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Oregon Medical Malpractice Law Blog

Fine line exists between diagnosis and overdiagnosis

As Oregon residents may know, health care professionals use a myriad of tools to arrive at a proper diagnosis. Today, the contents of that tool chest have expanded to include neuroimaging and other sophisticated techniques. Defining disease such a traumatic brain injury and breast cancer are but two of the areas where diagnosis is aided by new tests.

There is a fine line between diagnosis and overdiagnosis, according to a professor at the University of Pennsylvania. In some cases, the nidus of suspected disease detected by sophisticated instruments might not herald harm to the patient. In addition, in situations where the true diagnosis might be better confirmed by biopsy, deciding on a diagnosis is tenuous if a biopsy cannot be performed.

Understanding more about MELAS

Oregon residents may benefit from understanding more about the challenges physicians face when attempting to diagnose a unique medical condition like mitochondrial myopathy, lactic acidosis, encephalopathy and stroke-like episodes. Otherwise referred to as MELAS, this medical condition is described as a common mitochondrial disease, or DNA mutation, that is a neurodegenerative disorder affecting a number of internal systems, especially the muscle and nervous system.

Patients with MELAS often exhibit different symptoms, and the actual course of the disease can vary as well. In addition, the episodes are often recurrent for many MELAS patients. Researchers claim that establishing an accurate diagnosis for MELAS relies heavily on monitoring the muscle biopsy, genetic results, serial MRI readings and clinical manifestations. Adhering to these parameters may help improve physicians' ability to diagnose this condition in its earlier stages. Some of the early symptoms of MELAS include vomiting, loss of appetite, persistent headaches and muscle weakness. Seizure and pain and exercise intolerance are common MELAS symptoms as well.

Electronic fetal monitoring devices may cause harm

In Oregon and around the country, obstetricians often use electronic fetal monitoring devices on pregnant patients. Large-scale trials using continuous EFM were done in the late 1980s, and it became clear that EFM was not lowering risks during birth. More research in the past 20 years has also shown this, but doctors still prefer to use it because of cultural reasons that include the increased medicalization of childbirth and obstetricians' fear of a malpractice suit.

EFM use has been associated most with instrumental and C-section births, which lead to a higher risk of birth injuries, according to the American Academy of Nursing. Doctors cannot agree on the meaning of the EFM printouts, even though they think the heartbeat printout could help them in a malpractice suit. A medical center midwife says that a safer way to monitor the fetus heartbeat is intermittently using a stethoscope or fetoscope, and that only in a high-risk situation, such as inducing labor, is continuous monitoring helpful.

Can Toyota make hospitals safer?

As patient volumes increase in the wake of the Affordable Care Act, some public hospitals are turning to a surprising source to help them keep pace: Toyota. By adapting the Japanese automaker's production system to health care, hospital administrators have been able to cut costs and improve patient care. The philosophy could impact patient care in Oregon and nationwide.

Toyota uses a system known as "lean," which involves a concentrated team effort to improve quality and efficiency. Private hospitals in Washington, Wisconsin and elsewhere began using the method over a decade ago, but it's just now catching on in busy public hospitals. Harbor-UCLA Medical Center in Los Angeles recently used the philosophy to streamline the way it schedules surgeries, stores equipment and discharges patients. For example, its operating room staff reorganized their storage closet, clearly labeling everything and giving each item an assigned location. This makes it possible for staff to easily locate what they need and provide care quickly. Four public San Francisco Bay Area hospitals are also trying the approach.

New test may help doctors diagnose pancreatic cancer sooner

Oregon residents who have or know someone with pancreatic cancer are probably aware of how serious this disease can be. Around 40,000 Americans will die from it in 2015, out of the nearly 50,000 who will be diagnosed with it this year. Patients have better luck if they are diagnosed as soon as possible, but about 80 percent of people with pancreatic cancer are diagnosed at later stages. A new study explores the option for a low-cost test that can diagnose the disease in its early stages.

A biomarker found in a patient's urine could detect pancreatic cancer in a noninvasive way, according to the study published in the scholarly journal Clinical Cancer Research. When studying the urine samples of healthy individuals and those with pancreatic cancer, chronic pancreatitis and other conditions related to the liver and gall bladder, researchers found that the amount of three proteins were much higher in those with pancreatic cancer. After forming a panel with the three proteins, the researchers were able to diagnose those in the early stages of pancreatic cancer with greater than 90 percent accuracy.

Hospitals make efforts to reduce medical malpractice lawsuits

Oregon residents may be surprised to learn that approximately 1 million medical injuries occur each year. Many of these injuries are caused by doctor or hospital negligence or mistakes, and health care facilities across the country are taking proactive steps to reduce the likelihood of a medical malpractice lawsuit being filed against them. Particular attention is being paid to reducing medication errors and unnecessary surgeries, which combine to claim the lives of almost 20,000 patients each year.

Some hospitals are hoping that the implementation of additional quality control procedures will help them to avoid malpractice litigation. An independent third party may be brought in to ask patients questions about their experiences after undergoing a surgical procedure, and this information could provide doctors with valuable insights should a patient's condition deteriorate. The goal of this kind of quality control follow up is to identify patterns of substandard care that could lead to improvements in procedures or the removal of medical team members who regularly perform poorly.

Recording of surgery proposed

Some patients in Oregon and across the United States may have experienced adverse results following a surgery or other medical procedure. In response, some state legislatures have proposed that patients be able to record their surgeries. They believe that this may help to prevent errors by allowing patients to review their surgeries and determine if any of the doctors or support staff were negligent in their duty to provide quality medical care. However, there are also issues of legality and ethics involved with this kind of legislation.

Patient privacy laws are often rigorous in preventing any sort of recording being made of a surgery. Modifications to the law may be necessary for the patient to make a video record of a procedure.

New standards for patient care at nursing homes

Families in Oregon that have loved ones who are living in nursing homes or other long-term care facilities may be interested to learn about a proposed rule that was recently issued by the Centers for Medicare and Medicaid Services. On July 16, CMS published a set of new standards that will set stricter guidelines for patient care and create more government oversight of nursing homes and long-term care facilities.

One of the main components of the proposed rule is a set of requirements for nursing home staff. Staff members must have training in elder abuse prevention as well as appropriate skill sets that are needed to provide person-centered care. Before taking on new hires, nursing homes would be required to conduct thorough background checks, and they would be prohibited from hiring any staff members that have previously been disciplined for theft, mistreatment or abuse.

Do pharmaceutical payments compromise physician integrity? Part II

Earlier this week, we began a discussion about doctors who receive payments (cash and otherwise) from pharmaceutical companies and medical device manufacturers. These for-profit companies are not buying lunch for physicians and paying them to speak on behalf of their products simply because they want to reward doctors for the important work they do. Instead, these companies understand that such tactics work. It takes money to make money, and pharmaceutical companies definitely make money.

ProPublica reports that about 606,000 physicians received payments from pharmaceutical and medical device companies last year (as did dentists, optometrists, chiropractors and other medical professionals). Obviously, a physician who has frequent contact with pharmaceutical reps and receives a lot of payments is less likely to be trustworthy than the doctor who has maybe accepted a free lunch once or twice. But where do we draw the line between objective/ethical and biased/unethical? It is precisely this question that prompts some physicians to avoid drug company payments and perks altogether.

Do pharmaceutical payments compromise physician integrity? Part I

Medicine is a science. And like all sciences, one of its most important aspects is objectivity. If a doctor prescribes a certain course of treatment or a certain medication, it should be because it has proven to be effective, it is reasonably safe and it will meet the patient's medical needs. In most cases, these are the only factors a doctor needs to consider.

As patients, we have to trust that are doctors are objective. But can we trust them if they regularly receive payments and other perks from pharmaceutical companies? Many doctors say that they can remain objective, but how can we be sure. Moreover, how can the doctors themselves be sure?