Physicians finally become politically active

Overlawyered has a great story on political battles over medical malpractice. Just go read it – Malpractice key issue in NJ, Pa. races

Another potential blow to HMOs

Supreme Court to Rule on Patients’ Rights

The Supreme Court said Monday it will use the case of a Texas woman whose HMO gave her only one day in the hospital to recover from a hysterectomy to clarify when patients can sue health insurers for denying treatment that a doctor recommends.

“That is the quintessential HMO horror story,” said George Parker Young, Calad’s lawyer. “They gave her one day after major female surgery,” even though her doctor objected. “It kind of sums up (patients’) worst fears about HMOs.”

The court also agreed to hear a companion case from Texas involving a post-polio patient required to use a cheaper pain pill than his doctor had recommended. Juan Davila claims he suffered bleeding ulcers and nearly had a heart attack.

Calad, of Sugar Land, and Davila of Denton, ended up in the emergency room, and both later sued over allegedly shoddy treatment.

Patients rights advocates and trial lawyers say HMOs need the threat of lawsuits to ensure they don’t shortchange patients. HMOs say lawsuits drive up costs for everyone and they must draw the line somewhere.

Employer-sponsored health insurance covers nearly 160 million employees and their families, as well as 16 million retirees, according to court filings in a related lawsuit. As of 2001, 93 percent of employees with employer-sponsored health plans were enrolled in some kind of managed care.

This case puts me in a quandry. I emphasize greatly with the patients and the doctors who get bullied by HMOs. I dislike opening the flood gates to lawsuits. Should I flip a coin?

Naw. The HMOs are the greater evil here. They have bullied physicians and patients for too long. They need to bear responsibility for their decisions. The Supreme Court can right a wrong here.

Coronary artery disease in women

We generally understand coronary artery disease (CAD) in men. Read the textbooks and you quickly see classic presentations. Work on the wards and those presentations fit the textbooks.

However, we seem to have more difficulty diagnosing CAD in women. This article provides some suggestions and perhaps some insights. Fatigue an early sign of heart attack?

Unusual fatigue and sleeplessness might be early warning signs of a heart attack in women, a study suggests. The study, published Monday in the American Heart Association journal Circulation, surveyed 515 women who had heart attacks and found that 95 percent had such symptoms as much as a month before they were stricken.

Chest pains can be early indicator of a heart attack, but 43 percent of the women in the study said they never experienced chest discomfort, said researcher Jean C. McSweeney.

The study is the first time researchers have identified fatigue and sleeplessness as possible early warning signs of a heart attack in women.

“If we can get women to recognize the symptoms early, we can get them treatment and prevent or delay a heart attack,” said McSweeney, a professor at the University of Arkansas for Medical Sciences in Little Rock. “That’s why the early symptoms are significant.”

The researchers said they do not know whether the findings also apply to men, who tend to have somewhat different symptoms when a heart attack strikes.

The study surveyed women ages 29 to 97 who had been released four to six months earlier from five hospitals in Arkansas, North Carolina and Ohio after suffering a heart attack. They were shown a list of 70 symptoms they may have experienced during the months leading up the heart attack and were asked to rate them based on frequency and severity.

Almost all the women – 95 percent – said they had new or different symptoms more than a month before the heart attack that went away afterward.

The most common symptoms reported were unexplained or unusual fatigue, 71 percent; sleep disturbance, 48 percent; shortness of breath, 42 percent; indigestion, 39 percent; and anxiety, 35 percent. Only 30 percent said they experienced chest pain before the heart attack.

The women had more than just ordinary fatigue and sleeplessness.

“The fatigue is unexplained and unusual. They are more tired at the end of the day then they usually are,” McSweeney said. “For some, it’s so severe that they can?t make a bed without resting as they tuck the sheets. It interferes with their normal activities.”

I suspect further investigations will find the fatigue in some men. My anecdotal memory clicks with this observation. Hopefully we can get more such studies to improve our history taking and influence our index of suspicion.

Sunless sunburn

Time for a little game. I will provide an excerpt from a case. I will not provide the link until tomorrow. You can try to figure it out. Feel free to post your guesses in the comments section. The case is quite instructive.

My patient was a 25-year-old woman who came to me, a dermatologist, because her skin had been burning for the last nine days. She described it as feeling like a sunburn, although she had not been in the sun. The sensation began on her thighs and spread to her entire body. She was aware of it all the time, and found that she felt worse when her clothing touched her skin. The discomfort persisted throughout the day. She had not been sick recently and took no medications except for some vitamins.

On examination, the texture, color and temperature of her skin were normal, and there was no evidence of scratching or of any parasites. There are a number of disorders that can be accompanied by skin discomfort without visible signs. The sensation is usually one of itching, although if itching is severe enough, it can feel like burning. Those diseases include hepatitis, leukemia, diabetes, diminished kidney function and almost any cancer if it is advanced enough.

I had blood drawn for the routine tests for the first four of those ailments, but this young woman appeared quite healthy, and I doubted that the tests would turn up anything.

In the absence of anything else, I wondered about the possibility of some sort of poisoning. She worked in an office and had no occupational exposure to toxins. She did not garden and had not been exposed to insecticides, and she had no hobbies that would have put her at risk.

On further questioning, she told me that she had a roommate who had a similar symptom, but that it lasted only a day or two. Because of the slight possibility that both she and her roommate had been exposed to something that caused the burning skin, I asked her what kind of place she lived in. She said she lived in an apartment in a coach house.

So that is your challenge for the next 24 hours. I would not have figured this one out!