When defense lawyers try to make medical decisions
Each time I find another of these cases I become more astonished. Thanks to Overlawyered for finding them. Doctors on hook for $5M
On December 4, 1998, 11-month old Jack Sprague, while with his babysitter, suffered a subdural hematoma that has left him disabled. A Maryland jury just awarded $5 million against three doctors who saw Jack a couple of weeks earlier–the theory being that if they had performed a CT scan on the infant, the parents would have discovered the babysitter’s alleged abuse earlier, preventing the injury. …. Never mind that all three doctors diagnosed the asymptomatic infant as healthy: “What harm could it have done to do a CAT scan?” a juror asked. Well, even aside from the cost, and the risk of an anesthetic on an infant, doctors warn against unnecessary CAT scans to children because of the radiation exposure. How many healthy children will end up with cancer because of defensive medicine in response to this verdict?
Just another example of the problem of our tort system. This case makes no medical sense. The lawyer’s argument defies evidence based medicine (the cry that I keep getting as to the solution to the malpractice problem). I use this case to point out that many cases having nothing to do with evidence as physicians define evidence. Outrageous!!!
An interesting take on the pharmaceutical industry
No ranting – just a link – Pop That Pill This is how the article ends – the leadup is worthwhile also –
Is all of this bad? Not entirely. There is some notion of empowerment that goes along with being a medical consumer rather than a mere patient. Sure, drug companies are trying to persuade you, but that in itself means they are investing you with the power of decision-making. It means you are being emboldened to discuss alternatives with your doctor without being concerned that you will be patronized, as patients routinely were in the Marcus Welby era. But with empowerment comes increased responsibility. How many people have the insight or time to look at the published research before confronting their doctors with what they think is the drug they ought to be taking?
One doctor told me he’s gotten tired of arguing with those of his patients who insist on an inferior or inappropriate drug because they liked the advertisement. “I don’t make a case for or against individual treatments anymore,” he said, “no matter how much I may disagree, It takes away time I need to deal with other patients. I just flat out give my opinion, and they can take it or leave it. But considering that I’m the one with the M.D., if I were the patient, I’d listen up.”
Are there benefits to having a more informed patient base? “Informed is a loaded word,” this doctor said, “Informed about what? The ads usually end off by saying, ‘Ask your doctor,’ but the message they’re really conveying is, ‘Tell your doctor.’”
Whether to prescribe antibiotics for bronchitis
Antibiotic resistance represents a significant threat now, and in the future. Giving antibiotics for non-bacterial infections causes much of the problem. Physicians have a dilemma when patients have bronchitis. We just do not know whether whether we should prescribe antibiotics.
A new study suggests that we may be able to use a blood test to help with that decision. New test shows promise at reducing unnecessary antibiotic use
After the blood test results were revealed, the researchers then advised the doctors to prescribe antibiotics only if the blood level of the chemical marker, called procalcitonin, was above a certain level.
The rate of antibiotic prescriptions foreseen by the doctor was similar in both groups before the blood test results were disclosed.
But once test results were known, antibiotic prescriptions dropped almost in half. A total of 99 patients in the comparison group got antibiotics, compared with 55 in the blood test group.
Antibiotics were given to 22 patients with a blood test showing low levels of the chemical marker. Doctors often prescribe antibiotics to people with severe viral infections because viruses can damage the airways enough to encourage a subsequent life-threatening bacterial infection.
“Importantly, withholding antibiotic treatment was safe and did not compromise clinical and laboratory outcome,” said the study, led by Dr. Beat Muller at the University of Basel.
Dr. Marc Siegel, a professor of medicine at New York University School of Medicine, said the study convinced him the procalcitonin marker may help doctors, but larger studies are needed to determine if it is safe to withhold antibiotics from high-risk patients.
The danger of missing a severe or progressing bacterial infection is too great to rely solely on the blood test, Siegel said. “You worry about antibiotic resistance, but you also worry about patients dying,” he said.
Interesting! I hope we do see more studies on this test.
