|Exposing the LASIK Scam
|Should ophthalmic surgeons admit their mistakes?
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|Author:||Broken Eyes [ Mon May 22, 2006 11:55 am ]|
|Post subject:||Should ophthalmic surgeons admit their mistakes?|
http://www.escrs.com/Publications/Eurot ... DTABLE.pdf
Jean-Luc Seegmuller: "I don?t think ophthalmologists should admit their mistakes. It?s too dangerous, and I have seen several too-honest colleagues who were in a very bad situation afterwards, and we have tried our best to take them outside but it was very, very difficult.Admit the mistakes? No. Describe the facts and say ?I have done that,? but not say it was good or bad, but rather I have done that and this is the consequence and so it was like that, or the complication is like that. It?s too dangerous to say that I have done this and now you are in a bad situation."
|Author:||Eye [ Tue May 23, 2006 3:15 am ]|
|Post subject:||Broken trust|
If Ophthalmologists don't admit their mistakes, how will patients understand what is wrong with their eyes?
Isn't it sort of evil to harm to a patient and not 'fess up' to it? If we can't trust Ophthalmologists to be honest and responsible, why should anyone seek their professional services?
Doesn't it seem safer to trust your eye care to an Optometrist (save for cataract surgery and accidental eye trauma?)
|Author:||Broken Eyes [ Sat Jul 29, 2006 1:28 pm ]|
Cataract and Refractive Surgery Today
5 Questions with Lucio Buratto, MD
"What is the biggest obstacle facing refractive surgery and refractive surgeons today?
In the past, we made similar mistakes around the world. We excited our patients about the possibility of extremely good results, and we treated too many patients (some nonexcellent indications); I would say we treated all (or at least the overall majority) of the patients who entered our respective practices. Not all of the patients we treated were really good candidates for surgery, and not all of them received the treatment with the best machines and technology available. Unfortunately, because we had some bad worldwide results, we received bad publicity in the media.
Therefore, patients may now be skeptical about refractive surgery. I know for sure that when I have the right patient, I can give them excellent results. Patients do not always trust the surgery or the surgeon anymore, because we promised too much in the past.
What advice do you have for new surgeons, with regard to managing their patients' expectations and outcomes?
I would tell them to do less business and to take care of the patients they currently have. Unfortunately for many refractive surgeons, when they see a patient, they see dollars in their eyes and not a professional opportunity to improve quality of vision and life for their patient. It is not the same way for a cataract surgeon or a retina specialist, but it is a typical approach of a refractive surgeon. They should focus more on their patients and less on their incomes."
Read the entire article at http://www.crstoday.com/PDF%20Articles/ ... 06_5q.html
BE's comment: If it had been one of us saying this, instead of the "father of modern LASIK", our detractors would call us malcontents, whiners, and anti-LASIK zealots.
|Author:||avoidlasik [ Sat Jul 29, 2006 4:13 pm ]|
AL's comments: Even today, mistakes countinue to be made, promises not met. Your best vision is sticking with glasses.
|Author:||Broken Eyes [ Fri Aug 18, 2006 1:12 pm ]|
OSN SuperSite Top Story 8/16/2006
Admit mistakes, keep good records to protect against malpractice suits
BOSTON ? Keeping detailed patient charts, documenting informed consent and accepting responsibility for errors when they occur can help refractive surgeons avoid costly malpractice suits, according to two attorneys speaking here.
"Patients lose trust with their doctor if their doctor minimizes or ignores their problems. Physicians should be aware of this, because if patients lose trust, they will look for other doctors or find their way to a plaintiff lawyer," said Greg K. Zeuthen, a plaintiff attorney.
Mr. Zeuthen and Kevin E. Oliver, a defense attorney, discussed the current medicolegal climate in refractive surgery in two keynote lectures at American Society of Cataract and Refractive Surgery Summer Refractive Congress. They outlined LASIK cases they have handled in court and possible approaches surgeons could employ to avoid litigation.
Mr. Oliver said he tells doctors to imagine a hypothetical situation in which all their charts have court exhibit stickers on them. He then asks them to carefully consider whether those charts are well-documented and adequately clear to be used in a defense or a prosecution.
"You need to chart everything," Mr. Oliver said.
Mr. Zeuthen noted that draconian documentation is the key to minimizing the risk of legal action. Should a case go to trial, it is also important for mounting a defense.
"Paranoia is not bad at all," Mr. Zeuthen said. "It's just a higher state of awareness. If you practice medicine with a higher state of awareness, you're going to avoid more lawsuits."
Both lawyers noted that surgeons should be honest when dealing with refractive surgery mistakes or errors. Most refractive surgery patients are highly educated individuals who understand the legal system and will sue if not treated appropriately, they said.
"It's how a bad outcome is dealt with in your office that determines whether a patient will go to another doctor of to a plaintiff's lawyer," Mr. Zeuthen said.
|Author:||Eye [ Sat Aug 19, 2006 4:30 pm ]|
|Post subject:||Higher state of awareness and LASIK incompatible|
Gregory Zeuthen said:
If you practice medicine with a higher state of awareness, you're going to avoid more lawsuits.
How about a state of awareness high enough to recognize that corneal refractive surgery induces corneal distortions, thins and weakens the cornea and damages corneal nerves? Any surgeon who doesn't recognize this as 'bad medicine' isn't very aware. Do surgeons ever discuss with thier patients the potential consequences of these surgeries for the aging eye?
If you're screwed up by LASIK now, how well are you going to function as you age?
|Author:||Bill [ Wed Sep 06, 2006 2:05 pm ]|
When it comes to dealing with the unhappy patient, the temptation may be for the practitioner to deny that a result is less than optimal or to avoid the patient altogether.
Maloney spends a half-day a week just dealing with patients with LASIK complications who have been sent to him on referral. "It's difficult, because generally they don't get to me until there has been some fracture in the relationship with the surgeon," he said. If he can, Maloney reassures the patient that the surgeon didn't make any mistakes.
|Author:||Broken Eyes [ Sat Sep 29, 2007 7:13 pm ]|
But what about the patient who is the victim of a medical error?
Most risk management experts, including those at OMIC (Ophthalmic Mutual Insurance Company), recommend immediate and full disclosure of the error, as soon as the patient is able to understand.1 What is not as widely practiced is a heartfelt personal apology to the patient by the physician. An editorial by the chancellor of the University of Massachusetts Medical School, Aaron Lazare, MD, is well worth reading.2 Considerable literature has now accumulated showing that, where it is practiced, disclosure of errors and an apology to the patient has actually reduced the number and cost of malpractice claims. According to Dr. Lazare, there are four parts to an effective apology: acknowledgement of the offense (who, what, where); an explanation of the circumstances bearing on the offense (why); an expression of remorse, shame, humility and a commitment not to repeat the offense; and finally reparation (which could include early scheduling for next appointment, cancellation of the bill, etc.). Not all four parts need be present in every case for an apology to be effective, but an ineffective apology can usually be traced to omission of at least one part.
How do apologies heal? To understand this, it is helpful to examine how a patient feels when he or she learns of a medical error. They often express humiliation, ?I was treated like I was on an assembly line,? powerlessness, lack of validation of emotions, the feeling that they were somehow at fault, and, not surprisingly, concern that the same thing could happen to someone else. The longer those feelings fester, the more difficult they are to mitigate through apology. But a prompt and proper apology can make the patient feel cared about by the physician, whose self-humbling has leveled the emotional field between them. Showing a patient how their experience will lead to changes in procedure to avoid recurrence restores their sense of power. Validation of the reasonableness of the patient?s feelings about the error is also helpful in reducing their amplitude.
Read the full article at:
http://www.aao.org/aao/publications/eye ... pinion.cfm
|Author:||Broken Eyes [ Sun Oct 14, 2007 9:40 pm ]|
Excerpt from article about patient treated for a different patient's refractive error:
http://ophthalmology.stanford.edu/laser ... 241296.DTL
After about an hour in the dark after her surgery, someone told Steward she could go home for the day, but to come back the next day for the standard post- operative followup check of her eyes. Davis tried to reassure her, Steward recalled, suggesting the extreme blurriness she was experiencing should clear up by the next morning.
She was given no explanation of what had happened, no hint of any glitches, even though Davis said he realized what had happened soon after the procedure was over. He just decided to keep it to himself for a while.
"I was absolutely in shock when I found out," he said. "I was going to tell her immediately, and then I consulted with another physician, who said the result 'may not be as bad as you think, so wait a little while, let it settle down. Fit her with contact lenses and make sure she's seeing well, and then talk about it.' "
"That was my big mistake," Davis said. "I should have told her right away."
Steward, unaware, didn't know enough to ask why she wasn't given a name tag to wear. Because she couldn't see the road, much less make out street signs, a friend drove her home, where she spent most of the day in bed, feeling her way around when she had to get up.
Her father took her back for the follow-up exam the next morning. She was more than a little upset. Even though she had been warned to expect some cloudy vision to persist for a while after the surgery, something just didn't seem right.
"My dad had to lead me by the arm into the doctor's office," Steward said. "He examined me, and said I had had an adverse reaction to the procedure. It was just something in the way my body reacted. He wouldn't explain it to me beyond that. He wanted to have me fitted for contacts. He just said the optometrist would fit me for contacts to try to get me to see better."
Davis knew exactly what had gone wrong. But he said he was hoping that Steward's eyesight would improve over time, or that another operation might be able to fix any residual defects.
Sometimes, a situation that looks like disaster may look much different as the eyes heal and the cornea gradually changes contour. Sometimes, even big overcorrections with a laser have a tendency to ease back toward normal on their own. And sometimes, even the stopgap measures don't work: Steward's eyes were in such bad condition it proved impossible even to make contact lenses work properly anymore.
|Author:||Broken Eyes [ Tue Oct 16, 2007 2:04 am ]|
The faculty and attendees continued the discussion by evaluating a clinical case presented by Parag A. Majmudar, M.D., associate professor, Rush University, Chicago, and how much information should be provided to the patient when a mistake is made. In the provided example, a physician began performing LASIK on a 36-year-old man with ?6 D, but was treating the peripheral cornea instead and had completed 60% of the surgery before realizing the mistake. Dr. Majmudar concluded that deceiving the patient is harder to defend in a malpractice claim and therefore, the physician should be upfront with patients when a mistake is made. Dr. Salz agreed relaying a similar story in which he corrected the mistake, and even though the patient still sued the practice, the patient did not suffer any real damages and received little money in the settlement. Speaking from the audience, Marguerite B. McDonald, M.D., clinical professor of ophthalmology, Tulane University, New Orleans, and in private practice, Lynbrook, N.Y., suggested that physicians provide the essence of what went wrong without providing the exact details of what course of action led to the mistake.
|Author:||Broken Eyes [ Thu Oct 25, 2007 1:18 am ]|
Guilty, Afraid, and Alone ? Struggling with Medical Error
The New England Journal of Medicine
Volume 357:1682-1683 October 25, 2007 Number 17
Tom Delbanco, M.D., and Sigall K. Bell, M.D.
In interviews that our group conducted for a documentary film, patients and families that had been affected by medical error illuminated a number of themes.1 Three of these themes have been all but absent from the literature. First, though it is well recognized that clinicians feel guilty after medical mistakes, family members often have similar or even stronger feelings of guilt. Second, patients and their families may fear further harm, including retribution from health care workers, if they express their feelings or even ask about mistakes they perceive. And third, clinicians may turn away from patients who have been harmed, isolating them just when they are most in need.
Several such persons who were approached for interviews feared they would be investigated and possibly punished by "the authorities" if they told their stories. More strikingly, some patients and family members were afraid that confronting medical personnel might lead to further injury. Explained one patient whose subdural hematoma had been missed by clinicians: "I was frightened to complain any more ? scared that, you know, you hear about people being mistreated in the hospital. I was scared that I would get more mistreated."
How can patients, families, and clinicians move beyond these feelings and approach closure and forgiveness? Honest and direct communication may be the best antidote. "You have no idea how far a 'sorry' will go," said one patient with a systemic infection that occurred after a surgeon perforated his ileum while resecting a colon carcinoma. Families and patients don't want "spin doctors."
Withholding such information can lead to lawsuits if despairing patients feel that a mistake has not been taken seriously. Above all, silence and evasion breed distrust. One father, whose daughter with end-stage leukemia had received an intravenous medication despite her known allergy, was deeply disturbed that the incident was not acknowledged. "If the doctors aren't telling me the truth about this," he said, "what else aren't they telling me the truth about?"
Link to the article:
http://content.nejm.org/cgi/content/ful ... ?query=TOC
|Author:||Broken Eyes [ Sat Dec 08, 2007 4:17 pm ]|
Ann Intern Med. 2007 Dec 4;147(11):795-802.
Professionalism in medicine: results of a national survey of physicians.
Campbell EG, Regan S, Gruen RL, Ferris TG, Rao SR, Cleary PD, Blumenthal D.
Massachusetts General Hospital, Institute for Health Policy, Boston, Massachusetts 02114, USA. email@example.com
BACKGROUND: The prospect of improving care through increasing professionalism has been gaining momentum among physician organizations. Although there have been efforts to define and promote professionalism, few data are available on physician attitudes toward and conformance with professional norms.
OBJECTIVE: To ascertain the extent to which practicing physicians agree with and act consistently with norms of professionalism.
DESIGN: National survey using a stratified random sample.
SETTING: Medical care in the United States.
PARTICIPANTS: 3504 practicing physicians in internal medicine, family practice, pediatrics, surgery, anesthesiology, and cardiology.
MEASUREMENTS: Attitudes and behaviors were assessed by using indicators for each domain of professionalism developed by the American College of Physicians and the American Board of Internal Medicine. Of the eligible sampled physicians, 1662 responded, yielding a 58% weighted response rate (adjusting for noneligible physicians).
RESULTS: Ninety percent or more of the respondents agreed with specific statements about principles of fair distribution of finite resources, improving access to and quality of care, managing conflicts of interest, and professional self-regulation. Twenty-four percent disagreed that periodic recertification was desirable. Physician behavior did not always reflect the standards they endorsed. For example, although 96% of respondents agreed that physicians should report impaired or incompetent colleagues to relevant authorities, 45% of respondents who encountered such colleagues had not reported them.
LIMITATIONS: Our measures of behavior did not capture all activities that may reflect on the norms in question. Furthermore, behaviors were self-reported, and the results may not be generalizable to physicians in specialties not included in the study.
CONCLUSION: Physicians agreed with standards of professional behavior promulgated by professional societies. Reported behavior, however, did not always conform to those norms.
|Author:||Broken Eyes [ Wed May 21, 2008 12:07 am ]|
The New York Times
Doctors Say ?I?m Sorry? Before ?See You in Court?
For decades, malpractice lawyers and insurers have counseled doctors and hospitals to ?deny and defend.? Many still warn clients that any admission of fault, or even expression of regret, is likely to invite litigation and imperil careers.
But with providers choking on malpractice costs and consumers demanding action against medical errors, a handful of prominent academic medical centers, like Johns Hopkins and Stanford, are trying a disarming approach.
By promptly disclosing medical errors and offering earnest apologies and fair compensation, they hope to restore integrity to dealings with patients, make it easier to learn from mistakes and dilute anger that often fuels lawsuits.
Full article at:
http://www.nytimes.com/2008/05/18/us/18 ... =th&oref=s
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