Doctors need legal assurance today that they won’t get sued if they send low-risk non-virus cases home rather than keep them in scarce beds getting marginally valuable tests — even if it is only a temporary step for the duration of the emergency. [Jeremy Samuel Faust, Washington Post; Faust is an emergency physician at Brigham & Women’s in Boston, and an instructor at Harvard Medical School]
Excellent interview with Dan Klein, a George Mason economist bound by family and professional ties to Sweden, where his wife and daughter live. Among other things, confirms what I’ve been saying for years about comparative litigation climates:
Klein: Sweden does pretty well in the economic freedom ranking, currently 43rd of 162 in the Fraser ranking and 19th of 169 in the Heritage ranking. Incidentally, a significant advantage of Sweden over the US is civil law and litigation. The US system is terrible, as it does not have loser-pays and generally makes for shakedowns and extortion. Like most countries Sweden has loser-pays and no exorbitant and capricious damages. I believe that the freedom indexes do not pick up this advantage to Sweden, but I’m not sure. I’ll bet that per capita the US has ten times as much litigation and ten times as many lawyers as Sweden does. A sane court system shows up in ordinary life in Sweden, where trust and flexibility make possible things you don’t see in the US from fear of legal shakedown.
He goes on to recount a tale of emergency medicine that would very likely have gone differently in the United States. [Anders Ydstedt, interviewer, Svensk Tidskrift]
It is forbidden to save lives except in the prescribed location and manner: “In an effort to protect rural hospitals in Louisiana, state lawmakers have passed a bill that bans the creation of most freestanding emergency rooms.” [Alia Paavola, Becker’s Hospital Review]
“Patients sitting in emergency rooms, at chiropractors’ offices and at pain clinics in the Philadelphia area may start noticing on their phones the kind of messages typically seen along highway billboards and public transit: personal injury law firms looking for business by casting mobile online ads at patients. The potentially creepy part? They’re only getting fed the ad because somebody knows they are in an emergency room.” [Bobby Allyn, NPR]
Trying to order medications for a heart attack victim using electronic medical records, White Coat is frustrated to run into screen after screen preventing him from completing the order without addressing unlikely allergy issues (and thus protecting the hospital from liability):
For those of you who don’t know what alarm fatigue is, think of a car alarm. The first time you hear it going off, you run to your window to see who’s breaking into a car. Maybe you run to the window the second time and the third time, too. By the tenth time the alarm goes off, you’re thinking that the alarm is broken and someone needs to get that fixed. After about thirty false alarms, you’re feeling like going out there and busting up the car yourself – especially if the car alarm wakes you when you’re asleep.
It’s a concept with many applications beyond the emergency room setting, too, product warnings being just the start.
P.S. Dr. Westby Fisher has some related thoughts about the limits of trying to engineer physician responsibility through electronic records design.
- “On Average, Physicians Spend Nearly 11 Percent Of Their 40-Year Careers With An Open, Unresolved Malpractice Claim” [Health Affairs via Pauline Chen, NY Times]
- SCOTUS lets stand Feds’ “accept Medicare or lose your Social Security” edict [Ilya Shapiro, Cato]
- Robot surgery: from the Google ads, you might think lawyers are circling [Climateer via Tyler Cowen]
- New York mandates more aggressive anti-sepsis measures in hospitals, and White Coat thinks it won’t end well [EP Monthly]
- Shortages of generic FDA-regulated sterile injectables begin to take deadly toll [AP/Worcester Telegram, earlier]
- Continuing the discussion of electronic medical records from a few days back: as medico-legal documents, EMRs are under pressure to be something other than candid and spontaneous [Kaus] While other patients wait for critical care, ER docs and nurses enter mandatory data fields for whether the infant is a smoker or the flu victim is a fall risk [White Coat]
- Obamacare part-time-work fiasco “only starting to become news when it hits university professors” [Coyote, David Henderson, earlier]
On July 12 New York Times columnist Jim Dwyer wrote an extensive story about the death of a 12-year-old boy who had been brought to an emergency room with fever and rapid pulse, sent home, and died of septic shock. Lab test results and other indicators of distress allegedly went unheeded, and the boy’s family is represented by Thomas Moore, perhaps the city’s premier medical malpractice lawyer. Some legal blogs had a field day citing Dwyer’s article as an example of flagrant medical malpractice, as they depicted it; other reactions, some gathered in a Dwyer follow-up column, were more mixed.