Medical Malpractice News and Views

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A Complete and Total Failure – Part One

September 25, 2023

I recently finished listening to a podcast about a Texas neurosurgeon, who was so incompetent and injured so many people that he is now serving a life term for elder abuse and assault as a result of a surgery gone wrong.  The doctor was Dr. Christopher Duntsch and the podcast was called Dr. Death.  It was both mesmerizing and horrifying.  I have never heard of a surgeon who seriously injured so many people in such a short period of time.  The question, which is explored in the podcast but never really answered, is how could this person have ever gotten in this position and stayed there long enough to do the damage he did.  In this post and the one to follow, I want to discuss the entities that failed the public so badly and without which this tragedy could not have reached the magnitude it did.  In the third post, I will discuss the final betrayal of the patients of Dr. Death.

Wondery poster

Before Dr. Duntsch began his first job at a prestigious hospital in a well-to-do section of Dallas, he graduated from college, went to medical school, where he obtained both an MD degree and a PhD, took a neurosurgery residency, and then participated in a fellowship to get further training in spine surgery.   His academic credentials were impressive and he received glowing reviews from the doctors at his residency and his fellowship.  Given how quickly he demonstrated complete incompetence at his first job, you have to ask, “What were they thinking in giving him these glowing recommendations?”

The first failure of the system, which is supposed to protect us, was that it allowed Dr. Duntsch to complete a neurosurgery residency.  Based on later events, it is clear he was completely unqualified and that should have been obvious to the people he trained under.  It also appears that, because he spent a lot of time in the lab, he did very few surgeries during his residency.  Instead of the thousand or so surgeries performed by the typical neurosurgery resident, he did only about 100.  This is a stunningly low number.  He should have been required to do more surgery.  Had he done more surgery, perhaps he would have learned more.  Had he done more surgery, perhaps his lack of competence and temperament would have become so obvious that the system could not have covered for him.  On top of lack of surgical experience and incompetence, he was suspected of using cocaine and sent to a rehabilitation facility for a few months before being allowed to return to the residency program.  How is a person who is suspected of being under the influence of cocaine while operating get allowed back into a neurosurgery residency program?  As it was, when prospective employers called about Dr. Duntsch, the people at the residency program never mentioned any problems, even after they had to have known how incompetent and potentially impaired he was.

The second failure took place at the hospital where he got his first job.  Almost immediately, he began to experience horrific surgical outcomes.  The first patient he operated on was left with chronic pain when he operated on the wrong part of his back.  When he took the patient back to surgery to address the chronic pain, he left him partially paralyzed.  Soon after that, he operated on one of his best friends and turned him into a quadriplegic.  Another of his patients bled to death as a result of his not recognizing that he had severed an artery.  The hospital quickly realized he was a problem and revoked his privileges to perform surgery there.  It sent him off to find another job as a spine surgeon.  In order to avoid a potential lawsuit with him, the hospital agreed that, if ever questioned about his time there, it would simply say that there were no issues with him.  Although required by law to do so, the hospital did not report Dr. Duntsch to the National Practitioners Data Bank.  Had it done so, Dr. Duntsch may have found it difficult to find other employment as a spine surgeon.

By now a pattern was emerging that would continue and would allow Dr. Duntsch to hurt more people.  Everyone who came into contact with Dr. Duntsch was looking out for themselves first.  If protecting themselves from criticism, or a lawsuit, or public exposure meant letting Dr. Duntsch move on without consequences, so be it.

Next week, Dr. Duntsch moves on again and again before finally being stopped.

Posted in disclosure of medical mistakes, Doctors, Hospital Negligence, Hospitals, Lawsuits, medical errors, medical ethics, Medical Malpractice, medical mistakes, Medical Negligence, never events, Secrecy, Surgical Errors, tort reform |

Many Doctors Are Hurting

September 18, 2023

Probably most of the people who choose to become doctors or nurses do so because they want to help others.  For the doctors and nurses who have this as their reason for being, these are difficult times indeed.  More and more they are being forced to treat patients in a way that maximizes profits regardless of whether that treatment may be in the patient’s best interest or not.  This clash between the ideals of the health care professional and what they are being required to do by their employers is causing great emotional distress and driving many of the most idealistic from the profession.

Physician Burnout Costs The U.S. Health Care System Billions Each Year :  Shots - Health News : NPR

Moral injury is the term applied when a person does something that conflicts with their moral compass.  The term has its origin in warfare where people sometimes find themselves doing things that repulse them and horrify them.  More and more often, it is being applied to doctors and nurses who cannot reconcile their obligation to their patients with the requirements laid down by their employers.

A growing swath of the health care industry has been taken over by private equity, which demands returns on its investment.  Private equity has been buying up doctor’s practices, clinics, hospitals, and home health companies.  Today over 70% of doctors are salaried employees, who must answer to administrators and executives.  That is a shocking number and the consequences to the health care system are profound.

Doctors increasingly see themselves, not as advocates for their patients, but as cogs in a larger machine that eats patients up and one end and spits them out at the other.  They see that it is no longer whether they have helped their patients that is important but how many patients did they see, how many tests did they order, and how many value units did they create.  Most of these doctors don’t mind working hard to serve their patients, but that is not what is happening today.

Our health care system, which was never a model of fairness and equity, is becoming less fair and more inequitable with every passing day.  If you have money, you usually have health insurance.  If you have health insurance, you are a potential cash cow that private equity can milk.

Doctors who complain are being treated like low level employees at Starbucks who complain.  They are being shown the door or disciplined in some way.  Some emergency room physicians who have raised concerns have found themselves looking at reduced hours or no work at all.  The result is that some doctors and nurses are looking to unionize to protect themselves.

In the years after World War II, the American Medical Association fought hard against the idea of universal health care.  Their stated reason was to preserve physician independence.  As the old adage goes, “Be careful what you wish for.”  Much to the detriment of society as a whole, we do not have universal health care and most doctors have lost their independence anyway as their employers ramp up their demands for profits.  Something needs to change.

Posted in Doctors, Fee for Service, Health Care Costs, Health Insurers, Hospitals, Medical Costs, medical ethics, Nurses |

Another Tragic Death

September 11, 2023

Stop me if you have heard this one, because I know you have.  It is almost the same case as I wrote about back in May and here it is happening again.  This time the dead patient was an 18 year old woman, who had just graduated from high school.

Doctors Come In Many Different Flavors - Sandweg & Ager PC

The most recent case comes to us from the state of Colorado, where an 18 year old woman was undergoing a breast augmentation surgery at a surgery center owned by the surgeon.  The anesthesia was being administered by a Nurse Anesthetist (NA).  During the surgery, the patient got in trouble and her status declined precipitously.  She went into cardiac arrest.  The NA recognized the problem and that it was beyond his ability to address.  The patient needed to go to a full service hospital for resuscitation.  He informed the surgeon and said the surgeon needed to call 911.  The surgeon refused and refused to permit anyone else to call 911 either.  The team administered CPR to the unconscious patient, but 5 1/2 hours elapsed before help was summoned to take her to the hospital.  By the time she arrived at the hospital, she had suffered irreversible brain damage.  She lingered in a nursing home for over a year before finally getting pneumonia and dying.

Both the surgeon and the NA were charged criminally in the death.  The charges against the NA were dropped when he turned in his nursing license and agreed to testify against the surgeon.  At trial the surgeon blamed everything on the NA.  The jury disagreed and found the surgeon guilty of attempted manslaughter and obstructing telephone service.  The surgeon and the NA were both sued by the patient’s family and apparently settled for $1M each, which was probably their policy limits.  As of this writing, the surgeon is still in good standing with the Colorado medical board and is awaiting sentencing.

This is eerily similar to the case I reported on in May.  They both involved young, female, plastic surgery patients undergoing surgery at a surgery center owned by the surgeon.  Both patients got in trouble and, in both cases, the surgeon refused to call 911 or to permit anyone else to do so.  In both cases, the young women died.  Both cases were so egregious that criminal charges were filed.

While it is true that plastic surgery and other procedures are successfully performed under general anesthesia in surgery centers every day, when there is a significant problem, the patient has to be transferred to a hospital for a higher level of care.  Even under the best of circumstances, the transfer will take time.  Even under the best of circumstances, it will take time before the patient can receive the care she or he needs at a full-service hospital.

The odds are that everything will be fine with your plastic surgery, if you have chosen a well-qualified and well-trained surgeon.  However, we know for certain that some patients will get in trouble and will need an emergency ambulance ride to the hospital.  What that trouble will be, how long it will take to get to the hospital, and whether it will be too late by the time the patient arrives at the hospital is unknown.  It could happen to you.

If you want to have cosmetic surgery, be my guest, but remember that there are risks and that some people will be damaged.  Lower the risks by choosing your surgeon wisely and, if possible, having your procedure at a hospital.  Good luck.

Posted in Doctors, Hospitals, medical errors, medical ethics, Medical Malpractice, Nurses, Surgical Errors |

Be On The Lookout For Ticks: They Are Dangerous

September 04, 2023

As our climate changes, biological threats that were never a concern may become very concerning in your area.  One example is the occurrence of multiple cases of malaria spread by certain mosquitos in Florida, Texas and Maryland.  The disease, which had been eradicated in the United States by 1951 is making a comeback.  Today, however, I want to talk about the humble tick.

Rocky Mountain Spotted Fever (RMSF) | CDC

This is an image of the tick that carries Rocky Mountain Spotted Fever (RMSF).  It is the American dog tick.  It would be nice if the tick were this large and this easy to see.  In fact, an adult is about the size of a sesame seed.  When it is swollen with blood, it can expand to the size of a small olive.  Larvae and nymphs of the tick are even smaller.

If the tick bites a person or animal infected with the bacterium that causes the disease, it passes it along to the next person or animal it feeds on.  The tick feeds on animals in the wild, but when temperatures are high and the weather is dry, they prefer to feed on humans.  Dogs, especially dogs that are allowed to run around outside, are a fairly common way for the tick to be introduced to a human host.  There have been a number of cases of RMSF on the Indian reservations of the southwest, where dogs are often allowed to roam freely.  There have also been a number of cases reported in villages in Northern Mexico.  Both of these areas are uncomfortably close to the major metropolitan areas of Arizona.

Rocky Mountain Spotted Fever is a deadly bacterial disease.  In addition to being potentially fatal, if left untreated, it can cause severe damage to blood vessels and result in amputations, hearing loss and mental disability.  There are antibiotics which can successfully treat it but they need to be administered early in the course of the disease.

The symptoms of RMSF are similar to those of many other conditions.  Among them are fever, headache, nausea, vomiting, stomach pain, and muscle pain.  The disease often causes a rash, but the rash doesn’t usually show up until the disease process is advanced.  See your health care provider, if you develop any of these symptoms after being in areas where ticks are found.  This is especially true, if you have evidence that you have been bitten by a tick.

The most important way to protect against RMSF is to avoid places ticks are found.  They like grassy and forested areas.  There are many ticks in the forests of Northern and Central Arizona.  They live in our desert areas as well.  If you are going camping, treat your clothes with permethrin.  You can also use topical repellant on your person.  Check your dog for ticks when you return from a walk in the woods or the desert.  If your cat is a sometimes outdoor cat, check it for ticks as well.  You can purchase a tick collar for your pets.  Check yourself for ticks when you come back from an area where ticks live.  A shower will wash off ticks that have not yet attached to your body.  Put your clothes in the dryer on high heat for 10 minutes to kill any ticks which may be hiding in them.  Check your backpack, daypack or any other item that you are bringing into the house after being in the woods or desert.

We live in a wonderful part of the world but no place is free from all risks.  Take some common sense precautions and you and your family should be safe from Rocky Mountain Spotted Fever and from other tick borne diseases as well.

Posted in blood infections, health, healthy living, Infection, science news |

The Many Faces of a Heart Attack

August 28, 2023

Many times a year we see a case in which someone has a heart attack (known medically as a myocardial infarction), seeks medical attention, and dies when they should not have.  We also know that there are many, many more who have heart attacks at home and, for one reason or another, do not seek treatment and die or are badly damaged.  Almost all of these situations arise from the same cause:  The symptoms of a heart attack were not recognized, either by the person having the heart attack, or by the health care provider to whom the person went for treatment.  With a condition as common and deadly as a  heart attack, how can that happen?

What's Behind the Rise in Heart Attacks Among Young People?: Cardio Metabolic Institute: Multi-Specialty Group

The picture above provides a big clue to how this can happen.  When people, including medical professionals, think about a heart attack, they think about crushing, substernal chest pain.  The proverbial “elephant sitting on my chest.”  Medical professionals know that not all heart attacks present with crushing, substernal chest pain, but they can’t help themselves sometimes when a cardiac patient presents with some other manifestation of a heart attack.  Lay people are less likely to know about all of the different ways a heart attack can present, so it is easier to understand why they may not make a bee line for the hospital when they start to have symptoms.

Here are some of the different ways in which a heart attack can present:

Chest pain.  Crushing, substernal chest pain is the classic presentation.  It is most often on the left but need not be.  As with many other things in medicine, if you have a classic presentation, the doctors are most likely to correctly diagnose your problem.  The rarer your illness or presentation is, the less likely doctors are to correctly recognize it.

Back pain.  This can be anywhere in the back, but is most likely in the upper back.

Abdominal pain.  This is less likely but still one of the ways in which a heart attack might present.  A good rule of thumb is that any discomfort between the belly button and the jaw may be a heart attack and you should seek treatment accordingly.

Pain radiating down the arm (especially the left arm).  This also one of the classic presentations.

Jaw pain.  Another presentation that is likely to be recognized as a possible heart attack.

Indigestion.  Another vague symptom that may easily be due to a heart attack.

Cold sweats.  Usually a sign of a heart attack in conjunction with the symptoms listed below.


Unusual shortness of breath.  Shortness of breath not associated with significant activity.

Dizziness or Lightheadedness.

Unusual fatigue.  Again not associated with significant activity.

A general feeling of being unwell or of impending doom.

While heart attacks can strike suddenly and without warning, most of the time there are warning signs prior to the main event.  Be very alert and concerned if these symptoms appear and you are over 50 years old.  Remember women can have heart attacks too.  Be proactive and get checked out at an emergency department.  Don’t waste your time at Urgent Care.  They won’t treat chest pain patients or patients who may be having a heart attack (or at least they shouldn’t).

Family history plays a big role in heart health.  If you are a male and your father had a heart attack in his 40’s, be very vigilant.  Every time I have seen a young man with a heart attack, his father has also had early onset heart disease.

In the meantime, everyone over 50 ought to be getting regular check ups, which include blood work to check for elevated lipid levels.  Low Density Lipoprotein (LDL), the bad cholesterol is a lipid and can be measured with these blood tests.  Heart attacks are usually the result of fatty deposits in the coronary arteries.  High lipid levels contribute to these deposits.  If your lipid levels are high, the doctor can give you medication to drive the numbers down.

Stop smoking, eat a reasonably healthy diet, drop a few pounds, if you are overweight, and get off the couch and move around.  Take good care of yourself and you may live to a ripe old age.

On the other hand, if you have symptoms, go to the emergency department, and get sent home by mistake, call me.

Posted in Doctors, General Health, health, healthy living, heart attack, Heart Attacks, Misdiagnosis |

Analysis of a Recent Large Medical Malpractice Verdict

August 21, 2023

I recently wrote that most large medical malpractice verdicts share some things in common.  Here is a recent Idaho verdict that demonstrates the point.

Stroke - Wikipedia

An ischemic stroke is one in which blood flow to the brain is interrupted by a blood clot or some other mechanical obstruction.  All of the brain downstream of the blocked area will suffer from the loss of its blood supply.  Brain cells may die or be permanently damaged.  Depending on the size and location of the obstruction, the effects of the blockage can be mild or devastating.  In any event, the faster a stroke is recognized and blood flow restored, the better for the patient.  As neurologists put it, when it comes to an ischemic stroke, “Time is brain.”  Everyone who treats potential stroke victims knows these important facts.

On the morning this sad series of events began, a wife found her husband on the bathroom floor with a terrible headache, vomiting, and confusion that seemed to be getting worse.  She called 911.  Fortunately, they lived close to a good hospital and within a few minutes her husband was being examined by an emergency room (ER) physician.  The ER physician considered the possibility of stroke and ordered a CT scan of the neck and head to determine if there was a blockage or some problem with circulation to the brain.  A CT scan is a computer-enhanced form of x-ray that allows an area to be viewed in three dimensions.  The CT was interpreted by a radiologist as showing essentially nothing going on in the brain.  The radiologist was wrong as there was a tear in one of the arteries of the neck that delivers blood to the brain and the patient had suffered a stroke as a result.  Believing that there was no stroke, the ER doctor diagnosed the patient with positional vertigo, a mild condition, and asked that he be admitted to the hospital for observation.

As often happens these days, there was no hospital bed immediately available for the patient, so he stayed on a bed in the emergency department while awaiting a room.  It is a sad fact of life that patients who have been evaluated in the ER and are awaiting a bed do not get monitored with the same degree of attention that they would get had they been in a regular room.  The patient’s condition deteriorated and no one recognized the fact.  By the time he reached a room, he was described as being “delirious without meaningful interaction.”

It took four or five hours for him to be seen by a doctor after reaching his room.  The ER doctor had recommended an MRI of the brain, if his condition did not improve, but the MRI was “unavailable” for a period of hours.  When the MRI was finally performed, the stroke and the arterial tear were discovered, but by then it was too late to save all of the patient’s brain function.  The final determination was that he had an irreparable brain injury, was totally disabled, and would need substantial medical care for the rest of his life.

The patient and his family sued the ER doctor and the group employing him, the hospital, the group employing the radiologist who misread the CT scan, and some other doctors.  Everyone denied they were at fault but, by the time of trial some six years later, everyone else had settled except the ER doctor and his group.

The jury returned a verdict in favor of the patient and his family in the amount of $13.5 million, the second largest malpractice award in Idaho history.  In so doing, the jury found that the conduct of the ER doctor was not just negligent but was “willful or reckless.”  This cleared the way for the jury to award more for pain and suffering than the $400,000 limit imposed by Idaho law.  Needless to say, the patient and his family were pleased and the ER doctor and his group were disappointed.  With this much money at stake, an appeal will certainly be filed.

So what does this verdict have in common with other large verdicts?

A tragic injury:  Check.

A loving family:  Check.

Large medical bills:  Check

Large wage loss:  Check

Good Trial Lawyer:  Check.  Plaintiffs’ counsel here has won many awards for his excellence as a trial lawyer.

X-factor:  Unknown.  It is unclear from the press accounts what prompted the jury, not just to find for the plaintiffs, but to conclude that the care given by the ER doctor was aggravated.  Clearly something set them off.  After all the ER doctor had been misled by the radiologist, who assured him there was no stroke and who also failed to detect the torn artery in the neck.  Furthermore, in cases such as this the jury will surmise that the radiologist and the other defendants who were not a trial had paid the plaintiffs some money and reduce the plaintiff’s recovery accordingly.  Whether the X-factor was extreme sympathy for the plaintiff or whether the ER doctor acted like a jerk on the stand, I cannot tell but something caused this jury to act in a manner different from most malpractice juries, which usually find in favor of the doctor or hospital.

Although it will not get anything like the publicity the jury verdict received, there will be an appeal, which may throw the whole verdict out, or may reduce the award, or do any one of a number of other things that are favorable to the defendants.  Often, the plaintiffs agree to accept a lesser figure in settlement while the case is on appeal rather than trust the outcome to the appellate court.  Especially in a conservative state like Idaho, the appellate courts will be on the conservative side and plaintiffs know that.  Check back in a year or two to see what happened.




Posted in Blood Clots, Doctors, Hospital Negligence, Hospitals, Lawsuits, Malpractice caps, medical errors, Medical Malpractice, Medical Malpractice Case Value, medical malpractice cases, medical malpractice damages caps, Stroke, trial, Verdicts |

You And Your New Doctor – A Few Thoughts

August 14, 2023

I was going to title this post “How to Choose a New Doctor” but that doesn’t happen very much any more.  Long gone are the days when a person chose a doctor and received most of his or her health care from that doctor over a period of many years.  Today’s health care is fragmented so that patients may see multiple different doctors in different specialties over the course of just a short period of time.  Even the process of selecting a primary care physician is different now with managed care and hospital chains buying up private practices.  Today, you are just as likely to be assigned a doctor as you are to choose one.  In fact assignment may even be more likely.  Even so, you have some rights and choices.

Only 5.7% of US doctors are Black, and experts warn the shortage harms public health | CNN

Your first choice is your primary care physician (PCP).  Your PCP is probably the most critical person to your health care.  This will be the doctor you see most often.  This may also be the person who decides when and if you can see a specialist.  What is your health insurance plan and what does it require?  Can you choose your PCP from all the doctors in your area or are you limited to those in your network?

Even if limited to those PCPs in your network, there are certain qualities you need and want in your PCP.

Don’t just take whoever the plan may assign to you.  Who is this person?  Where did she train?  How much training has she received?  Did she do a residency?  What certifications does she have?  Does she have a discipline record down at the medical board?  All these are questions you should be able to get answers to before you meet the doctor for the first time.

When you meet the doctor, you want to assess her and figure out if she is both what you want in a doctor and if the two of you are a good fit for each other.  Here are some things I think are important and that you should consider.

Will this doctor take the time needed to provide good care?  If you read this blog regularly, you know that doctors are facing more pressure than ever to see more patients than ever.  The economics of the practice of medicine or the demands of their employers want them to maximize the bottom line.  You, on the other hand, want a doctor who will spend an hour with you, if that is what it takes to understand your health issue and decide upon a treatment plan. You need to find someone who will listen to you, take the time to properly care for you, and be your advocate, if you need further care.

Is this doctor a good listener or is he an impatient person who cuts you off?  Good listening is the key to good diagnosis.  On the other hand, even an impatient doctor can be a wonderful doctor.  Good listening is not a deal breaker, but one of the factors you should be considering.

Is the doctor honest and open?  Does the doctor clearly explain what she or he thinks may be going on and what he or she plans for you going forward?   Does the doctor keep clear and complete records of your treatment?  Nowadays, most health care providers have portals that allow patients to see their records.  Even if there is no portal, get a copy of your records and review them.  You are entitled to a copy by law and should review them for accuracy.  Mistaken information in your medical records (something that is sadly not uncommon) can follow you forever and affect the treatment decisions of subsequent doctors.  Make sure your new doctor has gotten your health problems right.

Is the doctor’s office staff professional?  You can tell a lot about a doctor by the staff she has hired to interact with her patients.

Does the doctor appear to respect patient privacy?  If the doctor is talking to you about other patients, that is a bad sign.

Does this doctor seem to care about you?  Or is this doctor an upseller, who is trying to get you to purchase additional services you might not need.  Even worse, is this doctor someone who may order tests you don’t need or treatments you don’t need.  Always remember that there is no free lunch.  Every medical treatment carries with it some risk, however rare or slight, and you don’t want to expose yourself to unnecessary medical risks.

I am sure there are other qualities you may want to consider when deciding whether to form a long-term relationship with a PCP.  Just remember that you have the right to insist on another doctor, if the one you have is not the one you need.  Choose wisely.


Posted in Doctors, electronic medical records, Fee for Service, Health Insurers, medical charts, medical ethics, Misdiagnosis |

Prostate Cancer

August 07, 2023

Prostate cancer can be aggressive or slow-growing.  It may not be easy to distinguish between the two and there is a substantial risk of overtreatment.

How Androgen Controls the Conversation in Prostate Cancer Cells

After skin cancer, prostate cancer is the most common form of cancer among men.  One in seven men will develop prostate cancer and, if a man has a family history of prostate cancer, his risk is even greater.  Furthermore, the older a man gets, the greater the risk that he will develop prostate cancer.

While there have been advances in detection, monitoring and treating prostate cancer, because of its location, it remains a difficult cancer to accurately diagnose and stage.  Staging refers to the determination of how advanced a cancer is.  There are ten possible stages for prostate cancer.  Treatment options depend upon accurate diagnosis and accurate staging.

Prostate cancer is usually detected by either palpation of the prostate gland showing physical changes or by use of a prostate specific antigen (PSA) test or both.  Complicating matters is that there are a number of unrelated conditions that can cause elevation of PSA levels.

Elevated PSA levels lead doctors to consider biopsies.  In the biopsy, a needle is inserted into the prostate and a small amount of tissue is extracted for testing.  The sampling may be done at multiple sites in the prostate and is usually ultrasound-guided to make sure the needle is actually in the prostate.

This form of biopsy has its problems.  The tip of the needle may miss collections of cancerous cells and result in an erroneous report of no cancer, a false negative.  Or the needle may locate low malignancy cells while missing more aggressive ones, again resulting in a more benign picture than is actually warranted.

Once cancer is detected, however, it must be graded and staged.  The more aggressive the cancer, the more important it is to treat it aggressively.  On the other hand, if the cancer appears slow growing, especially in an older man, the best current thinking is to carefully watch it and take aggressive action only if the cancer itself becomes more aggressive.  Most older men with slow growing prostate tumors will die of something else before the cancer becomes a problem.

For men diagnosed with slow growing prostate cancer, there can be a lot of societal and family pressure to “do something.”  Since each of the three main treatments for prostate cancer have a greater than 50% chance of leaving the man without a functional erection and with urinary urgency, the decision to proceed with aggressive treatment should be made carefully.  Once aggressive treatment has been undertaken, there is no going back.

The good news is that prostate cancer is highly survivable.  According to the Centers for Disease Control, the five year survival rate for men diagnosed with prostate cancer is just over 97%.  Contrast that with colorectal cancer at 65% and lung cancer at 19%.

Researchers continue to make progress in diagnosing, staging and treating prostate cancer as well as many other cancers.  Among the promising new strategies is immunotherapy in which the patient’s own immune system is essentially turbocharged to enable it to attack the prostate cancer.  Other new therapies and approaches are also being pursued and show a lot of promise.

I hope you never get prostate cancer, but, if you do, don’t despair.  There is a good chance you will be able to outlive it.




Posted in Cancer, Doctors, Prostate Cancer, prostate cancer testing, science news |

Pay Me Now Or Pay Me Later

July 31, 2023

Maybe you remember the old television advertisement in which the auto mechanic told the audience that they could pay him now to install a new oil filter or they could pay him later when their car broke down due to dirty oil.  That ad hasn’t been on television for over 40 years now but the concept is applicable to the debate about how we should pay for healthcare.

Pay Me Now or Pay Me Later - A Sweet Way To Pay

Regular readers of this blog know that the United States is the only nation in the industrialized world that does not have universal health care.  The reasons are rooted in our history and the way health insurance developed during the wage control years of World War II.  Although those controls are long gone, while they existed, they fostered the creation of large, very profitable health insurance companies that do not want to lose the money they receive selling health insurance.  As a result, our current expensive and inefficient system of paying for health care is very resistant to change.

The inefficiencies of our system weigh heavily upon us.  We spend more per capita for health care than any of the other industrialized countries but get less for it.  Our outcomes on important health measures are terrible, despite what we pay.  Among the industrialized nations we have the lowest life expectancy at birth, the highest maternal and fetal mortality, extremely high rates of obesity and among the highest suicide rates.  We also have the highest percentage of people with multiple, chronic health issues.

We already provide health care to the poorest among us.  Occasionally, we see some politicians advocate for universal health care.  Their proposals usually do not get far.  On the other hand, there are many politicians who oppose measures to expand health care for the poor.  For example, despite the federal government providing for an expansion of Medicaid eligibility and willing to pay most of the cost, the legislatures of many states have been unwilling to take advantage, even though it would greatly improve the health of their citizens.  The residents of some states with reluctant legislatures have taken matters into their own hands and passed initiatives to force their state to expand Medicaid.

We require hospitals with emergency departments to provide emergency care to anyone who shows up at the door, regardless of their ability to pay.  Only after the emergency condition has been stabilized and it is safe to transfer the patient may a hospital transfer or discharge a patient who has no insurance and no ability to pay.

The hospitals and doctors who are required to provide emergency care to the destitute have to get paid somehow.  Hospitals with poor patients will usually see if they can get the patients enrolled in Medicaid (AHCCCS here in Arizona) and get paid that way.  But if patients are not eligible for Medicaid, the hospital and doctors must absorb the cost of the treatment.  That cost gets passed on to the rest of us in the form of higher hospital and doctor bills.    This where “Pay me now or pay me later” comes into play.

If we are going to have to pay for the cost of medical treatment for the poor once their health care issue has become a medical emergency, doesn’t it make sense to address that health care issue before it becomes a medical emergency when it will almost certainly be cheaper to treat?  Not only will it be cheaper to treat but, by preventing the onset of a medical emergency, society saves money by keeping those patients who are employed actively on the job.  Even if the patient is not working, they may have family members who are.  Having a family member in the hospital with a medical emergency disrupts all of the usual family arrangements and also contributes to lost time from work among family members.

We are so far behind the rest of the world that there is a lot of low-hanging fruit that can be harvested to get us improved health care outcomes without great additional expense.  What we need are people and politicians who will look at practical realities rather than simply adhere to ideological talking points.  We need people and politicians who, when asked if they want to pay $1 for health care now or $2 later, will choose the responsible option.


Posted in Doctors, Fee for Service, General Health, health, Health Care Costs, Health Insurers, Hospitals, Medical Costs, Medicare |

Acute Compartment Syndrome

July 24, 2023

Unrecognized or improperly treated acute compartment syndrome can cause serious injury, including limb loss and even death.  As a result, it is the underlying medical condition in many medical malpractice lawsuits.

Our bodies have a number of muscle compartments, which are separated by fascia, a tough, inelastic, fibrous sheet.  Acute compartment syndrome occurs when swelling creates pressure inside one of the compartments.  The inelasticity of the fascia surrounding the compartment prevents the pressure from escaping.  If the pressure reaches a certain point, it prevents or severely reduces the ability of the body to deliver blood to the compartment.  The absence of blood flow (ischemia) will cause tissue damage and, if it persists long enough, tissue death.

Acute compartment syndrome after minor trauma in a patient with undiagnosed mild haemophilia B - The Lancet

The images above show the before and after of acute compartment syndrome.  Note the swelling in image A.  Image B shows a reduced size after surgery to relieve the pressure.  Acute compartment syndrome is a surgical emergency and the window during which surgery can be successfully performed to reduce the compartment pressure is generally considered to be no more than six hours after onset.  After that point in time, permanent muscle damage is likely.  If tissue death occurs before the pressure can be relieved, amputation of the affected limb may be necessary.

Acute compartment syndrome is most often caused by trauma.  The usual causal mechanism is a fracture of one of the long bones in the arm or leg but it can also be caused by a crush injury that does not result in a bone fracture as well as some other conditions.  While most commonly found in the legs or arms, it can also occur in the buttock, shoulder, hand, or foot.  Any condition that can cause a sudden swelling in a compartment can set the stage for acute compartment syndrome.

The diagnosis of acute compartment syndrome is a clinical one, that is, the diagnosis is usually made on the basis of the patient’s symptoms.  There are no good tests for it.  One of the dangerous characteristics of acute compartment syndrome is that it may not appear for as much as 48 hours after the traumatic injury.

The symptoms commonly found in acute compartment syndrome are pain, paresthesia (numbness and tingling), pallor, pulselessness, and paralysis.  The pain associated with this condition is usually severe and seemingly out of proportion to the underlying injury.  Unfortunately, most of the symptoms of acute compartment syndrome are late findings, that is they don’t show up until late in the process.  The earliest finding is almost always a tense compartment that is frequently described as feeling “woody.”

Because of the emergent nature of acute compartment syndrome, doctors encountering patients who might be at risk for it should be concerned it might develop and be watchful for symptoms.  At the earliest sign of a developing syndrome, they should call for an emergency surgical consultation.  They must also recognize that, even if not immediately present, the condition may develop in the coming hours.  It is important, therefore, that the patient be instructed about what to watch out for and to return immediately, if any of the symptoms of a developing compartment syndrome appear.

The occurrence of an acute compartment syndrome presents many opportunities for medical providers to make mistakes and, if its presence is missed, the risk of a very serious injury.  If you have suffered an injury due to acute compartment syndrome for which you sought medical treatment, you may have been the victim of medical malpractice.  You should consult with an experienced malpractice lawyer, who can review your medical records and advise you whether you have a claim that can be successfully pursued.


Posted in Doctors, Lawsuits, medical charts, Medical Malpractice, medical malpractice lawyers, medical mistakes, Medical Negligence, Orthopedics |