Friday, November 6, 2009
QD: News Every Day--waiting for the weekend
ACP Internist's daily digest of news and events continues with this weekend's expected vote on health care reform, H1N1 influenza's ascendance as the dominant strain, and Texas' look at doctor-owned hospitals.
Health care reform
Everyone is gearing up for the expected weekend vote in the U.S. House on health care reform. ACP President Joseph W. Stubbs, FACP, said while the legislation doesn't have every proposal the organiation wants, it "... would represent an historic step forward to achieving ACP's desired future of a U.S. health care delivery system that provides access, best quality care and health insurance coverage for 100% of its people." The American Medical Association is supporting it, with its president saying in a press release that while the legislation is not perfect, "It goes a long way toward expanding access to high-quality affordable health coverage for all Americans, and it would make the system better for patients and physicians."
While the Congressional Budget Office estimates the legislation will cost $894 billion over 10 years and reduce the national deficit by $30 billion, the actuary for the Centers for Medicare and Medicaid Services said he may not have an estimate ready by the weekend vote. While Congress is bound to budget office estimates, CMS figures may sway some votes. (The Hill)
H1N1 influenza
H1N1 influenza is now the dominant strain globally. Obesity may be a factor for complications. More on this will be reported in ACP InternistWeekly on Tuesday. (CNN, CBS News)
In case you missed it ...
This weekend's New York Times Magazine features the debate about evidence-based medicine--clinical judgment squares off against the scientific method, and what happens when doctors at Intermountain Healthcare create their own evidence base.
In Texas, legislators are debating how to treat doctor-owned hospitals. Texas has 67 physician-owned hospitals with about 50 more expected to open, state Rep. Sam Johnson told the Dallas Morning News. While pending legislation would severely curtail existing facilities and prohibit new ones, amendments may grandfather the existing ones. At is issue is whether these facilities cherry-pick the wealthiest patients.
Labels: evidence-based medicine, H1N1, health care reform, QD
posted by Ryan DuBosar at
10:47 AM
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Thursday, November 5, 2009
QD: News Every Day--health care reform's eerie repeat history
ACP Internist's daily digest of news and events continues with updates on health care reform, "swine" flu in a cat, and two views on fixing the shortage of primary care doctors.
Health care reform
Health care reform is streaking toward a vote in the U.S. House Saturday, but is it just a case of history repeating itself--specifically, the Clintons' 1994 effort? A New England Journal of Medicine paper analyzed 30 public opinion surveys and compared the shift in public opinion, both then and now. (AP, Boston Globe, NEJM)
Waiting in the wings, the Senate's legislation is facing opposition from surgeons and other specialists. (The Hill)
One aspect of health care that needs reform is the practice of defensive medicine. One doctor was profiled about why he encourages patients not to get unneeded tests, and then capitulates if the patients insist. (AP)
Primary care shortage
Op-eds in two major dailies agree that fixing the shortage of primary care doctors is an important component of health care reform. You wouldn't normally expect the Los Angeles Times and Wall Street Journal to agree on anything but the rising cost of newsprint.
H1N1 influenza
Swine flu has jumped from a cat owner to the pet, ABC News reports.
In case you missed it ...
In case the mainstream media misses something, there's always a blogger who digs a little deeper and finds it. Hats off to the person who found this outlier right in the middle of the U.S. House legislation on health care reform--a tax credit for second generation biofuels. (FireDogLake.com)
And, an economist offers "vaguely heretical" musings on the proposed legislations floating around Congress. His social conscience doesn't override his desire to balance the books. (The New Yorker)
Labels: H1N1, health care reform, primary care shortage, QD
posted by Ryan DuBosar at
11:47 AM
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Which patients sue for malpractice?
There are a lot of myths out there about which patients are most likely to sue a doctor for malpractice. Many doctors think it is "poor patients on welfare." They would be wrong. Evidence shows that low income patients on Medicaid are actually less likely to sue than others. But there are some patients and situations that should raise a red flag for physicians that they could bring a lawsuit.
--Angry patients: A patient who is upset about the doctor-patient relationship, either because something didn't work out or they perceived a lack of caring, is more likely to sue the doctor. Plaintiff attorneys say that the majority of their calls come from patients who had poor rapport with their physicians. What works in a medical error? An explanation of what went wrong and, if appropriate, an apology!
--Money Issues: Now that more patients are paying out of pocket costs, if they feel overcharged they become less tolerant of errors. If patients know the approximate costs up front, they aren't surprised and outraged when that big bill arrives. We all know, however, how hard it is to find out anything about costs in advance. Big problem!
--Doctors Dissing Others: So many lawsuits have been filed because of one doctor or nurse making disparaging remarks about another; "How did such a thing happen to you?" It's easy to be a Monday morning quarterback.
--Lousy Service: Bad service goes along with poor doctor-patient rapport. It is hard for someone to feel respected and cared for, if they get bad service or the rooms are dirty or the phone call isn't returned. If a mistake happens, the doctor must be available to discuss it. An absent doctor or poor service turns patients and family members into "angry patients" (see number 1).
Medical mistakes happen because the human body is complex, treatments are complex and there are no guarantees in life. Most patients don't sue their doctors when a bad outcome occurs. The experts in risk warn us that the relationship is the most important prevention for lawsuits, followed by meticulous documentation in the medical record.
Toni Brayer, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.
Labels: malpractice, patient communication
posted by Toni Brayer MD at
7:00 AM
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Wednesday, November 4, 2009
Ties that bind, and make you gag
Here's a complex solution to a simple problem. Doctors wear ties, which may carry germs that may add to the problem of health care acquired infections. British hospitals banned ties. In America, we made them germ resistant.
SafetyTies claims to make ties and scarves with a built-in barrier for dirt, liquids and bacteria. The company describes its "nanotechnology" and cites "independent studies" that show 99.95% resistance to H1N1 influenza. 
Whether the ties are attractive enough to wear is a matter of opinion, however. Patterns include those of MRSA microbes and other common germs. Do write us or send pictures if you actually buy one of these and wear it to your health care facility.
"In our effort to stop the spread of H1N1, we need every tool at our disposal," said SafeSmart co-founder April Strider in a press release. "While vaccinations and handwashing are obviously the first line of defense, SafetyTies and SafetyScarves are an easy, sensible and fashionable way for individuals to help reduce the spread of H1N1."
Or, doctors can stop wearing them. We've covered this issue before. ACP Hospitalist has a bit more practical advice from our magazine and our weekly e-news about serious efforts to reduce health care acquired infections. And, others have suggested using dedicated stethoscopes in rooms dedicated to treating resistant infections.
posted by Ryan DuBosar at
12:37 PM
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QD: News Every Day--health care reform's 'sunshine provision'
ACP Internist's daily digest of news and events continues with findings that N95 respirators weren't all they were cracked up to be, and a look at disclosing more about doctors' financial ties with industry.
H1N1 influenza
Authors retracted findings that N95 respirators were better than surgical masks at preventing flu, causing a stir at the Infectious Diseases Society of America meeting, where the retraction was announced. Reviewers questioned the study, and re-analysis resulted in the findings being no longer significant. The original study spurred guidance from the Centers for Disease Control and Prevention and the Institute of Medicine on using the masks.
Blogger Gerald O'Malley, DO, says that he's not getting vaccinated. Hospital administrators are pressuring him, he sees flu patients in emergency wards and his two kids have it. But he's not budging. Neither are college students. (Physicians Practice, The Washington Post)
"Presenteeism" could exacerbate flu's spread, public health leaders said, since 39% of all private-sector workers do not receive paid sick days, (Bureau of Labor Statistics figure). They also send their sick kids to school because they have to work. (New York Times)
Health care reform
Legislation in the U.S. House could get a vote as early as Friday night, But in the senate, Majority Leader Harry Reid isn't making any promises to pass legislation this year, which could frustrate the White House if it delays health care reform until 2010. (The Hill, CBS News, AP)
One aspect of health care reform legislation includes "sunshine provisions" intended to disclose the financial relationships between the medical industry and doctors and hospitals. It's been tried before, though, and bioethicist Bernard Lo, FACP, argues that sunshine provisions don't go far enough. It needs to include other health professionals, and academic research. A survey in Health Affairs found that 53% of academic research faculty in the life sciences at top schools reported financial ties to industry. (New York Times, Wall Street Journal)
Labels: ethics, H1N1, health care reform, QD
posted by Ryan DuBosar at
12:20 PM
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Tuesday, November 3, 2009
QD: News Every Day--health care reform splits urban, rural hospitals
ACP Internist's daily digest of news and events continues with the focus of health care reform shifting toward the U.S. House of Representatives. Also, urban and rural hospitals eye each other for the lion's share of reimbursement.
Health care reform
Legislation released in the House faces opposition from abortion and immigration. The $1.2 trillion price tag over 10 years made many take a second look at what Americans would get for their money. Meanwhile, the deadline for potentially passing legislation is slipping into next year. (AP, Politico)
Rural and urban hospitals would fare differently under health care reform. For example, New York City facilities are worried about losing money to Iowa; Iowa, in turn, is already worried about subsidizing urban areas. (New York Times, WQAD.com)
H1N1 influenza
Pregnant women and children ages 10-17 need only one dose to inoculate against H1N1 influenza. But children ages 6 months to nine years still need two doses for best efficacy. Anne Schuchat, FACP, reports that half of all vaccinations have gone to minors. While the World Health Organization is recommending one dose for all kids and the use of adjuvanted vaccines to stretch supplies, U.S. officials are still recommending two doses. Adjuvanted doses have not been cleared for use in the U.S. Research on them was reported in the Sept. 15 ACP InternistWeekly. (Washington Post, Washington Times, New York Times)
Scientists have used a supercomputer to predict a third wave of H1N1 coming this spring. But others want to use handheld devices to predict which individuals might get sick before they actually do. (Wall Street Journal)
Labels: flu, H1N1, health care reform, hospital medicine, QD
posted by Ryan DuBosar at
1:28 PM
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Monday, November 2, 2009
QD: News Every Day--the public option as a Straw Man
ACP Internist's daily digest of news and events catches up with newly appointed Surgeon General Regina Benjamin, MD, fears about adverse reactions to H1N1 vaccinations, and why one ACP member says hope for recovery isn't always the best for a patient.
Surgeon General confirmed
Newly confirmed Surgeon General Regina Benjamin said preventive medicine will be her priority, following her confirmation by a unanimous Senate vote late last week. Month before, during a press conference announcing her nomination, she had spoken about losing relatives to lung cancer, diabetes and other lifestyle-related illnesses. (al.com)
Health care reform
For all the fuss over the public option, the Congressional Budget office estimates that 2% of the nation, 6 million in all, would enroll in it. (AP/The Washington Post)
Barry Izenstein, FACP, Governor of ACP's Massachusetts Chapter, writes that health care reform should cover all Americans, create more primary care doctors and reform medical liability. (The Springfield Republican)
Meanwhile, Peter Boling, ACP Member, is undertaking his own effort at health care reform by falling back on the old-fashioned house call. The House and Senate are considering such measures as part of the "Independence at Home" provision of current legislation. (AP)
H1N1 influenza
Independent experts started today tracking adverse events from the H1N1 vaccine to spot any real problems quickly, explain false alarms and separate normal disease rates from potential yet real risks. (AP/Boston Globe) There's a basis to the fear of H1N1 vaccination, and it's generational, says one psychologist. (Psychology Today)
In case you missed it ...
Sometimes, it's better to lose hope for recovery, University of Michigan researchers said.
Peter Ubel, ACP Member, teamed up on a study that noted while it's important not to lose hope, it's also important to realize that hope might make some people unhappier because they fall into a holding pattern of sorts, waiting for their condition or chronic pain to wane before moving on with their lives. They compared outlook among patients who'd just had colostomies. Some were told the procedure would be reversible, and some were told the procedures were permanent. He explains more about hope's "dark side."
Labels: H1N1, health care reform, patient communication, QD
posted by Ryan DuBosar at
12:12 PM
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ACP Internist hosted Grand Rounds on June 16, wrapping up the best of the medical blogosphere. Click here for the complete wrap-up.
Contact ACP Internist
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Previous Posts
- QD: News Every Day--waiting for the weekend
- QD: News Every Day--health care reform's eerie rep...
- Which patients sue for malpractice?
- Ties that bind, and make you gag
- QD: News Every Day--health care reform's 'sunshine...
- QD: News Every Day--health care reform splits urba...
- QD: News Every Day--the public option as a Straw M...
- The story of two little pigs
- Medical news of the obvious
- The vaccine that went away.
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American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
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A collaborative medical blog started by Neil Shapiro, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.
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Robert M. Centor, FACP, contributes short essays contemplating medicine and the health care system.
Everything Health
EverythingHealth is designed to address the rapid changes in science, medicine, health and healing in the 21st Century.
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Getting Better is the continuation of Dr. Val Jones' previous blog at Revolution Health. It is devoted to helping people understand health issues from a balanced, scientifically sound perspective.
HealthHombre
A roundup of health policy news drawn from a database of hundreds of Web sites.
Interact MD
Michael Benjamin, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.
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The alter ego of Kevin Pho, ACP Member, is the closest thing to royalty in the medical blog world.
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The Public Library of Science's open access materials include a blog.
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One of the most popular anonymous blogs written by a doctor.
