Medical Directions

Follow Us To Good Health


Telemedicine is the remote diagnosis and treatment of patients through telecommunications technology. According to a January 2015 article in Forbes, telemedicine’s time has finally come in 2015 for the following reasons:

  • Technology has matured enough that doctors can offer patients a good experience.
  • Telemedicine technology now includes asynchronous messaging, so doctors can better utilize their time.
  • There is a greater demand among patients for the convenience of telemedicine.
  • The 60+ age group, which is not adverse to technology and has more difficulty getting to the doctor than younger patients, is expected to fully embrace the convenience of telemedicine.
  • Telemedicine will save a great deal of money and increase the value of doctors’ time by reducing the amount of time spent with patients who do not need to be seen in the doctor’s office.
  • It can keep patients engaged with their primary health care providers and their care integrated with existing health care records.

However, not everyone agrees that telemedicine is a good thing. The Texas medical board, for example, issued an emergency ruling on January 16, 2015 requiring doctors to meet personally with their patients before prescribing medications, as reported in a February 12, 2015 article in the Texas Tribune. The Tribune reports that the medical board felt these emergency measures were necessary to protect public health.

Teladoc, one of largest telemedicine companies in Texas, obtained a temporary restraining order from a Travis County judge to prevent the ruling from going into effect four days after it was issued on the basis that there was no existing imminent danger to public safety, health, or welfare. The Tribune article quotes Tara Kepler, a telemedicine attorney, as saying that all medical boards across the nation are taking similar actions, and that Texas is just a little bolder.

According to the Tribune article, Dr. Russell Thomas, an osteopath, expressed the opinion that telemedicine services pose risks for patients, particularly when drugs are prescribed. He questioned the quality of service a physician would be able to provide sight unseen, with no relationship with the patient.

The Great Plains Telehealth Resource & Assistance Center (g pTRAC) argues that telemedicine is not meant to replace existing healthcare methods, but rather intended as a tool to complement them. According to g p TRAC, e-visits are not intended for new patients or for established patients with urgent medical conditions or conditions requiring a physical examination or with significant visible components, such as a rash.

Medicaid.gov describes telemedicine as “a cost effective alternative to the more traditional face-to-face way of providing medical care . . . that states can choose to cover under Medicaid. Within certain provider and facility guidelines, Medicaid allows states the option to determine whether or not to cover telemedicine, what types of telemedicine to cover, and where and how it is provided.

The consensus of opinion appears to be that telemedicine has a number of advantages, not the least of which is the convenience and the time and money it can save. However, the question remains whether or not virtual doctors can provide the standard of care that American patients are entitled to expect from their healthcare providers.

Sources:

Read More
Medical Errors: An Update

Medical Errors: An Update


Posted By on Feb 4, 2015

Surgical Errors Based on Wrong Medication Not Uncommon

You may have suffered a surgical error and are dealing with terrible consequences, or have lost a loved one due to a surgical error. Some surgical errors relate to instruments or sponges being left in the body after surgery, but there can be other causes. For example, administering a wrong medication or wrong dosage is also a common type of medical negligence.

How Could This Type of Error Happen?

Surgeons and other medical professionals (as well as people generally) have a tendency to see what they expect to see. This tendency even has a name – “ascertainment bias” – a form of cognitive error. A team of medical providers in a hospital setting who work together often may tend to trust each other based on prior knowledge. So, when a medication is brought to a surgeon to give to a patient, the surgeon may trust all those who handled that medication, beginning with the pharmacist and ending with the person holding the medication who hands it to him.

That expectation held by the surgeon that others can be trusted to provide the correct medication plays a role in this ascertainment bias.

A Quick Check of Medication Can Drastically Change a Patient’s Outcome

Medical malpractice errors related to giving the wrong medicine or an incorrect dosage can sometimes have terrible results. A recent tragic case in Massachusetts exemplifies the problem of a doctor having an ascertainment bias and trusting in all those who handled a medicine before him.

The surgeon looks at a drug handed over by a nurse, and is convinced that it is the right medication because it appears to be the correct medication – yet it is not. He did not read the label. The wrong medication can cause serious medical conditions, some permanent, or in many tragic cases, loss of life.

Although medical professionals must have a high level of trust in each other, every possible point at which an avoidable error is detectable should be part of standard safety protocols for surgery and all treatments involving the administration of medications. Surgeons and nurse practitioners should be required, for example, to submit detailed written prescriptions to pharmacists.

Avoidable Injuries in Hospitals at an All Time High

Medical errors are the third leading cause of death in the nation, following heart disease and cancer. Overdoses due to wrong amount of medication, or the wrong drug being administered are of great concern because these errors add to those unfortunate deaths.

A recent report estimates that 210,000 people die each year due to a preventable medical error, with the actual numbers estimated to be closer to 440,000. Serious harm to a patient is estimated to be 10 to 20 times more common than these lethal mistakes. These numbers are unnerving and are certainly cause for patients to be vigilant and proactively involved in their medical care. Sometimes simply stepping outside the norm of fully accepting all that a doctor says and does at face value and asking questions about treatment can be enough to make a doctor be more attentive. If a doctor knows he or she is being questioned, they may be more concerned about potential medical malpractice suits and therefore do their work more mindfully.

Roughly a sixth of all deaths in the USA could be attributed to a medical error, according to the report. Some disagreement exists about the numbers of deaths due to avoidable mistakes, but no one is disputing the fact that no matter what tracking system is used to measure the numbers, deaths resulting from medical errors is a serious problem.

Sources:
A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care. Journal of Patient Safety
How Many Die from Medical Mistakes in U.S. Hospitals? NPR

Read More

According to Public Citizen, a non-profit consumer group dedicated to advocating for a “healthier and more equitable world,” medical errors leading to brain and other significant injuries continue to be a persistent problem despite the overall decline in medical malpractice payments in recent years.

Although last year did see a marginal increase in medical malpractice payments, the amount paid out during 2013 was reportedly lower than any year between 1999 and 2011. What Public Citizen considers troublesome about this fact is there has been no significant evidence to show a correlating decline in medical errors. In fact, the Public Citizen says, “The actual crisis over avoidable medical errors is worse than we ever knew.”

Evidence of this can be seen in a study published in the September 2013 issue of the Journal of Patient Safety, wherein it was revealed that the number of patient deaths that could be attributed to avoidable medical errors was somewhere in the range of 400,000 per year. This number is dramatically higher than the earlier figure of between 44,000 to 98,000 deaths caused by preventable medical errors, as reported by the Institute of Medicine back in 1999.

MedPage Today claims that three-fifths of the medical malpractice cases filed during 2013 involved “significant permanent injury, major permanent injury, quadriplegia, brain damage, the need for lifelong care, or death.” This number is very troubling, particularly considering the fact that a majority of these types of injuries are entirely preventable.
The Need for Fair Compensation

Public Citizen attributes the drop in payments stemming from medical malpractice cases to the fight medical practitioners have aggressively waged to place a cap on the amount of damages a medical malpractice victim can pursue. This is despite the fact that medical liability insurance rates fell between 2012 and 2013. Limiting the amount of money a victim of medical malpractice can pursue is not right.

When a patient sustains a traumatic brain injury or other significant injury as a result of negligence or error by the medical professional entrusted with his or her care, that patient deserves to seek fair compensation for all injury-related expenses and non-economic damages. These types of injuries are usually life-altering, if not life-threatening. People who suffer from a traumatic brain injury or other serious injury very often experience a reduced quality of life. Care and treatment for these types of injuries can be extensive, not to mention the stress and strain it puts on family members and loved ones.

Aggressive Legal Representation in Medical Malpractice Cases Involving Brain Injury

Medical malpractice victims should not be held financially liable for the hospital bills and other long-term care costs resulting from the injuries they sustained due to medical error. Health care providers are responsible for the health and well-being of patients in their care. If a doctor, nurse or other medical provider fails to meet the basic expectations of care, and injury or death occurs, that individual or group needs to be held legally responsible for this failure. In these types of cases, the victim must have the right to pursue fair and just compensation. If you or a loved one has sustained a brain injury or other injury due to medical error, call an personal injury attorney right away.

Sources:
Citizen.org: http://www.citizen.org/documents/Medical-malpractice-2013.pdf
MedPage Today: http://www.medpagetoday.com/PracticeManagement/Medicolegal/48233

Read More

Computed tomography (CT) scans can help doctors to avoid missing or delaying a diagnosis of cancer or other serious medical conditions. However, the exposure to ionizing radiation that these tests involve may, at the same time, increase a patient’s risk of developing cancer.

This why many doctors and organizations are calling for patients to learn more and discuss the risks and benefits of a CT scan with their doctor before they undergo one, as ABC News/Health.com recently reported.

According to the article, CT scans have become increasingly used by doctors to check a patient for cancer due to the fact that they are cheaper and faster than MRIs or exploratory surgery and provide more detail than traditional X-rays. Between 1980 and 2013, the number of CT scans performed each year in the U.S. soared from around 3 million to 76 million, the article states.

However, a patient undergoing a CT scan generally receives a high dose of ionizing radiation. While the body can repair damage caused by small doses of radiation, the high dosage in a CT scan is one that simply overwhelms the body’s “repair mechanisms,” potentially leading to cancer, the article states.

The cancer risk is higher if a patient undergoes multiple CT scans, and women may face a higher possibility of developing cancer from the radiation than men, according to ABC News/Health.com.

The report cites a 2009 National Cancer Institute study which found that 29,000 future cases of cancer could result from 72 million CT scans that were performed in the U.S. in 2007.

Cardiologists Call for Patient-Doctor Discussion About CT Scans

As Reuters reports, several medical organizations issued a statement in September2014 in the medical journal, Circulation, which urged doctors to carefully discuss the risks and benefits of chest CT scans with their patients and to explain to patients why a CT scan was being used in their case.

Ultimately, a patient and doctor must “share” the decision to go forward with the test, according to the statement, which was signed by organizations that included the American Heart Association and American College of Cardiology.

Dr. Andrew J Einstein of Columbia University in New York told Reuters that patients should not necessarily be “scared off” by the discussion or refuse undergoing what could be a potentially life-saving test.

Still, Einstein said, “As doctors, it is our obligation to make sure that we, our colleagues and our patients understand the potential benefits of a medical imaging study as well as potential risks,” according to Reuters.

Questions You Should Ask Your Doctor

If you are suffering symptoms of cancer or any other serious medical condition, your doctor may tell you that he or she would like to order a CT scan. Before you agree to undergo the test, ask your doctor:

  • What specific symptoms make the CT scan necessary?
  • Could alternatives such as X-rays, MRIs or ultrasounds be used instead, and how do those alternatives compare to a CT scan in terms of risks and benefits? You may also ask about how the alternatives compare in terms of cost and the amount of time involved to perform each one.
  • If a CT scan is needed, what is the typical dosage of radiation for such a scan and/or the actual dosage that will be used in this specific test?
  • Will there be additional CT scans? If so, how many more tests? What are the risks and benefits of multiple CT scans?

The bottom line is that you have the right, as a patient, to have as much information as possible about the tests your doctor orders you to undergo. Ultimately, if you find that the risks outweigh the benefits, you have a right to withhold consent and seek a second medical opinion.

Read More

Confidentiality between doctor and patient has always been a given in the United States, and it’s something we have long taken for granted. However, that confidentiality isn’t as airtight as many may think. On the contrary, pharmacies such as CVS and Express Scripts have been selling anonymous prescription information to data mining companies for years. Why? It’s an effort to target advertisements to patient’s prescriptions and health conditions. The process is called matchback, and it has rightfully raised concerns about federal medical privacy laws.

How ‘Anonymous’ is It?

Matchback is allowed because the names of the patients are said to be concealed, though to many, that doesn’t justify the breach of confidentiality. IMS Health Holdings and other data brokers have collected prescription records numbering in the hundreds of millions, and they say the names of the patients are replaced by unique codes that are generated using algorithms. But, opponents of the practice are concerned that such technological advances undermine privacy laws, specifically the Health Insurance Portability and Accountability Act (HIPAA).

Confidentiality and Transparent Disclosure Concerns

While advocates of the matchback process claim that patient’s names are not directly connected to the prescription information, not all pharmaceutical companies are comfortable with it. For example, industry giant, GlaxoSmithKlinePlc, stopped engaging in the practice after its leadership became concerned about the potential for violating consumer privacy, and because not all websites were notifying users. The company’s legitimate concerns about transparent disclosure for internet users and breeches of confidentiality are at odds with other pharmaceutical companies, like Sanofi, that do use matchback to target consumers.

Money to be Made

Pharmaceutical companies aren’t the only ones who must choose whether or not to engage in prescription drug data mining. Internet companies can profit from it, too, so they have a decision to make as well. Yahoo has decided in favor of matchback. The company has been using IMS Health Holdings, Inc., one of the biggest data brokers, to target ads through matchback since 2011. Even though Yahoo’s privacy policy does address information sharing and disclosure, it does not specifically mention the release of information relative to prescription drugs. Yet, the internet giant, along with IMS, reportedly holds the records of some 100 million people. What’s the draw? Money, of course. Matchbacks can add $100,000 to the price tag of a digital advertising campaign.

Not all internet giants are on board with the selling of ‘anonymous’ prescription records though. Like SmithGlaxoKlinePlc, Facebook, Google and Microsoft don’t use matchbacks in their ad targeting strategies either. Perhaps the money to be made just isn’t worth the risk to them, especially given the breaches of information that occur. Opponents of matchback point to such breeches as evidence that long term tracking poses a risk to patient privacy regardless of how the data is presented, or who is in control of it.

Whether or not the mining of prescription data is legal, many believe that it is unethical. Opponents of the process argue that all health records should be kept confidential. Regardless of whether there is a name or random number attached to it, they claim, medical information is too personal to expose to any level of risk.

Read More

Medical professionals usually strive to provide the very best medical care to patients. They want to administer the right tests, prescribe the right medications, and perform needed surgeries flawlessly.

But humans make mistakes despite best intentions, including doctors and nurses. Sometimes those mistakes are the result of carelessness and actions that fall short of the accepted standards of medical care.

Patients injured as a result of medical mistakes have the right under the law to seek monetary compensation for their injuries, including medical bills, lost wages, and pain and suffering. This legal right undoubtedly helps to keep medical professionals accountable for their actions and provide a semblance of justice to injured patients and their loved ones.

But some states have passed laws that restrict the right of injured patients to seek compensation for medical malpractice. Despite dubious data, these laws are cast as a protection against “frivolous” lawsuits and a reduction of medical costs.

In the real world, these laws can put injured patients and their loved ones into legal limbo with little hope of recovering compensation for injuries, and – even more important – getting real answers to just went wrong.

A tragic Wisconsin story is a case in point.

A 91-year-old man died after breaking his pelvis when he fell off a table in a hospital while being prepped for a routine heart procedure, according to a recent article in the Milwaukee Journal Sentinel. Prior to falling, the gentleman was largely independent and able to get around on his own. He was the primary caretaker of his ailing 88-year-old wife of 65 years, attending to her needs in their home and transporting her around town.

Wisconsin has thrown up legal roadblocks for those seeking compensation for medical malpractice, and, perhaps just as troubling, obtaining information about details on medical incidents.

Similar to numerous other states, Wisconsin has placed a cap on the amount of pain and suffering damages an injured patient can receive in a lawsuit. The cap amounts vary from state to state, and in Wisconsin the limit is $750,000.

Another restriction facing the widow and her adult children: Under a unique Wisconsin law, only a surviving spouse and minor children can pursue a wrongful death lawsuit. Should the ailing widow pass away before the conclusion of a lawsuit, the wrongful death claim would end immediately. This increases the risk for an attorney to represent the woman, especially considering the relatively high expenses typically associated with pursuing a medical malpractice case.

In fact, this law creates an incentive for the hospital and its insurer to delay payment on the claim as well as resolution of any legal case.

Yet another law in Wisconsin impinges on the ability of the family of the deceased man to get answers to what went wrong. They still don’t know exactly how he fell off the prep table in the presence of medical personnel at the hospital, according to the Milwaukee Journal Sentinel.

The law bars patient access to confidential “incident reports” written by staff in hospitals, nursing homes and other health care providers, and from using the reports in civil or criminal cases. The law purportedly encourages medical professionals to be more forthcoming about the details of treatments and medical services provided to patients when accidents occur, with the ultimate goal of improving health care procedures.

But sunshine is the best disinfectant, right? Transparency and accountability to patients would more likely lead to improvements in medical care, rather than circling the proverbial wagons, and keeping incident reports under lock and key.

Achieving consistently outstanding health care is inarguably a goal shared by everyone. However, laws such as those in Wisconsin that limit the legal rights of injured patients do not appear to further that goal, and instead appear to favor the health care industry and insurance companies.

This article provided on behalf of Scott Gottlieb at Scott C. Gottlieb & Associates, LLP.

Read More

Medical errors continue to be one of our country’s leading causes of injury and death. Fortunately, medical device entrepreneur and Founder/CEO of Masimo Corporation, Joe Kiani, along with his patient safety group, Patient Safety Movement Foundation, is actively pursuing ways to reduce the number of medical errors resulting in injury or death.

According to the Patient Safety Movement, the number of deaths caused by medical errors now exceeds the number of deaths attributed to vehicle-related accidents, breast cancer and heart failure. An estimated 440,000 deaths and millions of injuries each year are caused by medical errors.

What Actions Are Being Taken to Reduce the Number of Medical Errors?

The Patient Safety Movement has as its goal the implementation of actionable patient safety solutions (APSS) that will bring about zero preventable deaths by 2020. Mr. Kiani is determined to take a stand against this type of medical malpractice. He vehemently believes Congress should pass a law prohibiting Medicare from reimbursing doctors and hospitals for procedures that lead to the accidental death of a patient. He also wants hospitals held accountable for their actions and is certain that transparency among medical practitioners could make a significant difference.

To further his cause, his patient safety group has been hosting an annual summit where patients, healthcare providers, medical technology companies and officials responsible for creating public policies can gather for the purpose of coming up with ideas and drafting strategies that will ultimately reduce the number of deaths caused by avoidable medical errors.

California Senator Barbara Boxer is a steadfast advocate as well. She is not only working to draw attention to the cause, but is actively taking steps to hold hospitals more accountable. The OC Register reports that Sen. Boxer has asked 283 California hospitals to provide her office with detailed information on the actions being taken to reduce on-site medical errors. She has also begun touring many hospitals in the state, including Children’s Hospital of Orange County (CHOC), in an effort to make hospital workers and the general public more aware of this widespread problem, and to initiate actions that protect patients. The University of Michigan reports it has been spearheading state efforts to create new statewide standards for children’s medicines, in an effort to dramatically reduce dosage errors.

Is Human Error Largely to Blame?

Close to 80 percent of all negative or injurious events in our healthcare system occur due to human error, the Patient Safety Movement reports. Incorrect diagnoses, improper treatment, failure to provide adequate care and medication errors are largely to blame. There are many instances, however, where it is the system itself causing problems, rather than individual doctor negligence or failures.

One of the factors that has made this growing problem worse is that although hospitals are required to report medical errors as one of the conditions of being paid by Medicare, an investigation conducted by the Department of Health and Human Services in 2012 found the majority of preventable medical errors were not being reported. Those hospitals that do report such errors often do not take the procedural actions necessary after such an incident to prevent them in the future. While some progress is being made in reducing medical errors, there are still many obstacles that must be overcome. And, according to the Patient Safety Movement’s website, “Getting to ZERO will take all of us working together – clinicians, administrators, medical technology companies, payers, government, and patients.”

Sources:
Patient Safety Movement: http://patientsafetymovement.org/challenges-and-solutions/medication-errors/
Orange County Register: http://www.ocregister.com/articles/hospital-641332-medical-boxer.html
University of Michigan: http://www.uofmhealth.org/news/archive/201402/u-m-leads-state-effort-create-new-standards-kids%E2%80%99-medicine

Read More

The idea that diet can maintain good health and fight disease is an old one. For centuries, physicians and parents alike have pushed certain foods to cure the body’s ills. Jewish mothers serve chicken soup to anyone with a cold, following the famous recommendation from the 12th century Hebrew physician Maimonides (who actually said it would cure asthma and leprosy). Chinese parents add ginger to their kids’ meals, and Mexican abuelas slip a little chili into the sopa.

When it comes to cancer and other serious illnesses, though, patients are cautioned about dietary claims that a certain food will cure or slow a disease. A visit with a nutritionist is a much better idea to ensure the diet is well-rounded and includes nutrients to strengthen weakened immune systems.

Derivative of a Popular Indian Spice May Slow Mesothelioma

But now, researchers in U.S. and German universities say curcumin, which comes from the spice turmeric, contains a peptide that slows the progression of mesothelioma. Asbestos exposure is the only known cause of mesothelioma. Mesothelioma attorney Joseph Belluck says that any medical breakthrough is important when it comes to cancer. Although we don’t have a cure for mesothelioma, we have new information studied by doctors, such as the study of turmeric.

Turmeric is used throughout Asia and is prominent in Indian food. At this point, though, evidence that consuming it will slow the disease is thin at best. But can it be restructured for this, perhaps in a future medication?

Mesothelioma and other cancers are often triggered by the protein and transcription factor STAT3, which sends messages to start and continue the cancer’s growth. PIAS3, a protein inhibitor, or peptide, is a very effective agent against STAT3. And, according to researchers, it is found in curcumin. “We must develop a curcumin analog that is absorbable by the human body,” Afshin Dowlati, MD, Professor of Medicine at Case Western Reserve University School of Medicine, Science Daily reports. “Currently, curcumin ingested as the spice turmeric has practically no absorption within the gut.”

High PIAS3 Tramples STAT3, Kills Mesothelioma Cells

Dowlati, who is the senior author of a report that will be published October 10 in Clinical Cancer Research, and colleagues at Georg-Speyer Haus in Frankfurt, Germany, looked at tissue samples from mesothelioma solid tumors removed from patients in different parts of the US. Each sample contained information about how long the patient lived with the disease and the type of mesothelioma.

Patients with low PIAS3 peptides had active STAT3 and were more likely to die sooner. But those with high PIAS3 levels were 44 percent more likely to live another year, “which is substantial,” Dowlati says in a Case Western press release.

The researchers conclude that curcumin and PIAS3 peptides raised PIAS3 levels, which lowered STAT3 activity and caused mesothelioma cells to die, a finding that can lead to clinical trials.

PIAS3 May Hold Clues to Mesothelioma Progression

The study also shows that PIAS3 may be a reliable indicator of mesothelioma progression. Mesothelioma tumors rarely progress the same way as other ones, making it hard to predict what twists and turns patients and physicians can anticipate.

 

“PIAS3 activation could become a therapeutic strategy,” Dowlati theorizes. “Our findings beg the question of what role [it] could play in limiting STAT3 activation in other cancers as well.”

Read More