"this wasn’t just error, but it was intent” by the doctors

Hospital Chain Inquiry Cited Unnecessary Cardiac Work

“The allegations related to unnecessary procedures being performed in the cath lab are substantiated,” according to a confidential memo written by a company ethics officer, Stephen Johnson, and reviewed by The New York Times.

But the nurse’s complaint was far from the only evidence that unnecessary — even dangerous — procedures were taking place at some HCA hospitals, driving up costs and increasing profits.

HCA, the largest for-profit hospital chain in the United States with 163 facilities, had uncovered evidence as far back as 2002 and as recently as late 2010 showing that some cardiologists at several of its hospitals in Florida were unable to justify many of the procedures they were performing. Those hospitals included the Cedars Medical Center in Miami, which the company no longer owns, and the Regional Medical Center Bayonet Point. In some cases, the doctors made misleading statements in medical records that made it appear the procedures were necessary, according to internal reports.

http://www.nytimes.com/2012/08/07/business/hospital-chain-internal-reports-found-dubious-cardiac-work.html?_r=2

Demand for sanctions on alternative therapists

PUBLIC health leaders have called for tougher and more consistent regulation of unregistered alternative therapy providers but appeared split on whether more pre-emptive policing is needed to protect sometimes desperate and vulnerable consumers.

Former University of NSW head of medicine and founder of Friends of Science in Medicine, Emeritus Professor John Dwyer, called for state-based regulators and the national registration body AHPRA to actively seek out unregistered practitioners who may be promising results without scientific support.

“All of [the regulators] work on an ‘after the event’ protocol,” Professor Dwyer said.

“They’re not out there looking to see what rubbish is on the net and moving in to say, ‘Hey, you’re making this claim, you can’t’,” he said.

“[Australia needs] consumer protection that says if you are charging money for a health service and you have no credibility and no credentials, that’s illegal… and there should be very heavy penalties for it.”

http://www.medicalobserver.com.au/news/demand-for-sanctions-on-alternative-therapists

Do Physicians Know When Their Diagnoses Are Correct?

Even experienced clinicians may be unaware of the correctness of their diagnoses at the time they make them. Medical decision support systems, and other interventions designed to reduce medical errors, cannot rely exclusively on clinicians' perceptions of their needs for such support.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1490097/

The statistics about errors in medical reasoning are sobering

The statistics about errors in medical reasoning are sobering. The correct diagnosis is missed or delayed in up to 14% of acute admissions (J Gen Intern Med 2005; 20: 334-339). If the diagnosis is correct, up to 43% of patients do not receive recommended care (doi: 10.5694/mja12.10510), and about $800 billion — nearly one-third of all health care spending — is wasted on unnecessary diagnostic tests, procedures and extra days in hospital (http://www.reuters.com/article/2012/02/16/us-overtreatment-idUSTRE81F0UF20120216). Wilson and colleague’s landmark analysis of the cause of adverse events in the Australian health care system reported that almost half of reported adverse events involved errors of reasoning (MJA 1999; 170: 411-415).
Med J Aust 2012; 197 (3): 129.