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What’s that, Doc?
Three-fourths of patients say they didn’t understand their discharge instructions
… and more EM news

What’s that, Doc?
Three-fourths of patients say they didn’t understand their discharge instructions

Ann Arbor, Michigan – Better patient education and formal training for EM providers could go a long way in closing a serious communication gap that exists regarding medication instructions and other follow-up care when patients leave the ED.
Though real-life conditions make perfect communication impossible, EPs need to take the time to identify patients with comprehension problems and encourage them to ask questions regarding their discharge instructions, according to researchers at the University of Michigan in Ann Arbor.


A study published last month in the Annals of Emergency Medicine found that more than three-fourths of ED patients did not understand their discharge instructions and that most were not even aware of their lack of understanding, the study suggested.
“We need to make every effort to improve the communication process and implement strategies and changes that will facilitate that process,” said Kirsten G. Engel, MD, an EP at Northwestern University in Chicago and a lead researcher in the Michigan study.
Not satisfied with your hospital? Build your own! 
Three EPs team up to build an 18-bed community hospital

Toledo, Ohio – A trio of enterprising EPs has struck out on its own, using its own money to build not just another emergency group practice but a fully functioning state-of-the art general hospital with a seven-bed ED.
Jerome McTague, MD, JD, John Wukie, DO, and Leilani LaBianco, MD, recently signed with a local developer-partner to build the 18-bed community hospital for an undisclosed sum.

When completed, Physician’s Choice Hospital, LLC, will feature state-of-the-art digital technology, including a new 64-slice CT scanner, computerized radiography, and a facility-wide electronic medical records system, according to McTague. The hospital is slated to open in Spring of 2009 and will be capable of handling between 6,000 to 12,000 ED visits per year, McTague said.


Financed through a coalition involving the three physicians, the developer, and a group of lenders, the project is the latest example of physicians assuming greater ownership control over their work environment. “We wanted a stable practice environment where we could do what we want when we wanted it. Owning your hospital is really the best way to go,” McTague said.

The color of medicine
Study shows persistent racial imbalance among emergency physicians. AMA promises to work harder to increase the ranks of minorities in medicine.
San Francisco, Calif. – California, which prides itself in having one of the most ethnically and racially diverse populations in the country, can’t say much that is positive about the ethnic representation of its physician workforce.
The same is true nationally. According to the American Medical Association, less than one in every four physicians working in the U.S. comes from the four major ethnic minority groups in the nation: Hispanics, blacks, Asians/Pacific Islanders, and Native Americans.“The numbers are so low that they become negligible when it comes to individual specialties such as emergency medicine,” said Phyllis Kopriva, director of the AMA’s Special Groups in Chicago. 

Last month, The Center for California Health Workforce Studies in San Francisco released findings of the first formal survey of its kind. It found that while Blacks account for 7 percent of the state’s population only 3 percent of physicians are African American. Only 5 percent of physicians are Hispanic out of 35 percent for the general population.
Native Americans fared even worse with one percent of the population but only 0.6 percent of physicians. Asians and Pacific Islanders did much better. Twenty-six percent of physicians are Asian out of a population that is only 11 percent.

Years of racial discrimination, poverty, and the exorbitant cost of medical training have accounted for the low numbers, Kopriva said. Last month, the AMA issued an unprecedented formal apology for “its past history of racial inequality toward African-American physicians.” The group promised to work harder to increase the ranks of minorities in medicine.
EPs in malpractice suit wrangle over definition of “expert witness”
North Carolina judge OKs EP testimony regarding MRI case

Raleigh, North Carolina – In an unusual case, the state supreme court has agreed to hear arguments that two emergency physicians and a neurologist are in fact qualified to give expert testimony in a private malpractice suit even though the defendants in the case, who are themselves EPs, question the validity of the witnesses’ testimony.


The plaintiffs in the case, Kenneth and Ann Weaver, sued physicians with Raleigh Emergency Medical Associates alleging that the EPs Charles Michael Sheppa, MD, and Leslie Patricia Marshall, MD, were negligent in failing to immediately order an MRI after Mr. Weaver presented at the ED at Rex Hospital complaining of neck, arm, and back pain.

The delay, according to documents filed with the court, deviated from an “applicable standard of care” and further delayed surgery that could have improved the patient’s outcome. The MRI ultimately revealed a large central herniated disk and compression of the cervical spinal cord.

The original case ended in a mistrial. But the trial judge granted the physicians’ motion for a judgment notwithstanding the verdict and set aside the Weavers’ complaint. The Weavers appealed. During the appeal, the defendants’ lawyers questioned the validity of Mr. Weaver’s expert witnesses, claiming that the testimony should have come from a neurosurgeon, not two EPs and a neurologist.

The appeals court disagreed ruling that expert testimony can be considered competent “as long [as it] is helpful to the jury and based sufficiently on information reasonably relied upon under” state law. Defendants’ lawyers did not return calls for comment. The state supreme court will ultimately decide the issue. 

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