Now that we are safely in mid August, I feel comfortable addressing the so called “July effect” without causing a mass exodus of hospital patients from their hospital beds. What is the July effect you ask? It’s the alleged rise in medical mistakes that coincidentally (or not) coincides with the increase of new medical residents at teaching hospitals starting July 1. While there is some research that mortality rates increase [...]
Vaccinations or rather, the lack thereof - has been a hot topic in the news lately. The media is reporting increased outbreaks of communicable diseases with the finger pointed at those individuals who choose to not vaccinate out of a fear, amongst others, that vaccinations cause autism. Studies conducted in the scientific community have largely discredited any association between vaccinations and autism. Most recently, a March 2013 study published in [...]
What is thought to be one of the most common vehicles for spreading germs in a hospital? The answer might surprise you: the white lab coat. Also ranking high are neck ties and wrist watches worn by health care practitioners. The Society for Healthcare Epidemiology of America has released new guidelines suggesting that the white lab coat be eliminated altogether or hung on an outside hook prior to entering a patient’s [...]
There is a blog being circulated right now that addresses frustrations over doctor tardiness. The woman who writes the blog is married to a pediatric physician and wants everyone to remember the reason why a physician might be running late to a dinner /next appointment/ anniversary date night / sporting event. There is always an appointment before our own. She writes: “We may never know what struggles the child and [...]
My husband, a local hospitalist in town, came home from work a few nights ago very tired. During his 14 hour work day, he had seen and treated quite a few sick patients and I could tell several of the sickest were still on his mind. Sensing he needed to unwind, I sat quietly on the couch with him for a few minutes – both of us deep in our [...]
Six people. That's the number of people who registered with the new healthcare website on Day 1 of its unveiling. Documents released yesterday by the House of Representatives showed this number modestly increased to 248 individuals successfully enrolled on Day 2 of the rollout. These numbers shine a light on the rocky introduction of President Obama's health care legislation to the American people. Criticisms of the new healthcare law include the [...]
The obvious and immediate impacts of the government shut down are visible before everyone’s eyes – the closing of the national parks, federally owned museums, IRS call centers advising taxpayers and offices handling federal grants, and the furloughing of thousands of federal employees. What’s not so visible is the impact on America’s already vulnerable healthcare system. No, I am not talking about the hot button topic of Obamacare here. What [...]
Diagram published by the CDC. Last week I discussed a report issued by the Centers for Diseases Control (“CDC”) that addressed the ever increasing prevalence of antibiotic resistance. One author, commenting on the potential demise of antibiotics, went as far as to compare a modern post antibiotic era to the plight of our ancestors during the “Black Death.” Piling on, the CDC declared antimicrobial resistance to be “one [...]
This week, the Centers for Disease Control (“CDC”) issued a report that addressed, in detail, the threat of antibiotic-resistant organisms to our world. Dr. Todd Friedman, the director of the CDC, cautioned that, “[i]f we are not careful, we will soon be in a post antibiotic era.” Antibiotic-resistant organisms account for 2,049,442 illnesses and 23,000 deaths each year. The estimated cost to society? $20 billion in additional healthcare spending and $35 [...]
Representative Earl Blumenauer from Oregon has introduced into legislation the “Personalize Your Care Act of 2013” that would provide Medicare and Medicaid coverage for end of life discussions. Mr. Blumenaur has been dubbed “the death panel guy” for his continued role in introducing bills that tackle end of life care. In 2009, he wrote it was “perverse” that Medicare pays for most medical procedures but does not reimburse physicians “for having a [...]
This past Wednesday, the Department of Health and Human Services released $67 million dollars to fund health care "navigators," intended, as the name states, to navigate uninsureds and other individuals through the new health care law. In total, 105 organizations received grant funds to assist with coverage in states where the government is running exchange programs. Navigators will receive 20 to 30 hours of training and are subject to prosecution [...]
Covenants not to compete are common in physician employment agreements but are they enforceable? The American Medical Association (AMA) has taken the position that physician non-compete agreements impact negatively on health care and are not in the public interest. Stopping short of completely prohibiting covenants not to compete, the AMA strongly discourages them. In line with the AMA, Colorado, Massachusetts, and Delaware have passed laws invalidating contractual provisions restricting a [...]
Under Nebraska law, it is unprofessional conduct to prescribe controlled substances to oneself, a spouse, child, parent, sibling, or “any person living in the same household as the prescriber.” The only exception to this prohibition is in times of medical emergency. The phrase "medical emergency" is not defined under the statutes - although it would presumably entail situations in which a family member would not have sufficient time to seek treatment elsewhere. The way [...]
America's healthcare system has been no stranger to controversy over the years. A large piece of the current debate pertains to the cost of healthcare – with the finger often pointed at the rising expense of emergency medicine and unnecessary treatments. One of the goals of the new healthcare overhaul is to lessen this burden with more access to primary care physicians. Another proposed solution is to make patients front the [...]
Today marks my husband’s last day of residency. As he walks out of his last call shift, he says a bittersweet farewell to not only his on call pager (the sound of which will likely trigger a nervous twitch for many years to come) - but to an army of mentors and a group of colleagues bonded through three years of work with little sleep. The topic of residency has [...]
It’s a scene straight from a movie – someone is injured and you rush to render aid. Of course, there’s blood – and with blood comes the potential exposure to communicable diseases. So, what should you do if you do not know whether the person you have been assisting may have placed you at risk? The Nebraska statutes and regulations provide some protection to emergency services providers (including individuals rendering [...]
How much time should a physician spend with their patient? In an ideal world, the answer would be as much time as needed. Yet, according to a new study conducted by researchers from the John Hopkins University and the University of Maryland, gone are the days where new physicians had the time to truly get to know the individuals they treat. This new study found that physicians-in-training spend about eight minutes per day [...]
My husband - Tony (left) with his twin brother Adam. Both are internal medicine residents at the University Nebraska Medical Center. A backyard bar-b-q this Memorial Day weekend with two third year resident physicians - one being my husband and another my brother-in-law (twins who coincidentally (or by design?) have chosen the same career path - see inset picture) prompted a somewhat unique although not unusual conversation considering the company involved: [...]
Last week I discussed a new study published by the journal BMJ Quality and Safety that analyzed malpractice claims since 1986 and found errors in diagnosis to be the worst offender for malpractice claims. This week, my discussion centers on a similar analysis performed by Diedrich Healthcare. Analyzing data gathered by the National Practitioner Data Bank, Diedrich Healthcare found that out of the $3.6 billion paid out for malpractice lawsuits in [...]
A new study published by the Journal BMJ Quality and Safety sought to characterize the frequency, health outcomes, and economic consequences of medical malpractice claims within the United States. The study’s authors analyzed closed, paid malpractice claims from the National Practitioner Bank, with claims dating back to 1986. In total, 350,706 paid claims were analyzed. Errors in diagnosis accounted for the most medical malpractice claims with 28.6% of paid medical [...]
Time magazine recently published an article highlighting the controversy surrounding work hour restrictions placed upon doctors in training. Work hour restrictions were initially enacted by the state of New York in 1987 in response to the death of an 18 year old female, caused by a medication prescribing error made by a resident in the middle of a 30 hour work shift. As a result of the 18 year old’s death, [...]
Does anyone remember the last episode from Seinfeld where Jerry, Elaine, George and Kramer end up in jail for failing to help an individual being held up at gunpoint? The arresting police officer cites the town’s “Good Samaritan” law as grounds for the arrest, which purports to impose upon citizens a duty to rescue. Unlike this fictionalized episode from Seinfeld, laws generally do not impose a duty to rescue. In [...]
With all of the recent cruise ship debacles, I was reminded of a doctrine often applied in malpractice cases informally referred to as the "Captain of the Ship" doctrine. This doctrine suggests that a surgeon has the ultimate responsibility for the care of the patient, and has a non-delegable duty to ensure that proper care is given while in the operating room. Simply put, the physician is the captain of the ship during the operation being performed [...]
On December 20, 2012, the Florida Supreme Court expanded the already far reaching scope of doctor-patient confidentiality. In the case of Hasan v. Garvar, 2012 WL 6619334 (Fla.), a patient sued a dentist (referred to as Dentist #1 for purposes of this post) after the dentist failed to diagnose and treat a dental condition resulting in a bone infection. The patient subsequently sought treatment from a second dentist. (Dentist #2). Dentist [...]
The Omaha World Herald published a thought provoking article on the topic of overtreatment and the use of MRI’s in last week’s paper, written by World Herald Columnist Matthew Hansen. In it, Dr. Thomas Tape from the University Nebraska Medical Center discusses how the health system in this country pushes people into hospitals, rather than out, with unnecessary medical tests, including the overuse of MRI’s, becoming the norm. According to [...]
This topic hits close to home. I am married to a third year resident who is starting his career as a hospitalist in August. Friends and family frequently ask my husband to write them a prescription for various ailments rather than visit their primary care physician. His response? "Sorry, unless you come visit me in my clinic and we establish a physician - patient relationship, the Statutes and Regulations in [...]
So, you didn't pass your medical boards? Or you didn't pass your medical boards on your first try? Worried how it might affect your career as a physician? Well, you can rest easy when it comes to malpractice suits. Generally, a defendant physician's failure to pass board certifications is not admissible as to whether a physician complied with the standard of care. While performance on a board certifying examination might [...]
