Doctors more likely to misdiagnose patients who are jerks

Going to see the doctor can bring out the worst in people. Being sick and fitting an appointment into an overcrowded schedule can be stressful. So can a long sit in the colorless cube of a waiting room.

But if you’ve ever given a doctor attitude, next time you might want to think twice — or risk being misdiagnosed.

That’s the implication of two new studies published in the journal BMJ Quality & Safety. Separately, the authors demonstrated that clinicians are more likely to make errors of judgment when they’re treating frustrating and difficult patients…

The researchers suspected physicians’ mental resources are so taxed from thinking about how to deal with tricky patients that their ability to process medical information becomes impaired. “If resource depletion affects simpler, everyday problems,” they wrote, “it is not surprising that these highly complex cognitive processes are impaired if a substantial proportion of mental resources is seized by the confrontation with emotional experiences triggered by patients’ troublesome behaviors…”

From the patient perspective, leaving any attitude outside the doctor’s office is probably a good idea, lest you risk being misdiagnosed.

I’ll second that emotion.

RTFA for an outline of the two studies. Actually, the suggestion is useful in many a context. I’d suggest you treat your doctor like a friendly, professional; but, overworked copper. And vice versa.

Politeness counts.

Anesthesiologist trash-talks sedated patient — $500K worth!


Sitting in his surgical gown inside a large medical suite in Reston, Va., a Vienna man prepared for his colonoscopy by pressing record on his smartphone, to capture the instructions his doctor would give him after the procedure.

But as soon as he pressed play on his way home, he was shocked out of his anesthesia-induced stupor: He found that he had recorded the entire examination and that the surgical team had mocked and insulted him as soon as he drifted off to sleep.

In addition to their vicious commentary, the doctors discussed avoiding the man after the colonoscopy, instructing an assistant to lie to him, and then placed a false diagnosis on his chart…

There was much more. So the man sued the two doctors and their practices for defamation and medical malpractice and, last week, after a three-day trial, a Fairfax County jury ordered the anesthesiologist and her practice to pay him $500,000…

The jury awarded the man $100,000 for defamation — $50,000 each for the comments about the man having syphilis and tuberculosis — and $200,000 for medical malpractice, as well as the $200,000 in punitive damages. Though the remarks by Ingham and Shah perhaps did not leave the operating room in Reston, experts in libel and slander said defamation does not have to be widely published, merely said by one party to another and understood by the second party to be fact, when it is not…

Because he was going to be fully anesthetized, the man decided to turn on his cellphone’s audio recorder before the procedure so it would capture the doctor’s post-operation instructions, the suit states. But the man’s phone, in his pants, was placed beneath him under the operating table and inadvertently recorded the audio of the entire procedure, court records show. The doctors’ attorneys argued that the recording was illegal, but the man’s attorneys noted that Virginia is a “one-party consent” state, meaning that only one person involved in a conversation need agree to the recording.

The recording captured Ingham mocking the amount of anesthetic needed to sedate the man, the lawsuit states…”…The discussion soon turned to the rash on the man’s penis, followed by…comments implying that the man had syphilis or tuberculosis. The doctors then discussed “misleading and avoiding” the man after he awoke

Ingham then mocked the man for attending Mary Washington College, once an all-women’s school, and wondered aloud whether her patient was gay, the suit states. Then the anesthesiologist said, “I’m going to mark ‘hemorrhoids’ even though we don’t see them and probably won’t,” and did write a diagnosis of hemorrhoids on the man’s chart, which the lawsuit said was a falsification of medical records.

After declaring the patient a “big wimp,” Ingham reportedly said: “People are into their medical problems. They need to have medical problems.”

Stupid 101. Testimony included expert opinion that anesthesiologists should be aware that any patient might not be in a deep sleep and might recall hearing silly, irrelevant remarks. Catching the whole procedure as an audio recording was a plus that locked everything up for the lawsuit.

If you feel like RTFA, some of the recordings are available. 🙂

Thanks, Honeyman

Biogen Idec has a wonderful new pill to treat Multiple Sclerosis

Biogen Idec said…it will price Tecfidera, its newly approved pill to treat multiple sclerosis, at $54,900 a year per patient in the United States.

Officials at the Weston-based biotechnology company said the figure represents a “solid value” for MS patients, who will take the capsule twice a day. Most MS treatments now on the market have to be injected or taken through intravenous infustion…

Biogen Idec…won Food and Drug Administration approval Wednesday to sell the oral therapy. Company officials said Tecfidera will distributed, stocked, and available topatients “on or around” Monday.

MS is a chronic autoimmune disease that affects the central nervous systems of about 400,000 people in the US and about 2.5 million worldwide, disrupting communication between the brain and other parts of the body. Over time, patients can suffer from muscle weakness, loss of balance, and a progressive decline in function.

Most current treatments for MS are priced between $45,000 and $60,000 annually.

The operative phrase in economics is – Take what the market can bear!

The cost of Tecfidera represents a slight premium over the the $51,000 projected by investment fund managers polled by New York research firm ISI Group. But it is less expensive than the first MS pill, Gilenya, sold by Swiss drug maker Novartis AG, which costs $60,000…

Health insurance covers most of the cost of the drug for the majority of patients. But Biogen Idec, like other drug makers, sponsors patient assistance programs to help pay for the drugs in cases where all or part of the cost is not covered by private or public payers.

What that means to ordinary human beings who need the treatment is that there is more than enough room in the profit structure to lower the price. When Big Pharma feel the need to to maintain sales targets.

Executive VP, Tony Kingsley said Biogen officials will be talking to commercial and government insurers over the next six to nine months about the clinical benefits of Tecfidera and its potential to lower overall medical expenses by keeping MS patients out of the hospital.

We’re days away from getting the product to patients, which we’re very excited about,” he said.

Like pretty much any medication for serious illness, Biogen will tailor the price to match national market demographics. That swing can be as much as 400% or more. Our government will back them up by working hard at preventing Americans from buying the pill in other countries.

You, too, can be arrested for trying to stay alive – and reducing pharmaceutical industry profits.

Judge forcing hysterectomy on fundamentalist woman

A cancer patient in Montana — identified only as L.K. — refused to undergo a hysterectomy as treatment for her cancer on the grounds that she is deeply religious and wants to have children. That’s sad enough in it’s own right. But no one could have foreseen what happened next: A judge found her “mentally incompetent” based on her “delusional religious beliefs” and ruled she was to have the procedure.

The Montana Supreme Court has halted the surgery to allow for an appeal, but in the interim let’s ponder this question: Since when do we force people to be sterilized in this country?

On one side of the case we have L.K.’s physician and psychiatrist testifying that without the surgery she could die in three years and that her “religious delusions” — namely, that God had cured her — interfered with her ability to make reasoned decisions about her care.

On the other, we have L.K. herself saying that while she did understand that she had been diagnosed with cancer and did understand the risks of dying if she did not have the procedure, she didn’t want it…Alas, this wasn’t enough to convince Judge Karen Townsend that she was of sound mind.

To be fair, it’s likely that Townsend acted in what she thought was the best interest of this woman: By ordering L.K. to have the lifesaving surgery, she was potentially saving her life…

Do you think this woman should be forced to have a hysterectomy?

What do you think? We interfere with beliefs like this all the time – to save children of True Believers. Do we have the right to do the same for adults?

Thanks, Mr. Fusion

FDA toughens standards for radiation therapy devices

The U.S. Food and Drug Administration has received nearly 1,200 complaints in the last decade about devices that deliver radiation treatments to cancer patients and has called on manufacturers to help improve safety.

The FDA sent letters to 93 makers of radiation treatment devices, urging them to attend a workshop to address concerns about patient exposure to excess radiation from medical treatments and procedures…

Radiation exposure became a major concern in October after the FDA said it was investigating 206 cases of patients being exposed to toxic doses of radiation during CT scans of the brain at Cedars-Sinai Medical Center in Los Angeles.

Last month, the FDA held a meeting with makers of diagnostic imaging equipment to gather ideas about how to protect patients from excess radiation exposure…

“Now we’re taking a broader look at the other uses of radiation,” FDA spokesman Dick Thompson told Reuters…

Hospitals, clinics and other users of medical devices report deaths to both the device manufacturer and the FDA but report serious injuries only to the manufacturer.

A review of the reports showed that linear accelerators — machines that deliver a concentrated beam of electron radiation directly to the tumors — accounted for 74 percent of the complaints…

The American College of Radiology has called for an accreditation program for facilities that deliver radiation therapy to cancer patients, something the medical equipment industry group AdvaMed supports as a way to enhance safety.


That’s not just my expected one-word comment on a topic like this. I presume our readers are bright enough, well-enough informed to make the link between political battles won since 2008 – and the failure of government agencies like the FDA to represent the people of this country in the past.

“Give us our damned data!” – a few cautionary tales

Who’s in charge?

For five days as her husband lay in his hospital bed suffering from kidney cancer, Regina Holliday begged doctors and nurses for his medical records, and for five days she never received them.

On the sixth day, her husband needed to be transferred to another hospital — without his complete medical records.

“When Fred arrived at the second hospital, they couldn’t give him any pain medication because they didn’t know what drugs he already had in his system, and they didn’t want to overdose him,” says Holliday, who lives in Washington. “For six hours he was in pain, panicking, while I ran back to the first hospital and got the rest of the records.”

Despite a federal law requiring hospitals and doctors to release medical records to patients who ask for them, patients are reporting they have a hard time accessing them leading to complications like the ones the Holliday family experienced.

‘What part of “Give us our damn data” do you not understand?’

RTFA and when you get down to the end – there is a list of tips to make certain you get your medical records.

Cancer patient held at airport because of missing fingerprints

A Singapore cancer patient was held for four hours by immigration officials in the United States when they could not detect his fingerprints — which had apparently disappeared because of a drug he was taking.

The incident, highlighted in the Annals of Oncology, was reported by the patient’s doctor, Tan Eng Huat, who advised cancer patients taking this drug to carry a doctor’s letter when traveling to the United States.

The drug, capecitabine, is commonly used to treat cancers in the head and neck, breast, stomach and colorectum.

One side-effect is chronic inflammation of the palms or soles of the feet and the skin can peel, bleed and develop ulcers or blisters — or what is known as hand-foot syndrome.

This can give rise to eradication of fingerprints with time,” explained Tan.

“He was detained at the airport customs for four hours because the immigration officers could not detect his fingerprints. He was allowed to enter after the custom officers were satisfied that he was not a security threat.”

We may have changed out the White House and a small piece of Congress for people with brains, education and integrity – but, Homeland Insecurity hasn’t changed a jot.

Doctors should be required to disclose off-label prescriptions


Doctors should be required to disclose when they are prescribing drugs off-label, argues a new article in this week’s PLoS Medicine. Michael Wilkes and Margaret Johns from the University of California Davis argue that the ethics related to informed consent and shared decision-making provide an imperative for doctors to inform patients about the risks of a medical treatment when their use has not been approved by regulators.

Off-label prescriptions are those that do not comply with the use approved by the Food and Drug Administration (FDA) for the drug. While off-label prescribing is legal and accounts for roughly half of all prescriptions currently written in the US, it is often not supported by sound scientific evidence. Worse, say the authors, off-label prescribing can put patients at risk and drive up healthcare costs.

The public often assumes that all common uses of prescription drugs have been approved by the FDA, say the authors. But current law does not prevent doctors from prescribing a drug to any patient for any use whether it was approved for this use or not.

“From an ethical perspective,” say Wilkes and Johns, “[what is required is] open, honest discussions where doctors tell their patients that the use of the drug will be off-label and thus not approved for this indication, explain the risks, potential benefits, and alternatives, and then ask patients for their permission to proceed.”

As an occasional patient I’m pleased the relationship I have with my physician is ethical and trusting.

Still, you trust your friends; but, you cut the cards. I’d rather have the ethical requirements spelled out in law – instead of having to rely on a trade commission or the AMA providing assurance.