Vascular Surgery Expert Witness

Will further reducing work hours enhance patient safety

This is an interesting revision to patient work hours. In an effort to reduce medical errors.

Inexperienced Resident Doctors to Receive More Supervision in Malpractice Prevention Effort

A newly minted M.D. doctor wandering the halls of a hospital, working long hours with little sleep as he or she begins years of residency training, can be a potential disaster waiting to happen. That's the source of the old bromide about July being the most dangerous month to get sick, since that's when residency programs start their new year.

In theory, all junior doctors receive careful supervision from senior doctors in training and from full-fledged "attending" physicians. But in practice, in busy institutions junior doctors can work long hours with little supervision, and mistakes that cause injuries to patients can result.

In 2003, residency programs accredited by the official supervisory body, the ACGME, were required to cut resident work weeks from 120 to 80 hours. But in December 2008, the Institute of Medicine, part of the National Academies of Sciences, recommended more changes to improve patient safety in residency programs.

One of them was to end the practice of 24-hour shifts.

The ACGME is now following that advice, but only in part. As of July 2011, first-year residents will be limited to 16-hour shifts, but after the first year, residents will still be able to work a 24-hour shift. Many experts believe the longer shifts are dangerous for patient safety because of sleep deprivation.

The 16-hour limit for first-years is part of a series of recommendations being submitted to the ACGME board for final approval in a few months.

Sidney Wolfe, MD., head of Public Citizen Health Research Group, is critical of the failure of the ACGME to propose a 16-hour limit across the board. He says: "The improvements in the new ACGME guidelines are largely swamped by the failure to cover the majority of medical residents with the protection of not having to work more than 16 hours continuously."

In the new proposal, first-year residents would also be barred from moonlighting at other jobs and from being "on call" in hospitals.

Source

A newly minted M.D. doctor wandering the halls of a hospital, working long hours with little sleep as he or she begins years of residency training, can be a potential disaster waiting to happen. That's the source of the old bromide about July being the most dangerous month to get sick, since that's when residency programs start their new year.

In theory, all junior doctors receive careful supervision from senior doctors in training and from full-fledged "attending" physicians. But in practice, in busy institutions junior doctors can work long hours with little supervision, and mistakes that cause injuries to patients can result.

In 2003, residency programs accredited by the official supervisory body, the ACGME, were required to cut resident work weeks from 120 to 80 hours. But in December 2008, the Institute of Medicine, part of the National Academies of Sciences, recommended more changes to improve patient safety in residency programs.

One of them was to end the practice of 24-hour shifts.

The ACGME is now following that advice, but only in part. As of July 2011, first-year residents will be limited to 16-hour shifts, but after the first year, residents will still be able to work a 24-hour shift. Many experts believe the longer shifts are dangerous for patient safety because of sleep deprivation.

The 16-hour limit for first-years is part of a series of recommendations being submitted to the ACGME board for final approval in a few months.

Sidney Wolfe, MD., head of Public Citizen Health Research Group, is critical of the failure of the ACGME to propose a 16-hour limit across the board. He says: "The improvements in the new ACGME guidelines are largely swamped by the failure to cover the majority of medical residents with the protection of not having to work more than 16 hours continuously."

In the new proposal, first-year residents would also be barred from moonlighting at other jobs and from being "on call" in hospitals.

Source

IME in Philadelphia, Pennsylvania and New Jersey

What is an Independent Medical Evaluation

Preparing for an Independent Medical Exam (IME)

Some of the information about workers compensation may not be the same in your state so please contact your attorney or state Worker's Compensation Board to check.
The Independent Medical Exam (IME) can be one of the most harrowing part of dealing with an injury. Whether it is the auto insurance company, the workers compensation carrier, a personal injury litigation or a exam for the Social Security Administration, the person being examined knows that this one exam could change the outcome of their care or legal case. Because of how important these exams are, it is imperative that the person being examined prepare for the exam.

One of the most important things to remember is that this doctor is being hired by the other side, the side that wants to prove that you are not disabled or that any disability that you have didn't come from the incident that you claim it came from. Don't expect this doctor to give you any treatment options or even discuss the case with you.

Make sure that you are dressed in appropriate clothing, clean and well kempt. Remember that you will may be observed from the time that you arrive at the office until the time that your car pull out of the parking lot. This is important because often the report will state how you sat in the chair, how you got in or out of the car, how you interacted with the staff and/or people in the waiting room.

The following letter was written by Sue Hickerson of the Tri- City Support Group in Michigan

"The Independent Medical Examiner (IME) is the doctor that your Worker's Compensation Insurance (carrier) or Employer has chosen. The IME doctor is paid for by the carrier or Employer. The injured employee must go to the IME exam or may have to forfeit their compensation. The carrier must pay the injured employee, in advance of the exam, for traveling expenses.

"You or your attorney can receive a copy of the IME's report by sending a request for the report, certified to your compensation claims person. The carrier has 15 days from the date on the return receipt, to furnish the IME report. If the carrier fails to provide the IME report within 15 days, the carrier cannot use the medical testimony of that doctor.

"You have the right to have a doctor or other person present during the IME examination, at your expense!

"An IME is very SERIOUS! What this person writes about you overrides ALL your doctor. You can have 5 doctors tell the comp insurance that your injury need immediate surgery and the IME doctor can say, I don't see any injury, no need for surgery, return to work with or without restrictions.

"You MUST take a witness with you to the exam. Some attorneys say that your spouse or attorney can go into the exam room with you. If the IME doctor objects, than the IME doctor can say that you were obstructing the examination and your compensation may be suspended. NO agent of your comp Insurance or Employer, this includes REHAB NURSES, has the right to go into your IME examination! Your and your witness should note the time you arrive, the time you go into the exam room, the time the IME doctor arrived, the time he left, and the time you left. Some IME exams last all of 10 minutes.

"Bring all of your X-rays, and other test results with you the day of the exam. Some attorneys say you can object to any invasive procedures, that includes X rays. You should have your attorney help you make the decision on whether you will object to new tests or X-rays before your exam day. This is an important decision to make because the IME can portray you as not cooperating. "Arrive on time and dress neatly. You want to make a favorable impression. Be courteous to the IM doctor and his staff. They may already have an attitude, so don't antagonize, cooperate with them.

"Make sure that the IME doctor who examines you is the same doctor you were to see. Contact your attorney if there is a problem with this. "Be truthful and brief, you want to give a general history of what happened to you and a rundown on your history of what happened to you and a run-down on the treatment you have had, It is very important for the IME to understand and make sure the IME knows what you current problems are.

"Don't exaggerate or fake any injuries or any part of the examination. The IME doctor will be able to detect this, parts of the exam are designed to detect faking. Also don't hold back, be honest, forthright, and explain your injury as well as possible.

"After the examination is over, make some general notes. If you have an attorney, Call him and let him know what happened while it is fresh in your memory.

"You should see your own doctor the same day you saw the IME doctor. Make sure you have an appointment some time after the IME's. Your doctor will be able to say what He found on the same day you saw the IME doctor. Sometimes the IME's examination will hurt you and your doctor should be able to document this, such as swelling.

" GOOD LUCK ON THE IME EXAM! "

A few extra thoughts that may help:
Make sure you tell how you got injured in the same way every time. Also report your history treatments the same way. Some attorneys might use inconsistencies against you. If you could write it down and take it with you to the IME. so you can offer it to the doctor.

Bring a camera. If your limb looks swollen, discolored, shiny or anything else that will show, take a picture that will show that you were at the IME's office( hold you hand next to his certificate on the wall, foot neck to a name plate from his desk etc.

Even though your Worker's Compensation Carrier paid for the exam, federal law states that you are entitled to all of your medical records. You just state what reports you want released to you in writing. If there is any sensitive information about a psychiatric or drug problem, you must state in your letter that this information can be released. Send this request by certified letter and the reports must be released to you within 15 days.