PubMed Health⌕ Search

Biomedical subjects

Thomas R McLean

Publications and source records attributed to Thomas R McLean.

At least 19 recordsLinked to original sources
PubMed2006

Risk management observations from litigation involving laparoscopic cholecystectomy.

HYPOTHESIS: Limited information exists on the outcome of laparoscopic cholecystectomy (LC) litigation. DESIGN: A retrospective review of a public malpractice database was compared with previously published reviews of LC litigation by K. A. Kern, MD, and the Physician Insurers Association of America. SETTING: Private surgery practice. Selection The database was searched for cases containing the terms laparoscopy, bile, or gall between August 1, 1999, and August 31, 2004. Identified cases were further reviewed to select only the unique cases that concerned elective biliary surgery. MAIN OUTCOME MEASURES: Surgical technique, injuries, and incidence of conversion to open procedures. RESULTS: In Kern's study, injuries triggering litigation involved the bile duct in 61%, bowel in 16%, vascular system in 9%, and miscellaneous events in 14%; in the present study, injuries involved the bile duct in 78%, bowel in 2%, vascular injury in 7%, and miscellaneous injuries in 13%. Missed injuries occurred in 86% in the present study and 83% of the Physician Insurers Association of America cases. Although 15% of cases in the present study were converted to open procedures, in 53% of these cases conversion was performed to repair an injury. CONCLUSIONS: Despite residency training, injuries triggering litigation after LC remain largely unchanged. The nature of the bile duct injuries suggests that routine intraoperative cholangiography is unlikely to make LC safer. To minimize the risk of litigation after LC, it is recommended that the threshold for conversion to open procedures be lowered.

Bile Duct Diseases↗
PubMed2006

Stapled diverticulectomy and myotomy for symptomatic Zenker's diverticulum.

BACKGROUND: Few surgeons have extensive experience with the operative management of Zenker's diverticulum (ZD). METHODS: Retrospective review of stapled diverticulectomy and cricopharyngeal myotomy (SDM) for ZD. All procedures were performed by midlevel surgery residents supervised by single board-certified surgeon. A drain was not used, and patients were liberally advanced to a regular diet postoperatively. RESULTS: Three patients with ZD underwent this procedure during a 6-year period. The mean age of the patients was 81 years, and all had multiple comorbidities. Time to discharge was less than 48 hours in 2 patients and 5 days in 1 patient who developed new atrial fibrillation. There were no deaths or clinical leaks. At a mean follow-up of 33 (range 6-62) months, 1 patient died of an unrelated cause, and the other 2 are free of esophageal-related symptoms. CONCLUSIONS: SDM for ZD is a safe and effective operation that is easily taught to surgical residents.

Aged, 80 and over↗
PubMed2006

The need for flexibility in the operative management of type III paraesophageal hernias.

BACKGROUND: A myriad of operation exist to treat type III paraesophageal hernias (T3PH). How does one choose? METHODS: A retrospective review of a consecutive series of resident-preformed T3PH repair. RESULTS: Three patients with T3PH were operated on during a 6-year period. The presentation of each patient was unique. Three different surgical procedures were used to treat these patients depending on the patient's condition at presentation, the location of the gastroesophageal junction, and the documentation of reflux. Transabdominal hernia reduction and a modified Hill procedure was used in 1 patient; a transthoracic hernia reduction was supplemented with a either a Belsy-Mark IV fundoplication or a Collis-Nissen gastroplasty in the other 2 patients. Patients were discharged home 7 (3-13) days postoperatively, and at a mean follow-up of 23 (2-60) months, all patients are asymptomatic and without radiographic recurrence. CONCLUSION: Operative selection for T3PH should be flexible depending on the (1) urgency of symptoms, (2) location of the gastroesophageal junction, and (3) evidence for gastroesophageal reflux.

Adult↗
PubMed2005

Turf wars: what can modern medicine learn from medieval guilds?

Medieval guilds for a time grew wealthy under a system of work rules that granted them a virtual trade monopoly, but such protection was worthless in the face of innovations in communications and commerce. Many medical specialists have grown wealthy under a guild system based on board certification. Unfortunately, creation of a vascular medicine board is unlikely to resolve the ongoing turf wars between cardiologists, radiologists, and vascular surgeons. Moreover, if medical specialists (who are facing innovations in the form of the Internet and telemedicine) wish to avoid the fate of the medieval guilds, a more flexible system based on individual competency is needed. While credentialing based on individual competence is good for specialists, it creates increased liability for hospitals because specialist credentialing will become more discretionary and less ministerial.

Attitude of Health Personnel↗
PubMed2005

Monetary lessons from litigation involving laparoscopic cholecystectomy.

Limited information exists on the relationship between adverse events associated with laparoscopic cholecystectomy (LC) and subsequent litigation. Out of 104 suits concerning LC, 18 cases were settled for 628,138 dollars; 48 cases resulted in a plaintiff's verdict with the plaintiff receiving 2,891,421 dollars; and 18 cases resulted in a surgeon's verdict. However, when multiple defendant cases were excluded, there was <20,000 dollars difference between a negotiated settlement and plaintiff's verdict. Given the minimal monetary differences between a settlement and a plaintiff's verdict, when a surgeon is the sole defendant in a malpractice case concerning LC, the surgeon should encourage their carriers not to settle before trial; as only a trial will exonerate the surgeon. However, this encouragement should be tempered when there are "red flags" that favor the plaintiff, including multiple defendants (especially a hospital), male plaintiffs, bile duct injuries, knowledgeable and well-financed plaintiff's attorneys, and certain plaintiff's venues.

Adult↗
PubMed2004

Using the market to regulate health care price: why heart hospitals will have a competitive advantage in the world of post-diagnostic related group pricing.

For the past 20 years, the federal government has reimbursed hospital services by administrating pricing. Simply put, under such a system the government dictated the prices of medical services. Not only has administrative pricing failed to control medical inflation, but such failure could have been predicted from a review of basic economics. Accordingly, to eliminate the deleterious effects of administrative pricing, it is not surprising that the government is gathering information on hospital quality and cost in anticipation of a return to a system in which the price for hospital services is determined by the market. For some hospitals, this will be good news because they will be able to negotiate a more favorable rate of reimbursement. Unfortunately, for some hospitals a market system will be bad news because the government is not going to negotiate a provider contract with every hospital. In short, when the government returns to a market system for pricing of hospital services, competition among hospitals is going to become even more competitive.

Cardiac Care Facilities↗
PubMed2004

Why do physicians who treat lung cancer get sued?

BACKGROUND: Minimal information exists on why malpractice actions are filed against physicians who treat lung cancer. OBJECTIVE: To review currently available data on lung cancer malpractice litigation to develop litigation-avoidance strategies. DESIGN: A retrospective review of a publicly available database containing verdicts and settlements of malpractice cases. Data were then compared to the Physician Insurers Association of America (PIAA) Lung Cancer Study, which was published in 1992. The PIAA report is considered the best available data on malpractice and lung cancer. RESULTS: There were 89 patients in the current study and 213 patients in the PIAA study. Physicians are most often sued by patients in their 50s (mean age, 58.9 years; range, 34 to 80 years [current study]; vs 55 years; range, 17 to 75 years [PIAA study]). Primary care physicians (60% cases in the current study vs 33% cases in the PIAA study) and radiologists (20% cases in the current study vs 55% cases in the PIAA study) were named as defendants in > 75% of suits. Failure to diagnosis lung cancer was the most common reason physicians were sued (80% case in the current study vs 23.3% cases in the PIAA series). Despite the similarity in litigation profiles, the mean award to plaintiffs, in constant dollars, increased from $172,271 in the PIAA study to $632,261 in the current study. CONCLUSIONS: (1) Recommended strategies to avoid litigation depend on physician subspecialties. While primary care physicians would benefit most from setting up a chest radiograph tracking system, radiologists would benefit most from initiating a continuous quality improvement system to substantially decrease the misinterpretation rate of chest radiographs. (2) Over the past 12 years, there appears to have been a substantial increase in awards to patients with lung cancer who sue their physicians. However, this finding may be artificial because of differing study design. Further investigation on this subject is recommended.

Adult↗
PubMed2003

Medical rationing: the implicit result of Leadership by Example.

The Institute of Medicine (IOM) has released the latest publication in its campaign to curtail medical error: Leadership by Example: Coordinating Government Roles in Improving Health Care Quality. In this publication, the IOM recommends that the government utilize its position as the country's largest purchaser of healthcare to institute unified performance standards, create appropriate incentives to improve quality of care, and develop a system to disseminate provider-specific quality information to the public. The author examines these recommendations and the contents of IOM's prior publications and concludes that necessary predicates of IOM's vision are rationing of care and a two-tiered system of healthcare. Thus, if the IOM's recommendations are carried out, the author envisions a healthcare system in which truly state-of-the-art care can only be purchased out of pocket. He concludes that, although Leadership by Example is a rational plan to address escalating healthcare costs, it is unclear both whether the American public would support it if the IOM were explicit about its ultimate impact, and whether the recommendations, in the long run, will prove to be a good thing.

Delivery of Health Care↗
PubMedDate not supplied

Discontinuation of Vioxx.

Explore the source record for details and available documents.

Anti-Inflammatory Agents, Non-Steroidal↗