Doctor-Patient Relationship

June 3, 2019

As doctors warned UNC about heart surgery program, kids kept dying

Although big hospitals may love to pat themselves on the back and boost their profits and professional standings by claiming to offer “comprehensive” services, children may suffer and die due to the reality versus the hubris of institutions’ excessive initiatives with specialized care.

Officials at the University of North Carolina blew past anguished warnings from their own pediatric cardiology staff of significant problems in the pediatric heart surgery program at the medical center’s children’s hospital, the New York Times reported. Brushing aside their concerns about a lack of resources within and to support the program, UNC declined to make public, as most similar specialty efforts do, key performance measures. They would show that the UNC pediatric heart surgery program had a higher death rate than “nearly all 82 institutions that do publicly report” this and other measures of patient care.

The newspaper, in a rare move, has internal tape recordings of doctors disputing among themselves whether dwindling resources, staff departures, and other problems meant that UNC should do what many of the specialists demanded — take a long hard look at what was going wrong, and, in the meantime, refer sick kids to other institutions to safeguard their care.

March 31, 2019

5 strikes and you’re not out? Only when you’re sued for bad medical care.

by Patrick A. Malone

Doctors, hospitals, and their malpractice insurers like to demonize lawsuits brought by injured patients, but these legal actions provide a powerful way to identify problem practitioners, and the medical profession should see this truth and use it to better police its own ranks.

That’s one of the recommendations from medical-legal researchers at Stanford University, who examined more than a decade of 60,000 payments for malpractice claims against more than 50,000 doctors. They found a tiny slice of doctors rack up a disproportionate share of repeated malpractice claims. They describe these MDs as “frequent flyers,” a term familiar to the medical community because it often is applied to indigent and homeless patients who rack up big bills for repeated emergency room visits.

Profs. David Studdert and Michelle Melloound found that 2% of physicians accounted for 40% of the paid malpractice claims over a 13-year period. Further, in the report of their study in the New England Journal of Medicine, they offered details on doctors who lose, and keep losing, malpractice cases due to problem care:

March 25, 2019

Electronic records mess threatens patient safety, investigation finds

by Patrick A. Malone

Tempting though it may be to dismiss doctors’ howls about electronic health records—maybe they’re Luddites or they’re just another group of high-paid workers beefing about their job tools—the persistent and significant nightmare of the complicated computer systems has been this: Do they harm patient care?

The answer now may be: Yes, billions of taxpayer and private dollars spent on EHRs may be reducing patient safety.

That’s the finding of the independent, nonpartisan Kaiser Health News Service, based on its extensive investigation in partnership with Fortune Magazine. The two media operations reported that:

January 24, 2019

Savvy Rx from a resident: Docs, know why and what you’re ordering, please

by Patrick A. Malone

Well, just because.

That isn’t a great answer for cranky toddlers with too many questions. It’s also an unacceptable but real reason why too many hospitalized patients get woken up in the middle of the night and subjected 24/7 to expensive, invasive, and often unnecessary tests and procedures.

Abraar Karan (right), an internal medicine resident at the Brigham and Women’s Hospital/ Harvard Medical School, has blogged with welcome candor about doctors’ casual acceptance of medical routines that not only discomfit but also can harm patients. As he wrote online for BMJ (aka the British Medical Journal): “The reality of medicine is that there are many things we as doctors do for absolutely no reason. That is to say, there is no evidence (randomized controlled trial or otherwise) for doing them, other than ‘that’s the way we’ve always done it.’”

January 13, 2019

Cracking down on medical hype could cut $30 billion in wasted costs

by Patrick A. Malone

When reformers look for ways to slash the ever-higher costs of American medical care, one line item should leap from television screens, print pages, and radio broadcasts: How does the nation benefit from medical enterprises spending $30 billion annually in a growing avalanche of marketing and advertising — and why can’t this be stopped or subjected to tougher regulation?

Two physician-scientists at The Center for Medicine in the Media at the Dartmouth Institute for Health Policy and Clinical Practice have published on the JAMA Network their new research, showing that:

[M]edical marketing expanded substantially [between 1997 and 2016], and spending increased from $17.7 to $29.9 billion, with direct-to-consumer advertising for prescription drugs and health services accounting for the most rapid growth, and pharmaceutical marketing to health professionals accounting for most promotional spending.

November 14, 2018

Misdiagnosis: a medical menace to quality and safety of patient care

by Patrick A. Malone

If patients weren’t already unhappy with drive-by medicine, in which clinicians spend on average of 15 minutes with them in an office visit, safety experts warn that too many doctors’ providing of harried care can worsen a medical menace that’s already hard to ignore: misdiagnosis.

Figuring out what ails a patient and taking a correct course of action already is a “complex, collaborative activity that involves clinical reasoning and information gathering,” reports Liz Seegert, a seasoned health journalist and a senior fellow at the Center for Health Policy and Media Engagement at George Washington University.

But, in a briefing posted online for her journalistic colleagues, she goes on to amass some eyebrow-raising information on diagnostic errors, their frequency, harms to patients, and why experts in the field see corrections in this area needed, stat. Among the data points she reports:

November 13, 2018

Harms of medical bunk are real, as $105 million verdict affirms

by Patrick A. Malone

Dr. Otis Brawley, formerly of the American Cancer Society

The rising flood of health care hype, bunk, and conflicts of interst really can harm patients, as has just been emphasized by a $105-million jury verdict, the brave actions of a leading patient advocacy expert, and the commentary of an expert health researcher and New York Times columnist.

In a more perfect world, a patient like Dawn Kali, 45, and a mother of four, wouldn’t give the time of day to the wild claims of Robert Oldham Young. Both live in San Diego, and when she was diagnosed with cancer, she told a court that she found Young persuasive.

October 31, 2018

Why are doctors and hospitals still bungling patients’ records requests?

by Patrick A. Malone

Uncle Sam more than ever wants it to happen, and patient advocates are pushing hard, too. So, why, when technology can make it easier than ever to do so, must patients struggle still to get easy, convenient, low- or no-cost access to invaluable electronic records about their own health care?

Judith Graham, a columnist focusing on aging issues for the Kaiser Health News Service, has written a timely, troubling update on perplexing challenges consumers still confront when trying to secure their electronic health records (EHRs).

She cites a study recently published by Yale researchers who gathered information from 83 leading hospitals that purport to assist their patients with EHR access. The experts swept up policies and forms the institutions said patients would need, then contacted them, telling hospital staffers not that they were academic researchers but that they were checking on behalf of an elderly relative in need of their records and how soon and how difficult and costly might it be to get them? This is an everyday dilemma for consumers, and the institutions should have dealt with these requests with ease and alacrity.

September 27, 2018

A harsh reminder: Medical errors are so common, they savage celebrities, too

by Patrick A. Malone

Celebrities can play an out-sized role in medicine and health care: Just consider the public attention paid to Angela Jolie or Ben Stiller and their discussions about cancer screening and the disease’s risks, or Michael Phelps, Mariah Carey, and Carrie Fisher raising awareness about mental health issues, or, yes, Gwyneth Paltrow promoting a rash of wellness goop.

But even with their wealth, accomplishment, looks, and social standing, public figures also can be savaged just like ordinary folks by medical errors that harm and even kill them and their loved ones, according to the Center for Justice and Democracy.

The group has put out a study with 22 cases, documented by lawsuits and medical board sanctions, to show that, “Celebrity is no safeguard when it comes to medical malpractice,” Emily Gottlieb, the report’s author and the center’s deputy director for law and policy, said in a statement. “As this report illustrates, patients with fame and fortune are just as likely to be horrifically injured or killed by dangerous health providers as the general public.”

September 26, 2018

‘Fat shaming’ plays ugly role in medicine’s failing campaign to treat obesity

by Patrick A. Malone

The medical establishment needs to take a hard, long look at its failing efforts to combat obesity and overweight, conditions that now affect just under 40 percent of American adults (93.3 million people) and 20 percent of youngsters (13.7 million) in the U.S.

That’s because doctors and medical scientists have “ignored mountains of evidence to wage a cruel and futile war on fat people, poisoning public perception and ruining millions of lives,” Michael Hobbes has reported in a long, strong story on the Huffington Post.

Hobbes has marshaled an array of available data to wag an unhappy finger at U.S. society, acting on conventional medical wisdom, for blaming and shaming those who are overweight or obese, contending that they lack self-control, discipline, and the personal fortitude to deal with what he says is clearly an uncontrolled medical and public health menace.