Annals of Internal Medicine, Tip Sheet, December 21, 1999

December 20, 1999

Annals of Internal Medicine is published by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), an organization of more than 115,000 physicians trained in internal medicine. The following highlights are not intended to substitute for articles as sources of information. For an article, call 1-800-523-1546, ext. 2656 or 215-351-2656.
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Hospital Errors: Full Disclosure Reduced Overall Lawsuit Costs in One VA Hospital

A Veterans Affairs hospital that adopted a policy of immediate disclosure to patients injured by medical mistakes and fair compensation to the injured found that total costs of litigation actually dropped (Medicine and Public Issues, p. 963). Further, the policy did not cause an onslaught of lawsuits at the hospital. Since veterans' hospitals pay no malpractice premiums, however, and can offer remedial treatment and even monthly disability payments to people injured by hospital treatment, the Veterans Affairs experience may not translate to the private sector, the authors point out. An editorial describes how physicians should disclose an error to a patient or family (Editorial, p. 970), but concludes that organizational and cultural changes will be necessary to realize the full benefits of the disclosure policy.
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Lyme Disease Shows Some Signs of Long-Term Effects

A study comparing 186 people who had a history of previous Lyme disease and 167 people who did not, found no objectively measurable muscular, skeletal or nervous system abnormalities between the groups, but people with previous Lyme disease reported more subjective symptoms of joint pain and memory impairment. (Article, p. 919).
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Warfarin, an Anticoagulant Known to Reduce Risk for Stroke, Is Much Underused

Fifty-five percent of 11,082 patients with nonvalvular atrial fibrillation and no known contraindications received warfarin, a study of patients in a large group-model health maintenance organization found (Article, p. 927). Although anticoagulation carries some risk of its own, warfarin is known to reduce dramatically the risk for ischemic stroke in nonvalvular atrial fibrillation.
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American College of Physicians

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