Why don’t patients ask questions of their doctor?

My wife came back from a doctor’s appointment the other day, and immediately, I noticed that she looked puzzled and somewhat confused. So, I asked her about her appointment.  She went over her discussion with the doctor as I kept probing with questions about their conversation.  I found myself asking the following question more than any other: “Well, did you ask him about…?” Before too long, doing what I do for a living, I could not help but wonder why patients aren’t more inquisitive. Is there something about the patient-doctor relationship that makes patients not want to ask questions of their physicians?

Surely, the primary responsibility for gathering information about the patient’s medical conditions is and should be with the physicians. After all, their knowledge of medicine is vastly superior to that of the average patient. Still, when a patient has questions, there is often no good reason not to ask them. Consider a physician who orders hormone replacement for a female patient with a history of blood clots or hypercoagulability of which the physician is unaware. Consider another patient who develops a series of complications after a surgical procedure but who decides to tough-it- out and not ask any questions during follow-up appointments with the physician. In both of these examples, the patient risks developing potentially life-threatening conditions, and, if the patient knows or suspects that possibility for whatever reason, it is probably not a good idea to assume that the doctor will be the one to ask the right questions. So, why are patients sometimes reluctant to ask more questions about their medical care or condition?  I don’t presume to know the answer, but I suspect, in part, it has to do with the patient’s expectations.

For example, when I am pain, I don’t really want to have an extensive Q & A session with my doctor. I just want treatment!  It is simply mentally relaxing to just let go and have someone else take care of me. In addition, my knowledge of medicine is superficial at best. I don’t feel comfortable asking questions if I don’t know what I am talking about. My ego would rather have me in pain than allow me to question a doctor at the risk of looking like a fool.

On a subconscious level, I am probably also dealing with preconceived notions about doctors.  As long as I can remember, I have been told that doctors are intelligent and in control. After all, who else is capable of getting into medical school and then have the stamina to survive some seven to ten years of medical training? All of this makes me think that my doctor can only make the right decisions about my medical care. And then there is the medical office or the hospital. The smells, the patients (most with problems far worse than I have), the complicated machines that look like they belong in a sci-fi movie don’t exactly add-up to a familiar, comfortable environment.  I am in pain, uncomfortable, and somewhat intimidated – not exactly an environment conducive of critical thinking.

Well, if this is how other people feel, I think that might explain why patients are sometimes not as inquisitive as they should be.  What do you think?  If you are a patient or a physician, your feedback is much appreciated. Of course, everyone is welcome to comment.

Contributing author: Jon Stefanuca

Editor’s Note: This piece was written by Jon Stefanuca. My own wife has an advanced degree in pathology, did surgical pathology and autopsies. She DOES ask questions! Do you really need a medically-related degree, however, to ask the basic questions so that you have a clue what you’ve just agreed to by way of medical care? I think not. Moral of the story: be your own patient advocate! If you need help, then have a family member or a close friend accompany you if you have any doubt.

Baltimore: After police officer accidentally kills bystander, settlement reached but terms confidential

A Rosedale woman, and mother of two, was killed when a Baltimore County police officer accidentily side-swiped her 1997 Mercury Tracer.

Bonnie Pappas, age 45, was traveling across Pulaski Highway when a police officer, Ray Pabon, sped over a hill at an estimated 85.7mph. The investigations conducted by both the Baltimore County Police Department and Pappas’ family found that Officer Pabon did not have the emergency lights and/or sirens on at the time of the collision.

A nearby liquor store’s surveillance tape confirmed that at the time of the crash, the cruiser lights and sirens were off. Ronald Parker, counsel for the Pappas’ family stated:

…an officer who arrived moments after the crash ran to Pabon’s car and turned on the emergency lights.

“We contend that had the officer had his siren and lights on when he was driving, our client would have seen or heard them,” Parker said.

A deputy states attorney for Baltimore County , Sue Schenning, later claimed that prosecutors had decided not to file charges of vehicular manslaughter. Grounds for this decision were claimed to be that lack of evidence could prove Officer Pabon acted with gross negligence, which is defined at times in Maryland as the conscious disregard for the high risk of others.

The Baltimore Sun reported that the civil suit was filed by Mr. Parker on behalf of the Pappas’ family, which sought $1 million in damages for Ms. Pappas’ estate and $50 million  for her two children. Although the suit was settled, the award and terms remain confidential. Keep in mind that Maryland ‘caps’ non-economic damages, such as pain and suffering and the distress and mental anguish of  loved ones who lose their beloved through the negligence of others.

Coming this Week: On the issue of ‘confidential settlement agreements,’ keep a lookout this week – should the public know? are they in the client’ s best interest? We’ll lay it out there for you to discuss and decide.

Florida’s doctor discipline system not tough enough, critics say

As a Florida-licensed attorney who spent 15 years working in consumer justice law firms in the ‘Sunshine State,’ I keep a watchful eye on trends and developments within various personal injury practice areas in Florida.  There is currently a real, legitimate concern regarding the system that is responsible for disciplining doctors who are licensed to practice medicine in Florida.  The Orlando Sentinel recently published an article how some believe there is much to be desired when it comes to how the  Florida Department of Health handles these matters.  

Consumer group Public Citizen last month ranked Florida the eighth most-lenient in the nation for disciplining doctors. The ranking stems from the number of serious actions per 1,000 doctors last year, when the state revoked the licenses of 94 and suspended 18 others. The toughest state disciplined doctors at rates three times as high. The trend has been true for a decade, the group said.

Critics contend the state does not act fast enough or toughly enough against the small share of practitioners accused of substandard care, negligence, crimes or improper behavior. Too often, they say, the state lets professionals such as Lan continue practicing while officials probe allegations of crimes or serious violations and injuries.

Regulators dismiss 90 percent of complaints that patients or others file against practitioners, more than 95 percent of those against doctors. When action is taken, the state rarely imposes serious punishments, such as revoking or suspending licenses.

There is ‘the other side’ of the story.  According to the article, some of the advocates for the way the system works take the following position:

State officials and some attorneys defend the system and say the criticisms are overstated. They say any system can be improved, but contend the state focuses on protecting the public from professionals who commit the most serious wrongs, and demands remedial training for professionals who make errors.

“I don’t see the evidence to support [the criticism]. We believe we are doing a good job,” said Lucy Gee, the health department’s director of medical quality assurance.

Gee said the process moves deliberately so it can be thorough. Cases remain secret because laws aim to keep baseless complaints from becoming public and unfairly tarnishing professionals, she said.

What about the doctors and individuals within the medical profession that repeatedly cause harm to patients or are charged with serious crimes (felonies) but are permitted to continue practicing medicine?  What about these same individuals within the profession, who do not receive ANY form of discipline whatsoever, or are allowed to continue practicing, while the investigation against them is pending. Here are just a few examples of such real world cases:

Dr. Stuart F. Tillman, a Tallahassee anesthesiologist arrested in July and charged with soliciting sex online from a police officer posing as a girl of 14.

Dr. Joseph M. Hernandez, formerly of Fort Lauderdale, who was arrested in Lake City in February and charged with trafficking narcotic pain pills and prescribing drugs for monetary gain. In 2006, records show the state banned him from doing surgery and temporarily suspended his license because his vision was severely impaired. In 2007, he was fined $5,000 for leaving part of an IV tube in a patient’s chest.

Dr. John N. Mubang, an internist in the Tampa suburb of Seffner who was arrested and charged in July 2008 with drug trafficking and prescribing controlled substances for monetary gain.

All three have pleaded not guilty, with trials pending. Hernandez and Mubang are practicing, according to their offices. Hernandez declined to comment. Mubang and Tillman could not be reached for comment, despite calls or messages left at their offices.

What does this say about the system that disciplines doctors in Florida?  Sure, there are many great doctors in Florida, but for the ones who put their patients’ lives at risk (through negligent treatment or otherwise) or are charged with serious crimes that may have an impact on their practice/medical license, the question remains: Would YOU want to have a surgical procedure performed by a doctor that has a criminal investigation pending against him or her that may land them in jail? I suspect you would prefer your doctor to be completely focused on your surgical procedure and not thinking about other ‘outside distractions.’  Shouldn’t there be additional aggressive safeguards in place that will IMMEDIATELY prevent the medical provider from committing more harm?

We leave you with this: Yes, emergency suspensions were put into effect 248 times in 2009.  However, compare that with the approximate 24,000 complaints that were filed against doctors and other members of the medical profession the same year, by both individuals and other agencies.  Are we really to believe that only 248 of those 24,000 cases required emergency suspension of one’s practice…??

IV infiltration leads to $1.5 million verdict when patient loses thumb.

Recent news from Georgia (where the state’s cap on non-economic damages was recently overturned): A patient, Johnnie Jackson, age 47, was awarded $1.5 million for pain and suffering in addition to recovery of his medical expenses, for injuries he sustained when delay in treating an infiltration of his IV ultimately led to the loss  of his thumb.

Mr Jackson presented to Coffee Regional Medical Center for complications resulting from a pancreatic condition on April 30, 2005. Mr. Jackson had a known history of diabetes and chronic pancreatitis.

Upon presentation, a nurse administered Phenergan and Demerol through an IV, which had been inserted into Mr. Jackson’s right wrist. At approximately 3:00 a.mm on the morning of May1, Mr. Jackson complained of swelling and pain at the site of the IV causing it to be removed 45 minutes later.

After nine hours of complaints, Mr. Jackson was examined by his physician, who found that the medications had leaked into the surrounding tissues. Mr. Jackson’s physician elevated the arm in a failed attempt to reduce the swelling. On the afternoon of May 2, Mr. Jackson was transported to the South Georgia Medical Center for advanced treatment.

A pretrial order revealed that Mr. Jackson was transported to  the medical center for the treatment of a blood clot that was found near his thumb.  During Mr. Jackson’s 24 day admission at the medical center, he underwent a multiple surgeries by an orthopedic surgeon, who was unable to salvage Mr. Jackson’s thumb.

Mr. Jackson’s attorney, Laura Shamp, filed suit against Coffee Regional and five treating nurses in 2007 alleging that Mr. Jackson was unable to work due to frequent hospitalizations caused by diabetes and pancreatitis, but that:

…the hospital gave him a ‘job’ of living without his thumb for the rest of his life, so he should be paid for it.

“Their defense was that the IV did not infiltrate and that even if it did, that was not what caused the loss of his thumb,” said Shamp. “They said it was simply that strange things happen and this was a coincidental blood clot that ended up contributing clotting at the same time.”

With the plaintiff’s permission, the named nurses were dismissed with the hospital remaining as the sole defendant. The Coffee County jury awarded Mr. Jackson $53,026 for medical expenses and $1.5 million for pain and suffering.

Wife suffers second-hand asbestos exposure from husband’s clothes. CA jury awards her huge verdict.

Bobby Evans was a loyal employee of the Los Angeles County Department of Water and Power (DWP) for nearly 25 years. Little did he know, he was exposing his wife to second-hand asbestos.

Rhoda Evans, wife of retired DWP worker Bobby Evans, was diagnosed with mesothelioma after years of washing Mr. Evans’ clothing that had been coated daily in asbestos fibers. For nearly 25 years, Mr. Evans unknowingly worked cutting cement water pipes that contained asbestos and brought these dangerous fibers home with him on his clothing. Certain Teed Corporation, the supplier of the asbestos cement pipes, neglected to warn consumers of the risks in using their products containing harmful substances.

Certain Teed Corporation had known about the risk factors of working with asbestos materials since the 1960’s, yet never placed warning labels on their products until 1985. By 1985, it was too late for Rhoda Evans, who now suffers from  a life-threatening, incurable cancer.

Mrs. Evan filed suit against the Certain Teed Corporation with the following accusations:

Certain Teed actually concealed the risk of asbestos exposure from DWP officials “in an effort to protect the $40 million in annual revenues the company made on selling asbestos-containing cement pipe to the county.”

The LA Department of Water and Power was also held partially responsible for the compensatory portion of the award for its failure to adequately protect Bobby Evans on the job.

Mrs. Evans was awarded $8.8 million for compensatory damages and an additional $200 million to be paid by the Certain Teed Corporation for punitive damages.  Attorney’s for the Corporation feel that the punitive damages award is unconstitutional and plan to appeal the verdict.

Since 1929, an estimate of 600,000 lawsuit have been filed for mesothelioma and asbestos disease. Whether the punitive damage award is lessened in the case of Mrs. Evans is unknown; however, it is expected to encourage manufacturers to settle such cases out of court, as opposed to trying them before a jury. Hopefully, this message sent by the jury will resonant among the manufacturing community as well: if you are aware of potential dangers to the users of your product, you better warn people about that danger while you are taking pr0active steps to correct it!

Actor Dennis Quaid sues drug maker

Last month, we reported in a blog through our website, how actor Dennis Quaid is involved as a patient advocate, after his newborn twins nearly lost their lives back in 2007, from a medical error that could have very easily been prevented.  Put simply, the precious twins were given two doses of Heparin instead of Hep-lock (an anti-coagulant medication widely used for children).  Why is this significant?  Heparin is a drug one thousand times stronger than what the twins were supposed to have received.

Earlier this week, it was reported in the Contra Costa Times, that Mr. Quaid has filed a lawsuit on behalf of his children.  As far as the extent of his children’s injuries, the article states “The children suffered internal injuries and shock, but the extent of what happened to them will probably not be known for years, according to the suit.”  The lawsuit alleges that vials of the 10,000 unit Heparin should have been recalled previous to what happened to his children, because other infants had already died from similar medication errors.  The suit also claims that the company responsible for making the drug, Baxter Healthcare, “was obligated to warn healthcare providers of the previous medication mistakes.”

We wish the best for the Quaid family, and hope that the discovery in this case shines a light on not only finding out exactly what happened in this case, but also makes information available that may be able to save the lives of other children from future similar medical errors.  We will continue to monitor the course of this case.

Child Health: Labels Urged for Food That Can Choke

Earlier this year, we posted a blog on our website in regard to the American Academy of Pediatrics (AAP) policy statement in regard to the prevention of choking among children.  Earlier this week, the New York Times featured an in-depth story on an issue that is very much a part of this policy statement:  food choking hazards among small children.  The article discusses the advocacy efforts to place warning labels on foods, which pose a choking hazard to small children, as well as the proposition that small children should not be allowed to eat certain foods at all.  The article starts with an all too familiar setting that ended in tragedy:

On a July afternoon in 2006, Patrick Hale microwaved a bag of popcorn for his two young children and sat down with them to watch television. When he got up to change the channel, he heard a strange noise behind him, and turned to see his 23-month-old daughter, Allison, turning purple and unable to breathe.

As a Marine, he was certified in CPR, but he could not dislodge the popcorn with blows to her back and finger swipes down her throat. He called 911, but it was too late: by the time Allison arrived at the hospital, her heart had stopped beating. An autopsy found that she had inhaled pieces of popcorn into her vocal cords, her bronchial tubes and a lung.

Does this story make you think twice before giving your little ones popcorn?  On a personal note, I called my wife immediately after reading this story, and we discussed the fact that we should no longer allow our son, who is now two and a half, to have any popcorn. Ironically, she was on her way to take him to a movie that was going to be serving….you guessed it, popcorn.

Now, some of you may say “Well, little kids can choke on anything.”  Well, that is true.  However, there are some foods that pose an increased risk of choking.  Consider the dynamics of how a small child eats, as well as the size of their airway:

Children under 4 are at the highest risk, not only because their airways are small (the back of a toddler’s throat narrows to the diameter of a straw) but also because of the way their eating abilities develop. Front teeth usually come in at 6 or 7 months — so babies can bite off a piece of food — but the first molars, which grind food down, do not arrive until about 15 months, and second molars around 26 months.

“Between the ages of 3 and 4, they’re developing their ability to chew adequately and prepare for swallowing,” said Dr. Nisha Kapadia, a pediatric resident at Johns Hopkins Children’s Center.

When young children chew foods like peanuts, raw carrots and popcorn, some is ground down and some is not, and they tend to swallow unchewed bits of food that can block the airway or be inhaled into the bronchial tubes and lungs.

This concern and the tragic deaths associated with this concern have prompted several organizations to propose various options to attempt to prevent these injuries and deaths.  One such organization is the Center for Science in the Public Interest:

Some advocates say the government should put hazardous foods off limits to young children.

“The F.D.A. needs to set a uniform standard for cautionary information on food that should not be consumed by children under 5,” said Bruce Silverglade, legal director of the Center for Science in the Public Interest, an advocacy group that lobbied unsuccessfully in 2003 for a bill to require the Food and Drug Administration to develop food labeling regulations.

Where this debate will end up, we don’t know.  However, to think that in 2001 there were 17,500 children 14 years old and younger treated in emergency rooms for choking, with 60% of those events caused by food, there must be a way to create a safer environment for our children when they are eating.  Any suggestions?

Cardiac Health: Implantable Cardiac Devices – number of procedures on the rise, but is the technology really there to handle this boom?

It is reported that an estimated 650,000 people in the United States currently have implanted cardiac devices (ICD’s) designed for defibrillation (cardiac electro-shock therapy) or combination defibrillation and heart pacing.  For you  Baby Boomers rounding (or having passed) the 60’s bend, these numbers are expected to grow exponentially.  Cardiovascular Business posted an article on April 20 advising that hospital admissions for implantation of ICD’s increased ten-fold from 1990 to 2005.

This same article was quite alarming in its lack of scientific data on factors that determine the best results.  While it may be comforting to know that several large patient-studies have recently shown that centers performing the greatest numbers of procedures have the lowest rates of procedural complications, it is important to also note that authorities in this area of medicine warn that more data and study are needed on individual operator volume, specialty identification, training, performance and outcomes.

Cardiovascular Business News released a feature on April 20, 2010, citing an article published in 2009 by the Journal of the American Medical Association.  The data suggest that your odds of having procedural complications were greater if the device was implanted by a non-electrophysiologist. In short, does this mean you have better odds with an electrophysiology cardiologist? What about a general cardiologist? Or a thoracic surgeon? The study data apparently did not adjust for underlying health conditions or patients who are more ill. Why not? Are we to assume the latter groups of patients may have merely been more prone to complications? Or do the non-electrophysiologists just have less experience and training in implanting ICD devices? As of this time, Boomers, the medical profession has not published answers to these questions.

Perhaps we should be encouraged that Medicare is requiring implant and performance outcome data. As of June 2009, the agency had collected information on more then 380,000 implants.  Yet almost a year later, with many more procedures entered into that same database, the medical specialty communities are still unable to let us know which are the safest specialists and hospitals performing ICD implant procedures.  Physicians say longer term outcomes are needed.

In the meantime, are Medicare and other payors paying for all procedures regardless of the quality of practitioner or hospital performance?

More alarming, on May 17, 2010, Dr. Westby G. Fisher, a cardiologist at North Shore University Hospital Health System wrote in medcitynews.com that the medical system currently can no longer sustain the volume to maintain the implanted devices safely. He complains that physicians are unable to re-program ICD devices remotely.  Is this true? Due to the growing volume of implanted devices now occurring, technicians with no medical degree are programing patient devices from remote locations with sometimes no documentation or notification to the patient’s physician. Physicians are supposed to be overseeing the process according to Dr. Foster. However, he is of the opinion that due to the high maintenance these devices require, along with the growing number of patients, managing the technology will be of great concern to the boomer population and their physicians.  Once again, how are the pressing issues of quality, safety, and cost going to be timely addressed in this burgeoning aspect of our healthcare?

Finally, perhaps we can be comforted by the recent news release from the Heart Rhythm Society. Apparently, the medical profession had never previously determined parameters on how and when to stop these devices at the end of one’s life.  The study cited a dying patient whose defibrillator went-off  greater than 12 times, causing the patient needless suffering. Several groups of medical societies have now have published a consensus statement outlining ethical and legal issues, a decision-making algorithm for withdrawing/deactivating the device(s), and rights/responsibilities for those physicians who have ethical conflicts. The Heart Rhythm Society is encouraging and educating physicians and patients on what needs to happen in this algorithm for ending ICD-sustained life.

One can only hope that a physician is not placed into a remote call-waiting voicetree for dying boomers when the time comes to deactivate. It’s bad enough that we don’t yet know how to choose the best physician and/or hospital to have these devices implanted. Now there is growing concern that simple but critical issues of maintenance, remote re-programming and the like will get out-of-hand due to the ever increasing volume of these devices being implanted.

Contributor: Sharon M. Stabile

UPDATE: AAP Compromise Statement on Female Genital Cutting – RETRACTED!

Please see UPDATE at end of article!

On April 26,2010, the American Academy of Pediatrics (AAP) issued a new policy statement seen by many as essentially advocating the practice in this country of female genital mutilation (FGM)[sometimes  this ‘tradition’ is referred to as female genital cutting (FGC) as well].  In pertinent part, the policy advocates for “federal and state laws [to] enable pediatricians to reach out to families by offering a ‘ritual nick’,” such as pricking or minor incisions of girls’ clitorises.

Yes, I said this was issued by the American Academy of Pediatrics. How, in the world, you ask, could such an august body promote such a misogynistic practice?

For those who may not be familiar with this barbaric (you fill-in the other adjectives – the list is simply too long) ‘ritual,’ a recent online article by PRNewswire sets the chilling background of this controversy.

FGM is a harmful traditional practice that involves the partial or total removal of the female genitalia and is carried out across Africa, some countries in Asia and the Middle East, and by immigrants of practicing communities living around the world, including in Europe and the U.S.  It is estimated that up to 140 million women and girls around the world are affected by FGM.

Putting aside my personal opinions regarding the overall chauvinistic cultures of – to name a few – Africa, Asia and the Middle East, what would motivate any culture to engage in such a ritualistic practice?

In an NPR interview of Professor of Law, Cleveland-Marshall College of Law, Cleveland State University, Dena Davis, on May 14, 2010, Professor Davis,  a consultant to the AAP and the lead author of the policy statement, the ‘rationale of this ‘tradition’ is explained.

RAEBURN: Do you have a sense I’m just I can’t help but interrupt. Do you have a sense of why in these cultures, there may be different reasons, but why this is done or what is supposed to be the benefit of it?

Ms. DAVIS: Right, it’s a wide array of things. On a positive side, it’s seen as a growing-up ritual, as a celebration of ethnic or national identity. It became politically important as a response to colonization, for example, but it’s also done to remove sexual pleasure from women so that they can be controlled, to guarantee women’s virginity so that they are marriageable and to protect the family’s honor.

So just how did this ‘celebration of ethnic or national identity’ work its way to our shores? How did it conceivably become a part of a policy statement by the AAP?

Professor Davis offers the following explanation:

Ms. DAVIS: Well, I want to start by reiterating what you already said. The statement ends with four recommendations, and none of those mention this compromise. The recommendations are that the American Academy of Pediatrics opposes all forms of female genital cutting that pose risks of physical or psychological harm, encourages its members to educate themselves about the practice, recommends that members actively seek to dissuade families from carrying out harmful forms of FGC and recommends compassionate education of the parents of patients.

Having said that, the controversial part, as you made mention, is a discussion toward the end of the possibility of pediatricians offering what would literally be a nick. And in the statement, we analogize it to ear piercing.

And the idea here was that we knew that some pediatricians in Seattle a number of years ago who had a good relationship with the Somali immigrant community around their hospital had been asked by mothers of girls for this kind of compromise. And they had gone down the road of – they’d had meetings with mothers and so on, and they were about to do that…

RAEBURN: So this was mothers from some of these cultures where this is practiced had suggested that…

Ms. DAVIS: Right, were Somali immigrant mothers.

RAEBURN: Okay, so it was their idea?

Ms. DAVIS: Well, I’m not sure whose idea it was, but they embraced it to the extent that they held off on doing something worse until the doctors could get set up to start offering this. But before that could happen, Congresswoman Pat Schroeder wrote to tell the hospital that it would be criminal under her new law that had recently passed in Congress.

The concern is that we know that in many cases, when pediatricians turn down parents, girls are taken back to Africa for the worst possible procedures done, you know, with no painkilling and no, you know, no infection control and extremely severe forms of these procedures where girls’ labia are scraped away, for example.

And there’s really that’s very difficult to stop…

The uproar from this AAP statement advocating a ‘compromise’ – ostensibly premised on the concept of the ‘lesser of two evils’ – comes from virtually every group in this nation.  One I quite frankly didn’t anticipate was posted by Jihad Watch: “[T]here are those four words of the Hippocratic oath that the American Academy of Pediatrics seems to have forgotten: First do no harm. And if it is supposed to be harmless, let the AAP doctors line up forthwith for their own “ritualized nick.” The comments to this posting by Jihad Watch, which refers to this practice as being “primarily enforced in Muslim countries, ” are also quite revealing. One person identified as ‘Ccoopen’ had this to say:

I’m not sure why this is listed under dhimmitude, considering that FGM is not Islamic. Sure, it is practiced by Muslims, but it is not a Muslim practice. It is a cultural practice which predates Islam by hundreds, if not thousands of years. In fact, the majority of practitioners in Africa are of the African Tribal religions, not Muslim. While it is a horrific practice, it doesn’t need to be tied to Islam since it has nothing to do with Islam, but with culture.

For those who have dedicated their life’s work to obtaining equality among the sexes, the AAP’s attempt at a ‘neutral’ statement of compromise has been vehemently rebuked:

“Encouraging pediatricians to perform FGM under the notion of ‘cultural sensitivity’ shows a shocking lack of understanding of a girl’s fundamental right to bodily integrity and equality,” says Taina Bien-Aime, executive director of the human rights organization Equality Now. “If foot-binding were still being carried out, would the AAP encourage pediatricians to execute a milder version of this practice?”(See “An End to Female Genital Cutting?”) See our source – Time online article.

In its online posting, Time, a partner of CNN, reports (as do many others) reports a legislative twist to the timing of the AAP’s policy statement:

On the same day the AAP published its new recommendation, the Girls Protection Act, which would make it illegal to take a minor outside the U.S. to seek female circumcision, was introduced in Congress. “I am sure the academy had only good intentions, but what their recommendation has done is only create confusion about whether FGM is acceptable in any form, and it is the wrong step forward on how best to protect young women and girls,” said one of the bill’s sponsors, New York Representative Joseph Crowley, speaking to the New York Times. Davis counters that such a law would be extremely difficult to enforce.

So where do you stand on the issue? Has the AAP done more harm than good? Is the ‘compromise simply dangerous folly or adoption of ‘the lesser evil’ for the safety and well-being of these children? You be the judge. Share with us and our community of readers your reaction.

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UPDATE: in response to my posting this blog on Twitter, one person using the Twitter name kvetchingguru brought to my attention a posting which is a ‘call to action.’ It is entitled “Urgent Alert: Call on the American Academy of Pediatrics to retract their endorsement of Type IV FGM.” A form letter is made available and the names of the Executive Director/CEO of AAP, the Chair of AAP and the President and CEO of the American Board of Medical Specialties are provided.

As I wrote earlier today, this ‘endorsement’ in any fashion – call it ritual snip or piercing – has created a groundswell of reaction.

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UPDATE: May 27, 2010

It appears that the uproar reported in this article has taken its toll.

The American Academy of Pediatrics has retracted its policy statement on female genital cutting after sparking controversy by apparently endorsing the illegal practice of “ritual nicks” to forestall more extensive mutilation.

“The AAP does not endorse the practice of offering a ‘clitoral nick,'” according to a new statement by the organization’s board of directors. “This minimal pinprick is forbidden under federal law, and the AAP does not recommend it to its members.”

The following from the AAP president about says it all:

In a new statement, AAP president Judith Palfrey, MD, of Harvard Medical School, clarified the academy’s position. “Our intention is not to endorse any form of female genital cutting or mutilation,” she said. “We retracted the policy because it is important that the world health community understands the AAP is totally opposed to all forms of female genital cutting, both here in the U.S. and anywhere in the world.”

The source for these quotes: medpagetoday

Why would anyone write a White Paper on how to get an #autopsy report?

On Saturday, April 22, 2010, I posted a new White Paper on our website, which deals with a number of issues of concern to many of our past clients – “They did an autopsy after my loved one died, but I can’t get them to give me the results. What can I do?”

In one week alone with had three calls from people saying the same thing in different plaintive words.

Last year, we successfully tried a lawsuit in Salisbury, Maryland relating to the death of a 19 day old infant. The parents knew that an autopsy had been performed as a result of their child tragically dying in his father’s arms. Patient for months, he called his now-deceased son’s pediatrician’s office several times and was basically told to not worry about it, they would let him know when they got word. Many months later, totally frustrated by the lack of caring and information and only wanting to know what had caused their baby to die so horribly, they sought out an attorney. The autopsy report finally surfaced – I wonder why.

I take  these wonderful people at their word. They had no intention of filing a lawsuit. As the months of frustration passed, they started to ask themselves – “Are they trying to hide something?” None of us will never know why such utter disregard and insensitivity to these grieving parents led to a failure by the doctor to provide the report and discuss it with the family. What it did was buy him a lawsuit and a multi-million dollar verdict.

So let’s examine why we just did a White Paper entitled “Having Trouble Getting a Hospital or Physician to Release an Autopsy Report?” Picture yourself in such a horrible situation. You just lost your spouse or child totally unexpectedly. An autopsy is done or requested. You don’t know which way to turn. All you want to do is try to understand what happened. You are put-off, ignored or  even berated for your persistence in simply wanting to know. This White Paper is offered to those in that horrible situation. Get some guidance on how to get  the information you so want.

While we hope you never need this information. If you do, it’s there for  the taking.