MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'defensive medicine'. Sat, 03 Sep 2011 02:25:54 +0100 http://www.medworm.com/index.php?rid=5174616&cid=t_222026_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fweaknesses-of-the-current-malpractice-system%2F2011.08.28 Medical malpractice reform is in the news again. Of course, for the medical profession, the medical malpractice system is the wound that simply will not heal. For the plaintiffs bar, in contrast, the medical liability system is the gift that keeps on giving. I have argued that the current system fails on four important fronts. Efficiency Cost Fairness Quality Improvement I admit readily that my profession has not been as diligent as it should be in holding ourselves accountable. We have not been forthright in admitting our medical errors, although can you blame us under the current medical liability construct? (more…) *This blog post was originally published at MD Whistleblower* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=5174616 Sun, 28 Aug 2011 21:30:00 +0100 5174616 http://www.medworm.com/index.php?rid=4893447&cid=t_222026_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fphysicians-dont-profit-from-tests-and-prescriptions%2F2011.06.04 Physicians don’t make money from the tests, prescriptions, procedures and admissions they order, according to a new survey by the staffing and technology company Jackson Healthcare. At most, 6.2% of physicians’ total compensation comes from the doctor’s orders, the survey reported. Direct income from medical orders comprised: –0.5% from charges from prescriptions, –1.0% from charges from lab tests, –1.1% from charges associated with hospital admission, –1.3% from charges associated with facility fees for surgeries, and –2.3% from charges from diagnostic imaging. The survey of 1,512 physicians challenged claims that physicians won’t stop practicing defensive medicine because they profit from their medical orders, the company stated in a ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4893447 Sat, 04 Jun 2011 12:00:00 +0100 4893447 http://www.medworm.com/index.php?rid=4575055&cid=t_222026_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Funiversal-cardiac-screening-for-all-young-athletes%2F2011.03.11 It’s heart wrenching when young athletes die of sudden cardiac death (SCD). Last week the death of Wes Leonard, a Michigan high school star athlete, was especially poignant since he collapsed right after making the game-winning shot. This sort of tragedy occurs about one hundred times each year in America. That’s a lot of sadness. The obvious question is: Could these deaths be prevented? Let’s start with what actually happens. Most cases of sudden death in young people occur as a result of either hypertrophic cardiomyopathy (HCM), an abnormal thickening of heart muscle, or long QT syndrome (LQTS), a mostly inherited disease of the heart’s electrical system. Both HCM and LQTS predispose the heart to ventricular fibrillation — electrical chaos of the pumping chamber of the he... Better Health blogs http://www.medworm.com/rss/comments.php?id=4575055 Fri, 11 Mar 2011 22:00:35 +0100 4575055 http://www.medworm.com/index.php?rid=4489592&cid=t_222026_83_f&fid=34856&url=http%3A%2F%2Finsidesurgery.com%2F2011%2F02%2Forthopedic-surgery-study-documents-overuse-mris-defensive-medicine-strategy%2F A new study being reported on this week has documented in a prospective manner the overuse of radiology studies, particularly MRIs, in an attempt by orthopedic surgeons to protect themselves from malpractice lawuits through the strategy of “defensive medicine.” The study was led by Dr. John Flynn of the Children’s Hospital of Philadelphia. (Source: Inside Surgery) Inside Surgery blogs http://www.medworm.com/rss/comments.php?id=4489592 Thu, 17 Feb 2011 00:14:07 +0100 4489592 http://www.medworm.com/index.php?rid=4275325&cid=t_222026_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Freassuring-patients-about-ct-scans-and-radiation-risks%2F2010.12.20 Emergency patients with acute abdominal pain feel more confident about medical diagnoses when a doctor has ordered a computed tomography (CT) scan, and nearly three-quarters of patients underestimate the radiation risk posed by this test, reports the Annals of Emergency Medicine. “Patients with abdominal pain are four times more confident in an exam that includes imaging than in an exam that has no testing,” said the paper’s lead author. “Most of the patients in our study had little understanding of the amount of radiation delivered by one CT scan, never mind several over the course of a lifetime. Many of the patients did not recall earlier CT scans, even though they were listed in electronic medical records.” Researchers surveyed 1,168 patients with non-traum... Better Health blogs http://www.medworm.com/rss/comments.php?id=4275325 Mon, 20 Dec 2010 22:00:00 +0100 4275325 http://www.medworm.com/index.php?rid=4225264&cid=t_222026_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F12%2Fhealthcare-update-12-02-2010%2F Also see the satellite edition of this week’s update over at ER Stories. Problems with Canadian health systems getting worse. “We’re trying to get a Size 13 foot into a Size 8 shoe.” Emergency department overcrowding increasing due to lack of available beds. The president of the Edmonton Emergency Physicians Association described the situation as a “potential catastrophic collapse” of emergency medicine. Edmonton plans to decrease hospital emergency department crowding by moving patients out of the emergency departments sooner once the hospitals meet certain criteria such as the ED being 110% full or there are more than 35% boarding patients in the emergency department. Five times this past year, Dr. Raj Sherman’s 73-year-old father almost died after waiti... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4225264 Thu, 02 Dec 2010 18:23:42 +0100 4225264 http://www.medworm.com/index.php?rid=4190164&cid=t_222026_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F11%2Fnew-defensive-medicine-survey%2F “Every word that I write on every form is crafted with the idea that a malpractice attorney will challenge me to defend my practice.” Just one of the quotes in the survey about defensive medicine published by Jackson Healthcare. The survey of more than 3000 physicians showed that 92% admitted practicing defensive medicine and that, based on physician responses, the annual estimated cost of defensive medicine in the US each year is $650 billion to $850 billion – accounting for $1 out of every $4 spent on US health care. You probably shouldn’t believe any of the statistics or quotes from physicians in the survey, though. Trial lawyers have a much better idea about why physicians order so many tests and why defensive medicine has no impact on the availability of health... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=4190164 Sun, 21 Nov 2010 00:03:43 +0100 4190164 http://www.medworm.com/index.php?rid=3954260&cid=t_222026_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoes-defensive-medicine-cost-less-than-doctors-think%2F2010.09.09 Nothing polarizes the heath care debate more than defensive medicine. A recent study from Health Affairs will only add more fuel to the fire. Here’s what I wrote a couple of years ago in USA Today: “When you consider that rampant testing is a major driver of escalating health care dollars, addressing defensive medicine should be a primary goal of cost containment.” Is that still true? Well, yes and no. (more…) *This blog post was originally published at KevinMD.com* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3954260 Thu, 09 Sep 2010 16:00:28 +0100 3954260 http://www.medworm.com/index.php?rid=3641023&cid=t_222026_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmedical-malpractice-perspectives-from-a-doctor-and-a-lawyer%2F2010.06.07 Medical malpractice is a major issue that divides doctors and lawyers — with patients often left in the middle. I wrote last year in USA Today that reform is sorely needed, mainly to help injured patients be compensated more quickly and fairly than they currently are: Researchers from the New England Journal of Medicine found that nearly one in six cases involving patients injured from medical errors received no payment. For patients who did receive compensation, they waited an average of five years before their case was decided, with one-third of claims requiring six years or more to resolve. These are long waits for patients and their families, who are forced to endure the uncertainty of whether they will be compensated or not. And with 54 cents of every dollar injured patients receive... Better Health blogs http://www.medworm.com/rss/comments.php?id=3641023 Mon, 07 Jun 2010 20:00:18 +0100 3641023 http://www.medworm.com/index.php?rid=3585617&cid=t_222026_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F05%2Fdr-whitecoat-goes-to-washington%2F Sorry about the sparse posting lately – have been away in Washington at an ACEP conference Just so Matt and others don’t think that all I’m all talk and no action, I’ll let you in on some things that I did at the conference. I attended some excellent lectures about leadership. Colonel Thomas Kolditz gave a great talk about leadership in extreme circumstances. He described his interviews with many soldiers, Iraqi prisoners, sports team captains and their teammates, and various other people in leadership positions to determine what makes a good leader. Why do people follow some leaders and not others? Commitment is important. If a leader doesn’t believe in a mission, neither will the rest of the team. Effective leaders work with the team – they get down i... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3585617 Thu, 20 May 2010 18:20:45 +0100 3585617 http://www.medworm.com/index.php?rid=3538093&cid=t_222026_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhow-patient-complaints-affect-defensive-medicine%2F2010.05.05 Doctors often have a communication disconnect with their patients. A recent piece from the New York Times encapsulates the issue, citing a recent New England Journal of Medicine perspective. According to oncologist Ethan Basch, “Direct reports from patients are rarely used during drug approval or in clinical trials. If patients’ comments are sought at all, they are usually filtered through doctors and nurses, who write their own impressions of what the patients are feeling.” There are a variety of reasons for this. Some doctors feel they have a better sense of the patient’s symptoms than the patient himself. Biases can affect how doctors and nurses perceive symptoms. (more…) *This blog post was originally published at KevinMD.com* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3538093 Wed, 05 May 2010 22:00:22 +0100 3538093 http://www.medworm.com/index.php?rid=3538094&cid=t_222026_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Frelational-medicine-the-joy-of-primary-care%2F2010.05.05 I was happy when I looked at [the day's] schedule. Two husband-and-wife pairs were on my schedule, both of whom have been seeing me for over 10 years. Their visits are comfortable for me — we talk about life and they are genuinely interested in how my family is doing. They remember that I have a son in college, and want to know how my blog and podcast are doing. I can tell that they not only like me as a doctor — they see me, to some degree, as a friend. Another patient on the schedule is a woman from South America. She has also been seeing me for over 10 years. I helped her through her husband’s sudden death in an accident. She brings me gifts whenever she goes on her trips, and also brings very tasteful gifts for my wife. Today she brought me a Panama hat. I know these pe... Better Health blogs http://www.medworm.com/rss/comments.php?id=3538094 Wed, 05 May 2010 20:00:58 +0100 3538094 http://www.medworm.com/index.php?rid=3429194&cid=t_222026_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F04%2Fhealthcare-update-04-01-2010%2F Tort reform lessens the risk of medical malpractice, “but it doesn’t change the capriciousness of the legal system … and it hasn’t changed the nature of the risk.” “If there is ANY DELAY AT ALL in the diagnosis of a condition, then they label it as ‘malpractice.’” This Newsweek article explains very succinctly why defensive medicine is real – despite what the American Association for Justice’s mouthpieces would tell you. Ooops. One lawyer in the comment section says defensive medicine is a myth. Oh well. There goes my theory. It’s not really patient “dumping” — I helped her get out of the car. Florida surgeon cuts wrong duct during gallbladder surgery, then brings patient to another hospital in his ow... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3429194 Thu, 01 Apr 2010 10:54:33 +0100 3429194 http://www.medworm.com/index.php?rid=3254457&cid=t_222026_88_f&fid=38959&url=http%3A%2F%2Fwww.epmonthly.com%2Fwhitecoat%2F2010%2F02%2Fon-nursing-home-transfers-and-liability-reform%2F Several times in the past few days we have gotten ambulance runs from the nursing homes in the middle of the night to evaluate elderly nursing home patients for “unresponsiveness”. When the “unresponsive” patients arrive, they are at their baseline mental status and, after the obligatory workup to rule out the bad causes of “unresponsiveness,” nothing is wrong with them. Is “unresponsive state – rule out REM sleep” a legitimate discharge diagnosis? Then, last night we got an 82 year old COPD patient by ambulance from a nursing home who was having “severe shortness of breath” and “hypoxia”. Her oxygen saturation was in the 70s in the nursing home (normal is in the 90s) and she was “dusky,” prompting th... WhiteCoat's Call Room blogs http://www.medworm.com/rss/comments.php?id=3254457 Tue, 09 Feb 2010 01:24:21 +0100 3254457 http://www.medworm.com/index.php?rid=2284464&cid=t_222026_87_f&fid=34595&url=http%3A%2F%2Fnhsblogdoc.blogspot.com%2F2009%2F03%2Fwussification-of-american-medical.html I am a frequent visitor to KevinMD. It’s the best place on the internet to get an immediate, up to date birds’ eye view of medicine as it is seen in the American medical blogosphere and beyond. The only problem with KevinMD is that it is no longer possible to comment under his posts.** My recent post on the Natasha Richardson tragedy was partially inspired by a report on KevinMD in which the Americans were discussing what had happened but in a rather pompous “Dear oh! Dear, she would have been saved if this accident had happened in America” sort of way.UPDATE : The gobstopping pomposity of the Americans continues. I feel a post about unemployed black American diabetics who cannot afford insulin coming on. An NHS BLOG DOCTOR reader in America emails me about this:Did Natasha Richar... NHS Blog Doctor blogs http://www.medworm.com/rss/comments.php?id=2284464 Sun, 22 Mar 2009 14:22:00 +0100 2284464 http://www.medworm.com/index.php?rid=2227196&cid=t_222026_88_f&fid=34857&url=http%3A%2F%2Fscalpelorsword.blogspot.com%2F2009%2F03%2Fself-censoring-medical-record.html A patient presented to the ER with a benign complaint at 3 am. She was incidentally noted to have moderately elevated blood pressure, and she appeared much more awake and talkative than the usual 3 am patient. She admitted to recent cocaine use but requested that I not mention that fact in the medical record for fear of possible repercussions. She was a HENRY with good insurance and didn't want to jeopardize those things if her secret were somehow discovered.Since the blood pressure wasn't dangerously high and the drug use was not even tangentially related to her initial presenting complaint, I complied with her request, documenting only that we discussed lifestyle modifications and secondary causes of hypertension, etc.When electronic medical records become more common and more widely (if... Scalpel or Sword? blogs http://www.medworm.com/rss/comments.php?id=2227196 Mon, 02 Mar 2009 11:23:00 +0100 2227196 http://www.medworm.com/index.php?rid=2137603&cid=t_222026_87_f&fid=34935&url=http%3A%2F%2Fmedicine.com.my%2Fwp%2F%3Fp%3D5993 A brilliant post on the harsh realities of performing unnecessary tests in the Emergency Department (via KevinMD.com) Even lawyers (a patient of mine was anyway) are shocked to know that malpractice insurance in this country is spiraling upwards to the extent that the top payers have to fork out over RM30,000 a year in malpractice insurance alone. It’s partly because of this unfortunate lack of faith by lay people, lawyers and the courts in anything other than “tests”. Tests are not infallible. Indeed unnecessary tests (often done by patients themselves or demanded by patients) may lead to even more unnecessary tests, yet people complain about the cost of medical practice! from the Malaysian Medical Resources Defensive medicine at work (Source: Malaysian Medical Resources... Malaysian Medical Resources blogs http://www.medworm.com/rss/comments.php?id=2137603 Tue, 27 Jan 2009 05:00:00 +0100 2137603 http://www.medworm.com/index.php?rid=2112200&cid=t_222026_88_f&fid=34857&url=http%3A%2F%2Fscalpelorsword.blogspot.com%2F2009%2F01%2Fshot-time.html At every ER where I've ever worked, there is a rule that must have been passed down through generations of nurses, a requirement with such authority that its justification is rarely questioned, a guideline that is so ingrained in nursing practice that only a fool would speak out against it, and then only in passing, because everyone knows that this policy is as important to nurses as their midshift break. I'm referring to the dogma that patients must remain in the ER for 20-30 minutes after receiving a tetanus shot before they are allowed to leave the premises. Nurses will occasionally bend the "only 2 visitors in a room" rule, they might fudge on putting both of the siderails up on your stretcher, they aren't always precise about how quickly they push certain drugs through an IV, and they... Scalpel or Sword? blogs http://www.medworm.com/rss/comments.php?id=2112200 Sat, 17 Jan 2009 22:41:00 +0100 2112200 http://www.medworm.com/index.php?rid=2104501&cid=t_222026_88_f&fid=34857&url=http%3A%2F%2Fscalpelorsword.blogspot.com%2F2009%2F01%2Fcoo-coo-or-contra-coup.html I recently treated a very old and pleasantly demented gentleman who had slipped and fallen at home, sustaining a laceration to the back of the scalp. It was a witnessed fall, his second in less than a month, and there was no report of syncope or loss of consciousness. Other than the laceration, the patient was without complaint and neurologically intact, at his baseline mental status. He just wanted me to hurry up and close his wound so he could go home.I briefly considered not ordering a CT scan; after all, his recent head scan (reflexively ordered by one of my risk-averse colleagues) was normal, he wasn't on any blood thinners, and he seemed to be OK. Apparently there are some ivory tower physicians who think we ER docs order too many imaging studies, and I heard them murmuring like a ch... Scalpel or Sword? blogs http://www.medworm.com/rss/comments.php?id=2104501 Wed, 14 Jan 2009 08:33:00 +0100 2104501