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Monday, March 31st 2008

Taking Claims Of Malpractice To The Internet

Let me be equivocal in saying that I would never dare to pass judgment on the merits of the claims Dan Walter makes or on the anger he appears to harbor. I’ve never been through anything like he lays out. What I do question is his strategy in trying to seek some sort of remedy and the generalizations he makes from his experience.

Okay, Not An Ablation But The Only Cath Image I Could Find Under A CC License

For a while national email listservs for use by medical students have been getting strange emails from a man named Dan Walter. Most of them reference back to a blog he’s running called Adventures in Cardiology. In the blog he details what he perceives as terrible medical care his wife got at the hands of Johns Hopkins staff. Specifically he targets an electrophysiologist whom his wife presented to for an ablation to correct her apparently chronic a fib.

His efforts extend away from the blog and out onto internet forums, about.com (see here and here), and even to posting phony profiles of the cardiologist he is targeting on physician review sites. At Wellness.com, Mr. Walter appears to have posed as the cardiologist and posted this,

I’m an ambitious doctor who puts my career above the safety of my patients.

This seems like a terribly inappropriate way to address an issue like this. I can understand why one, after going through something as terrible as what Mr. Walter describes, would like to find a place to rant. But emailing medical students, posting an obscure blog, posting phony physician profiles aren’t going to cost JH hospital or the cardiologist a lot of business I imagine. And in some cases you have to wonder if what Mr. Walter has done rises to libel.

In addition, I think some of the generalizations about medical care he makes are misleading for any future patients who may visit his website,

What we didn’t know is that [our electrophysiologist] – according to what he later told colleagues – follows the practice at most teaching hospitals wherein “the attending shows up to be there during the burn.”

His offense with trainees (mind you these are medical doctors) providing care to patients doesn’t appear limited to the comments above.

This presents another teaching opportunity, so they find someone who has never actually repaired a mitral valve. He opens her up and decides upon seeing the mess that he will just replace the valve, sentencing my wife to the high-wire balancing act of taking warfarin for the rest of her life. (You should look up Warfarin. It’s more commonly known as rat poison. No kidding.)

As Mr. Walter presents it, it doesn’t appear that anyone but who was in the cath lab and the operating room knows if the fact that trainees were involved in his wife’s care contributed to the terrible and tragic outcome she had. The fact is though that research, in general, does not support poorer outcomes when residents are involved in patient care. This is across a whole host of specialties, a whole host of procedures and operations. Mr. Walter seems to be drawing a whole lot of generalizations from his anecdote.

I think we can be reasonably sure (but obviously not know with certainty) that the CT or GS resident who aided in the heart surgery did not, singlehandedly make the determination that the mitral valve needed to be replaced. And I would hope Mr. Walter and his family could take some solace in knowing that the balance between whether to put in a bioprosthetic versus mechanical valve is one without a clear tilt often. So while we can rant against life long anticoagulation and the dangers of coumadin, different dangers exist with putting in a biologic valve and sparing a patient the coumadin.

These serve as just examples of what I think are overly general criticisms. There are more throughout the blog.

I feel for Mr. Walter and his wife. The concern I have is that Mr. Walter seems to be making broad claims and implying, for other patients who might visit his site, that some of the things his wife went through, some of the choices made in her care are ALWAYS inappropriate. I would just say: A resident or fellow being involved in a patient’s care does not generally put that patient in danger, a mechanical valve isn’t always the wrong thing, etc.