I am soooo glad you have returned with your wonderful and insightful commentary! It is a loss that you and Marty Makary are no longer at the FDA but that was unfortunately predictable, I think. Thank you both for reforming the drug approval process and trying to improve the FDA.
"I only read the doctor’s physical exam and review of systems when I want to transition from non-fiction to fiction." - Spot on - so much templated BS + note bloat, much of it leftover from older coding requirements requiring an MS 3 H&P.
This is a blueprint for fixing a car or building a house.....with a heads up that medicine is a little more complicated. You need IQ, but also you need to proceed stop by step , always telling your self that you are not that smart.
Not being snarky, genuine question for the legal minds out there: I always hear tort reform as a leading suggestion for helping lower healthcare costs. If we had tort reform, and a doctor sews in a valve upside down and then tries to harvest the organs, what recourse does the family have if any?
I think most "tort reform" seeks to limit or avoid punitive damage awards. Juries can run wild there. Others seeks to schedule pain and suffering awards - how do you measure pain and suffering? How do you put a value on it other than the "wisdom" of the jury and the skills of the plaintiff's attorney.
Medical and hospital errors are the third leading cause of death in the US. In other words, such errors (with deadly consequences) are far too common.
The only reason this error stands out is because people can visualize the error and think how stupid of the surgeon to make such an error. But an error where the doctor misspells the drug name (or the pharmacist misreads it) and the patient ends up dying from the wrong drug is equally deadly.
Outstanding post. I have long admired the efforts of Palliative Care teams.It is so true that they do the hard work abdicated by the clinician who declines to take comprehensive care of the patient, from the beginning to the end of the relationship. It’s also so true that the Palliative provider needs to know clinical medicine thoroughly in order to understand which patients benefit, and just as importantly those who do not, from their care.
Totally agree that when asked to consult on a patient, start with your own history, then your own physical exam, then look at imaging and labs. Starting with other doctor's notes biases how you will evaluate the data. I would tell my patients, when they woluld start, 'my doctor thinks ' or says", "I'm not that interested in what your doctor thinks, you're here to get a fresh look. Let's start when you were last well..." And I woud ask the family to step outside and not talk for the patient. Men might then say, "this is the first time my wife has not spoken for me..."
From the article “prioritize those who pay higher (might sound harsh, but this incentive is driving the hospitals thinking”. That sentence describes the perverse incentives during the COVID fiasco.
How could anyone know that the surgeon would make that mistake on that day? It’s too hard for a patient to know at the time decisions need to be made if the right surgeon has been chosen. The one and only benefit of a cancer diagnosis is as the patient you have more time than you think. You have time to ask questions. You have time to do a bit of reading and getting second opinions. But that’s it. Cancer, stage IV lung, is the Satan of diseases.
I am soooo glad you have returned with your wonderful and insightful commentary! It is a loss that you and Marty Makary are no longer at the FDA but that was unfortunately predictable, I think. Thank you both for reforming the drug approval process and trying to improve the FDA.
"I only read the doctor’s physical exam and review of systems when I want to transition from non-fiction to fiction." - Spot on - so much templated BS + note bloat, much of it leftover from older coding requirements requiring an MS 3 H&P.
This is a blueprint for fixing a car or building a house.....with a heads up that medicine is a little more complicated. You need IQ, but also you need to proceed stop by step , always telling your self that you are not that smart.
Not being snarky, genuine question for the legal minds out there: I always hear tort reform as a leading suggestion for helping lower healthcare costs. If we had tort reform, and a doctor sews in a valve upside down and then tries to harvest the organs, what recourse does the family have if any?
I think most "tort reform" seeks to limit or avoid punitive damage awards. Juries can run wild there. Others seeks to schedule pain and suffering awards - how do you measure pain and suffering? How do you put a value on it other than the "wisdom" of the jury and the skills of the plaintiff's attorney.
Dr Prasad, if I ever develop CA (or at this point any other dx), will you be my doc???!! I don’t live in Cali but I travel!
Ugh. Human error. I'd hate to be the surgeon and carry that on my conscience.
Medical and hospital errors are the third leading cause of death in the US. In other words, such errors (with deadly consequences) are far too common.
The only reason this error stands out is because people can visualize the error and think how stupid of the surgeon to make such an error. But an error where the doctor misspells the drug name (or the pharmacist misreads it) and the patient ends up dying from the wrong drug is equally deadly.
Outstanding post. I have long admired the efforts of Palliative Care teams.It is so true that they do the hard work abdicated by the clinician who declines to take comprehensive care of the patient, from the beginning to the end of the relationship. It’s also so true that the Palliative provider needs to know clinical medicine thoroughly in order to understand which patients benefit, and just as importantly those who do not, from their care.
Totally agree that when asked to consult on a patient, start with your own history, then your own physical exam, then look at imaging and labs. Starting with other doctor's notes biases how you will evaluate the data. I would tell my patients, when they woluld start, 'my doctor thinks ' or says", "I'm not that interested in what your doctor thinks, you're here to get a fresh look. Let's start when you were last well..." And I woud ask the family to step outside and not talk for the patient. Men might then say, "this is the first time my wife has not spoken for me..."
From the article “prioritize those who pay higher (might sound harsh, but this incentive is driving the hospitals thinking”. That sentence describes the perverse incentives during the COVID fiasco.
How could anyone know that the surgeon would make that mistake on that day? It’s too hard for a patient to know at the time decisions need to be made if the right surgeon has been chosen. The one and only benefit of a cancer diagnosis is as the patient you have more time than you think. You have time to ask questions. You have time to do a bit of reading and getting second opinions. But that’s it. Cancer, stage IV lung, is the Satan of diseases.