Politics and Malpractice

Dr. Steven Anagnost is a doctor in Oklahoma and, like many other physicians in the state, works in several practices and sees patients frequently. His career, nevertheless, has been distinct from several other doctors in the United States, as well as Oklahoma, largely due to his involvement with politics.

In 2010, the Oklahoma State Board of Medical Licensure began inquiring and preparing to revoke Dr. Anagnost's license after several patients suffered injury and even death after getting treatment from him. In addition, he was accused of billing for surgeries he had not performed and of improperly implanting spinal devices which he'd been paid to promote. Dr. Anagnost paid several malpractice settlements out of his own pocket rather than use his malpractice insurance.

Prior to the investigation, Dr. Anagnost had made contributions to Rick Perry's political campaign. After learning of the investigation, Perry called the Governor of Oklahoma, Mary Fallin. Fallin's general counsel, Steve Mullins, met in March 2013 with the Oklahoma State Board of Medical Licensure and Perry's phone call was part of the discussion which resulted in the dismissal of the investigation.

The media reports about Perry's phone call and Fallin's involvement surfaced two years later because a civil lawsuit against Dr. Anagnost continued in state court.  The Democratic Party in Oklahoma has called for investigation into Mullins and Fallin for possible ethical and legal violations. Fallin's office has denied wrongdoing, though time will tell whether an investigation will demonstrate otherwise.

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Patients Search the Internet For Health Info, But Is It Ethical For Physicians to Google Patients?

Patients regularly surf the internet for health care information, doctor reviews, and treatment choices, generally starting with Google. Nonetheless, is it ethical for physicians to Google their patients? Doctors and bioethicists are weighing if this sort of search is proper.

Jessica Pierce, bioethicist, says that doctors shouldn't Google their patients. An Internet search isn't an ethical method to gather information about a patient and a physician isn't likely to find anything clinically applicable, she writes in Psychology Today.

Others contend that Internet searches by physicians regarding a patient might be satisfactory in very limited circumstances.  Examples of possible satisfactory utilization of Internet searches include scenarios where the doctor has a duty to warn of possible injury, to see if a patient's story is credible, to see if another professional's advice raises questions about a patient's story, and if there are suspicions of abuse or concern about suicide risk.

One example the authors noted was an instance where the doctor discovered that a cancer patient misrepresented her family's cancer history and was increasing funds, maybe fraudulently, to attend a cancer convention.

A bioethicist at The Hastings Center, a bioethics institute, argues that these notions of what represents an appropriate search are too far reaching. She says that doctor intent is what matters most. Why is the physician moved to do this? Is it going to help the patient or is it just out of personal curiosity?

The American Medical Association has new guidelines involving physician use of social media, nevertheless, those guidelines do not adequately cover this issue of a physician's Internet research on patients. The AMA admits this is an unresolved issue within the organization. The AMA's chair on the Council of Judicial and Ethical Affairs, Patrick McCormick, wrote in a blog post that physicians have a fundamental obligation to honor a patient's privacy and that professionalism and physician ethos extend to social networking.

Standards and guidelines involving a physician's use of the Web and social media are complex and still in development. To learn more,contact us.

False Hope: Is It Malpractice?

How much would you want to be told by your doctor if you were diagnosed with a terminal disease? The communication of such a diagnosis, for example cancer, is one of the worst things any doctor has to cope with, but can giving false hope lead to malpractice?

Perhaps an ethical doctor should communicate the unembellished factual truth. This gives the patient time cross several things off their bucket list, to get their affairs in order, and go through the stages of grief. The patient's loved ones must also be advised so they can offer assistance and support to the dying individual.

Another theory contends that a dying patient shouldn't be told right away he or she is facing impending death. This may spare the patient a lengthy period of despair and anxiety. Moreover, she or he could be one of the small percentage of people who actually overcome the odds and survive their disease. This strategy has obvious downsides.

Oncologist, Dr. James Salwitz, relates the story of a cancer patient who'd not been told of the seriousness of her affliction. As her cancer spread, her first oncologist told her that she had nothing to worry about. However, by the time she saw Dr. Salwitz for a second opinion, she had only weeks to live. She was outraged that she had been kept in the dark and she believed she would have lived her life differently had she known she was dying. Her first oncologist justified his decision by saying that her last months would be hopeful and happy.

Another doctor, Stanislaw Burzynski, claims he can cure half of the cancer patients who get his treatment, which utilizes sodium-rich drugs taken directly from blood and urine, but now created synthetically. For $25,000 he will treat terminally ill cancer patients with this dubious drug. Some of his patients swear they were cured by the treatment, nevertheless the FDA has found no evidence that even one patient has been cured by it.

Is giving false hope considered malpractice? In the first case it could be, depending on the way the judge or jury see it. In the case of Dr Burzynski, if it is found that he's taking money from desperate people in exchange for an ineffective treatment, what he is doing would not only be medical malpractice, but also fraud.

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Overdiagnosis and Overtreatment Can Lead to Treatment Worse Than the Disease

It may be hard to understand, but in cancer cases, the treatment can sometimes be worse than the disease itself. The possible outcomes should be considered in cases where diagnosis leads to unnecessary treatment.

Many cancer treatments come with serious side effects to patients because treatments, such as chemotherapy, which are toxic to cancer cells, also can affect normal cells which leads to side effects and sickness.  Some damage from chemotherapy might be permanent, thus, doctors must be sure diagnosis decisions avert treatment that the patient may not need in the first place.

Overdiagnosis mainly occurs as a result of screening tests done by a doctor to be able to detect diseases early. Early detection is a great thing as it enables early intervention and treatment which could lead to cancer remedy. Unfortunately, cancer screenings regularly find tumors that are clinically of no consequence. If that discovery leads to unneeded treatments, it is not difficult to understand how the treatment can be worse than living with the ailment.

One common example of overdiagnosis resulting in treatment is prostate cancer. The prostate-specific antigen test is frequently elevated in older men. Those results can lead to over radiation therapy or aggressive surgery, which expose the individual to possible unwanted side effects like incontinence and impotency. Autopsies of males who died from conditions besides cancer have found that prostate cancer is extremely common particularly as men age. However, developing the cancer in the form that's deadly is rare.

Hypertension is just another common malady which could result in overtreatment. A recent study in The BMJ noted that about 40% of adults worldwide have hypertension with more than half of those having a mild form of the disease that is low risk and has not progressed to cardiovascular disease. The study also found that more than half of the patients with mild hypertension are treated with medications despite the lack of medical evidence that this treatment actually reduces the risk of cardiovascular disease. 

Screening evaluations are essential to educating medical diagnosis, however, there are limits to testing. Doctors must ensure that treatments are specific to each patient and disease as much as possible. Contact us to share a story about overdiagnosis or overtreatment.

The Ethics of Money in Medicine

Many doctors have patients that are not able to manage the expense of drugs prescribed to them. The sad truth is that some of these patients end up in the emergency department with an exacerbation of their illness or condition because they could not afford their medicines and therefore did not take them. Providers, having a responsibility to care for patients, cannot ignore this problem. Controversial relationships created by drug company representatives, outrageous expenses for advertisements of public policy, and outlandish executive compensation are driving healthcare costs up and providers cannot merely ignore or accept these factors. It's easy to fall into the trap of wanting to patronize someone who's buying you lunch or giving you new pencils, but this can put patients at a great disadvantage. For example, when a physician prescribes medications of questionably better efficacy (name brand drugs) that are more costly than generic drugs, just because they choose to support the drug rep who brings them breakfast once per week, this is not good for the patient.

Prices of some top-selling prescription medications have increased astronomically in a short span of time. For instance, 60 Minutes reported about the rise in the price of Gleevec, a cancer drug from Novartis, that rose to $90,000 per year from $24,000 per year. What could have caused such a leap? Bloomberg Business reports that some top-selling prescription drugs have increased as much as 841% over the past seven years. Are you aware that after the FDA approves a drug, Medicare is legally mandated to pay the drug company's asking price? Picture the lobbying that was behind that legislation!

What do you think of the increasing costs of prescription drugs? What is your alternative? Let us know!