Warning

[Marty]

In my newsletter from the Maryland Board of Physicians-

Bahram Pishdad M.D. License # D51520
Area of Practise:General Preventive Medicine
(Silver Spring, MD)
Reprimand; Probation for three years subject to terms and conditions.
The physicianfailed to meet standards of quality care in his management
of a patient on Coumadin. Date of Action: June 22,2005

[Ross]

Would be interesting to know the specifics of the case. We all know that there are many more operating that should be in the same boat.

[Natanni]

Down right scary...but as Ross mentioned, I fear it happens far far more than is documented :(

[lance]

I can't help but wonder why hospitals performing valve replace surgery don't properly inform their patients about anticoagulation therapy. After all they have the expertise and opportunity to provide patients, at a nominal cost, a booklet outlining what proper mangement of warfarin should be.

At least then a patient should be able to decide how well their caregivers are managing warfarin therapy.

[allodwick]

This is particularly true of hospitals. I consulted on one case where the doctor and the hospital both were barred from billing Medicare or Medicaid because of an inpatient suffering a bleeding-type stroke. The nurse even documented in the chart every day that she asked the doctor to order an INR but he ignored her day after day.

[Marty]

I can't help but wonder why hospitals performing valve replace surgery don't properly inform their patients about anticoagulation therapy. After all they have the expertise and opportunity to provide patients, at a nominal cost, a booklet outlining what proper mangement of warfarin should be.

At least then a patient should be able to decide how well their caregivers are managing warfarin therapy.

Believe it or not, I tried to get Inova Fairfax to do this after my surgery. As an MD radiologist I was woefully ignorant how to mange Coumadin. However I studied the available literature. My cardiologist prescribed a Coaguchek for me at my first post op check.I then discussed the lack of orientation with my surgeon, who did arrange for me to give a talk to the surgery staff, doctors, nurses, administrators. I handed out a sheet containing my idea of patient info and as far as I know nothing changed. My surgeon said years ago OHS patients stayed in the hospital two or three weeks.
They had time to stabilize the Coumadin dose and educate the patient. Now most of the patients are discharged fourth or fifth post op day and turned over to a wideranging variety of cardiologists, PCP's, etc. The surgeons have no control from that point on. In fact they run into medical politics if they try to hold on to the patient.I don't know the answer. I hope more patients are able to find us here at vr.com.More pharmacist clinics like Al's are needed. At my Kaiser clinic there is no problem because the pharmacists take over when the patients are discharged from Inova. I check the records of patients I X-ray that are on warfarin and they are all well managed.

[perkicar]

Interestingly, my cardiology team was willing to discharge me when my INR was <2.0 post surgery, but it was the surgeons NP that insisted I stay in until I hit at least 2.0. I was ready to get the heck out of there and ended up staying two more days waiting for my INR to get high enough. The information I got about coumadin was more related to what it is and what to be careful about, not so much about dosing. I've learned a ton more on this form than I even got from a doctor or nurse. I'm printing off a copy of the one article and taking it with me to the cardio tomorrow when I go to get my INR checked again.