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Medical Rationing: The Last Best Hope?

Photo Credit In 1972, George Carlin, the irreverent comedian who believed that boundaries are meant to be crossed, listed the 7 dirty words that could never be aired. These were considered to be a broadcaster’s ‘never event’. While society’s prohibition against offensive language and images have relaxed exponentially, there are still words and expressions that are radioactive. I am quite certain that health care reformers have conducted focus groups to determine which verbiage offends and which phrase soothes the skeptical public. Words matter. I used to think that studying linguistics was merely an academic pursuit for grad students. Not so. These wordsmiths can now find honest work on Capital Hill. They can educate politicians on the nuances of language and expression so that our elected officials can speak out of a third side of their mouths. We all remember from the prior presidential campaign how a wayward sentence can be exploited by adversaries who are poised to pounce. Recall

Medical Malpractice Strikes Again! A New Confession

I’m surprised that they haven’t thrown me out of the profession yet. In the past year alone, I have been sued for medical malpractice , committed a ‘ never event’ and confessed to performing an unnecessary medical test on a patient. It’s a wonder that my medical license hasn’t been revoked. Keep in mind that the above events are only those transgressions that I have admitted to. Imagine the misdeeds, misadventures and misconduct that I’ve kept secret. Are handcuffs in my future? For example, I should I have come clean that a 2nd medical malpractice case was recently filed against me. I received the thick envelope from noble and altruistic Cleveland barristers about 6 weeks ago. Once again, I saw my name in the good company of many other physicians and our local hospital. I reviewed my medical records and felt comfortable with the care I had provided. In a medical malpractice case, quality of medical care is important, but the truth won’t set you free. It’s the documentation, stupid! I

The High Cost of Health Care: A Personal Confession

Photo Credit Who says one person can’t make a difference? This past week, I personally set back health care reform. No, I wasn’t attending a ‘tea party’ or decrying Obamacare in a venomous letter to the editor. I single-handedly bent the health care cost curve in the wrong direction. I performed an unnecessary medical test on a hospitalized patient, which exposed her to risk and cost the system money. Why did I do this? Personal enrichment? Fear of litigation? Need for a juicy Whistleblower post? None of the above. The patient was hospitalized after a week of abdominal cramps, nausea, vomiting and diarrhea. A CAT scan of the abdomen, often ordered by reflex in the emergency department (ED), showed no abnormal findings. In the ED, her white blood count was modestly elevated, but had normalized by the following morning when I met her. My physical examination demonstrated no concerning findings. I suspected that she was suffering from gastroenteritis, medical jargon for‘stomach flu’. Ph

U.S. Preventive Services Task Force and Mammography: Evidence-Based Medicine or Medical Rationing?

WELCOME TO MAMMOGATE! This week, the revised U.S Preventive Services Task Force (USPSTF) mammography guidelines monopolized newsprint and airtime. Was this truly Page 1 news? For a few days, mammojournalism pushed aside stories on the war in Afghanistan, double digit unemployment, Iran’s hidden nukes, the president’s foreign nation tour and the war on terror. (Note to readers: The phrase ‘war on terror’ is now verboten in the the Obama administration. No spokesmen will utter it, except on deep backround. I unabashedly use it since it seems that our enemies are still at war with us.) Of course, it’s not the science of mammography that is white hot – it’s the politics of breast cancer that is volatile and combustible. Medical guidelines in every specialty are revised regularly, yet no conflagration erupts in the public square, as occurred last week. When my own specialty revises colonoscopy guidelines every few years, the public and the medical community respond with a collective yawn. N

A ‘Never Event’ In My Own Practice!

I have already opined on the ‘ never events’ reform where hospitals would not be compensated for certain medical catastrophes that should never occur. We all agree that performing surgery on the wrong organ, or the wrong patient, should never happen. My fear is that the list of events will metastasize and will include many unfortunate medical outcomes that cannot be avoided by even the most diligent physicians and institutions, a point echoed at The Covert Rationing Blog, and elsewhere. Dr. Val, in a guest post at Health Care Law Blog argues that patient falls in the hospital, while regrettable, should not be a 'never event'. Dr. Wes , a cardiologist, irreverently suggests that the common cold may be added to the 'never events' list! We bloggers know how easy it is to hurl opinions from our safe sanctuaries. I learned this when I wrote a post about excessive emergency room care. Folks who had never heard of me, an obscure gastroenterologist from Cleveland, were leav

Tort Reform for Lawyers!

The law has many privileges and protections for its own players that are necessary for the legal process to operate effectively. For example, we all accept that a judge should have absolute legal immunity for decisions and judgments made in his judicial capacity. If a judge could be sued because he ruled that certain evidence was inadmissible, for example, then the system would collapse. Immunity allows judges to decide legal issues freely, without any threat that he could be legally vulnerable. This is how it should be. Earlier this week, the U.S. Supreme Court heard oral arguments that challenge legal immunity for prosecutors, under certain circumstances. As an aside, I learned an astonishing fact in the New York Times article that reported that … prosecutors cannot be sued for anything they do during trial, including knowingly submitting false evidence . Read this sentence again. I had to as I was sure I had misread it initially. Immunity for trial conduct was not the issue bein