Robert Hurwitz, M.D. is professional and offers his expertise for all of your legal needs.

Dr. Hurwitz is available seven days a week for immediate telephone consultation at no charge. He knows that the time of attorneys is valuable, and frequently the clock is running due to Court ordered demands. He will follow a case as it progresses and make himself available by phone at all times.

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Exciting News: Dr. Brink the new Chair of Radiology at Harvard Med!

After 25 years, Dr. James Thrall is retiring from the post of Chief of Radiology, Massachusetts General Hospital. Dr. Brink, previously at Yale Med., returns to Harvard to assume this important position.

http://www.massgeneral.org/News/newsarticle.aspx?id=3938

Video example 3-D imaging

To illustrate the value of 3-D, I attach a video. This shows how the data set of an individual
patient imaged on CT can be translated into 3-D models. This assists patient education, teaching
of residents and assistance with surgeons. A 3-D model makes for faster and more precise surgical approach.

3D X-ray is here!


3-D XRay is here for improved diagnosis, communication with consultants (both local and world-wide).
Improved teaching of students and residents.
Improved communication with patients.

Have a safe and happy summer!

Dr. Bob

Summer Update- Medical Assistants and Physicians

Summer is here,  Patient care comes first and this is what I advise all my residents in teaching programs:

There is now a hierarchy in medical practice, important for best delivery of good patient care. With medical care comprising 17% of this Nation's GDP,

a team approach will provide rapid care for all and help keep costs down.  The day of "Doctor" and his/her one nurse is long gone.

Every individual should wear a name badge and repeat who they are. Patients are concerned with their invidual problems and may be confused by all the individuals they meet in any medical encounter.

Physicians: Name badge and qualifications (M.D. or D.O.)

Nurse Practitioners: Name badge necessary  These are highly trained professionals that (under supervision of a physician can diagnose, treat and write prescriptions)

Physician Assistants: Name badge necessary. These are highly trained professionals, graduates of specific designated Universities.  They may not diagnose illnesses but are

licenced by each State to write progress notes, assist in procedures and even dispense prescriptions.  All must be supervised by a physician.

Medical Assistants:  These outnumber physicians in the U.S.A.   They play an indispensable role in preparing patients for examination, taking vital signs, taking brief histories and transmitting lab and X-ray results to the professionals above.  Thay can call in renewal prescriptions and even administer medications as per written orders of the physician or nurse practioner.

 

Patients may not fully understand this hierarchy of personnel.  Each plays a role in providing cost efficient care, whether in private practice or academic settings.  Ultimately the physician (or University) has the legal obligation to supervise this efficient team.  Any breach places the Physician as ultimately responsible.

 

Physicians and Universities need to provide written Job Descriptions for each of these individuals, review responsibilities and assure that all meet State regulations.

Chart reviews and regular meetings of this team assures each performs their duties within the law.  I emphasize that  unintended "Mission Creep" can occur over the years with

trusted NPs, PAs and MAs.

As medicine evolves into a more efficient model, patient trust will follow. 

 

A Happy and Healthy Summer to All!

 

Dr. Bob

 

 

Winter Update: Telemedicine and Teleradiology

Telemedicine

#1. With today's shortage of physicians, telemedicine plays a crucial role in the nation's health. 

       A good definition of telemedicine is the use of modern computer tehnology to deliver healthcare

      at a distance.  The U.S. Department of Health and Human Services even has a website with toolkit

      to guide best use of this Internet resource

 

#2. Rural facilities are strained for specialists.  They rely on consultants from distant cities to interpret exams

     and work with on-site staff for best care. This could be through video-conferencing, transmission of images,

     and remote monitoring.

 

#3. The rules of good medicine must prevail.  A consultant, whether 100 feet or 100 miles away must have privileges

      at the Facility.  He/She must be licensed in State in which the facility is located, and must obey the Hospital rules and

      regulations. 

 

#4. Communication is essential.  Critical findings need be called in.  Reports generated for such urgent matters need to

     be dated, timed, and with documentation of whom the report was discussed with.  To ensure that appropriate action will be

    taken, specify in the report that such action was recommended and accepted.

 

#5. Teleradiology certainly led the way.  Most Hospital staff radiologists have medical grade monitors at home to view

      night-time studies and consult with on-site E.R. physicians and others.

 

#6. Consultants who are asked to participate in telemedicine must be prepared to know the rules and keep lines of communication

open for feedback and further questions.  This is a growing field: robotics, telehealth, and compliance.

 

A very Happy and Healthy New Year to all!

Dr. Bob

 

 

 

 

 

 

 

Cancer Screening: Fall update

The CDC in Atlanta has published data that cancer has overtaken heart disease as the #1 killer in the United States.  Men and women are living longer.  Better diets and exercize have made the

100+ age group the fastest growing decade!   Everyone accepts PSA and mammography screening for men and women.  Lung cancer is now the leading tumor, however.  The National Lung Cancer Screening Trial (NLST) is now in its 15th year.

  • Patients with airways disease have a 100% higher risk of lung cancer than controls.  COPD (airways disease) is undiagnosed in 60-80% in population studies.
  • Should all individuals over 60 years of age undergo CT screening every five years (as some in the literature suggest)?
  • An ultra-lowdose CT protocol (without contrast) reduces radiation dose to 4% of standard CT is now available
  • Federal regulations require that radiation dose be incorporated into all CT reports (CT machines automatically produce this data).

CT screening of the lungs is inevitable.  Stage I lung cancer has a 90% cure rate.

The Farmer's Almanac predicts an unusually cold winter.  The Almanac has a great track record.

Best regards,

Dr. Bob

 

Spring Update: Preventing Medical Errors

In 1999, the Institute of Medicine published "To Err is Human", using data that claimed up to 98,000 unnecessary deaths/year in American hospitals.  The IOM authorized two researchers from my alma mater, the Johns Hopkins Hospital, to update this as of Year 2016.

Drs. Makary and Daniel of Johns Hopkins have now published figures that medical error is the third leading cause of death in the United States, after cancer and heart disease.  One concern they have is the standard death certificate has no box for "medical error".

What these fine researchers fail to point out that these concerns have been step-wise addressed for 25 years, using better communication skills and computer technology.  The goal is to make Hospitals and Imaging Centers "zones of safety".

 

  • 25 years ago, all hospitals converted to centralized pharmacies.   No medications are kept on hospital floors as was done in the past.  Each medication is patient-specific with a bar code to guarantee accuracy
  • All ER, Hospital and even some outpatient centers now use patient wrist bands.  These are also bar-coded to guarantee the right patient and specify any allergies.  I have seen patients with as many as three wrist bands
  • The institution of "Time Out" by the Joint Commission is now routine nationally.  Any participant in a procedure (physician, nurse, technologist) can call a "time out" to assure that the correct patient, the correct procedure, and the correct body part is being biopsied or operated on.
  • State legislatures are now contemplating revision of death certificates to include "medical error" as a cause of death.   The Joint Commission also recommends that patient's family should be promptly informed if an error has been made.  Hospital Risk Management Departments play a major role in this on-going process.

Thank you for reading this long, but important Spring Update.  It addresses issues that Drs. Makary and Daniel fail to bring up.

 

Litigation Stress

With winter arrives "seasonal affective disorder".  This is a well recognized depressive disorder.

A similar and even more important stressor is Litigation

 

l. As physicians and patients move through the various stages of a lawsuit, I have observed

peaks and valleys of emotion.

2. This is regardless of dismissal, settlement, summary judgment or at trial.

3. I have recommended to both defense and plaintiff's attorneys to assist their client with the sometimes overwhelming emotions that come with litigation.

4. Helpful books and on-line articles are available (from this expert) can be suggested- the sooner, the better.

5. Family support is essential.  When the process is completed, there is a sense of relief by all sides.  I have observed that family ties become stronger when an individual privately airs out all feelings.  Life goes on.

6. Physicians should learn from the experience and become a better doctor for it.  Patients need to focus on recovery and not bitterness.

7. Like "seasonal affective disorder", spring comes and none too soon.

 

Thank you for reading my thoughts and 38 years experience and pass them to your colleagues and friends.

 

Dr. Bob

 

 

Radiology: Autumn is here!

With autumn leaves, comes the Radiologic Society of North America.

The RSNA meeting in Chicago (the week after Thanksgiving) is the largest world assembly of radiologists, vendors and academicians:  60,000 strong!

 

Upcoming key topics are where radiology is helping to contribute to best medical care:

#l Computed Tomography.  Has been available since 1976 and improves each year.  The latest development, now approved by the FDA in 2013, is spectral imaging.   Images are acquired at two different energy levels.  Images can be displayed in black and white or color  .  The public, the FDA, and most radiologists still think this increases radiation dose.  The opposite is true:  dose is reduced!  I predict this decade will see 10% of CTs utilizing this available technology.

#2 Electronic Medical Record.  Medicare has for some years offered financial incentives to hospitals and physicians to convert to the EMR, with great success.  Radiology carries the greatest burden.  All of the Library of Congress contains 10 terrabytes (TB) of text data.  The focused Duke University Heart Center processes 30 TB of data a year!

This is only a small fraction of the entire Duke University Radiology Department.  Multiply this by 6,000 U.S. Hospitals!

This includes reports, images and wave forms.   My hope is that mining of the enormous mass of radiology data will uncover health trends in the nation, healthcare research, and best and most useful procedures for patient outcomes.

#3. 3-D printing.  Described as the growing trend in every profession.  In medical care, I expect to see radiologists printing out anatomic and pathologic findings by C.T. in 3D to aid surgeons.  This will allow best approach to any pathologic process and minimize danger to normal adjacent structures.  The cost of this technology is rapidly dropping.

 

Thanks for coming to my blog.  I try to keep it short and useful to all.  It is a privilege to be a radiologist and at the crossroads of all the medical specialties.  We try to be helpful to our referring clinicians and keep up with how our technology can help their patients.

 

Best to all: 

"Dr. Bob"

2015 Summer Update: Communication

These comments address a major problem for all physicians, particularly radiologists.

  • All phone conversations with clincians should be documented as an addendum to original report
  • All serious findings should immediately be telephoned to the clinician (or his./her designated nurse or covering physician)
  • No more "curb-side" consults.  Anything discussed should be documented as a report (at no charge)
  • Phone calls from curious patients.  Their doctor is "Captain of the Ship".  They must call him for results
  • If any information (however innocent) is given to the patient, their attending physician should be notified of such a conversation
  • CMS has long forbidden "professional courtesy".  They do permit accepting Medicare and supplements as payment in full

Medical Societies

Member of the American Medical Association

American Medical Association

Member of the American College of Nuclear Medicine

American College of Nuclear Medicine

American Roentgen Ray Society

American Roentgen Ray Society

American Institute of Ultrasound in Medicine

American Institute of Ultrasound in Medicine

Johns Hopkins Medicine

Johns Hopkins Medicine

Society of Breast Imaging

Society of Breast Imaging

Contact Information

Robert Hurwitz, M.D.
8805 Jeffreys St. #2014
Las Vegas, NV 89123
Phone: 949-422-1453
E-mail: Bob95Fox@aol.com

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