Articles Posted in Doctor-Patient Relationship

aspirinDoctors subject older patients to risky, costly, invasive, and painful tests and treatments, perhaps with good intention but also because they fail to see that the seniors in their care are individuals with specific situations with real needs that must be considered.

If  physicians too readily accept conventional wisdom in their field, for example, they may push patients 65 and older to take low-aspirin, with the popular but mistaken belief that this practice will help prevent heart attacks, strokes, and dementia. This doesn’t work, and, it increases the risk in seniors of “significant bleeding in the digestive tract, brain or other sites that required transfusions or admission to the hospital,” the New York Times reported.

The newspaper cited a trio of studies, published in the New England Journal of Medicine and based on “more than 19,000 people, including whites 70 and older, and blacks and Hispanics 65 and older. They took low-dose aspirin — 100 milligrams — or a placebo every day for a median of 4.7 years.”

docshistoric-300x234Doctors put their patients at grave risk by failing to stay current with professional best practices, eliminating outdated and ineffective therapies and approaches and instead learning and adapting better ways of care, notably treatments to help deal with the opioid crisis.

Vulnerable children can pay an unacceptable price, for example, for pediatricians’ unwillingness to “unlearn” what they were taught decades earlier in medical school, reported Aaron Carrol, a professor of pediatrics at Indiana University School of Medicine, a health researcher, and a contributor to the New York Times’ evidence-based column “The Upshot.” As he wrote:

In May, a systematic review in JAMA Pediatrics looked at the medical literature related to overuse in pediatric care published in 2016. The articles were ranked by the quality of methods; the magnitude of potential harm to patients from overuse; and the potential number of children that might be harmed. In 2016 alone, studies were published that showed that we still recommend that children consume commercial rehydration drinks (like Pedialyte), which cost more, when their drink of choice would do. We give antidepressants to children too often. We induce deliveries too early, instead of waiting for labor to kick in naturally, which is associated with developmental issues in children born that way. We get X-rays of ankles looking for injuries we almost never find. And although there’s almost no evidence that hydrolyzed formulas do anything to prevent allergic or autoimmune disease, they’re still recommended in many guidelines.

theater-228x300What’s an internist to do when an 81-year-old patient, already in failing health with advanced emphysema, seeks a second opinion because he’s been told his prostate specific antigen (PSA) levels are unacceptably high? This senior also has been advised to schedule a prostate biopsy urgently to determine if he has cancer. Can this discussion with both a scared patient — and his bright, concerned personal doctor — be any tougher?

For Andrew Lazris, who is also a geriatric specialist practicing in Maryland, this was a hard, complicated case because it involved his dying dad.

It also exemplified for him the work that he has undertaken with Eric Rifkin, an environmental scientist and adjunct researcher at Johns Hopkins University, in ensuring that patients retain their fundamental and critical right to have a say in their care. And, in doing so, they have developed what they argue is a clear, comprehensible way to help patients grasp and deal with the inevitable uncertainties, risks, and complexities of the array of medical treatments they can get overwhelmed with by doctors, hospitals, Big Pharma, medical device makers, and others in health care.

krumholzIn many parts of the developing world, families play a big part in patients’ hospital care. They not only sit for long hours with loved ones, supporting and encouraging their recovery. They also may help with direct services, bathing and cleaning patients, tending to their beds and quarters, and even assisting with their medications and treatments.

Such attentiveness from loved ones— once common in this country, too —  may be deemed by many now as quaint and unnecessary, what with the rise of big, shiny, expensive American hospitals.

But think again: As Paula Span reported in her New York Times column on “The New Old Age,” care-giving institutions across the country have become such stressful, disruptive places that seniors, especially, not only heal poorly in them but also may be launched into a downward cycle of repeat admissions.

buckeyes-300x295Soon, many young people  will be back to school and signing up for  sports teams. Many will have to undergo physical exams before they can play.  And it’s a tragic reality that grown-ups may need to think a lot how to protect young people from sexual predators who also are doctors.

That’s because Ohio State University, sadly, has joined the University of Southern California, Michigan State-USA Gymnastics, and Penn State University in the notoriety of dealing with a sexual abuse scandal involving adults and students. In the case of the Buckeyes, it’s Big Ten male wrestlers.

OSU said it had hired an outside law firm to investigate the allegations against Richard Strauss, who had blue-chip credentials and served as the team doctor to university wrestlers roughly from 1979 to 1997. The doctor killed himself in 2005. Lawyers interviewed more than 200 one-time OSU students, with 100 of them accusing Strauss of sexual misconduct, “including former athletes from 14 different sports teams.”

mentalnyt-300x142Although Americans keep making progress toward ending the stigma associated with mental disorders, including trying to put public funding for the diseases’ treatment on a more even footing, patients with serious mental illness suffer unfairly and harshly still due to their conditions.

Dhruv Khullar, a doctor at NewYork-Presbyterian Hospital and a researcher at the Weill Cornell Department of Healthcare Policy and Research, has written a painful piece for the “Upshot,” an evidence-based column for the New York Times. His article, “The Largest Health Disparity We Don’t Talk About,” reports that:

Americans with depression, bipolar disorder or other serious mental illnesses die 15 to 30 years younger than those without mental illness — a disparity larger than for race, ethnicity, geography or socioeconomic status. It’s a gap, unlike many others, that has been growing, but it receives considerably less academic study or public attention. The extraordinary life expectancy gains of the past half-century [for most in this country] have left these patients behind, with the result that Americans with serious mental illness live shorter lives than those in many of the world’s poorest countries.

medicare-300x109Callous institutional inertia can allow dangerous doctors to keep harming patients. But media digging deserves credit for raising needed alarms when professional caregivers and others fail to step up to protect individuals as disparate as taxpayers, seniors, coeds, and heart transplant recipients.

The Milwaukee Journal-Sentinel and MedPage Today performed a public service, reporting that they found more than 200 doctors nationwide who surrendered a license, had one revoked, or were excluded from state-paid health care rolls in the previous five years  but somehow remained on the federal Medicare rolls in 2015.

This meant the problem doctors could keep bad practices afloat, in part because Uncle Sam ─ that’s taxpayers like you and me ─ paid these hundreds of MDs $25.8 million to care for seniors, among the nation’s most vulnerable patients.

roulette-300x188Although Americans may love to wager on ponies, lotteries, and even church bingo games, they’re getting restive and confused about playing the odds with their health — and doctors need to step up their game a lot to help patients better cope with medical uncertainties.

Dhruv Khullar, a physician at NewYork-Presbyterian Hospital and a researcher at the Weill Cornell Department of Healthcare Policy and Research, has written an excellent piece for the New York Times’ evidence-driven “Upshot” column, detailing a modern, thorny part of doctor-patient relationships:

Medicine’s decades-long march toward patient autonomy means patients are often now asked to make the hard decisions — to weigh trade-offs, to grapple with how their values suggest one path over another. This is particularly true when medical science doesn’t offer a clear answer: Doctors encourage patients to decide where evidence is weak, while making strong recommendations when evidence is robust. But should we be doing the opposite? Research suggests that physicians’ recommendations powerfully influence how patients weigh their choices, and that while almost all patients want to know their options, most want their doctor to make the final decision. The greater the uncertainty, the more support they want — but the less likely they are to receive it.

walmartclinic-300x209Americans are showing with their feet and their money how they feel about doctors’ offices and  shiny hospitals, places they’re shunning more and more. They’re racing to neighborhood clinics and urgent care centers that seem to be popping up on every suburban street corner and shopping mall.

Before these facilities transform U.S. health care, would it be worth asking what this trend might mean, not just for profit-seeking retailers, drug store chains, and, yes, also hospitals and doctors who are shifting into new lines of business?

The New York Times found that:

FAST-infographic-2016-300x169It’s no April Fool joke: Emergency doctors across the country, according to the New York Times, have been defying widely accepted standards of care and withholding a drug that rigorous clinical trials and medical specialists long have recommended for stroke victims.

Administration of the drug, tPA or tissue plasminogen activator, helps to prevent brain injury after a stroke by dissolving the blood clot and opening up the blocked vessel. Neurologists and neurosurgeons as well as cardiologists, have campaigned for its aggressive use within hours after the onset of symptoms.  Indeed, hospitals nationwide have adopted speedy stroke care, including with tPA, under slogans like “Time is Brain.”

The drug’s fast use has become so accepted, the capacity to administer it is a keystone for hospitals to receive a much-sought designation as specialized stroke treatment centers. And though it has long been thought that tPA needed to be given within three or four hours from the start of stroke symptoms, new research funded by the National Institute of Neurological Disorders and Stroke has opened the strong possibility that many more patients could benefit from tPA and neurosurgery within 16 or even 24 hours after suffering a stroke.

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