Mischief Maker

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There is a woman whose mischief is causing me a whole lot of problems. Now, I don’t want you to think that I’m a misogynist or some type of closet chauvinist, but Miss Information is really troublesome. Besides me, this wayward troublemaker has managed to entwine herself in multiple aspects of the daily lives of practicing physicians. The widespread introduction of electronic medical record keeping has opened Pandora’s Box for Miss Information to flit about, inserting a word or two here, and fiddling with macros there. Yet it is not only her delight in altering medical records, although that is where I first noticed her trickery.

There could be no other way to explain that a local cardiologist’s history and physical described his patient as having “3 plus ankle pulses” despite the patient’s being a double amputee. Further, another’s records claimed that a patient was “neurologically intact” although he had suffered a dense left hemiplegia following carotid stenting. When I questioned the patient I got the distinct impression that perhaps Miss Information had disguised herself as his cardiologist. She told him that he needed a carotid stent because he had a 60% stenosis which if not treated would result in a stroke … and now he actually had one. I asked him why he had not consulted with me; after all, I am relatively well respected in my town, or so I thought! He said my web reviews were not stellar. Impossible, I believed! But when I checked, I found that impudent rascal Miss Information had inserted derogatory reviews about the cleanliness and friendliness of my office staff. I knew it was her doing because she had actually made a mistake in my favor. She had erroneously claimed that the wait time in my office was better than average and I know for a fact I am tardy in that respect.

Coincidentally, I had just Googled “indications for carotid surgery and stenting” since I had to give a talk on asymptomatic carotid stenosis at the VEITH symposium. To my consternation, I discovered evidence that Miss Information had also infiltrated the Internet. The mischievous imp has jumbled the data, causing researchers to write contrary articles demonstrating stents to be less dangerous than endarterectomy, but equally that they are more hazardous. She also has inserted articles suggesting that patients with greater than 70% blockages need invasive treatment whereas other references adamantly proclaim that no one should have CEA or CAS unless they are symptomatic.

I don’t want to insinuate that Miss Information is necessarily unethical, but I am concerned by how she has altered the credentials of some of the doctors in my area. For example, I read an ad in the newspaper that a general surgeon who does vein therapy claimed to be a “Board Certified Vascular Surgeon,” whereas he had never taken a fellowship, nor ever passed the boards in vascular surgery. Surely, such a mistaken advertisement could only have resulted from that playful wordsmith, Miss Information. The same doctor’s records had also been manipulated by this little devil. She altered the note of one of his patients to falsely claim that the patient had severe pain despite having complied with insurance regulations that required exercising and wearing stockings for 3 months. The patient had no pain and had not worn stockings at all. Further, the duplex scan described an incompetent saphenous vein that had previously been removed for his cardiac bypass.

And, lo and behold, even our patients can succumb to her advances. A 30-year-old fitness instructor informed me that he suffered from such severe pain from an ugly calf varicose vein that he was reduced to consuming large quantities of analgesics. He did not want phlebectomy even though scars would be minimal. Rather, he requested that I prescribe oxycodone!

Miss Information even seems to be able to get herself on TV. I saw her in an ad masquerading as a vein doctor claiming that varicose veins can lead to life-threatening complications. Like the sorcerer that she is, she charms viewers by assuring them that most insurers will pay for treatment. Another of her tricks is to show spider veins vanishing in an instant with sclerotherapy, when we all know they may look even worse for a while. And, every morning and throughout the day, I see TV ads touting that a large legal firm specializing in malpractice asserts that it is “For the people”… Really?

Even a hospital with all its ability to keep out dangerous pathogens can be infected by this ill-behaved sprite. A hospital in a neighboring county claims to be a full service hospital, but has no vascular surgeon to cover the emergency department. Two other local hospitals claim to be in the “Top 100” of American hospitals. Yet one was cited by the state department of health services for unsanitary conditions. The other just paid $2 million to the U.S. Department of Justice to settle allegations of improperly implanted cardiac devices. Miss Information, acting as the spokesperson for the latter hospital, claimed that payment was made to avoid “costly and distracting litigation.”

Industry also is not immune to her conniving ways. I have already devoted an editorial to target lesion revascularization (TLR), a term she frequently uses to mislead us into believing one device is better than another.

With all the potential for Miss Information to negatively affect our professional judgment and outcomes, I question the government’s insistence that we all use electronic medical records. The premise for widespread use of an EMR is that if a surgeon has easy access to patient records from another state, he or she will not have to repeat costly tests or procedures. However, how do we know if Miss Information has rendered these tests unreliable? I was recently placed in a clinical quandary when an insurance company insisted that it would not pay for a confirmatory duplex scan on its client. I was aware that the patient had the scan performed at another lab where Miss Information would notoriously exaggerate the degree of stenosis to support unnecessary endarterectomies.

I have tried to make myself immune to Miss Information’s depravity since I know how insidious her efforts can be. However, it is possible that even some of my writings may be contaminated. Accordingly, I must sadly acknowledge that some of the “stories” I relayed above might not be completely factual. You will have to decide which, if any, Miss Information got hold of. Good luck!

Dr. Samson is clinical professor of surgery (vascular) at Florida State University Medical School, is president of Mote Vascular Foundation, and an attending vascular surgeon, Sarasota (Fla.) Vascular Specialists. Dr. Samson also considers himself a member of his proposed American College of Vascular Surgery.

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