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September is Leukemia Awareness Month

July 2013 Archives

Doctor Credentials Must Be Given To Patients

Doctors should communicate their qualifications and training to patients, and a new law in Maine now requires health care professionals to tell patients their credentials. It is the fourth such law that has been enacted this year. This truth in credentialing requirement is based on the American Medical Association's "Truth in Advertising" model bill. The new law requires that all health care professionals display their education and licensure so patients know who is providing their care. Physicians and non-physicians must wear identification that displays their name, type of license and staff position. When advertising their services, physicians must communicate their licensure status and not promise more than what their education, training and licensure allow.

Diagnostic Errors by Smart Doctors

Diagnostic errors are estimated to occur 10 to 15% of the times with the highest error rates in general care cases where patients are diagnostically undifferentiated, such as emergency rooms, family medicine and internal medicine. The article in the New England Journal of Medicine looked at why so many errors are made. In focused visual specialties such as radiology and pathology, error rates are much lower at 2%. Smart doctors make dumb mistakes when they fail to recognize that they are thinking on an intuitive level rather than on analytical level. That is, even doctors fall victim to cognitive bias which leads them to incorrect diagnoses. For instance, in 55% of fatal cases of pulmonary embolus, the diagnosis was completely missed. The brain processes information on two levels: an intuitive (Type 1) level and an analytical (Type 2) level. Intuitive Type 1 thinking is largely reflexive and autonomous often happening in the blink of an eye. These intuitive thinking patterns (heuristics) are either hard-wired into our brain or acquired through repeated experience. Trusting ones intuition is generally correct but not always. Unless physicians recognize when they are susceptible to Intuitive Type 1 errors, the misdiagnosis rate will not decrease.

Primary Care Malpractice Claims

Primary Care Malpractice Claims are mostly a result of missed diagnoses and medication errors, a recent study in the British Medical Journal reports. Thirty four studies performed in the United States, United Kingdom, Australia, Canada and France were reviewed. The most common cause of malpractice claims were missed or delayed diagnosis, accounting from 26% to 63% of all claims in all the studies. Death was the most frequent result of these misdiagnoses. Failing to diagnose cancer, myocardial infarction and meningitis were the most common errors. Medication errors were the second most frequent cause for malpractice claims, totaling between 5.6% and 20% depending on the study reviewed. Errors occurred with multi-provider care, with 43% of errors involving 2 or more clinicians and 16% involving 3 or more clinicians.

Brain Aneurysm Growth Is Most Important Predictor of Rupture Risk

Brain aneurysms are more likely to rupture if they are growing even if they are small, a new study in Radiology reports. Aneurysms of 7 mm or more are the size where the benefits of treatment generally outweigh the risks of rupture, based on earlier studies. This had been interpreted that size alone is determinative of rupture risk. But ones that grow in size over time are at even greater risk for rupture, regardless of size. This means that all aneurysms of any size need to be followed. If they are growing, then treatment needs to be considered. Monitoring can be done by annual CT examination which is readily available and not cost prohibitive.

Narcotic Painkiller Overdoses in Women Skyrocket

Deaths from overdose of prescription narcotic painkillers have skyrocketed in women according to new data from the U.S. Center for Disease Control (CDC). The problem is getting worse quickly. The number of women dying from prescription painkillers has increase 5 fold between 1999 and 2010. These fatalities have included too many mothers, wives, sisters and daughters to go ignored. The increase in fatalities is directly related to an increase in the number of prescriptions written by physicians for both acute and chronic pain that cannot possibly be clinically indicated. In 2010, 18 women died every day from narcotic painkiller overdose, with four times as many women dying from these drugs than from cocaine and heroin. "These are troubling numbers," said the CDC Director Tom Frieden, MD, MPH.

Hypothermia Reduces Neonatal Hypoxic-Ischemic Brain Damage

Whole body cooling reduces brain damage from oxygen deprivation during birth and can lessen death and disability rates for these infants. A study of the use of hypothermia therapy (reduced body temperature) for babies with a gestational age of 36 weeks or more and who had severe asphyxia during birth was performed. Infants were randomly assigned to normothermia or hypothermia, and neurodevelopmental outcomes were assessed at 18 to 22 months of age. Without hypothermia, infants with severe encephalopathy have a 60% chance of death and those that survive are handicapped. Reductions in brain temperature provide neuroprotection when assessed in animal experiments. The use of whole body cooling initiated within 6 hours of a birth and continued for 72 hours was studied. The results showed a decrease in death from 62% to 44% with hypothermia. The incidence of disabling cerebral palsy decreased from 30% to 19%.

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