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So many lawyers, so little time...

"The prospect of hanging focuses the mind wonderfully"--Samuel Johnson

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Location: Louisville, KY, United States

Gastroenterologist, cyclist, cellist, Christian, husband, father, grandfather.

Wednesday, March 16, 2005

Two little questions

At the age of three or four we start asking two questions that would make us all a lot smarter if we made a life-long habit of it: "Who sez?" and "Why?". These questions don't tend to survive our college careers, not if we don't want to tick off our women's and ethnic studies professors.

The really bright doctors ask them all the time. At the GI rounds at the Major University in the Large City in the 80's, a bright GI trainee presented his study of Ogilvies Syndrome. Ogilvies syndrome is a nasty condition in which the patient's colon slows down and the cecum, ever obedient to LaPlace's Law, swells up with gas until it pops and empties stool into the peritoneal cavity.

The Wisdom of the Ages holds that the cecum will rupture when it reaches a diameter of 9 cm., so intervene before then or risk serious consequences.

"Who sez that 9 cm. cecum is on the verge of rupture, and why did he say it?" the GI fellow wondered. So into the library he went. He started with Roberts Rules of Medicine which cited a study in the 1978 edition of the National Medical Dispatch, which in turn cited an article from the 1969 edition of Surgery: Yesterday, Today, and Forever which in turn cited a 1961 edition of Rhode Island Surgeons Club which in turn cited a 1957 edition of the New Zealand Journal of Fish and Poultry which finally lead to an article from the 1952 edition of The Xray Journal in which the author admitted that he just made up the 9 cm. cecal diameter cutoff that had been accepted as gospel truth for thirty years.

This is not arcane lore. Knowing that there is nothing magical about the 9 cm. cecal diameter, we can give conservative measures a lot more time to work before risking any sort of surgical intervention.

These days I've been asking "Who sez?" and "Why?" about a study being quoted all the time asserting that there are 98,000 deaths each year from malpractice.

I tried to hunt the study down by googling it. The first fifty web sites were from malpractice firms informing us that doctors were killing off patients like flies and that only their law firms can protect the public. None of them referenced the actual study, and my Zoloft level wouldn't sustain additional research.

I then pulled up the statistics on cancer deaths. Colon cancer takes about 57,000 lives a year in the U.S.; breast cancer takes 41,000 lives a year.

If my math skills are holding up, the lawyers claim that for every person who dies of colon or breast cancer in this country, some doctor knocks off an innocent patient.

Think about it. If this were true, instead of wearing pink ribbons commemorating Susan Koman, patients would be wearing tiny little rope nooses on their lapels reminding them of the last time they dragged a doctor out into the streets and hanged him. The figure as cited by the lawyers is clearly nonsense.

There are legions of bright bloggers out there who may be more familiar with the study who can come to my aid. In anticipation of that assistance, I will maintain that the 98,000 figure defies common sense.


Anonymous Anonymous said...

The terms you use have to be better defined. Does the patient have to die within 24 hours, a week, a year or a decade? What does cause mean? If a surgeon removes a cancerous breast tumor and the patient dies anyhow do we place the blame on the doctors.

If a doctor removes the healthy kidney and leaves the diseased one in place then we can chaulk up one against the doctor. Does this happen 98,000 times a year I doubt it.

11:23 AM  
Blogger JusPasenThru said...

I doubt it, too.

11:39 AM  
Blogger The Medicine Man said...

I'm not suggesting that you'd find the report particularly compelling or without methodological flaws but here's your reference to the original report:

"To Err Is Human: Building a Safer Health System", Institute of Medicine, March, 2000

Here's a link: http://books.nap.edu/books/0309068371/html/

By the way, I love your blog. And as far as your malpractice cases...we've all been there!


5:38 PM  
Blogger JusPasenThru said...

Thank you! I'll check it out.

8:05 PM  
Blogger jon said...

I was looking at your posts about cancer pancreatic and found a good article about the same cancer pancreatic info too...

God luck with it : )

1:27 PM  
Blogger amacdrummer said...

If you need cancer lung picture info... Go to this cancer lung picture site : cancer lung picture

2:10 AM  

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