Citation Styles

Citation styles — not exhaustive…

NLM style:

Pho K. How to cite a blog in a paper [Internet]. Nashua, New Hampshire: Kevin Pho. 2004 May - [cited 2007 Oct 12]. Available from: http://www.kevinmd.com/blog/2007/10/how-to-cite-blog-in-paper.html.

ALWD (Rule 40.3) style:

Kevin Pho, Kevin, M.D. Medical Weblog, How to cite a blog in a paper, http://www.kevinmd.com/blog/2007/10/how-to-cite-blog-in-paper.html (Oct. 12, 2007).

Bluebook (Rule 18.2.3) style:

Kevin Pho, How to cite a blog in a paper, Kevin, M.D. Medical Weblog, Oct. 12, 2007, http://www.kevinmd.com/blog/2007/10/how-to-cite-blog-in-paper.html.

Aside, with the legal profession’s recent interest in medical weblogs, it is more likely that formal citations will be in the ALWD or Bluebook style…

Kidney Notes, Kevin, M.D., medGadget

Negligent Credentialing

http://www.ama-assn.org/amednews/2007/10/15/prsa1015.htm | AMN | 10.15.07

Physicians fear that a recent Minnesota Supreme Court decision could compromise statutory peer review protections and taint physicians in medical liability cases that are tied to negligent credentialing claims.

For the first time, the high court recognized that patients can sue hospitals for allegedly granting privileges to doctors with questionable credentials. The unanimous decision adds Minnesota to a list of at least 25 other states that recognize negligent credentialing claims.

Meanwhile, doctors worry that such claims will chip away at peer review confidentiality because hospitals will find it difficult to fight back without disclosing the details that go into credentialing decisions.

In any consideration of “universal” tort reform, should we first clean our own house? Is negligent credentialing any different from negligent hiring — and is it not a reasonable alternate legal theory for negligent outcome?

EDD, a Bigger Noose?

Hit ‘Delete’ to Prevent EDD Disaster | Law.com | 8.7.07

[Plaintiff:] Gary Michelson, M.D., a spine surgeon and prolific inventor, with hundreds of patents and patent applications worldwide, primarily in the field of spinal fixation and surgical implants, instruments and methods.

[Defendant:] Medtronic Sofamor Danek Inc., a subsidiary of Medtronic Inc., manufactures and markets medical devices used to treat spinal conditions.

Discovery was extensive…44 million pages of e-data…thousands of requests for admission…nearly 70 depositions taken in the case. Medtronic produced more than 2 million pages of paper documents and over 500 gigabytes of electronic data…

Medtronic estimated at one point during the litigation that the EDD processing and review would cost approximately $16 million to $22 million dollars — all to find, retrieve and review evidence that was helpful to [the plaintiff].

EDD is a growing strain on companies, law firms and solo attorneys. Better electronic record management is critical to keeping costs under control — and all companies should remember to “take out the trash.” If a company does not need the ESI for business, regulatory or litigation reasons, it should be discarded.

The verdict in this case was for $570 million. On the high side the defendant’s burden for discovery production was almost 4% (of the verdict award). As physicians and healthcare move towards the “holy grail” of an EHR—so does the problem of ESI loom larger. Moving paper to ESI may be the easy part—and a trade up in the size of the noose.

Toast

Toast, that is what I felt like at 17:03 hours PST on 7.26.07. That’s when the July 2007 administration of the California Bar Exam ended (for me). The stats:

• 3 days
• 6 1-hour essays
• 2 3-hour essays
• 200 multi-choice questions (1-2 questions/page)

Significantly more arduous then the Emergency Medicine written and oral boards or the recertification exam—primarily because writing (at such length) is so alien to a scientific/medical background, education and training.

Mid-life/mid-career humor: you know you are getting old, when you go to lunch during your bar exam with your eldest son who is going to lunch from his jury duty.

Oh yea, the ordeal continues until 18:00 hours PST on 11.16.07, when you get to log-in and see if you passed…

Nonlocality Rules

The Locality Rule and the Physician’s Dilemma | JAMA | 6.20.07

The purpose of medical malpractice law is to protect patients from substandard medical care and to compensate them for injuries sustained as a result of substandard care. Each medical malpractice case serves an additional function by further delineating the medical care that is legally acceptable in a particular field.

Although medical school training, medical licensing requirements, and board certification requirements are based on national standards, many states rely on local practice standards to determine the applicable standard of care in medical malpractice lawsuits. Jurisdictions that maintain local practice standards may inhibit the incorporation of scientific progress into practice standards. In addition, adherence to the locality rule can create uncertainty for physicians when they must choose between following local practice standards and national, evidence-based standards for care.

With apologies to Einstein, the medical-equivalent of the locality priniciple is being replaced by a nonlocality equivalent—well described in the article cited above. An excellent read. When most aspects of healthcare are regulated and paid for on a national level is it unreasonable to hold the providers of that care to anything less than national standards of care? Is the medical locality rule anything more than the residual vestige of non-specialization and non-board-certification in medicine. Specialization and certification seem to be the professional adoption and endorsement of a nonlocality rule.

Fleaing Perspective

I simply agree. The Flea’s real persona is irrelevant to the message this case should convey to my “kindred”—physicians. You live and die by your words—in this case the words were imprudently placed beyond reach. Physicians, their defense counsels and insurers now need to look at another form of EMR—electronic medical my record.

Flea at Post

“At post,” as in post-mortem. Excellent (albeit limited) interview (from Eric Turkewitz’s Deconstructing the Trial of Flea - Part 1 post) with the plaintiff’s attorney, Elizabeth Mulvey. Flea was going to have his character impeached because of a prior inconsistent statement from his blog. He got “bagged” on Nelson’s Pediatricts as the “bible of pediatrics” — reliance on an expert treatise. I guess us ER doctors will have to watch what we blog about PEPID (here and here).

Unmasked, Undone

See also:

• New York Personal Injury Law Blog
• Kevin, M.D.

Days of Fame

Flea’s fall sobering for other bloggers | Boston Globe | 5.31.07

If there was any remaining doubt, the settlement of Natick pediatrician and medical blogger['s]…malpractice trial removed any illusion that blogging could be done anonymously.

Under the name [the] Flea…posted opinions on his case and the plaintiff’s lawyer, described his preparations for it and the defense strategy, and commented on the jurors. Today’s Globe story details how the plaintiff’s lawyer asked him on the stand if he was Flea. The case, which was settled the next day…

Dr. Kevin Pho, a Nashua, NH, internal medicine physician who blogs under his own name on Kevin, M.D., called the situation sobering.

…

Eric Turkewitz, a lawyer who writes the New York Personal Injury Law Blog, posts today that he’d been fascinated by Flea’s blog…”[t]he subject was, simply put, irresistible,”…”I know that I found his activity fascinating, not only for its raw content, but also for the walking-a-high-wire-without-a-net danger of what he was doing.”

…

David E. Williams, says on his Health Business Blog that he won’t debate Lindeman’s case but gives this endorsement[,]‘ “[l]et me just say that Rob is a fantastic pediatrician and a wonderful human being…[i[f you have kids and live anywhere near Natick, MA you should consider choosing him as their physician…”

Dr. Tim Sturgill, an emergency physician in Sacramento…his blog, symtym.

The Flea’s case will be remembered for many reasons. He has earned a place in legal textbooks and the armentarium of discovery and trial tactics. The merits of his case will never be known—no doubt sealed as part of the settlement. His “anonymous” actions, on his blog, gave his opposition suffiicient leverage to threaten character trumping merit before the jury. And the tragedy of a twelve-year-old’s death should never be lost, no matter what the cause. The plaintiff had a victorious day in court because the defendant had his days of fame in the blogosphere.

This case, hopefully, brought about a necessary death in the medical blogosphere—the death to the notion that anonymity and privacy are protected by an anonymous name. Also, death to the notion that removing content or taking down a blog is necessarily protective, see here and here.

Fleased

Blogger unmasked, court case upended | Boston Globe | 5.31.07

As Ivy League-educated pediatrician…sat on the stand in Suffolk Superior Court this month, defending himself in a malpractice suit involving the death of a 12-year-old patient, the opposing counsel startled him with a question.

…

Shortly before the end of his second day on the witness stand…[opposing counsel] asked him whether he had a medical blog, she recalled. He said he did. Then she asked him if he was Flea. He said he was.

The exchange may have been lost on jurors, but…[opposing counsel] had telegraphed that she was ready to share [defendant]’s blog—containing his unvarnished views of lawyers, jurors, and the legal process—with the jury.

The next day, the case was settled.

The Flea	The Flea’s Real Persona

Arrogance, ignorance, or both? The defendant’s most potent defense was his character—a character the Flea so thoroughly impeached—case over and settled. Hosea 8:7. For they sow the wind And they reap the whirlwind.

Related: The Flea Circus

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