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Appleton Personal Injury Law Blog

New CDC opioid guidelines could harm patients

Wisconsin readers may be interested to learn that the Centers for Disease Control and Prevention has issued new draft guidelines for opioid prescribing. However, some patient advocates fear that the rules are more concerned with avoiding patient drug addiction than with providing quality care.

Advocates claim that the CDC opioid prescription guidelines overstate the addiction risk of opioid use and ignore the legitimate pain management needs of patients, which is tantamount to institutionalized medical malpractice. They believe doctors are moving toward an overly conservative prescribing model that will expose patients to a lifetime of needless pain.

Misdiagnoses lead to costly mistakes

The problem of misdiagnosis affects patients in Wisconsin and the rest of the nation every year. Although many misdiagnoses are either inconvenient or harmless to patients, others could cause severe consequences such as the patient's death or, in some cases, unintended exposure to a contagious disease. Although the amount specifically attributed to misdiagnoses was not specified, a 1999 report from the U.S. Institute of Medicine estimated 98,000 fatalities from medical errors in general each year. A more direct figure may be available soon thanks to a new report scheduled for release this month that focuses on misdiagnosis.

Technical causes cited in misdiagnosis errors include poorly functioning imaging devices as well as written and verbal miscommunication. Errors also result due to some doctors' cognitive mistakes, such as focusing on an initial diagnosis without adjusting for changes to a patient's symptoms.

New study links ADHD and TBI in adults

Attention-deficit hyperactivity disorder complicates the daily lives of many Wisconsin residents of all ages. Traumatic brain injuries subject millions of individuals to an assortment of cognitive problems yearly. A recent study has helped to affirm a potential correlation between these problems, raising the possibility that more might be done to screen adults with past brain injuries for ADHD.

The study pulled data from a telephone survey monitoring the general health of adults in Ontario. Some of the individuals in the survey reported a history of traumatic brain injury. Of these respondents, the researchers discovered that 5.9 percent had received an ADHD diagnosis at some point either before or after their injuries; furthermore, an extra 6.6 percent took a self-reporting ADHD exam during the phone survey with positive results. According to one researcher, the data suggested that adults suffering from traumatic brain injuries had double the chance of reporting ADHD symptoms compared to adults without such a history.

Common drugs could delay brain injury recovery

According to a new study, a class of drugs commonly prescribed to treat conditions like depression, insomnia and bladder issues could make it more difficult for Wisconsin patients to recover from brain injuries. The medications, called anticholinergics, are given to up 50 percent of older patients around the country.

The study, which was conducted by a group of British scientists and published in the journal Brain Injury, examined 52 patients who were treated at a neuro-rehabilitation unit for brain injuries or spinal injuries. Patients in neuro-rehab are often prescribed anticholinergics to alleviate pain, urinary incontinence and other problems. Researchers discovered that patients with higher levels of anticholinergic drug burden, or ACB, in their system had longer average rehab stays than patients with lower levels of ACB.

Wisconsin legislature mulling bill to allow recording of surgery

Proposed legislation in Wisconsin would allow patients to film any surgery or medical procedure which they may undergo. The law would require the medical service provider to offer all patients the option of recording what happens in the operating theater. Although many conjecture that this would lead to fewer cases of surgical error, major Wisconsin medical advocacy groups have spoken out against the proposed legislation.

According to the bill, citizens would also be able to issue advance directives requiring videotaping of any medical procedures in the case of their incapacity. The data from this recorder would be useful for several reasons. The doctors and medical team could review the recording later, seeking answers for unusual circumstances that may have occurred during the procedure. If there is some sort of surgical error or easily preventable negative outcome from the surgery, then any tape may also be reviewed by the patient and their legal counsel.

Some health conditions that are commonly misdiagnosed

Wisconsin courts often hear medical malpractice cases based on a misdiagnosis by a doctor. Doctors may miss a diagnosis for any number of reasons, but there are a few conditions that go undiagnosed more often than others. Celiac disease, for example, may be difficult to diagnose because of its non-specific, vague symptoms. Celiac disease is a reaction to gluten, which is present in some foods. It can be diagnosed by a blood test.

Lyme disease has been referred to in medical literature as "the great masquerader" for its propensity to go misdiagnosed. A dermatologist said doctors should order blood tests if the patient may have been in contact with ticks. Thyroid disorders are also difficult to diagnose, because the hormone produced by the thyroid gland has an effect on every cell in the body. Symptoms like insomnia, weight loss, shakiness or restlessness may indicate an overactive thyroid, while low thyroid activity may be indicated by fatigue, weight gain or lethargy.

New COPD guidelines may lead to misdiagnosis

New research indicates that new guidelines for diagnosing chronic obstructive pulmonary disease, or COPD, may be causing patients to be misdiagnosed in Wisconsin and worldwide. A recently-published study calls for the guidelines to be modified in order to correct the problem.

According to the authors of the study, up to 13 percent of people diagnosed with COPD, one of the most prevalent lung diseases in the world, under the new guidelines are being misdiagnosed. In 2001, the Global Initiative for Obstructive Lung Disease, or GOLD, was introduced as an alternative to a diagnostic method known as "lower limits of normal," or LLN. Researchers found there are discrepancies between the two diagnostic methods. For example, the GOLD method estimates the prevalence of COPD to be approximately 22 percent in people over the age of 40 in the United Kingdom, but the LLN method estimates that only 13 percent of people in that group have COPD. Meanwhile, the GOLD method misses one in eight cases of airflow obstruction in young women compared to the LLN method.

MRI drugs could leave toxic residue in the brain

Wisconsin patients who experienced renal failure or kidney dysfunction may be interested to learn that some drugs used when performing an MRI may leave toxins behind. Magnetic resonance imaging is a machine that may be used to obtain images of a person's soft tissues and internal body structures. To improve the quality of the images, many doctors use an intravenous drug that makes the body structures more visible.

According to a report published on June 16, however, it appeared that some of the drugs used could pass through the blood brain barrier and leave harmful residue in the person's brain. Some of the intravenous drugs include gadolinium, which happens to be toxic. Until the study was published, it was believed by medical professionals that the gadolinium was harmlessly excreted by the patient later on. Depending on the patient's heath, however, the small amount that may be left behind cause serious damage.

The human factors that lead to surgical errors

Wisconsin residents may be interested in the results of a study conducted by researchers at the Mayo Clinic that looked into the causes of surgical errors. These medical mistakes are referred to as "never events" because they should never occur, and the researchers analyzed 69 such events that took place over a five-year period at the Minnesota facility. They identified 628 different human factors that may contribute to surgical errors, and an average of between four and nine of these factors were observed in each of the never events.

The surgical mistakes researchers scrutinized included performing surgery on the wrong site or side of the patient, leaving items inside the patient's body and performing the wrong procedure. Most of the never events occurred during minor surgery, and performing the wrong procedure was the most common mistake. The system used by the researchers had been earlier developed by investigators to determine the causes of military aviation accidents.

Increased education key to patient satisfaction

In an effort to avoid mistakes when preparing for surgery, it is important that patients in Wisconsin receive education regarding the medical procedures they are facing. While it might be difficult and take a bit more time to explain the situation to patients, it is a worthwhile endeavor. The results of a recent Gallup survey indicate that patients who were about to have a medical device implanted wanted to be kept apprised of important aspects of their care.

The patients who were surveyed indicated that they did not always know what to expect after the procedure. Some felt inadequately prepared for what would happen after the surgery, and that the were not always advised of the importance of following the instructions the doctors gave them for medication and rehabilitation. One key to the patients being educated is that the doctors, nurses and other medical people need to take the time to explain everything including potential negative implications.