ANEMONA HARTOCOLLIS in a recent New York Times article describes outrageous behavior by the clinical director and medical director of Harlem medical center. Under the direction of these former hospital officers (they have since been fired and demoted,  respectively) the cardiology department of the Medical Center permitted 4,000 echocardiograms performed on patients suffering from suspected cardiac problems to be read only by technicians. The tests supposed to be read by cardiologists were not submitted to any doctor for review. An investigation  conducted by physicians from another medical center suggests hundreds of these patients may have suffered serious harm as a consequence of inadequately skilled technicians reviewing these tests instead of cardiologists.  In an apparent cost cutting move, Harlem Medical Center had allowed their staff of cardiologists to be reduced. The cardiologists claimed the back log of echocardiograms requiring physician review accumulated at the rate of 2500 per year. The Harlem Medical Center cardiologists’ cries for additional staff went unheeded.  Harlem Medical Center continues to deny that any patient suffered harm.

Certainly patients who trusted the Harlem Medical Center  have been betrayed. Can anyone believe that similar problems are not occurring with some frequency elsewhere? The only real oversight is limited help that medical malpractice lawyers can provide victims after the fact.  And yet trial lawyers are besieged in the Legislature of most states and by members of the Congress who are blind and deaf to the pleas of victims  to not restrict the only tool available to most victims to uncover the truth and seek justice.

What do you think?

Online Journal watch is a publication which surveys medical newly published medical literature and comments on various relevant medical issues. One of the January’s postings reported upon a study of patients being evaluated by  cardiac CT scan.  The study addressed, among other things, the value of utilizing information made available by reason of the study having been performed, though such information was not the reason for the scan being done.

The editors of Journal Watch published my remarks under the title captioning this post.  For my remarks see Journal Watch .

The Archives of Internal Medicine, June 22, 2009, published results of a retrospective medical record review involving nineteen community based and four academic medical center primary care practices.  The researchers were intent upon examining how frequently patients were not informed of clinically significant abnormal outpatient test results.  The researcher’s conclusion was that it is common for patients to be uninformed of significant abnormal outpatient test results and they suggest a simple process currently not being followed by most primary caregivers to correct what the researchers see as a problem.

Remarkably, they fail to comment on an additional meaningful conclusion that can be arrived at from examining the same data.  The doctors who didn’t inform their patients must not have done anything about the abnormal lab results.  Surely, it is not possible that physicians failed to inform patients of significant abnormal lab results only in cases where the lab results, though abnormal, suggested no need for a different course of medical treatment.  Perhaps a more important issue for these researchers to have examined is whether the results were communicated to the doctor and whether the doctor incorporated those results in the formulation of each patient’s continued and future course of care.

In these circumstances, a patient’s safeguard of last resort is their own interest in their medical care.  Patients need to be attentive not just in the outpatient setting but also in the hospital setting.  A patient should not assume that because there are a number of people who seem involved in their care, doctors, nurses, etc., that someone in fact is aware of all clinical events and test results and is thoughtfully guiding the patient’s care with a professional interest in the best possible outcome.

Learn more about abnormal pap smears.

Each year many die of multiple myeloma. It is a cancer principally affecting bone but capable of metastasizing to the lung and soft tissue. A man or woman in their 40’s or 50’s suddenly suffering a fracture of some spinal element without any precedent trauma that they can recall is certainly a possible victim of this disease. Other primary bone cancers and infection are also possibilities.

In such setting, physicians often will perform a test called Protein Urine Electrophoresis. This test is calculated to determine the presence in the urine of light chain protein. It is not very important that one understand what a light chain protein is.   It is important to understand that kidneys are not supposed to leak proteins and if they do leak proteins, it is a distinct possibility that a light chain protein is involved (also sometimes referred to as M proteins).

MGUS is not multiple myeloma. There are distinguished physicians who write ably and in detail about the differences. It is however also the case that if a person has evidence of MGUS and they live long enough, they suffer a one in four chances of dying of multiple myeloma, a terrible illness.

It is for this reason that it is worthwhile to be screened by urine electrophoresis testing any time there is an unexplained fracture.

There are some who follow MGUS simply by doing regular screening to determine whether the concentration of protein increases or not. These physicians will argue that there is no reliable evidence that treating multiple myeloma prior to its full-blown appearance does no good. On the other hand, if one doesn’t carefully monitor for this cancer by the time a diagnosis is made it is entirely possible that one will be suffering several crushed vertebrae with metastasis and other dreadful consequences. A delay in diagnosis worsens the outcome.

A client of ours once suffered a fracture while playing golf.  He did not fall or strike himself.  The fracture was of  a neck bone (cervical vertebra).  An intern appropriately considered the possibility that this unusual fracture without trauma might be due to osteomyelitis or some form of cancer such as multiple myeloma. Among the tests that were ordered was the urine protein electrophoresis examination.   The test was positive but was reported to no one.

It is essential when you are in the hospital for a workup for any illness that you take active steps to learn whether all lab results and imaging results have in fact been directly communicated to persons with an interest in your health.   A mistake in communication can have disastrous consequences.