Unhappy Patients Research Articles

Critical Condition: How Health Care in America Became Big Business and Bad Medicine • The Big Fix: How the Pharmaceutical Industry Rips Off American Consumers

Critical Condition: How Health Care in America Became Big Business and Bad Medicine • The Big Fix: How the Pharmaceutical Industry Rips Off American Consumers

The future of simulators in GI endoscopy: An unlikely possibility or a virtual reality?

The future of simulators in GI endoscopy: An unlikely possibility or a virtual reality?

Widespread Immunity for HMOs via ERISA Preemption Leaves Physicians Solely Liable for Medical Malpractice

The American health care market has evolved to the point where independent practice association structured health maintenance organizations (HMOs) are the most common health benefit offered to employees by their employers. Employer-sponsored health care delivery systems are regulated by the Employee Retirement Income Security Act (ERISA) of 1974, which contains a loophole against liability for HMOs. That is, although HMOs are both an insurer and a health care provider, they are immune from liability for acts of medical negligence. Therefore, although HMOs have usurped physician and patient control over health care decisions through characteristic cost-containment policies and procedures, physicians remain fully accountable in a lawsuit brought by unhappy and dissatisfied patients. The Patient Bill of Rights is legislation currently before Congress that would amend ERISA and force insurers to put patients' health before the company bottom line. The American Medical Association and American College of Physicians, among many, endorse proposed reform provisions, including assurances that doctors and patients can openly discuss treatment options and enforcement mechanisms in which health plans would be held legally accountable when they make decisions that harm patients. The United States Supreme Court, given the conservative composition, will likely practice judicial restraint and defer to Congress to enact the needed changes to ERISA.

BASIC CONSIDERATIONS IN GASTROESOPHAGEAL REFLUX DISEASE

The cause of foregut symptoms is often quite uncertain until a comprehensive evaluation has been performed. The critical elements of this evaluation include historic, radiographic, endoscopic, and physiologic data, and most importantly, the insight of a mature diagnostician. Patients who are not evaluated in a comprehensive way are at risk for serious postoperative problems; surgeons who perform interventions without appropriate diagnostic support may have to deal with these unhappy patients. In the long run, a complete workup provides the guidance for treatment and is cost-effective.

Day-Case Anaesthesia and Sedation

Ed J G Whitwam Blackwell Scientific, £49.50, p 424 ISBN 0-632-03704-0 Most hospitals have introduced day care services in the search for cost savings and reductions in waiting lists. Those that have merely decided to send for patients on the day of surgery and discharge them a few hours later are likely to find limited success, restless managers, and unhappy patients. Those that have appreciated that successful day care surgery and anaesthesia require major changes in organisation and patients' management are more likely to accept and enjoy the experience, as are …

Techniques: Single-pedicle TRAM

The single-pedicle TRAM flap is a very satisfactory method for breast reconstruction either when performed at the time of the mastectomy or as a delayed procedure provided in every case the patient is in good health and the surgeon is experienced in this technique. To vary from these two provisos will lead to frequent complications and unhappy patients. This brief visual description of our single-pedicle TRAM technique will provide the reader with a clear view of our procedure. In-depth reading on the subject and actual cadaver dissections are recommended before the beginning surgeon undertakes this deceptively difficult procedure.

Intraocular lenses.

In reviewing the 1990 literature on intraocular lenses, it is evident that the increased popularity of phacoemulsification in North America has stimulated interest in lens designs that can be inserted through small incisions, and various methods for folding soft lenses. Critical evaluation of various multifocal lenses has now resulted in greater understanding of their advantages and drawbacks, and it is becoming apparent that there are guidelines of suitable candidates for such lenses. Use of multifocals has stimulated interest in contrast sensitivity testing, and new more accurate lens power formulas. Heparin surface modification of polymethylmethacrylate lenses now seems to be accepted as having value in reducing pigment deposits after surgery. Clinical trials of lenses for patients suffering from age-related macular degeneration hold some promise for this large group of unhappy patients. However, the use of anterior chamber lenses to correct high myopia in phakic eyes is now on hold because of reports of progressive endothelial cell loss in some eyes. More reports are available on the technique and results of suturing posterior chamber lenses to the sclera where there is absent or insufficient capsule to support a conventional sulcus fixated posterior chamber lens. Intraocular lenses remain alive and well in 1990 with increased usage worldwide.

Adenotonsillectomy

<i>To the Editor</i>.—Dr David Austin¹is to be commended for his courageous second look at adenotonsillectomy visa-vis chronic serous otitis media/recurrent bacterial otitis media. A number of senior otolaryngologists have, for decades, advocated an adenotonsillectomy approach to recurrent bacterial otitis media. Their work was, unfortunately, drowned out by the rush to tympanostomy tube placement. In a way, the tympanostomy tube with its complications of otorrhea, extrusion, cholesterol pearl formation, and persistent perforations represents a double-edged sword. Crying, traumatized, unhappy pediatric otologic patients have "enslaved" two generations of otolaryngologists. Adenotonsillectomy has proven to be the procedure of choice for the following conditions: upper airway compromise^2-4 obstructive sleep apnea^2,5,6 upper airway compromise with secondary cor pulmonale^2,7 aberrant dentofacial development^8-10 recurrent bacterial adenotonsillitis chronic serous otitis media/bacterial otitis media some cases of enuresis excessive daytime sleepiness³ retarded intellectual and physical growth³ It is indeed unfortunate that third-party health insurance carriers pay so poorly for such a wonderful procedure. When an

Cystoid Macular Edema Following Cataract Surgery-Reply

In Reply. —Dr Flach suggests that my estimate of 10 000 new unhappy patients per year (1% of cases) with chronic, visually significant postcataract CME may be an underestimate because the two studies reviewed employed postoperative topical corticosteroid therapy. 1,2 While it is possible that routine postoperative use of corticosteroids decreases the incidence of persistent aphakic or pseudophakic CME, we have no definite evidence to support this hypothesis, in regard to either angiographic or visually significant CME. 3,4 However, virtually all cataract surgeons in the United States do indeed use a postoperative topical corticosteroid. Many patients are given topical corticosteroids indefinitely. Thus, an estimated rate of persistent, visually significant CME of approximately 1% to 2% seems appropriate. Dr Flach's next point is that the severity of the angiographic CME may not correlate with the patient's visual acuity. In their recently reported study, with small numbers of patients, Flach et al

A Review of Extracoronal and Intracoronal Retainer Systems

Regardless of what type of retainer is used, it must be thoroughly planned in advance using diagnostic casts, radiographs, a surveyor and knowledge gleaned from previous experience and continuous study. The time spent in diagnosis and treatment planning will save untold hours of chair-time doing adjustments and placating unhappy patients. It is our goal to preserve what is left of a once intact detention by the most efficient means possible.

THE ROLE OF THE OBSTETRICIAN-GYNECOLOGIST IN MARITAL MALADJUSTMENT

H u R I N G the past decade, considerable attention has been focused by educators, religious leaders, jurists, and physicians on marital maladjustments. In 1954, McCormickl’ wrote, “In my opinion the medical profession has, for long, been too complacent, if not remiss, in assisting American society to solve one of its most undermining evils-divorce. Its detailed knowledge of the chief etiological factor, sex disharmony; its singularly intimate relation to the family; and its sworn oath to relieve mankind of its physical and psychological ills, add up to an inescapable responsibility to serve here as in any other field of preventive medicine.” The obstetrician-gynecologist is commonly brought into marital problems by devoted but confused and unhappy patients. There are some in our specialty who choose not to discuss family problems. This may be due to our lack of training in the behavioral sciences. It is suggested that this be remedied. It should be as important to deal adequately with the emotional complexities of our patients as it is to develop certain surgical techniques. The many facets which may be considered in marital counseling involve problems in economics, religion, “in-laws,”

The role of the obstetrician-gynecologist in marital maladjustment

H u R I N G the past decade, considerable attention has been focused by educators, religious leaders, jurists, and physicians on marital maladjustments. In 1954, McCormickl’ wrote, “In my opinion the medical profession has, for long, been too complacent, if not remiss, in assisting American society to solve one of its most undermining evils-divorce. Its detailed knowledge of the chief etiological factor, sex disharmony; its singularly intimate relation to the family; and its sworn oath to relieve mankind of its physical and psychological ills, add up to an inescapable responsibility to serve here as in any other field of preventive medicine.” The obstetrician-gynecologist is commonly brought into marital problems by devoted but confused and unhappy patients. There are some in our specialty who choose not to discuss family problems. This may be due to our lack of training in the behavioral sciences. It is suggested that this be remedied. It should be as important to deal adequately with the emotional complexities of our patients as it is to develop certain surgical techniques. The many facets which may be considered in marital counseling involve problems in economics, religion, “in-laws,”