Healthcare Update Satellite – 04-08-2014


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Emergency physicians more likely to miss signs of strokes in young patients – often headaches with dizziness. Those misdisgnoses may account for 40,000 to 80,000 preventable deaths each year.
Of course, the answer to save lives is to perform MRIs/MRAs on everyone with those symptoms.
Until some beancounter tells you that the MRIs and MRAs are “unnecessary”. Then you’re a bad doctor for ordering the tests. So you don’t order as many tests.
Then you miss a stroke and the news media references a journal article about missing strokes with those same symptoms, points to your care and tells everyone what a bad doctor you are.
Then some administrator tells you that your failure to order a test that missed the uncommon presentation of a disease cost them a million dollar settlement.
Then you order more tests to keep from missing another case of a stroke.
Then the beancounters tell you that your testing is unnecessary …

Kansas City area pain clinic gets hit with $2.88 million verdict when patient commits suicide due to pain from MRSA meningitis. Clinic physicians allegedly performed spinal injections through an abscess that had formed on the patient’s back and seeded his spinal canal.

Speaking about pain, the American College of Medical Toxicology meeting had research showing that there was a 65% increase in opioid prescribing for headaches. For hydromorphone (Dilaudid), the increase was 450%. Investigators noted that “we are concerned that providers are prescribing these medications, despite guidelines recommending against their routine use” but also noted that patient satisfaction scores and regulatory requirements (pain is the fifth vital sign, right Joint Commission?) are likely driving these prescribing trends. These types of unintended consequences are exactly what happens when you have clueless people trying to regulate health care.

Physicians finding it more and more difficult to deal with online trolls. “Because the Health Insurance Portability and Accountability Act (HIPAA) of 1996 prevents doctors from discussing patients, disgruntled and anonymous individuals can pick fights over their quality of medical care with little chance of being successfully hit back, leaving physicians almost powerless to defend themselves. In some instances, aggravated patients use that advantage to mount calculated attacks with the intention of inflicting irreparable damage to careers and reputations.”
Anyone willing to donate to a Kickstarter campaign to create a HIPAA compliant web site for doctors to rate patients?

Physician describes how he prescribes more Adderall and Dexedrine to increase his satisfaction scores on Yelp. He also notes how he “hasn’t advised a single patient to exercise regularly or maintain a healthy diet since 2011, saying he learned his lesson after receiving a devastating one-star review.” Courtesy of the Onion – America’s Finest News Source.

Former nurse jailed for 20 years for killing her infant … by breastfeeding. The woman was taking morphine for chronic pain due to a car crash and prosecutors convinced a jury that there was sufficient morphine secreted in the woman’s breast milk to kill the infant. A pathologist testified that there was enough morphine in the infant’s system to kill an adult.
Yet the American Academy of Pediatrics actually recommends using morphine over other pain medications when breastfeeding.

How can you spot a psychopath? This article gives 20 psychopathic traits and also gives a good discussion of what makes a psychopath. “These people lack remorse and empathy and feel emotion only shallowly … it’s like colour-blind people trying to understand the colour red, but in this case ‘red’ is other people’s emotions.”

Breath-actuated nebulizers and traditional handheld nebulizers showed no difference in clinical effectiveness when compared in the emergency department. Guess which one is more expensive.


  1. For Matt – not related to this post, but I just saw on CNN (yeah, I know) that US lawyers have gone to the hotel that the Malaysia flight families are staying at, trying to get them to sign up to their firms to sue. What is your take on this? For example, if there was some horrible, huge fire, and plastic surgeons flocked to the victims’ families hotel/hospitals to garner business – people would be repelled. Why is this acceptable for attorneys and not MDs? I’m not dissing – I really want to know. As a doc, I’ve never understood why it’s OK for other professions to advertise, but it’s frowned on for us. Thoughts?

    • I’m not sure how I comment on a story I haven’t seen. It sounds pretty unseemly, and I certainly wouldn’t do it, but like with any profession there are always some who push the boundaries.

      As far as why you guys don’t advertise, I don’t know. Bar associations tried for years to stop lawyers from doing it, but there were really no grounds to stop them. It’s probably the same with physicians, at least those who are compensated via third parties, because the insurers do the marketing for you really. They get the patients in-network. I’ve seen plenty of ads for physicians who are paid directly by the patient, such as plastic surgeons.

      • Thanks for your reply. It is bizarre why we can’t/don’t advertise, although facilities – hospitals, EDs with their new “wait times” crap on billboards, substance abuse treatment centers, etc do. I guess these days, since very few of us are directly compensated by patients, it’s a moot point. But even in the days where that wasn’t the case, no ads.

  2. “Anyone willing to donate to a Kickstarter campaign to create a HIPAA compliant web site for doctors to rate patients?”


    It’s an interesting question as to why HIPAA trumps MDs’ First Amendment rights to free speech. At the very least, HIPPA should be revised so that once a patient posts about his or her medical history via a complaint on an MD, he or she has automatically given up the right to privacy.

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