Use Measured Firmness When Dealing With Pediatrician About Swine Flu Concerns

If you're like me and live in a large metropolitan area (Chicago) and have small children (18 months) in school or daycare (the latter), you may be a little concerned about the swine flu. There is no vaccine or cure, it is spreading quickly in crowded environments and it has proven deadly in the very young. I imagine that many pediatric and family practice offices are being inundated with calls from worried parents wondering if little Johnny's or Jane's sniffles could be related to this growing epidemic. I have to admit that I have visited the website of a well-known pediatric office here in Chicago to check on recommendations for dealing with this situation. Should I be stocking up on Tamiflu just in case? The answer, of course, is no for now. Frequent hand washing and avoiding obviously sick people is all one can reasonably do for the moment.

But what if your child starts to experience flu-like symptoms?

Take him or her to the doctor and request a test for the swine flu, aka the H1N1 virus. A quick test can be done at the doctor's office to determine if your child has influenza (flu). If that test is positive additional testing can be done to determine if it's the H1N1 virus vs. the garden variety flu. Do not allow your doctor to brush you off with comments like, "It's probably just a cold," or "I'm sure she's fine." I appreciate that physicians will likely grow weary of patient concerns about the swine flu, but there is simply no reason for such speculation, especially with regard to young children. Do not allow your concerns to be brushed aside. If your child has flu symptoms, ask for the test. Time is of the essence because Tamiflu, which can reduce the severity of H1N1 virus once contracted, must be given within 48 hours of the onset of symptoms.

Not All Hospitals Are Created Equal

Last week I wrote that when it comes to picking a family doctor you don't need the best. What you need is someone who is competent and caring and whom you like and feel comfortable communicating with. To treat a serious ailment, injury or disease the family practice doctor will refer you to a specialist anyway. However, when it comes to picking a hospital, it's a different story. Not all hospitals are the same. The importance of choosing a good hospital is highlighted here.

Choosing a good hospital can be tricky, but the bottom line is that it usually comes down to resources, money. Some hospitals have it, and use it to create fantastic centers for diagnosis, treatment and learning, and others do not. There are some hospitals here in Chicago that constantly seem to be spending money to improve patient services. Northwestern Memorial Hospital just opened its brand new Prentice Women's Hospital and Loyola University Hospital is expanding its Center for Heart & Vascular Medicine. With regard to hospitals like Roseland Community Hospital and St. Bernard I have to wonder how they manage to even keep the lights on. A hospital's wealth is certainly no guarantee that it will provide safe, error free care to all of its patients, but odds are that you'll be better off.

The other thing you'll need to consider in choosing a hospital is they type of care you need. Some hospitals are simply better at treating certain kinds of patients than are others. For example, if you are having a baby I doubt you could do better in Chicago than the aforementioned Prentice Women's Hospital. If you have heart issues, St. Francis in Blue Island (now Metro South) has a good reputation. Once again, no hospital is perfect. I am aware of serious errors committed at each of the hospitals I have mentioned here. But remember, you are playing the odds. Do your homework before you require a significant hospital stay and you will decrease your chances of becoming a victim.

Here is a link to what US News & World Report thinks are the best hospitals in the United States.

VA patients test positive for HIV after treated with contaminated equipment

Here's a follow up to the story about Veteran's Administration patients who received treatment with contaminated endoscopic equipment. Some have tested positive for HIV.

Less Romance, More Communication

Several years ago I was sitting in the back of the courtroom during closing arguments in a medical malpractice case tried by two senior and very talented trial attorneys. The case arose from the death of a man who died of meningitis after physicians completely ignored obvious signs and symptoms. The man left a grieving widow and a son. During his closing argument the defense lawyer asked the jury rhetorically, "What is a doctor?" He then preceded to wax on eloquently about the challenges physicians face during their careers. I remember the defendant doctor sitting there emotionless in his expensive looking suit as his lawyer went on, painting him as a tragic hero. I also remember seeing the wife of the deceased sitting at the adjacent table looking forlorn and detached. I was sure that she wanted to be anywhere else. The doctor's lawyer, coming near the end of his closing, again asked the question, "What is a doctor?" clearly feeling that by that point, everyone had received his message that a doctor, his client, was nothing less than a hero. As the lawyer took his seat a tense silence enveloped the courtroom. The judge looked over at the widow's attorney, "Counsel?" The old attorney looked grim as he stood, a bit of anger on his face as he strode slowly to the center of the courtroom to face the jury. "What is a doctor?" he growled; "What is a husband?" His voice trailed as he looked at the jury. It looked as if he might say something else, but he didn't. He turned quietly and returned to his seat next to the widow.

Earlier this week I saw a story in USA Today announcing a new book called The Soul of Medicine by Sherwin Nuland, a former physician. The headline of the story proclaimed the apparent premise and primary subject matter of the book, that A doctor's 'Soul' is tormented by medical errors. Reading that reminded me of the closing arguments in that trial from several years ago. It bothers me too. I have no doubt that some physicians feel haunted by their mistakes. However, I have spent too many years going after arrogantly unrepentant doctors to feel anything but cynical with regard to the medical profession. I remember going to visit a neurosurgeon at his office to discuss a client of mine. I remember being shocked to see clear evidence of his god complex hanging right on his wall:



We all feel haunted by our mistakes. When any of us make a mistake that causes harm to another person the pain we feel is worse. I become deeply troubled, however, by the romanticizing of the medical professional. I feel this way because I frequently witness the impact it has. It makes physicians seem like exalted "others"; like gods among us mere mortals. This falsehood creates an atmosphere of tension, apprehension between doctor and patient. The patient all too often feels intimidated by his caregiver. This is undoubtedly a counterproductive state of affairs.

One of the reasons that we trust our doctors is that there is a perceived difference in social status between them and us. But this is not healthy. It discourages frank and open communication, which leads to poor treatment and an increase in medical errors. The more you communicate with your doctor the more you will see each other as individuals entitled to equal amounts of respect. This will encourage even more communication and openness which will lead to better care and fewer mistakes.

Pick A Doctor You Like, Then Hold On Tight

Continuity of care. That concept is vital when it comes to fostering good health care where a minimum of errors are made. What it means is that you should stick with the same doctor for as long as possible. Doing so is often difficult in our current system where patients usually rely on private health insurance to cover costs. Often a insurer will unexpectedly decide to drop a physician or physician group from its plan. Many times a physician's office will decide to no longer except a patient's health insurance. Those significant realities aside, the importance of doing whatever possible to keep seeing the same doctor cannot be overstated. This is especially true when it comes to your primary care or family physician.

A good friend of mine who is a board certified family practice doctor recently forwarded to me a video from ABC News discussing the importance of continuity of care and the family practice doctor. The video can be seen by clicking here. Continuous care with the same family doctor means regular medical follow ups. It means preventative and consistent care for chronic health issues like diabetes and allergies. There are few if any formulas for patient care. Different physicians have different approaches to patient care and treatment. There is nothing necessarily wrong with this. However, when a patient constantly switches from doctor to doctor with their different approaches to treatment and prescribing medication, confusion is all too often the end product. This leads to more medical errors and patient injury or death as a result.

Let's be frank, you do not need the very best doctor to be your family care physician (as if there were a way to measure what it means to be the best.) You need a competent, caring physician who knows you, your body and your medical history. In my view there is nothing more important to safeguard patient safety and to reduce preventable medical errors.

What's Up In Wisconsin

For quite a few years Wisconsin Medical Society has maintained a victim's compensation fund to provide for the harms done to patients due to medical errors. Here is an interesting story about how the State has stolen money from that fund.

Illinois Hospitals Working to Overcome Language Barriers

The importance of communicating clearly and effectively with your doctor cannot be overstated. This can be a huge problem where you and your physician do not share a common first language. The Chicago Tribute recently reported on an innovation that is meant to help patients and doctors overcome a language barrier. Click here to view full story.

What is medical malpractice anyway?

Here at the old firm we often test a case in front of a group of regular people prior to trial to see how they react to various issues. We do this because after years of litigation in which we've focused on minutia we often worry about losing sight of the forest through the trees. Nothing is better, in my opinion, than asking a group of non-lawyers what they think of your case to help prepare for trial. Most often the kind of cases we test in this way are lawsuits brought against doctors, nurses and hospitals; medical malpractice cases. During these tests one question comes up time and again: What is medical malpractice anyway? Is it different from medical negligence? After presenting a case to a focus group we often hear people say that they felt the defendant, i.e. physician, acted negligently but was probably not guilty of malpractice. This tends to leave us scratching our heads. Under Illinois law "medical negligence" and "medical malpractice" mean exactly the same thing. So why is it that non-lawyers, the kind of folks you'd see on a jury, tend to intuitively see the two differently?

A physician is guilty of medical negligence and medical malpractice when she fails to act towards a patient as a reasonably careful physician would in a given circumstance thereby causing that patient harm. The jury must make a determination of reasonableness by listening to expert testimony. What we often see, however, is that many people naturally tend to think that malpractice is something worse than negligence. I frankly don't know why this is. My guess is that malpractice just sounds worse. It sounds like malfeasance, malcontent, malicious, malodorous and other words with the prefix "mal" that tend to have a very strong negative connotation. The problem with this confusion for injured patients and their attorneys is that a jury may be misled into believing that they ought not return a verdict that provides for the harms suffered by the patient unless the physician did something bordering on the intentionally evil. Virtually no medical malpractice cases involve an intent by a physician (or other health care professional) to do harm. All such cases involve an allegation of negligence.

Patients are not entitled to receive the very best care from their doctors, though one would hope that all professionals try to serve their clients/patients to the very best of their abilities. A physician, however, has a duty to at least care for and treat her patients reasonably. This is important to remember. One need not feel as if their doctor intended to harm her before she questions her physician's conduct.

Health Safety Guru Says That Current Approach to Dealing With Medical Mistakes Is "Nuts"

The Wall Street Journal's Health Blog reports of a proposal from a health safety "guru" at Johns Hopkins to reduce the number of health care mistakes. He proposes bringing certain big health care players together to identify common problems and propose solutions. As a broad concept its hard to find fault with that approach. However, it will be important to come up with actual guidelines, standards. Too often the health care community comes up with "practice guidelines" (I'm talking to you ACOG) on how to deal with a given patient care situation, only to run from it later, i.e. during litigation, saying that such guidelines do not offer proof of the medical standard of care. Practice guidelines, many physicians would have you believe, are little more than suggestions which the doctor may or may not choose to follow. The problem is that many doctors really do need guidance, a set of standards to be followed in dealing with a difficult situation. No rule or set of rules can be crafted to address every conceivable circumstance. But, there are certainly some situations that arise time and again in various fields of medicine that can be dealt with by set, written standards. A violation of such standards which results in grievous harm and lose should result in compensation being provided to the patient and her family.

VA patient tests positive for HIV after mistakes

Apparently, a Veterans Affairs patient undergoing a colonoscopy may have contracted HIV after unsterilized equipment was used during the procedure. I didn't think I could be surprised by medical errors, but this is shocking if it turns out to be true. How do you protect yourself against such reckless disregard for patient safety? Should you ask the physician, "Listen, before you stick that thing up my guswhatzits is it clean?" Maybe.

To read the full story click here.

Roll Up Your Sleeves and Don the White Coat

You and your doctor are partners, and equal partners at that when it comes to managing your health. When a health issue arises, you are best off viewing the relationship in just that way. The physician should not be seen as the person charged with making you well as you sit idly by. Instead, the two of you are tackling the matter together. True, the doctor has a base of knowledge, training and experience in medicine that you do not. However, in our age of information you might be surprised how quickly and easily you can learn about a particular health issue whether it be about a specific disease, drug interactions or therapeutic options. I know this from first hand experience. Whenever I file a lawsuit against a physician alleging medical malpractice I learn all I can about the health issues relevant to the case. I generally start online searching relevant topics broadly before narrowing my search. I might start by searching the web on Google using basic terms like say "pulmonary embolism". Google will usually lead me to places like Wikipedia or WebMD where I will gain some basic information about what a pulmonary embolism is. From there, I will likely narrow my search terms and build upon my knowledge base by going to Google Scholar or PubMed. These websites contain articles and research papers often written by physicians for other physicians that you can often obtain for free. They help you learn what the doctors know. At one of these sites I might enter search terms like "prevalence of pulmonary embolism in pediatric patients with nephrotic syndrome." Doing so will often produce the most up to date research on a given medical topic. Also, searching the bibliography of a particular medical article will often lead you to other research papers relevant to your search. While you do this more and more intelligent questions to be posed to your doctor pop into your head. By spending some time at this you eventually learn enough to offer some real input into the search for your diagnosis or the options for your treatment.

Links to several websites that I've found helpful over the years are listed down the right hand side of this blog. It is important to note that you should always, always confirm information you get on the internet by searching more than one website. If website "q" says blue, but websites "x", "y" and "z" say green you'll probably want to disregard the credibility of website "q".

A few weeks after my daughter was born I noticed that on two or three occasions she shook or quivered very briefly for no apparent reason. These were not violent events, but I noticed them. She was our first born so I didn't know what to think and I was trying be hyper-vigilant about her health and needs. I mentioned these events to her pediatrician at the next visit. As I tried clumsily to describe what I had noticed, I told the doctor that my daughter seemed to have brief "seizures." That was a big mistake. Using that term made the doctor feel compelled to order a brain CAT scan, a test which, for a newborn, presents its own complexities and troublesome aspects. We scheduled her for a scan, but in the meantime I did as much research as I could to figure out the likelihood that my daughter had a serious problem. I determined that her "seizures" were probably caused by gas in her still developing digestive tract. I stressed about going through with the CAT scan for a few days, but then ultimately decided that putting her through the trauma the test would bring for what was almost certainly nothing would be a bad idea. We canceled the CAT scan and she's been perfectly normal since.

"Hey doc, WTF?"

A few years ago I represented the children of a young woman who died from an undetected and untreated pulmonary embolism (PE). A PE is a clot, usually blood, that travels into the lungs from some distant part of the body, most often the legs. Small clots that travel to the lungs can cause shortness of breath, sharp chest pain upon breathing in, back pain and other symptoms. If the clot is large enough it can kill you very quickly. Many times, a large, deadly clot is preceded by small clots. If the presence of small clots is diagnosed, the condition can be easily treated with blood thinners, hence avoiding the formation of a large deadly clot.

My clients' mother presented herself to her doctor in January complaining about shortness of breath, sharp chest pain when breathing in and back pain. She did not have a productive cough and her lungs sounded clear through the physician's stethoscope. The doctor ordered some lab tests that revealed an increase in white blood cells and a reduction in the amount of oxygen in her blood. Additional testing did not reveal the formation of blood clots in her legs. However, a chest scan demonstrated the presence of small emboli. The doctor diagnosed PE and placed her on blood thinners which she took, as ordered and without incident, for six months.

In August of that same year, about two months after the blood thinners were discontinued, the woman went back to see the same doctor . She again complained to him of shortness of breath, sharp chest pain when breathing in and back pain. Like before she did not have a productive cough and her lungs sounded clear. Lab tests revealed an increase in white blood cells and a reduction in the amount of oxygen in her blood. There were no blood clots in her legs. The doctor order a different kind a chest scan than he ordered in January. The August scan showed cloudiness in the left lung, and it was noted that it was difficult to evaluate the small vessels of the lung. The doctor diagnosed the patient not with PE, but with pneumonia. In fact, when I took his deposition many months after the fact, he conceded that in August PE wasn't even on his radar screen for this patient. She died a short time later of PE, suffocating in front of her children.

The case resolved favorably for the woman's family.

Could she have done anything to protect herself, so as not to have been victimized by this clearly incompetent doctor? We trust our doctors. Most of us are inclined to except their opinions, diagnoses and treatment without question. There is, after all, a knowledge gap between them and us. They know things about our bodies that we just don't. They treat diseases and other ailments day after day. Who they hell are we to question. But, question we must. Should my clients' mother have asked her doctor, "Hey, WTF? I was just here 8 months ago with the same symptoms. Don't you think I could be experiencing the same thing now as then?" I know, that's easy for us to say now. It's much harder to think of such things when you don't feel well; when you're vulnerable. The point is not to second guess, but to drive home the notion that we simply must challenge our doctors when something just doesn't seem right. It could end up being a matter of life or death.

How prevalent are medical errors?

Many physicians -- or, more often than not, the companies that insure them -- would have you believe that there is a glut of frivolous lawsuits filed in the United States against them. They have consistently argued for years that these cases not only needlessly clog our courts, but force too many good doctors out of the practice of medicine. Often, however, this is disingenuous propaganda. The prevalence of medical errors was studied just a few short years ago at Harvard University. The conclusion reached by this research was that, "There is a substantial amount of injury to patients from medical management, and many injuries are the result of substandard care."

Read the full study by clicking Harvard Medical Practice Study.

I don't want you as a client

The vast majority of physicians and surgeons are good, caring, skilled professionals. Sadly though there are some doctors who are neither caring nor competent. They refuse to listen, they are arrogant or lazy. Maybe they are inexperienced or poorly trained. These physicians are dangerous. They cause serious harm that can effect the lives of their patients, and their families, for the rest of their lives. I've been suing these bad doctors for nearly 13 years, and I, of course, will continue to do so. But, I'd rather not. I'd rather see fewer clients who were victims of bad medical care. Sometimes there is little or nothing a patient can do to avoid becoming a victim. If you're unconscious and under-the-knife you're helpless against the surgeon who doesn't know what he's doing. (I once represented a woman who was very badly hurt when her surgeon decided to take a telephone call in the operating room while he continued to work on her.) However, sometimes you can take steps to reduce (greatly in some instances) the likelihood that you will be the victim of lousy medical care. That is what this blog is about. It is meant as a resource for patients (which is all of us at some point) to learn how to take charge of their own health and to work with the physicians that care for them from a position of strength so as not to be a victim.

Nollo Erratum means No Error. I concede that error free medicine -- or error free anything for that matter -- is a bit of a fantasy. But striving for a better world is how we make progress.