At the recent Crittenden Medical Insurance Conference held virtually from April 13-14, 2021, Michael Wong, JD (Founder and Executive Director, Physician-Patient Alliance for Health & Safety (PPAHS)) predicted that malpractice cases will likely rise post-COVID due to delayed diagnosis.
Presenting with Mr. Wong were:
- Naresh M. Punjabi, MD, PhD (Mary Jane and Lino Sertel Professor of Pulmonary Diseases, Department of Medicine, University of Miami, Miller School of Medicine)
- Jason P. Kirkness, Ph.D. (Medicine), ATSF (Drug/Device Discovery and Development Committee, American Thoracic Society; VP Medical and Clinical Affairs, 4DMedical)
At the Crittenden Conference, Mr. Wong presented findings from the survey of PPAHS’s respiratory clinicians conducted online from September 10-15, 2020. This survey found that a significant majority of clinicians were not recommending lung function testing during COVID-19 because of safety concerns.
As well, he discussed the risks and liabilities of delayed diagnosis during COVID-19, saying:
“Delays in diagnosis may result in worsening of the patient’s condition and a resultant claim alleging malpractice. The COVID-19 pandemic has laid bare the dangers to both patients and their clinicians in testing and treating respiratory illnesses. This danger may occur when patients receive pulmonary lung function tests, such as spirometry which requires patients to exhale air out of their lungs. This recent survey conducted amongst our respiratory care clinicians found that very few lung function tests were being recommended during COVID-19, mostly because of safety concerns. Moreover, this survey also found that clinicians would like safer ways to measure their patients’ lung function. Safer lung function testing would ensure that patients’ lung conditions are diagnosed in a timely manner, as well as make sure that the safety of clinicians is maintained. The results of the PPAHS survey on lung function testing shows that there is a need for improved technologies and procedures to measure lung dynamics and function that are outside of traditional pulmonary function testing (such as spirometry).”
A copy of Mr. Wong’s presentation can be viewed and downloaded by clicking Wong Crittenden Presentation.
Dr. Kirkness discussed the risks associated with the standard lung function test (spirometry), which involves the patient exhaling forcefully, resulting in an aerosol generating procedure. During the COVID-19 pandemic, this understandably may have made clinicians more hesitant to prescribe and perform lung function testing as the PPAHS survey has found.
Said Dr. Kirkness:
“Spirometry is more likely to provoke cough, although transfer factor and static lung volume measurements were also associated with post -test cough. Lung function tests therefore pose a considerable risk for the spread of infection to individuals and surrounding surfaces within test areas.”
A copy of Dr. Kirkness’ presentation can be viewed and downloaded by clicking Kirkness Critenden Presentation.
Dr. Punjabi discussed clinical applications of functional lung imaging, saying that current testing is limited and pose a major challenge in understanding the pathophysiology of lung disease and potential exploration of therapeutic interventions.
He then discussed a technique he is currently using at the University of Miami, Miller School of Medicine, saying:
“This technique employs a unique cross-correlation analysis and non-linear optimization to reconstruct lung tissue motion from a small number of standard projections. By using this technique, we have been able to measure pulmonary function by quantifying tissue and airway changes from cine-fluoroscopy during spontaneous respiration.”
A copy of Dr. Punjabi’s presentation can be viewed and downloaded by clicking Punjabi Crittenden Presentation.