12-year-old is now an amputee after a 10-hour wait in the ER, New Mexico lawsuit says

[DeadCactus]

Sounds a lot like diverticulitis. Tough to get people to change practice in a world where everyone can envision getting smoked in a courtroom if there is a bad outcome associated with withholding of antibiotics (and where there is likely a long line of "experts" who will testify that GI/ID guidelines are meaningless compared some some imaginary "standard of care").

Sigh.

The AGA Guidelines themselves are a hedge. "Conditional", "low-quality evidence", "suggests", "recommendations could change with further evidence", etc. That's the best the specialists who spent weeks, months, or years digging through the literature and coming to a consensus could come up with.

---

Members don't see this ad.

 

[Birdstrike]

Imagine a world where our textbooks and journals were actually honest and stated what's medically right, then followed it up with caveats saying, "But you you can't actually do that. You should actually do X, Y or Z, to get better patient satisfaction scores, avoid a frivolous lawsuit, please an insurance company, or because your administrator wants to make more money for his hospital this year."

We have a huge disconnect between written teaching in Medicine and how Medicine in the real world dictates we must practice. Our textbooks have good information in them, but the disconnect between that information and what is applicable in reality, seems to grow every year.

 

[Siggy]

Imagine a world where our textbooks and journals were actually honest and stated what's medically right, then followed it up with caveats saying, "But you you can't actually do that. You should actually do X, Y or Z, to get better patient satisfaction scores, avoid a frivolous lawsuit, please an insurance company, or because your administrator wants to make more money for his hospital this year."

We have a huge disconnect between written teaching in Medicine and how Medicine in the real world dictates we must practice. Our textbooks have good information in them, but the disconnect between that information and what is applicable in reality, seems to grow every year.

I think there’s some psychology to this as well. A lot of the research comes out to “do less” but we just feel better doing more.

 

[pkwraith]

Additionally ceftriaxone actually has decent oral aenarobic coverage anyways

 

[ScepticSkeksis]

I think there’s some psychology to this as well. A lot of the research comes out to “do less” but we just feel better doing more.

Like antibiotics for strep throat, bronchitis, otitis media and sinus infections. It's quicker and easier to just give it rather than waste time on a lengthy medical explanation that the patient won't understand anyway. All they know is they get antibiotics, and they get better.

 

[Siggy]

Like antibiotics for strep throat, bronchitis, otitis media and sinus infections. It's quicker and easier to just give it rather than waste time on a lengthy medical explanation that the patient won't understand anyway. All they know is they get antibiotics, and they get better.

I think it’s also in the medical field.

ABX for everyone.

Crystalloid vs colloid (let’s give albumin because it’s more special)

Treating subsegmental asymptomatic PE.

Daily labs and CXR.

 

[Kryptocoin]

NM actually has good tort reform. Individual physician medmal liability is capped at $250k. Overall noneconomic damages for plaintiffs is capped at $600k.

 

[turkeyjerky]

I think it’s also in the medical field.

Treating subsegmental asymptomatic PE.

Unfortunately, I don't think the evidence against this one is as good as most of us expected.

NM actually has good tort reform. Individual physician medmal liability is capped at $250k. Overall noneconomic damages for plaintiffs is capped at $600k.

This is a confusing topic, as I've spoken to a few docs who had some experience working in NM and they've unanimously offered the opinion that its got a miserable practice environment.

RE Aspiration: I think this guideline is actually pretty reasonable. I think we should try our best to be diligent in accurately describing what we're treating, eg aspiration event vs aspiration pneumonitis vs aspiration pneumonia vs aspiration-associated pulmonary abscess or empyema (w/ only the latter two requiring special anaerobic coverage).

 

[WilcoWorld]

This is a confusing topic, as I've spoken to a few docs who had some experience working in NM and they've unanimously offered the opinion that its got a miserable practice environment.

I worked in NM for several years. It was a very difficult practice environment, but I didn't worry about getting sued. It was a tough place to practice because it's so resource poor that providing care is always an uphill battle.

 

[FutureInternist]

UK

Girl who had all four limbs amputated after hospital mistake wins eight-figure payout

‘Money cannot bring who your daughter was back but it can secure her future’, Judge Glyn told the girl’s family at the High Court in London

www.independent.co.uk

 

[Siggy]

Unfortunately, I don't think the evidence against this one is as good as most of us expected.

This is a confusing topic, as I've spoken to a few docs who had some experience working in NM and they've unanimously offered the opinion that its got a miserable practice environment.

RE Aspiration: I think this guideline is actually pretty reasonable. I think we should try our best to be diligent in accurately describing what we're treating, eg aspiration event vs aspiration pneumonitis vs aspiration pneumonia vs aspiration-associated pulmonary abscess or empyema (w/ only the latter two requiring special anaerobic coverage).

Re PE To be fair, the CHEST VTE guidelines has a ton of hedged built in regarding subsegmental PEs and criteria for artifact (why there’s a rec against treatment) and true PE.

RE Aspiration: the AHRQ basically says “do what ever, but no real reason to add anaerobic coverage.” It even has a pathway for watchful waiting at the bottom.

 

[Kryptocoin]

This is a confusing topic, as I've spoken to a few docs who had some experience working in NM and they've unanimously offered the opinion that its got a miserable practice environment.

NM is resource poor. It's a hellhole to practice in. Lots of drug violence. Heavy mental health and addiction issues. However, lawsuits are quite uncommon actually.

 

[dantt]

Agree completely with your second paragraph, that’s a no brainer.

But as far as state med mal ratings go, I believe New Mexico is up there as one of the worst, if I can remember from ACEP rankings. If I’m not mistaken, there’s no caps on damages for ‘pain and suffering’, don’t have to demonstrate gross negligence to win etc.

I could be wrong.

You are totally wrong. Not only is there a cap on non economic damages, there is a patient compensation fund to take care of thos type of issue.

 

[Old_Mil]

NM actually has good tort reform. Individual physician medmal liability is capped at $250k. Overall noneconomic damages for plaintiffs is capped at $600k.

I wonder if this changed after ACEP published (and then took down) their report card. I too recall something about NM being a bad medmal climate.

 

[dantt]

I wonder if this changed after ACEP published (and then took down) their report card. I too recall something about NM being a bad medmal climate.

It's okay. Cap has actually been increased to 250/750 but now indexed to inflation. Problem is as others described above, resource poor/bad payor mix/predatory health systems. Other issues like crime, bad public schools, etc.

 

[WilcoWorld]

It's okay. Cap has actually been increased to 250/750 but now indexed to inflation. Problem is as others described above, resource poor/bad payor mix/predatory health systems. Other issues like crime, bad public schools, etc.

There's a phrase in ABQ, "you can send your kids to public school...or they can go to college"