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Medical Issues

Pulmonary Medicine - Urology

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Pulmonary Medicine

Pulmonary medicine involves the diagnosis and treatment of diseases of the lung and lung structures. These physicians are consulted in a wide variety of medical conditions ranging from lung cancer, to pulmonary dysfunction resulting from pulmonary interstitial fibrosis, to simple breathing disorders such as asthma and bronchitis. These physicians are frequently placed in charge of intensive care units. Failure to diagnose and treat conditions that progress to incurable diseases result in medical malpractice suits.

The pulmonologist must be able to recognize and distinguish the causes of pulmonary fibrosis which could be caused by advancing thyroid cancer, a lingering case of histoplasmosis or pulmonary interstitial fibrosis. Failure to make the differential diagnosis can result in an action in malpractice.

Radiology

Historically, this medical specialist reviewed and interpreted radiographic films only. The advancement in radiographic science has vastly expanded the radiologist's expertise. The specialty started with fluoroscopic examination (with the help of Thomas Edison) but now encompasses such scientific marvels as the C.T. scan (computerized tomographic scan), the MRI (Magnetic Resonance imaging) and of course, includes mammography to detect breast tumors and lesions. In addition to those radiologists who concentrate on reading and interpreting these radiographic studies, some radiologists are now practicing "invasive radiology" where the body is actually invaded with instruments not only for radiographic studies but also with the placing of stents in the body to assist the flow of fluids (blood, urine, etc.). The liability of the radiologist has greatly expanded with their invasive practices in the above areas. The radiologist who embarks upon these procedures must meet the standard of care of any other physician who enters the body organs and must avoid injury to vital organs and blood vessels.

Surgery

What was once a single field of medicine has evolved into many separate fields with sophisticated training and expertise in each field.

• General Surgery – This surgeon is today limited to certain anatomical areas. Probably the foremost area is the abdomen, performing appendectomies, bowel resections, etc. Malpractice is likely to occur when the surgeon makes a mechanical mistake, fails to recognize it at surgery, fails to correct it and the patient suffers the sequelae. The cases we see are frequently caused by the surgeon with a post-operative complication fails to look back at the surgery itself as causing the complication.
  In the last ten years, laparoscopic cholecystectomy (removal of the gall bladder by a laproscope) have been performed by general surgeons who are not properly trained, resulting in permanent damage to the biliary tract, that is damage to the structures surrounding the gall bladder. Frequently, this damage is not recognized until it is too late for successful repair for the patient.

• Neurological Surgery – These surgeons operate on those parts of the body ranging from the brain to far away nerves in the extremities. They also operate on a variety of conditions and diseases involving the spinal cord and surrounding structures, such as the intervertebral disc. The negligent mistakes vary from misdiagnosis of the condition itself to technical errors in the procedure attempted to be performed. The injuries that result can be devastating and include coma, paralysis, or death.

• Oncologic Surgery – These surgeons are generally trained first as general surgeons and then further, their study and training to operate on patients with malignancy with their anatomical area.

• Plastic and Reconstructive Surgery – This specialist performs cosmetic as well as functional surgery. Originally these physicians were concerned with patients who wanted to be more physically appealing. These specialists have expanded their horizons and now do surgeries that have physiologic implications such as breast reductions and reconstruction after mastectomies. The plastic and reconstructive surgeon has no anatomical limitations and operates on most parts of the human body. Historically, they have been found liable to their patients in a wide variety of cases usually where they venture into other specialties such as operating in and around the orbit of the eye, causing vision loss, or operating in the sinus cavities. They have been involved in "bad results" in cosmetic surgeries, which many times could be avoided by a more careful selection of their patients.

• Thoracic and Cardiovascular Surgery – Surgeons in this specialty operate within the structures guarded by the ribcage including the heart and the aorta. Common surgeries are open-heart surgery and aneurysm repair. Vascular surgery includes surgery on the blood vessels, arteries, capillaries, veins, the pulmonary systemic circulation and pulmonary emboli.

• Transplant Surgery – These highly trained surgeons transfer and graft organs and tissues to replace failed organs and tissues. Transplants include the heart, lung, kidney, liver, pancreas, cornea, larger blood vessels, tendons, cartilage, skin, bone and bone marrow. Physicians must choose appropriate candidates and proper tissue to be compatible with the recipient's cells. Post-operative care is also an area that physicians must watch carefully.

Urology

Urology is that specialty of medicine concerned with the urinary tract of both males and females, and the male genital tract. Diagnosis and treatment of kidney, bladder and prostate cancer, along with interstitial cystitis are areas of frequent malpractice claims.

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