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Managing medical errors

Capozzi, James D; Rhodes, Rosamond
A patient with severe arthritis of the hip and shortening of the ipsilateral extremity undergoes hip replacement surgery with correction of the limb-length discrepancy. At the time of the postoperative examination, he is found to have a complete foot drop.
PMID: 19797589
ISSN: 1535-1386
CID: 3459642

Discussing treatment options [Case Report]

Capozzi, James D; Rhodes, Rosamond; Chen, Darwin
A sixty-year-old man presented to an orthopaedic surgeon with a periprosthetic infection after total knee arthroplasty performed by another surgeon. He underwent removal of the components, placement of an antibiotic spacer, and antibiotic suppression therapy. Eight weeks later, a revision total knee arthroplasty was performed. The patient did well initially but returned four months after the revision with periprosthetic reinfection. The revision components were removed, another antibiotic spacer was placed, and antibiotic suppression therapy was again administered. During the operation, the entire extensor mechanism, including the quadriceps tendon, patella, and patellar tendon, was found to be necrotic and required radical débridement. Five months later, another operation was performed to remove the spacer, and a plastic surgeon was consulted to assist in the wound closure because of the presence of extensive scar tissue. Intraoperative cultures were negative during these two most recent procedures. The orthopaedic surgeon presented the patient with four treatment options: arthrodesis, resection arthroplasty, amputation, or revision total knee arthroplasty with extensor mechanism allograft and a possible flap closure (rotational or free flap). The patient refused a knee arthrodesis and voiced a strong preference for amputation over arthrodesis. The patient's first choice, however, was to save the knee and to have a second radical revision performed. The surgeon then discussed in detail the risks that would be involved with reconstruction, including the high risk of reinfection and other wound complications. An infection, he explained, could lead to amputation, sepsis, and death. The surgeon also informed the patient that the procedure was not commonly performed, had no proven success rate, and could be fraught with complications. The patient remained steadfast in his choice and elected to undergo radical reconstruction of the knee.
PMID: 19255240
ISSN: 1535-1386
CID: 3459462

Caring for doctors

Capozzi, James D
M.G., an orthopaedic surgeon, is stopped in the hallway of his hospital by one of his medical colleagues. The physician begins to ask several questions regarding a recent onset of shoulder pain. M.G. suggests that the colleague be seen in the office so that a complete evaluation of the shoulder can be performed. The colleague asks if he can try some home exercises and anti-inflammatory medications first. M.G. shows him some basic shoulder exercises. Several weeks later, the colleague meets M.G. again and is furious at him, stating that the problem was not his shoulder at all but rather a cervical disc herniation.
PMID: 18594112
ISSN: 1535-1386
CID: 3459452

Ethics in practice. Terminating the physician-patient relationship [Letter]

Capozzi, James D.; Rhodes, Rosamond; Gantsoudes, George
ISI:000255615000037
ISSN: 0021-9355
CID: 3459392

Ethics in practice. Terminating the physician-patient relationship [Case Report]

Capozzi, James D; Rhodes, Rosamond; Gantsoudes, George
A.G. is a thirty-six-year-old reading teacher who presented to an orthopaedic surgeon with patellofemoral pain. After an appropriate evaluation, the physician suggested a course of physical therapy and anti-inflammatory medication. The patient asked for and received time off from her work, stating that her job required her to climb stairs. At multiple follow-up visits, A.G. was found to be poorly compliant with physical therapy and home-exercise programs. Her only interest appeared to be in securing the doctor's letter of support for an extended medical leave. At each visit, she demanded that the physician write a letter stating that she was unable to work as a reading teacher due to knee pain. At one point, she became belligerent with the medical office staff when the letter was not prepared. When her physician tried to elicit information about whether there were any unaddressed obstacles to rehabilitation treatment, A.G. did not answer the questions. Instead, she explained that her job required her to climb stairs and that she was unable to return to work because of the continued knee pain. The physician explained that, on the basis of his examination and assessment, he expected that her pain would improve if she complied with the treatment plan. After multiple visits, the orthopaedic surgeon counseled the patient that he did not see that his attempts to help her were providing any benefit and that perhaps it would be best for her to seek help from another physician. A.G. replied that she did not want to start going to another doctor. She stated emphatically that he was her doctor, that she was paying him, and that she wanted a letter saying that she should be granted an extended medical leave from work because of her inability to climb stairs. After this encounter, the surgeon thought it best to terminate the professional relationship.
PMID: 18171977
ISSN: 1535-1386
CID: 3459442

Physician advertising: evaluation of a sample advertisement

Capozzi, James D
PMID: 17768210
ISSN: 0021-9355
CID: 3459432

Corporate sponsorship of continuing medical education

Rhodes, Rosamond; Capozzi, James D
PMID: 23217757
ISSN: 1937-7010
CID: 3459662

Coping with racism in a patient

Capozzi, James D; Rhodes, Rosamond
PMID: 17079429
ISSN: 0021-9355
CID: 3459422

A family's request for deception - J.D. Capozzi and R. Rhodes reply [Letter]

Capozzi, James D.; Rhodes, Rosamond
ISI:000239638100038
ISSN: 0021-9355
CID: 3459382

Professionalism in the face of adversity [Case Report]

Capozzi, James D; Rhodes, Rosamond; Gantsoudes, George
PMID: 16818994
ISSN: 0021-9355
CID: 3459632