Primary Care

March 31, 2019

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

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 29, 2019

Doctors retreat on low-dose aspirin advice, underscoring that one size seldom fits all

by Patrick A. Malone

After persuading as many as 7 in 10 American adults to take a daily low dose of a common painkiller to protect against heart disease and cancer, experts now say it is time for more nuanced advice on who should and who shouldn’t take the daily baby aspirin regimen.

Recent studies have shown that the believed protective benefits of low-dose aspirin need to be balanced against the risks of bleeding caused by the drug, the American Heart Association and the American College of Cardiology have declared.

Here is who should NOT go on low-dose daily aspirin:

March 27, 2019

Clinicians are facing up to the preventable harms that ICU’s inflict on many patients in the process of saving lives

by Patrick A. Malone

Doctors and hospitals finally are owning up to and treating mental and physical damages inflicted on some of the sickest and most vulnerable individuals in their care—the 5 million or so patients who get helped in intensive care units, published research shows.

Although ICU patients may get dramatic emergency care that saves them from deadly infections, major disease, and significant accident or injury, experts only recently have begun to recognize and assist them with a condition associated with their stays: post-intensive care syndrome (PICS). A readable new study in the medical journal JAMA says that ICU patients may suffer a “constellation of symptoms” with PICS that hinders their recovery to their pre-hospitalization well-being, including: “muscle weakness, cognitive impairment, depression, anxiety, and post-traumatic stress disorder (PTSD).”

March 26, 2019

In battle for science and against anti-vacciners, experts reckon with social media’s sway

by Patrick A. Malone

As doctors and public health officials coast-to-coast battle infectious outbreaks — of measles, mumps, meningitis, whooping cough, influenza, as well as typhus, hepatitis, and TB — the nation is also struggling with the right response for yet another contagion: the viral spread of medical misinformation on social media.

Medical nonsense isn’t new, and savvy patient-consumers long have needed to do a little work to protect themselves from what can be its real and significant harms. But a season of rapidly spreading and 100% preventable infectious diseases has forced modern medicine to confront generational dilemmas with health disinformation that is “shared” widely online and especially via social media.

For the rising generation that now parents youngsters who need and should be vaccinated, social media sites like Facebook, YouTube, and Instagram, as well as information searches via Google have become as ordinary and accepted as once were daily newspapers and the 6 o’clock TV news. But cyber world’s ubiquity also has allowed counter factual, unfounded, nonscientific, and extreme notions to proliferate, as users of all kinds “create content” online. This has fueled the dangerous normalizing and further rise of the anti-vaccination or anti-vaxxer movement.

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:

March 22, 2019

Health care has its share of gaming by the deep-pocketed and powerful

by Patrick A. Malone

The rich and powerful may seem to run amok as the nation lurches through its latest gilded age. But sometimes:

They get reined in by public shaming, as seems to be occurring with a developing scandal over insider deals in the University of Maryland Medical System (UMMS).
It takes prosecutors to check abuses, as is occurring with the college admissions mess and notably how it harms students with genuine need for learning accommodations.

March 21, 2019

Rise in ‘medieval’ ills and other infections should send a big health warning

by Patrick A. Malone

Americans have battled for at least a decade over the role of government in individuals’ health, specifically through health insurance. But communities across the county may be grappling with the baleful and more direct consequences of society’s ignoring others’ well-being, as a public health crisis erupts over the re-emergence and spread of “medieval diseases.”

Say what you’d like about the vanity and superficiality of Tinsel Town. But it’s no matter for mockery that Los Angeles municipal employees are deathly afraid of and have been infected in the heart of the city’s busy downtown by typhus, a bacterial infection that brings high fever, stomach pain, and chills. It can be treated with antibiotics.

But its outbreak—168 cases since January 2018, including one staffer at Los Angeles City Hall—speaks to significant problems that cities especially are battling with infections borne by vermin, notably rats and the fleas that they carry, as well as lice.

March 19, 2019

$29 million jury verdict in talc case underscores need for asbestos regulation

by Patrick A. Malone

Although research has shown that asbestos can cause cancer and other harmful illnesses and the federal government has sought to limit and even ban its use, yet another sizable judgment in a tainted talc case and the discovery of the substance in a popular cosmetics line shows how America’s oversight and regulation of risky materials can be too slow and ineffective.

As the New York Times reported, a jury in the San Francisco area has joined similar deliberative panels in accepting claims that longtime use of Johnson & Johnson baby power causes cancers. The state jury decided that J&J must pay plaintiff Teresa Leavitt a total of $29 million because the company knew its talc was tainted with asbestos but failed to warn her and others. Leavitt, who used the product for three decades, was diagnosed in 2017 with mesothelioma, a cancer of the lining of internal organs that is associated with asbestos.

The newspaper said the jury told J&J to pay her “$22 million for her pain and suffering, $5 million to compensate her family members, nearly $1.3 million for her medical costs and $1.2 million for her lost wages.”

March 17, 2019

A lesson on vaping from sugary drinks of yore: Crack down on Big Tobacco

by Patrick A. Malone

Those who are senior enough to remember the allures of sweet drinks like Tang, Hawaiian Punch, and Kool-Aid also may need to be sage enough to share a deep, evidence-based distrust and disapproval for the nefarious actions of Big Sugar and Big Tobacco. Those suspicions may need to be renewed in regulators’ crackdowns on vaping, its flavorings, and flavored tobacco cigarettes.

Yes, the federal Food and Drug Administration now has formally detailed its plan to curb the soaring youthful purchases and uses of e-cigarettes for vaping, telling merchants that they soon will be required to keep these goods, including flavored liquids that the devices catalyze, in separate walled off areas of stores and away from those age 18 and younger. This will affect not only big retailers like Walgreens and Wal-Marts but also gas stations and convenience stores.

Online vendors soon will be required to have mechanisms, so proof of age becomes part of cyber buys of e-cigarettes and their associated products.

March 15, 2019

In celebrity death and diagnosis, cautions for all on stroke and cancer

by Patrick A. Malone

For Americans of a certain age, the power of celebrity and sad news — the early death of acting heart-throb Luke Perry and the announced Stage 4 cancer diagnosis of game show host Alex Trebek — may offer important health warnings about two leading causes of death: strokes and cancer.

Strokes kill 140,000 Americans each year—that’s 1 out of every 20 deaths, the federal Centers for Disease Control and Prevention reports. The agency says, “Someone in the United States has a stroke every 40 seconds. Every 4 minutes, someone dies of stroke. Every year, more than 795,000 people in the United States have a stroke. About 610,000 of these are first or new strokes.”

The condition mostly affects those 65 and older, but strokes can occur in younger people, with the New York Times reporting that “seven in one million Americans under age 50 die annually from strokes caused by a blocked blood vessel, and nine per million die from a brain hemorrhage, the two main types of strokes.”