Articles Posted in Medical Error

drkhan-150x150Doctors must step up and better police their own ranks, taking a helpful warning from medical malpractice lawsuits in dealing with problem practitioners or systemic wrongs.

That’s the wise view of Dr. Shah-Naz H. Khan, a neurosurgeon and a clinical assistant Professor of Surgery at Michigan State University (shown, right).

Her trenchant commentary — published on KevinMD, which describes itself asthe web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories” — is salient as medicine confronts a startling number of doctors, who, frankly, have run amok in putting forth health falsehoods in the midst of the deadliest public health emergency in more than a century.

Patients, politicians, and regulators may find it tough to believe, so they need sharp periodic reminders: While there are many terrific, dedicated doctors working today, there also are some truly terrible ones. And dealing with the harms of medical malpractice by the incompetent and abusive can require courage and vigilance.

  • Perhaps a new, streamed Hollywood serial — starring the likes of Alec Baldwin, Christian Slater, AnnaSophia Robb, and Joshua Jackson — can underscore for the public how grisly the results can be until a rare criminal prosecution derails the likes of Christopher Duntsch, a Dallas surgeon so grim he is nicknamed “Dr. Death?”

colorectalcancerhotspotmap-300x230While technological advances may help provide crucial warnings to young men, especially those who are black, about their heightened risk of early-onset colorectal cancer, the rise of other high-tech diagnostic aids may only worsen built-in, harmful racial biases in an array of medical practices.

Researchers at the University of Chicago, to their credit, have sought the assistance of health providers across the country to inventory and assess increasingly common medical software and the algorithms on which they rely to ensure whiz-bang decision-making tools don’t discriminate against patients of color.

The early results are distressing, showing how well-intentioned experts inject prejudices into programs that can lead to racially unfair choices about patient care. Ziad Obermeyer, an emergency medicine physician and co-author of the Chicago research, told Stat, the science and medical news site, this about algorithms used in many diagnostic tools:

surgerylown-300x196When it comes to hospitals performing low-value tests or procedures and putting older patients at increased risk, Dixie may have little to whistle about.

The Lown Institute, a respected and nonpartisan think tank that says it “believes a radically better American health system is possible,” has published a new hospital index that puts dozens of southern institutions in a dubious light.

That’s because institute researchers scrutinized federal Medicare records on more than 1.3 million fee-for-services provided to older patents at more than 3,300 hospitals nationwide. They reported in findings published in an online part of the Journal of the American Medical Association that “hospitals in the South, for-profit hospitals, and nonteaching hospitals were associated with the highest rates of overuse” of health care services.

disabledkidsfla-300x233When doctors, hospitals, and insurers bellyache about malpractice claims with little evidence on their prevalence or outcomes, patients and politicians should push back: And they can cite the nightmares people in grievous circumstance have suffered when their constitutional right to seek justice in civil lawsuits gets stripped away.

The Miami Herald and ProPublica, the Pulitzer Prize-winning investigative website, have conducted a joint, deep dive into Florida’s decades-old legislative experiment, purportedly to assist families struggling with infants’ birth-related and catastrophic disabilities. The state’s neurological injury compensation initiative also was promoted as a way to stem a problem seen mostly in anecdote and not evidence — obstetricians and other specialists supposedly fleeing Florida, reputedly due to spiking malpractice insurance costs.

The media investigators, in a multipart series , have found that eliminating medical malpractice lawsuits for this slice of patients has benefited not the patients but instead, doctors, hospitals, and insurers.

cancerexam-300x225One consequence of the coronavirus pandemic may be showing up in tragic fashion: Cancer specialists say they are treating a wave of advanced cases in which patients might have benefited from earlier care had fear of Covid-19 infection not kept them away from doctors’ offices and hospitals.

The information about the harms of missed appointments, especially for important cancer tests and screenings, is, at present, more anecdotal than quantifiable in hard data, the New York Times reported. But the newspaper quoted doctors across the country reporting this:

“While it is too early to assess the full impact of the delays in screenings, many cancer specialists say they are concerned that patients are coming in with more severe disease. ‘There’s no question in practice that we are seeing patients with more advanced breast cancer and colorectal cancer,’ said Dr. Lucio N. Gordan, the president of the Florida Cancer Specialists & Research Institute, one of the nation’s largest independent oncology groups. He is working on a study to see if, overall, these missed screenings resulted in more patients with later-stage cancers.”

bookingpicretamays-150x150She was a 46-year-old Army veteran hired by the Louis A. Johnson Medical Center in 2015 with no certification or license to care for patients. Reta Mays worked in the middle of the night, tending to elderly, onetime service personnel, sitting bedside and monitoring their vitals, including their blood sugar levels. Mays went room to room, largely unnoticed for three years on Ward 3A.

But as unexplained deaths mounted on the surgical unit between 2017 and 2018, the bespectacled mother of three — who had served in the Army National Guard and had deployed to Iraq and Kuwait — shifted from being a nurse’s aide to becoming a murder suspect.

She now has confirmed in court that she injected multiple doses of insulin in at least seven patients in the rural Veterans Affairs hospital a few hours away from the nation’s capital, causing the frail victims’ blood glucose levels to plunge in fatal fashion.

algorithmwoes2-300x200High-tech wizards may be pushing medicine into a brave new world where important medical decisions rely on supposedly data-driven findings that also may be rooted in an old malignancy: discrimination against black patients.

A new study published in the New England Journal of Medicine warns that race-based tools and formulas, algorithms aimed to assist doctors in speeding up their diagnosis and treatment in such areas as heart disease, cancer, and kidney and maternity care, improperly steer blacks away from therapies commonly given to whites without sound reasons, the New York Times reported:

“The tools are often digital calculators on web sites of medical organizations or — in the case of assessing kidney function — actually built into the tools commercial labs use to calculate normal values of blood tests. They assess risk and potential outcomes based on formulas derived from population studies and modeling that looked for variables associated with different outcomes. ‘These tests are woven into the fabric of medicine,’ said Dr. David Jones, the paper’s senior author, a Harvard historian who also teaches ethics to medical students. ‘Despite mounting evidence that race is not a reliable proxy for genetic difference, the belief that it is has become embedded, sometimes insidiously, within medical practice,’ he wrote.”

coronaflawnursinghome-300x237Hundreds of thousands of institutionalized Americans have been infected with the novel coronavirus. Tens of thousands of them are dead. Yet a lethal bungling persists in the response to Covid-19’s savaging of residents of nursing homes and other long-term care facilities. Why?

Their owners and operators agree with medical scientists that significantly more testing is required, urgently, so the sick can be diagnosed, treated, and isolated.

But insurers and owners are bickering over who should pay for Covid-19 tests, notably for institutions’ staffers — many of whom are themselves getting sick and dying. As the New York Times reported:

asclepliusrodof-70x300As the Covid-19 pandemic has put huge stresses on medical systems around the globe, the strains have taken their toll:  The credibility and authority — of federal agencies like the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Centers for Medicare and Medicaid Services (CMS), and elite professional journals like the Lancet and the New England Journal of Medicine — have taken big hits in recent weeks.

In times of huge uncertainty and high anxiety, the public should be able to turn to these respected pillars of the health care establishment for steady, trustworthy, and independent information and execution of crucial policies that benefit the public.

The agencies are not just a pile of letters. Their work, based in rigorous medical science and the best available evidence, is supposed to reject damaging and dangerous rumor, hunch, myth, mis- and dis-information. They help to set standards for care, especially in crises, and they are charged with safeguarding us from disease, dangerous drugs and vaccines, and in protecting the old, sick, and injured in institutional care.

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