Thursday, January 27, 2011

FDA links breast implants to rare cancer

FDA links breast implants to rare cancer

(The New York Times, 1/26/11)

The Food and Drug Administration (FDA) has linked both saline- and silicone-filled breast implants to a rare but treatable form of cancer. The cancer, anaplastic large-cell lymphoma, involves the immune system and is not a breast cancer. Usually a systemic disease, the lymphoma linked to implants grew in the breast, usually in the capsule of scar tissue around the implant. The cases were discovered in women who developed symptoms such as lumps, pain, asymmetry of the breasts, fluid buildup and swelling, long after implant surgery. In some instances, removing the implants and scar tissue eliminates the disease, but some women may need chemotherapy and radiation.

So far, there are about 60 of these cases worldwide. Although that is a small number compared with the five to 10 million women who have breast implants, it is still a concern, considering this type of cancer is found in only three in 100 million women who do not have implants.

The FDA says the data does not support discontinuing the marketing of implants, but women considering them should first discuss the matter with their doctors. Women with implants who have no symptoms need do nothing special or change their routine health care, but they should call their doctors if they notice any changes such as those noted above.

Sunday, January 9, 2011

State medical boards do not do enough in protecting patients.

State medical boards lax in oversight and discipline of bad doctors

(University of California “Reporting on Health,” 12/29/10)

Medical boards from coast to coast do a terrible job of protecting patients and informing the public about bad doctors. On December 29, 2010, the University of Southern California (USC) published the findings of a year-long review of the records of 100 physicians in every state and the District of Columbia. The review highlighted 51 doctors who were responsible for injuring or killing 290 individuals through medical errors that included overdosing, blinding and misdiagnosing patients. The majority of these doctors, 82%, are still in practice. This is partly because state medical boards take too long to act or mete out weak discipline. A second factor is that 70% of the doctors are licensed in multiple states, so when they get in trouble in one state, they simply set up practice in another.

The USC investigation showed gross inconsistency in the way board handles discipline for the same offense, from license revocation to an ineffective letter placed in a file. Some disturbing trends were revealed, including several states that regularly send doctors with history of fraud, negligence and abuse to practice in poor communities where patients are already vulnerable. Hospitals and physician’s groups not only shirk their responsibilities to warn medical boards and the public about bad doctors, but shield them, instead.

Patients have a right to know if their doctors have harmed their patients, but they must be proactive; checking the state medical board’s records is not enough. Patients should push their state lawmakers to strengthen oversight and disciplinary procedures against bad doctors and those who protect them from the consequences of their actions.

Burnout among doctors could hurt patients, too

Burnout among doctors could hurt patients, too

(, 1/4/11)

Patients across the country are seriously at risk for medical errors due to physician burnout. The results of two studies published January 4 in the journal Anesthesiology bear out the crucial nature of this risk. A Vanderbilt University School of Medicine study found doctors, particularly residents, to be at higher risk for burnout than nurses or other medical personnel. A second study by Northwestern University’s Feinberg School of Medicine revealed that about half of senior physicians (chairs of academic anesthesiology departments) suffer from “high” or “moderately high” burnout.

These findings correlate with previous research showing sleep-deprived doctors make more mistakes in the operating room. Likewise, burned-out physicians – those who work long hours, see patients before and after surgical procedures, perform elective procedures after their nights on call, or are generally dissatisfied with their jobs – are more likely to make medical errors and provide inferior quality of care. The message for patients: Before undergoing a medical procedure, you have a right to know if your doctor is working under these circumstances.

Tuesday, January 4, 2011

Staying Safe When Having Surgery

Where Medical Errors Occur and How to Avoid Them

Promoting Patient Safety

Preventing Medical

Patient Safety

Is your surgeon sleep deprived?

Patient health and safety: Would you consent to a sleepy surgeon?

Posted On: Today
4626759807_ab19de35f1_bAn editorial in a recent New England Journal of Medicine is calling for yet another form that patients entering the hospital for elective surgery should sign: Informed consent when your surgeon is sleep deprived. No joke, it's a real proposal. A recent study found that attending surgeons who performed elective surgeries during the day after an on-call night of having less than "a six-hour opportunity for sleep" were significantly more likely to have complications related to their ….yawn…. procedure.

The authors also remind us that unlike doctors in training, surgeons don't have limits to the number of hours they work. And to make matters worse, studies have found that people are generally poor judges of their own degree of fatigue-induced impairment.

Hence the suggestion that when you are about to undergo an elective surgical procedure with a sleep-deprived surgeon, you should be informed of the potential health risks and sign a waiver if you consent to continue. Do you think that's a good idea? Would you consent under such conditions?

Potentially this is a problem rooted in the American tendency to frame health care from the perspective of scarcity, rather than one of abundance. Or in other words, a problem of resource management. Elective procedures are by definition not emergencies. They can be planned ahead, postponed if needed. Contrary to many claims, we also do not appear to have a shortage of physicians. The physician workforce may be poorly incented and inappropriately deployed, but shortage is unlikely. And I'm not sure anyone is claiming we have a shortage of surgeons performing elective surgery. Health care facilities like to schedule certain procedures into certain blocks of time, and rescheduling is considered inconvenient for patient and practitioner alike. But pushing docs to perform beyond their physiological capacity seems foolish at best, and a recipe for disaster at worst. It also appears predicated on the assumption that there is a shortage of time in which to perform elective procedures, or a shortage of surgeons to perform them. Hence the sleepy surgeon stooped over you in the OR. That's just not healthy. There's plenty of time, and plenty of professionals.

Truckers aren't allowed to drive more than a certain number of hours. Airplane pilots have mandated rest periods between flights. Why should surgeons be any different, barring unforeseen emergencies? Health care facilities should instead restrict sleep-deprived surgeons from performing elective procedures. It seems like poor judgment for patient health, poor judgment for liability, and plain unhealthy for the surgeon and their quality metrics.

And what exactly would an informed consent waiver about your sleepy surgeon look like? I'd love to see that wording.