Misdiagnosis

May 27, 2019

High court leaves it to Congress to restore service members’ basic rights

The U.S. Supreme Court has left it up to Congress to decide if service members may pursue in the civil justice system claims that they have suffered harms while seeking medical services, a fundamental civil right now denied to military personnel.

Justices Clarence Thomas and Ruth Bader Ginsburg — who rarely agree on much — both wanted but were unsuccessful in getting their high court colleagues to revisit an inequitable, 69-year-old Supreme Court ruling involving the Federal Tort Claims Act. That act governs who can bring a claim for negligence at a military or other government health care facility.

Active duty military personnel cannot bring a medical negligence claim for care at a military facility. This is called the “Feres doctrine,” after the Supreme Court decision, Feres v. United States, 340 U.S. 135 (1950). Under the Feres doctrine, members of the United States armed forces are barred from making a claim against the United States for personal injury or death arising “incident to service.” Military medical treatment received by a service member, while on active duty, has been held by the courts to be “incident to service,” and, thus not actionable, even if that treatment was for a purely elective procedure, and even if the procedure was performed negligently.

May 24, 2019

Walmart sees a bigger picture with costly imaging: frequent misdiagnosis

by Patrick A. Malone

As Walmart tries to work with its 1 million-plus U.S. employees in controlling health care costs, the retailing giant has not only struck a blow for quality medical treatment, it also has raised key questions about a costly and booming specialization in health care: medical imaging.

Walmart decided to shake up this diagnostic field by telling its employees to pay more themselves or to first seek CT scans and MRIs at one of 800 imaging centers that a company-retained health care consulting firm has identified as providing high-quality care. Covera Health, a New York City-based health analytics company, “uses data to help spot facilities likely to provide accurate imaging for a wide variety of conditions, from cancer to torn knee ligaments,” Kaiser Health News Service reported.

KHN reporter Phil Galewitz said Walmart targeted improved imaging based on the giant retailers’ experiences already in funneling workers to select facilities its research has found to offer efficient, high-quality care in specific areas, such as organ transplantation, back and knee surgeries, and heart and cancer treatment.

May 6, 2019

Bill takes aim at injustice for service personnel hurt by military medical care

by Patrick A. Malone

Members of Congress have taken steps aimed at allowing service members to pursue actions in the civil justice system when they suffer harms while seeking medical services, a fundamental civil right now denied to military personnel.

Members of the U.S. House Armed Services Committee heard powerful testimony from a Green Beret, an airman, and a judge advocate general about the need for a bill introduced by Rep. Jackie Speier (D.-Calif.) — a measure that has won bipartisan backing — to correct problems caused by a 69-year-old U.S. Supreme Court ruling in a case involving the Federal Tort Claims Act. That act governs who can bring a claim for negligence at a military or other government health care facility.

Active duty military personnel cannot bring a medical negligence claim for care at a military facility. This is called the “Feres doctrine,” after the U.S. Supreme Court decision, Feres v. United States, 340 U.S. 135 (1950). Under the Feres doctrine, members of the United States armed forces are barred from making a claim against the United States for personal injury or death arising “incident to service.” Military medical treatment received by a service member, while on active duty, has been held by the courts to be “incident to service,” and, thus not actionable, even if that treatment was for a purely elective procedure, and even if the procedure was performed negligently.

January 31, 2019

Doctors ordering wasteful and excessive MRI and CT scans, experts say

by Patrick A. Malone

When patients experience bad headaches, severe chest pain, back or neck aches, or even when kids come in with gut pain that likely is appendicitis, doctors too readily push them into and through what may be hospitals’ over-sized cash-generating machines. It’s past time to end wasteful use of high-powered imaging systems, experts from the Mayo Clinic and Stanford University say.

Drs. Ohad Oren, Electron Kebebew, and John Ioannidis have called out their medical colleagues in an opinion piece published in the medical journal JAMA over excess computed tomography (CT) and magnetic resonance imaging (MRI), saying conditions can’t justify why Americans undergo these costly scans at many times the rate, for example, that Finns do.

Research shows diagnoses don’t improve with many more MRIs and CTs. Instead, they may lead to yet more costly, invasive, and unnecessary tests and procedures, some of which can harm patients.

December 9, 2018

Just the Facts, Ma’am: Medical malpractice lawsuits safeguard patients & improve health system

by Patrick A. Malone

Facts matter, and, when amassed in a smart way, they can paint a powerful and accurate picture of reality, as is made clear with findings presented in the annual “Briefing Book” on medical malpractice from the Center for Justice and Democracy at New York Law School.

As the Kentucky Supreme Court recently affirmed when it slapped down an attempt in the Bluegrass state to “reform” medical malpractice lawsuits, doctors, hospitals, nursing homes, and insurers too readily embrace and spread counter-factual notions about patients who seek in the civil justice system remedies for harms they have suffered while seeking medical services.

It’s our fundamental, guaranteed right to pursue such claims, the justices affirmed — and the CJ&D experts have put together research to show that medical malpractice cases don’t happen often but are valuable in protecting the quality and safety of all patients’ care.

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:

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 25, 2018

Doctors too readily provide dubious treatments to vulnerable seniors

by Patrick A. Malone

Doctors 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.”

May 23, 2018

Overrun by sports performance chatter? Can questions on MBI bust the bunk?

by Patrick A. Malone

If you can get your favorite sports fans peeled away from the latest broadcast pro event ─ whether it’s the basketball playoffs, hockey championship series, golf tourneys, or the heating up baseball season ─ a conversation of sorts could be sparked by dropping numbers on them. See what kind of rise you can get by telling them their data-driven obsession with improving their own athletic performance may be built on shoddy calculation.

In the “Moneyball,” statistics’ crazy world of contemporary sports and athletic fandom, that statement could be heretical. But the numbers-driven folks at the web site “528” deserve credit for digging into a popular but dubious approach employed by researchers in sports medical science: Magnitude-based inference, aka MBI. Their article’s worth a read, especially for wonks and the numerically inclined. For those who are less so, here’s a taste of what’s at stake, as 528 reported:

At first blush, the studies look reasonable enough. Low-intensity stretching seems to reduce muscle soreness. Beta-alanine supplements may boost performance in water polo players. Isokinetic strength training could improve swing kinematics in golfers. Foam rollers can reduce muscle soreness after exercise. The problem: All of these studies shared a statistical analysis method unique to sports science. And that method is severely flawed.

January 10, 2018

Over-screening skews disease research and puts harsh burdens on seniors

by Patrick A. Malone

Medical over-screening and over-testing not only adds hundreds of billions of dollars in unnecessary costs to U.S. health care, it also may be skewing researchers’ understanding of what causes disease and imposing harsh burdens on older Americans.

Stat, an online health and medical news service, has highlighted an intriguing study from the Dartmouth Institute for Health Policy and Clinical Practice, whose researchers are well-respected for their work on their Atlas Project, which “documents glaring variations in how medical resources are distributed and used in the United States.”

Dartmouth researchers recently examined screening, especially for breast, prostate, and thyroid cancers, and found that over-testing, as Stat reported, may be “misleading doctors and the public about what increases people’s risk of developing cancers,” especially “the types of cancer that matter.”