Articles Posted in Training

umcDoctors and hospitals across the country push the frontiers of medical science every day, finding new ways to improve health care and to change and save lives. But at the same time, some of medicine’s basics—like delivering babies safely and protecting mothers’ well being—also keep getting botched, especially for poor and black women. It’s a national disgrace, and it’s on sad, terrible display in the growing scandal in Southeast Washington’s only full-service hospital, which recently was ordered to stop delivering babies.

Why? The Washington Post, which has done some good digging and needs to do more, says that health regulators for the District of Columbia have provided sketchy details to officials of United Medical Center, which serves the poor and predominantly African American residents of the neighborhoods east of the Anacostia River, as to why the public hospital’s obstetrics unit was shut down for 90 days.

The paper says United’s staff failed to properly care for a newborn to ensure the infant didn’t acquire HIV from the baby’s mother, who was infected and had a high viral load. The hospital didn’t test the baby properly for HIV, failed to deliver the child via cesarean to reduce the chances of HIV infection, and didn’t administer a recommended antiretroviral drug as a postpartum precaution.

spinning-300x200Although many sports enthusiasts relish the summer as a peak time to train hard to get especially fit, wise athletes for safety’s sake may wish to build their way up to exhausting workouts, and to ensure they’re staying hydrated in healthful ways, while also recognizing that endurance competitions may alter their bodies in ways that they should at least be aware of.

The New York Times has posted an eyebrow-raising story on the perils to hard-driving jocks, male and female, of “rhabdo,” aka rhabdomyolysis, a “rare but life-threatening condition often caused by extreme exercise. It occurs when overworked muscles begin to die and leak their contents into the bloodstream, straining the kidneys and causing severe pain.”

Two doctors say they treated three recent, severe rhabdo cases brought on when novices in not great shape leaped into intense spinning classes, demanding exercise regimens lasting around an hour and involving specialized stationery bicycles. They found in medical literature 46 other, documented rhabdo cases, with 42 tied to novices’ spinning.

anesthesia-300x153Some of the very medical specialists who are supposed to put patients to sleep experience big problems themselves staying awake, with more than half of anesthetic trainees reporting in a new national survey in Britain that they had crashed their cars or nearly done so while headed home after long night shifts.

American doctors’ social media responses to this new research indicate that work weariness and drowsy driving are perils for practitioners on this side of the Atlantic, too.

The doctors’ complaints also underscores the irrationality of recent decisions by American medical educators to reinstate long shifts for interns and residents, trainees who play important—and sleep-deprived— front-line roles in providing medical services to too many patients in academic medical centers and hospitals nationwide.

doc-sleep-300x225Must doctors be absolutely impervious to common sense improvements in the way they train their own? Their bullheadedness has reemerged with the revisited decision by a major academic credentialing group to allow medical residents yet again to work 24-hour shifts.

The Accreditation Council for Graduate Medical Education clearly was on the defensive when it issued its memo on residents’ learning and working hours, guidance that academic medical centers and hospitals nationwide will rely on in setting workplace standards for the young doctors in whose hands so many patients will put their lives. The council noted that it had established a high-level task force to reconsider criticisms of residents’ stress and overwork and how this might imperil patient care, responding to an early rollback of shift hours:

“… The Task Force has determined that the hypothesized benefits associated with the changes made to first-year resident scheduled hours in 2011 have not been realized, and the disruption of team-based care and supervisory systems has had a significant negative impact on the professional education of the first-year resident, and effectiveness of care delivery of the team as a whole. It is important to note that 24 hours is a ceiling, not a floor. Residents in many specialties may never experience a 24-hour clinical work period. Individual specialties have the flexibility to modify these requirements to make them more restrictive as appropriate, and in fact, some already do. As in the past, it is expected that emergency medicine and internal medicine will make individual requirements more restrictive.”

consent-300x170Modern medicine has become so complex, bureaucratic, and forbidding that it’s little wonder that patients—already ailing—don’t grasp the risks and consequences of treatments they prescribe. Overwhelmed patients also don’t demand that doctors fully brief them.

And shame on physicians for failing to help patients more in this critical area of caregiving, two doctors have written in an excellent New York Times Op-Ed column. The doctors—Mikkael Sekeres, director of the leukemia program at the Cleveland Clinic, and Timothy Gilligan, director of coaching, Center for Excellence in Healthcare Communication, at the Cleveland Clinic—deserve credit for calling out colleagues while describing the vital health care concept of informed consent.

My firm has detailed information on this important patient right in health care (click here to see).

IVThree Washington, D.C.-area teaching hospitals have ranked in the lowest-scoring group nationally on preventing infections when their patients are hooked up to central lines, intravenous tubes that supply fluids, medications, and nutrients to those in dire need. Two institutions in the region rated highly.

Consumer Reports deserves credit for its continuing reporting on hospital acquired infections (HAIs), a scourge that in 2011 afflicted 650,000 already ailing Americans and which contributed to 75,000 deaths. The advocacy group says 27,000 patients were felled with central line infections in 2015, with a quarter of these especially sick and frail individuals dying of them. Treating patients for central line infections cost on average $46,000—more than for any other HAI.

The area teaching hospitals that the magazine ranked poorly, based on an analysis of federal data from 2011 to 2015, were: George Washington University Hospital, Holy Cross Hospital in Silver Spring, and Howard University Hospital. The two high-ranking institutions were: MedStar Franklin Square Medical Center in Baltimore and Sentara Norfolk (Va.) General Hospital.

ICUThe spots in hospitals where patients in the direst shape receive specialized treatment are themselves in need of urgent care, experts say, explaining that antiquated intensive care units (ICUs)

contribute to needless harm. But how exactly to yank them and the therapies they provide into the 21st century?

Usha Lee McFarling, a Pulitzer Prize winner, examines ICU reforms for the online health news site Stat, finding that these crucial and “heroic” hospital facilities fundamentally have changed little in a half century, although they now are jammed with new technology and devices. They serve almost 6 million Americans in grave condition, but in them, she says, “studies show serious and sometimes fatal medical errors are routine. And a recent review published in the journal Critical Care found no major advances in ICU care since the field’s inception in the 1960s.”

After four years of undergraduate education, four years of medical school, and then internships and residencies for several years after, doctors should be a well-informed lot, right? But they can get themselves into some downright dumb stuff. This includes their wrong thinking about the prevalence of medical malpractice litigation, and their head-scratching revisiting of a less stressful way to train tomorrow’s practitioners.

Contrary to conventional wisdom, new research has found that a relatively few number of physicians account for almost a third of medical malpractice claims paid. The researchers, examining more than 66,000 malpractice claims paid against 54,000 MDs nationwide between 2005 and 2014, said that just 6 percent of doctors had paid claims in the decade. Just 1 percent of physicians paid nearly a third of all claims. The researchers focused on paid claims as a marker of substandard care.

The MDs who had to pay out generally were older, internists, OB-gyns, general practitioners, or family medicine practitioners. As one news report on the study noted: “Each time a doctor got sued, the likelihood that he or she would be sued again went up.” Neurosurgeons, orthopedists, general surgeons, plastic surgeons and OB/GYNs were roughly twice as likely to have repeat settlements, as compared with internists, even after the researchers controlled for the inherent risk of practices like surgery, another news report on the study said.

Hospitals love new technology and new treatment initiatives because using them can result in better outcomes for patients. But hospitals also like them because they can charge more for an expensive or complicated surgical tool or protocol, and leverage that use for promotional purposes.

Unfortunately, as we’ve often pointed out, new and complicated treatments sometimes don’t work right. Sometimes they’re used by people insufficiently trained. Sometimes they cause grievous harm to patients and qualify as malpractice. So, many policy experts are calling for hospitals to prove they’re capable before they engage in certain surgical practices.

“As the U.S. health-care landscape advances toward rewarding quality rather than quantity, just buying a new high-tech surgical tool or hiring skilled surgeons may not be enough to support offering the new service,” according to a recent story in Modern Healthcare. “Facilities should more frequently be asked to prove not only the ability to achieve good clinical outcomes, but that there is a community demand for the service in the first place, [health quality and policy leaders] say.”

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