Know Your Doctor

I was working with an executive at a local media outlet on a marketing campaign for our law firm. We spoke on the phone and met in person quite a bit to discuss the project. In doing so we developed a cordial, friendly relationship. In the course of some chit chat with her one day, she mentioned that she and her husband were attempting to have a baby with the aid of a Chicago area fertility doctor. At the time I was working on a medical malpractice case arising out of the death of a young woman caused when the fertility specialist she was seeing negligently damaged her bowel during a surgical procedure. In light of my involvement with that case I asked the executive who her doctor was. It turned out that she was seeing the same physician whom we were suing. Though I was at first a little reticent about doing so I decided to tell her about my case. I figured that she was entitled to know what I knew about this physician. When I did, she confided that she had had her own concerns about the doctor. She and her husband ended up adopting a child instead.

People look into the backgrounds of their babysitters and plummers. All too often, however, patients do not take a few moments to look into their physician's background. All 50 states and the District of Columbia allow patients to look up the status of a physician's medical licensure. Some states will even show you online whether a doctor has been disciplined. There is simply no reason not to take advantage of this service when seeing a new doctor.

I have put together a link (located on the right side of this blog) that will take you to a list of all 50 states and the District of Columbia. Click on a state and you will immediately be taken to that state's medical license look up service.

On the benefits of requesting an autopsy

Over the last 13 or so years, I've worked with many families who have just lost a loved one. There is so much that goes through your mind when that sort of tragedy strikes; so much to think about and so much you do not want to think about. In my experience these overwhelming feelings are compounded when the death takes place in a health care facility under confusing or suspicious circumstances. Family members tend to feel anger (what did the hospital/doctors do or not do) and guilt (is there something I should have done differently), in additional to the sense of terrible loss. Getting answers that uncover why and how the death occurred when it did often seems to help family members cope with many of these emotions. The best pathway to understanding "why" is to have an autopsy performed.

Often the last thing on many people's minds when they have lost a loved one is submitting the deceased's body to the autopsy process. Frankly, it is a gruesome thought. However, nothing is better for uncovering answers, for getting to the bottom of why. If a medical malpractice lawsuit is to follow, an autopsy will be extremely helpful in putting together the case against the hospital, doctors and nurses.

I recently read an article in the New York Times written by a physician that offers a very nice explanation of the benefits of autopsy. You can read the article by clicking here.

A doctor with a troubling record

Many doctors get sued for malpractice. Some good doctors even get sued more than once. However, there are some bad doctors out there, physicians who should be denied the privilege (it is not a right) of practicing medicine. This morning's Chicago Tribune exposes one such doctor, Mayer Eisenstein. I am quite familiar with this character as I sued him many years ago for pediatric malpractice. We alleged that Dr. Eisenstein and another physician in his group failed to take action in response to a baby whose head was growing in circumference at an unusual and alarming rate. They documented the disturbing growth, and we felt that they should have seen that it was literally off the charts. We alleged that because they did nothing, the child experienced a severe seizure. She ended up with profound and permanent brain damage. The pediatric expert that I hired to review the medical records was astounded by what he saw. He could not believe that any licensed physician could ignore such profound growth. Tragically too, the treatment to relieve the pressure in the child's head would have been simple and would have prevented the unfortunate outcome that befell her.

We sued Dr. Eisenstein and his group only to find that he had no medical malpractice insurance. It was a situation in which the family needed millions to take care of their daughter for the rest of her life, yet there would be no way for them to be adequately compensated. Dr. Eisenstein would never have to answer the charges against him in a court of law. It was one of the most unfortunate circumstances that I have come across in my career. I often think of that little girl, even today, some 10 years since I took on that case.

Thank you Chicago Tribune for exposing this doctor. Hopefully, today's reporting will warn other families away from Dr. Eisenstein and those of his ilk.

Reduction in medical errors

Sadly, in 10 years medical errors have been reduced not at all. Read the story here.

Lupron: Autism Cure or False Hope?

There will always be snake oil salesmen, hucksters looking to separate you from your money in exchange for the drug to cure whatever ails you. Sometimes such folks offer a harmless though ineffective remedy for a mild problem. Sadly, however, on other occasions real doctors offer false hope that can be dangerous and heartbreaking. The Chicago Tribune is reporting this morning about a some doctors who are proposing treatment of autism with a drug called Lupron. There is an untested, unproved theory floating around that autism may be linked to testosterone. Lupron is a drug that has been used to chemically castrate sex offenders. "Children with autism have too much of the hormone, according to the theory, and . . . Lupron can fix that," says the Tribune story. The problem is that this theory is pure quackery. The Tribune noted, "Four of the world's top pediatric endocrinologists told the Tribune that the Lupron protocol is baseless, supported only by junk science. More than two dozen prominent endocrinologists dismissed the treatment earlier this year in a paper published online by the journal Pediatrics."

In the Chicago area patients can apparently get the "treatment" though a family doctor named Mayer Eisenstein, M.D. According to the Tribune story, Dr. Eisenstein has had no experience treating autistic children. He is a physician who runs Homefirst Health Services, which advocates home birth. He has been sued numerous times for alleged medical malpractice. He has been known in the past to practice without any medical malpractice insurance of any kind. One has to wonder what kind of physician practices without malpractice insurance.

Hope is a terrible thing to prey upon. There is no cure for autism. For parents of autistic children the desire to help, to find a cure is undoubtedly strong. For physicians to exploit the vulnerability of hopeful parents and their autistic children is profoundly troubling. The lesson, of course, for parents and patients: Do your homework. Remember the old adage that if it seems too good to be true it probably is. Use the resources available on the internet to research treatments for autism or any other ailment, condition or disease. Though it can be painfully hard, lead with your head and not your heart. Be skeptical, smart and thorough.

Click here to view the American Academy of Pediatrics autism web page.

Time matters.

In preparing to give a lecture to medical residents I came across a journal article from a few years ago studying the causes of errors in the family practice setting. I was interested -- though not too surprised -- to read that "physician stressors" were reported by physicians themselves as one of the main causes for medical errors. The top stressors identified were the physician feeling "hurried," the physician feeling "distracted" and "the time of the visit was stressful to the physician (eg, night, weekend, off-duty hours, quitting time)."

Physicians are people too (though some may see themselves as something close to divine). They get tired, pissed-off, anxious. At quitting time they want to go home. Health problems and medical emergencies don't always occur at convenient hours, and patients are most certainly due good, competent care at all times of the day and night. However, for those visits to the doctor than are not emergencies, schedule an appointment when your doctor is least likely to be stressed. Get the first appointment of the day, and always try to avoid being the last patient he or she sees. Once you've seen your doctor for a period of years you'll get to learn when she's least busy and more likely to give you her undivided attention. Ask your doctor when the best time is to schedule a visit. You'll be better off for it.

Watch Out For Medical Billing Errors

Apparently, many doctors are removing the wrong amount of money from many patients' wallets. According to Consumer Reports 80% of medical bills contain errors.

New Study Released On Patient Error

The medical journal, Annals Of Family Medicine, has published the results of a new study categorizing the kinds of mistakes patients may make in the course of their own health care. The study was authored by a group of doctors from New Zealand and Wales, UK and the results appear in the journal's May/June 2009 issue.

The study, titled Patient Error: A Preliminary Taxonomy (a sciency sounding word that means categorization), is controversial in my view not so much for the results -- the errors identified are common sense stuff like "forgetting to take medication" and "nonattendance" at doctor visits -- but rather for the title which sets a tone present throughout the article: Patient Error. The authors themselves admit to an inherent and likely problem with this term, that the term "error" suggests "blame." Certainly, a patient may be to blame for a given failure in health care treatment. There are undoubtedly those who would refuse to follow reasonable, clearly elucidated instructions from a physician. That obvious truth noted, the article seems defensive. "There is a need," the authors note, "to move beyond seeing patient, clinician, and system errors as separate categories of error, since they are interdependent rather than mutually exclusive." I am guessing that this "need" is perceived by the authors out of fear of medical malpractice litigation. If the death or crippling of a patient is usually due to a tangled thicket of errors by patients, doctors and "system[s]" then it is unfair to hold physicians accountable. This is a self serving, cynical point of view. Patients certainly can and should take control over their own health care. However, physicians often, in my experience, commit erroneous acts that no patient could reasonably have protected himself or herself against.

Notwithstanding the title and tone of the article, there is some value to be gained from it. For the patient and physician alike it provides a lengthy list of areas where the doctor/patient relationship can breakdown. The advice the patient can take away is educate yourself, communicate with your doctor, and cooperate where appropriate (education will help with this.) For the physician, the article provides notice of challenges that will often need to be overcome when treating a patient. For example, one of the "errors" patients purportedly make are those involving memory. Some patients are forgetful. Ask your patient if he or she has memory problems. Sometimes you'll even have a strong suspicion, especially when dealing with the elderly. Once the problem is identified, work with the patient on a solution. Have your office call the patient to remind her of an upcoming appointment. Involve a family member in reminding the patient to take his medication daily.

I sincerely hope that the publication of this article does not represent the start of a campaign in blame shifting by the medical establishment. It is undisputed that physician error is an enormous problem. To focus on laying blame for bad outcomes on patients who are often sick and vulnerable would be counter productive.

Understanding How Your Doctor Reaches A Diagnosis

A physician friend of mine who trains family practice residents at a Chicago hospital recently asked me to come and speak to them about medical negligence. She asked me to speak about the most common errors I see pertaining to family practice/primary care medicine. In anticipation I've been thinking about the kinds of mistakes I have seen over and over made by family and primary care physicians. One trend I have been able to identify is the failure of the family doctor to properly use the process known as "differential diagnosis." This process is how your doctor figures out what is wrong with you. With it your doctor will make a list of possible ailments from which you may be suffering based upon your symptoms. He or she will then examine you and will perhaps order tests in order to rule out the ailments on the list until only one is left standing. That will be your diagnosis. Sadly, however, sometimes physicians get into trouble by ignoring this tenet of good medical practice. Family practice doctors tend to see the same ailments, diseases and complaints day in and day out. This unfortunately leads to laziness in the approach they take with their patients. After seeing the 100th patient in a given week with the same symptoms, the physician may side step the differential diagnosis process and jump right to a single diagnosis, which for patient number 100 may be dead wrong.

This morning I came across a very good article at About.com about how the patient can involve himself or herself in the differential diagnosis process. The crux of the article is that you can and should question, test your doctor in order to determine whether she used the differential diagnosis process or simply jumped to a single conclusion. Click here to read the entire article.

Google To The Rescue?

So many cases in which I have been successful suing doctors have revolved around a lack of information; either the defendant physician didn't have it, didn't ask for it or didn't know he or she needed it. The importance of information gathering for proper patient care cannot be overemphasized. If a patient has a past history of diabetes, or recent surgery, or cancer, or stroke that information may be vital -- sometimes the difference between life and death -- to the physician treating the patient. This is one of the reasons that continuity of care is so important. If your physician knows about your health history by virtue of having been your doctor for many years, he or she will have a base of knowledge to use in diagnosing and treating future health issues. If you are seeing a doctor who doesn't know you, you and the physician, are at a disadvantage. So how can you keep your health and medical history well organized and closely at hand to share with those who may need it?

Google to the rescue.

Google Health allows you to keep all of your health care information, including prescription information and your medical records, in one central place. The advantages of this service are that you can share your health information with your doctor, and you can research your own health needs online guided by data contained in your medical records. Say, for example, your physician's office decides to no longer accept your insurance plan. You have to choose someone new. You would be able to quickly, and effectively transfer to the new doctor your entire medical history, including your prescription information. There is also significant value in being able to see your own records. A few years ago I represented a woman who was being screened by a new doctor to determine if the cancer that had been treated by a different doctor in a different city had returned. Test results indicated that it had. However, she never learned that because the new physician's office had communicated the results to her verbally, over the telephone, incorrectly. Had she been able to see the test results for herself she may have been able to take the initiative in getting additional treatment.

Google Health also allows participants to browse an online health services directory to research health issues. For example, a pregnant mom to be could research whether the drugs she is taking for depression are safe for her fetus. A person with hypertension could research drugs and their various side effects so as to have an informed discussion with a physician about treatment options.

This is empowering stuff. Google Health seems to be a tool that truly puts the patient in charge. There are, of course, potential and arguably significant downsides to this service. Whenever I have mentioned Google Health to a friend or colleague the first, inevitable response I get pertains to privacy concerns. Google is, after all, a giant corporation. Why, people have asked me, would I give the most personal details about myself to Google? For its part, Google swears on a stack of bibles that it will safeguard your privacy. But in the end you will need to ask yourself, "Do I trust Google?" Certainly, everyone will have to decide for themselves, but it seems to me that many if not most of us are already sharing this information with big corporations, insurance companies, hospitals, pharmacies and health care networks. Will they be more benevolent in the way they safeguard your data than Google would be? Also, ask yourself what exactly it is that you don't want Google to know or share. Sure you wouldn't want records forwarded to your mother documenting that nasty case of crabs you had, or to your employer that you've been treated for anxiety. But you have to balance the likelihood of something like that happening versus the value of being able to get vital information quickly and efficiently into the hands of a doctor who may need it to treat you.

Another downside of Google Health, at the moment, is that it is clearly in the chicken wire stage of development. Google has very few health care partners presently participating in this project. Notably, the large pharmacy chains CVS and Walgreens allow you to upload your prescription information to Google Health. However, very few doctors offices and hospitals have cooperated. The bottom line is that even were you to sign up tomorrow, you probably wouldn't be able to upload much. You could, of course, obtain paper medical records from your providers and scan them into your Google Health account, but that's a lot of work. I can't imagine many folks choosing to do that.

Notwithstanding the downsides, so far, Google Health sounds promising. Stay tuned.

Going Under The Knife

I have written before about what a patient can do to protect herself against surgical errors. A story in Sunday's Atlanta Journal-Constitution offers some scary examples of surgical negligence, but also some good tips on how patients can protect themselves when going under the knife.