Misdiagnosis

January 31, 2019

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

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.”

January 9, 2018

Experts fret over how precise key basics may be in ‘precision medicine’

by Patrick A. Malone

Although billions of dollars and lots of positive public attention have been lavished on the promise of genetic-based “precision medicine,” this therapeutic approach to treating cancer and other serious diseases may need more scrutiny for basics of quality control.

National Public Radio deserves credit for airing some less-heard experts’ worries about the roles of at least two groups of little-seen and often-ignored medical specialists — pathologists and med techs — and how their common practices may undercut the potential of efforts to target disease treatments to individual patients based on maps of their genes.

Despite its powerful and progress-promising name, precision medicine relies on some old-fashioned, unchanged, and possibly problematic medical techniques, experts told NPR. Blood and tissue samples, which later will be analyzed with costly and supposedly state-of-the-art equipment, still get taken by med techs with limited training. Little attention typically gets paid to how they collect samples and how carefully they get handled before arriving in labs. They may sit on carts for hours, and they may be dragged through different parts of hospitals where temperatures vary widely and can hit extremes.

December 5, 2017

Does modern medicine give patients with major brain trauma really fair care?

by Patrick A. Malone

Nick Tullier once was a handsome, strapping sheriff’s deputy in Baton Rouge, La. Then, in a blink, he and five others were gunned down by a former Marine and black separatist who had come from Missouri to Louisiana to kill cops. Tullier was one of three deputies who survived the attack.

What happened next to him is part of a series worth reading in the Houston Chronicle, a year-long dig the newspaper has dubbed “Alive Inside.” The work asks whether doctors and hospitals across the country have stayed current with medical advances that maybe, just might, possibly offer greater glimmers of hope to patients like Tullier who suffer traumatic brain injuries.

Such individuals, the Chronicle carefully says, may too quickly be deemed too injured to survive. Doctors, in sincere acts of perceived compassion, may be too fast to urge family and loved ones to withhold or halt medical services for the brain-injured, partly out of the pragmatic reality that their recovery prospects remain poor.

November 21, 2017

Non-MDs do skin biopsies at many dermatology clinics, with sketchy results

by Patrick A. Malone

When the private equity firms move into skin cancer treatment, you know the story is not going to end well for patients. Think lots of treatments, but hit or miss on protecting you from serious cancers.

There’s a simple self-protection solution for the many boomers – like me – who need to get skin lesions regularly looked at by the skin doctor.

Just ask this question whenever you meet a new practitioner who proposes to examine your skin and cut or freeze off the growths there: What is the degree behind your name?