick patients and unknown diagnoses. We all love a good mystery, but this book is much more than a compelling mystery yarn. Through deftly told true stories, Lisa Sanders shows how correct medical diagnosis requires a combination of skills and right attitudes. As the book's title implies, careful listening to the patient comes first. A good physical exam is critical, and the worrisome part of the book is how this old-fashioned art is increasingly neglected in medical schools. Luck has a role too -- or maybe it's humility -- as the author gives several cases where happenstance seems to have helped find the correct diagnosis from a medical bystander, but that requires the ability to admit you don't have all the answers and to reach out for help. But perhaps most important: the empathy to persist toward the answer and the quiet time to contemplate the entire patient. This book will help young physicians do better and will help patients find the right doctors who will care about them.

Sorrel King is a Baltimore mother who lost her infant daughter in a medical catastrophe at Johns Hopkins Hospital. Her new book is "Josie's Story: A Mother's Inspiring Crusade to Make Medical Care Safe." Sorrel King has already saved many lives with her tireless work to urge hospitals to listen carefully to what parents say about their sick children. It takes a special person to turn tragedy into something positive. I featured Sorrel and several other brave survivors of medical errors in my book: The Life You Save: Nine Steps to Finding the Best Medical Care -- and Avoiding the Worst. It's wonderful to see her now tell the full story of her daughter Josie and her inspiring crusade. I hope everyone can read this book and absorb its lessons.

A few brave medical journal editors are cracking down on the common practice of drug companies ghost-writing articles for authors who are willing to lend their names to drug industry propaganda. But at other journals, editors seem to have a "don't ask, don't tell" policy. For patients, it is vital that the truth come out.

The problem with ghost-written medical articles is that they purport to be something that -- once the disclosure of who wrote them is made -- they clearly are not: independent, objective evaluations of which medications work best for a particular disease. Instead, the ghosted articles turn out to be elaborate infomercials, disguised by the author's prestigious name and studded with multiple footnotes and the other signs of scholarly elbow grease. Yet because they are published under false pretenses, these articles can be very effective at selling their sponsors' products.

What first broke open this scandal was lawsuits against Wyeth for breast cancer and other injuries caused by its hormone drugs Prempro and Premarin. Attorneys for the patients found multiple examples in the manufacturer's records of prominent medical researchers putting their names on articles written by someone hired by the drug company.

Some of the medical school professors who were caught tried to brazen their way out of it by saying that of course, they wouldn't put their name on something they didn't agree with, and they just happened to agree with every single word that was written for them. For example:

Dr. Gloria Bachmann of the Robert Wood Johnson School of Medicine said in a published report: “This is my work, this is what I believe, this is reflective of my view.”

With shameless attitudes like that rife in the medical academic world, it's important for the editors who control what goes into the journals to step up and enforce some accountability. The first steps down that road have been cautious at best. As the New York Times reported:

Dr. Cynthia E. Dunbar, the editor in chief of Blood, said that, in the future, the journal would consider a ban of several years for authors caught lying about ghostwriting, in addition to retracting their ghosted articles.

But, said Dr. Dunbar, who is a hematologist at the National Institutes of Health in Bethesda, “I hope we don’t have to do that.”

The Times reported on another journal that took a stand:

In an editorial last week calling for a zero tolerance policy, the editors of the medical journal PLoS Medicine, from the Public Library of Science, called for journals to identify and retract ghostwritten articles and banish their authors.

“Any papers where this breach is substantiated should be immediately retracted,” the editors wrote. “Authors found to have not declared such interest should be banned from any subsequent publication in the journal and their misconduct reported to their institutions.”

Click here to read the full editorial.

Other journal editors told the Times that because they banned ghostwriting, they didn't really have to have a specific policy enforcing the ban. Huh???

For an amusingly arch, tell-it-like-it-is take about medical ghostwriting from someone outside the medical industry, I recommend English professor Margaret Soltan's blog, University Diaries.

The ghostwriting scandal, and the cautious, tepid response from many in the medical journal world, are the latest proof of why I advocate that patients be skeptical about prescription drugs, especially those with expensive marketing campaigns behind them. Read more in Chapter 7 of my book, "The Life You Save: Nine Steps to Finding the Best Medical Care -- and Avoiding the Worst." The chapter is titled: "Drugs: A Dose of Reality About the Prescription Drug Industry and How You Can Safely Use Medicines."

Every hospital patient needs someone with them at all times to help prevent medical errors and keep them safe. That's a mantra I have advocated for years, and another example of why it's good advice comes with a riveting story in the Washington Post by health writer Sandra Boodman.

Ms. Boodman's article tells how a Washington area woman's advocacy in the emergency room and hospital helped lead to a correct diagnosis of baffling symptoms, and likely saved her sick daughter from harm. The article interviews Patricia Dawn about her 4-year-old daughter Brooke's illness, that was eventually discovered to be Kawasaki disease, an unusual heart condition.

Brooke got the right treatment in time, but only because of her mother's persistence. Mrs. Dawn refused the recommendation of the emergency room doctors to take her daughter home at 2 a.m. when she wasn't feeling any better but they had run out of things to do. At her insistence, her daughter was hospitalized, and an infectious disease specialist eventually figured out that the red lips, red eyes, fever longer than five days, and swollen lymph node in the neck all were signs of Kawasaki, which affects about 2,000 American children a year.

It was also at the family's suggestion that the infectious disease doctor was brought in who made the correct diagnosis.

The story underlines the importance of having a good advocate present at all times with a patient in the hospital. Even a lay advocate can see when symptoms aren't improving and can insist on action.

I discuss this subject in depth in Chapter 12 of my book, "The Life You Save: Nine Steps to Finding the Best Medical Care -- and Avoiding the Worst."

A lawsuit by the state of South Carolina has turned up evidence that one sales representative for Eli Lilly bet golf scores with a doctor client -- and the payoff was the doctor's agreement to write more prescriptions for the drug Zyprexa.

According to an article by Bloomberg News, notes from this and other sales reps showed attempts to get the doctors to prescribe Zyprexa for "off-label" uses -- those for which the manufacturer had not shown evidence to the FDA that the drug was safe and effective.

The state is trying to get a court to force Eli Lilly to refund excessive spending in the state Medicaid program on Zyprexa prescriptions. Lilly has settled one state lawsuit from Alaska and also agreed to a U.S. Justice Department settlement that involved thirty other states.

The inducements to doctors to prescribe the powerful antipsychotic drug included deep-sea fishing trips and speaker fees for those doctors who would address meetings of their colleagues, according to the suit.

This is yet another example of why I urge patients to be skeptical about drugs and to try to find a primary care doctor who doesn't take freebies from drug manufacturers. Even the most innocuous of handouts from drug companies can influence how a doctor writes prescriptions. Read more about this in my book, "The Life You Save: Nine Steps to Finding the Best Medical Care -- and Avoiding the Worst."

Pennsylvania continues to lead the nation in showing how public health authorities can cast a little disinfecting sunshine onto the patient safety practices of hospitals.

In its latest report, the Pennsylvania Patient Safety Authority says that in 2008, a total of 194 surgery patients were sewed up with a foreign object still inside them. They have a term for it: RFO, for Retained Foreign Object.

To avoid leaving behind a sponge, needle or other instrument, the nurses and doctors involved in any surgery are supposed to go through a counting ritual. The problem is that the count doesn't always end correctly. In fact, the same Authority reported that last year, there were over 2,000 instances of incorrect counts, which doesn't always mean an object has actually been left behind.

One technique to follow up when there has been a discrepancy in the count is to do an x-ray of the affected area. That should show up any hidden objects.

The RFO problem is expensive for patients and hospitals. According to the Consumer Union Safe Patient Project, the average cost of a hospital stay for the corrective surgery and other problems that come from a retained object is $62,631.