Wednesday, November 4, 2009
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
0 Comments
Wednesday, July 29, 2009
Is it wrong to sell your body?
Corruption in New Jersey is depressingly unsurprising, so the most interesting news to come out of last week's mass arrests was about the group of rabbis who had been selling organs. They were allegedly raking in the bucks buying organs low ($10,000) from poor donors and selling them high ($150,000) to the wealthy. Obviously, that kind of profiteering seems wrong, but what about the actual transaction?
An article in Slate explains why the rabbis would be OK with selling organs: their priority is the preservation of life above all else. If you have to pay people to get the organ donated, you do it.
And a column in U.S. News and World Report makes another good point. If we let women be paid for providing their eggs, what's so different about a kidney?
This is one scandal that will keep bioethicists busy for a while.
Labels: ethics
posted by Stacey Butterfield at
3:03 PM
0 Comments
Tuesday, July 21, 2009
Apologizing for errors halves malpractice suits
University of Michigan Health System reports that admitting medical errors and offering compensation before being sued resulted in malpractice claims falling from 121 in 2001 to 61 in 2006, with corresponding savings in costs per claim.
The Associated Press profiled the hospital system's efforts not only as a business decision but also an ethical one that benefits patients, while not exposing the system to further litigation.
Apologies aren't easy, but ACP's news publications have offered advice to make them easier:
--"Internist searches for answers when test results go missing," ACP Internist, April 2009.
--"Apologize like a pro," ACP Hospitalist, January 2008.
--"To err is human ... to not plan for it is trouble," ACP Hospitalist, December 2008.
--"Owning up to a mistake takes courage--and practice," ACP Internist, April 2009.
Also, PIER offers an entire module on disclosing medical errors, and Annals of Internal Medicine looked at the state-by-state efforts to implement shield laws for physicians who disclose errors.
Labels: ethics, malpractice, patient communication
posted by Ryan DuBosar at
10:34 AM
2 Comments
Thursday, April 23, 2009
Is it wrong for you to pay patients?
In the "Ethics year in review" session this afternoon, Daniel P. Sulmasy, FACP, and attendees debated the moral and practical merits of paying patients to lose weight or quit smoking. The concept dramatically changes the way physicians would go about encouraging healthy practices, he said. "I think it begins to move us along the continuum from persuasion to manipulation." Financial incentives also may be ineffective, according to some research, because of the way they mess with people's motives. For example, patients can be reluctant to engage in healthy behaviors if they're not being paid, or suspicious of their physicians' motivations for providing compensation.
The discussion naturally led to the financial incentives that shape physicians' behavior, from pay for performance to pharma support. And that led to some hot debate on whether meetings like Internal Medicine 2009 should allow any industry funding--an issue that doesn't seem likely to be resolved any time soon.
Labels: ethics, internal medicine 2009
posted by Stacey Butterfield at
4:06 PM
0 Comments
Monday, March 30, 2009
When test results go missing, an internist searches for answers
Ethics columnist Paul S. Mueller, FACP, discusses a case study that would bring chills to any primary care provider: what happens when an internist orders test results, and then never sees the results?
From an actual case file, Dr. Mueller discusses a 61-year-old asymptomatic man seeing his internist of 10 years for a check-up. When reviewing the medical record, the internist sees PSA test results of 11.8 ng/mL. Surprised by this finding, the internist digs further. A year ago, the PSA was 8.2 ng/mL and three years ago it was normal. The patient was never told; the internist is certain she never saw it. She wonders what to do next.
Click on "More" below for advice on how to handle the disclosure of previously missed test results.
Clinicians experience negative emotions when they realize they have committed an error, Dr. Mueller writes. Nevertheless, they are ethically obligated to disclose errors to patients.
First, clinicians should act in the best interests of patients. Explain the nature of the error and its implications and continue to provide professional and compassionate care.
Second, respect for patient autonomy requires that clinicians disclose errors to patients to allow for informed decision making.
Finally, justice requires that patients be given what is due to them, such as information about their medical condition and, if injured, appropriate compensation.
In this case, the internist met with her patient and his wife to tell them that the prior PSA test result was mishandled. The patient was upset, angry and felt helpless, which internist acknowledged. However, the patient later stated that he appreciated the internist's honesty. Together, they developed a follow-up plan.
Dr. Mueller suggests these steps when disclosing medical errors
-Speak in private with the patient, his or her loved ones, and essential members of the health care team present. Avoid interruptions (such as pagers) and allow time for questions.
-Discern the patient's perception of the problem before disclosing the error. For example, you might ask, "Do you recall the results of your PSA from a year ago?" Such questions allow for correction of misinformation.
-Speak clearly and check for comprehension (such as, "Is there anything I can clarify?"). The patient should understand what happened and the consequences of the error.
-Avoid attributing blame (such as, "The laboratory must have forgotten to call me about the result"). Patients desire a sincere apology and want to know how the clinician and organization will act to prevent future errors.
-Acknowledge the patient's emotional response to the disclosure by using empathic statements, such as, "I can see that you are upset by this news."
-Formulate a plan for further assessment, treatment, and follow-up and how you will work to prevent future errors.
-Document all discussions related to the error and its disclosure.
Dr. Mueller contributes to Ethical Dilemmas, a regular column appearing in ACP Internist.
Labels: ethics, Grand rounds, patient communication
posted by Ryan DuBosar at
9:00 AM
0 Comments
Tuesday, January 27, 2009
The rights and wrongs of child plastic surgery
I've always been horrified by babies who even have their ears pierced, so I expected to be self-righteously certain about the cases in the new Hastings Center Report on cosmetic procedures for children (mostly subscription-only, unfortunately). In fact, it raised a lot of fascinating, unanswerable questions. For example, if many Asians choose to have blepharoplasty to widen their eyes, is it more wrong for a white adoptive father to elect the surgery for his adopted Asian daughter?
Or what's the right course of action when a young child identifies with the opposite gender, or even more complicated, has ambiguous genitalia? Medical intervention could likely make life easier for them, but not if their gender identification changed at a later date.
The issue also revisits the case of Ashley, the profoundly disabled girl whose parents requested surgery and therapy to prevent her from going through puberty. Although this is cited as "most controversial case" in the field, it actually seems the easiest to answer. The writing experts all seemed to agree, too, that no argument about messing with nature or Ashley's sovereignty could outweigh the expected positive effects on her and her parents' well-being.
Makes deciding whether to let your 17-year-old get a nose job seem easy.
Labels: ethics
posted by Stacey Butterfield at
2:55 PM
0 Comments
Thursday, December 11, 2008
Ritalin for everyone
This Nature article, in which a group of scientists and ethicists come out in favor of allowing healthy people to take cognitive-enhancing drugs, has gotten a lot of news coverage, but it's definitely still worthwhile to read it for yourself.
The authors go pretty far out on some theoretical limbs--making the case that brain-stimulating drugs are no different than sleep or education and suggesting that someday it could be mandatory for surgeons to take the pills if they were proven to improve outcomes. But they build a compelling argument (and a lot of curiousity--would this blog post be vastly more intelligent if I had popped an Adderall beforehand?).
The article also puts a lot of responsibility on physicians, noting that they are already pushed by some healthy patients to prescribe the drugs (anyone want to comment on their experiences with that?). And, in the end, the experts want docs, or their representative organizations, to decide this tricky issue:
"It would therefore be helpful if physicians as a profession gave serious consideration to the ethics of appropriate prescribing of cognitive enhancers, and consulted widely as to how to strike the balance of limits for patient benefit and protection in a liberal democracy."
posted by Stacey Butterfield at
12:21 PM
0 Comments
Friday, October 24, 2008
Physicians using antibiotics, sedatives as placebos
Internists and rheumatologists are using antibiotics and sedatives for their placebo effect, researchers reported.
Before 1960, sugar pills were common and ethical. Then advances in pharmaceuticals and in informed consent cast placebos in a negative light. But internists are using them, so researchers looked at internists and rheumatologists use of placebos, figuring they dealt with "debilitating chronic clinical conditions that are notoriously difficult to manage."
Researchers collected 679 responses split nearly evenly bewteen internist and rheumatologists. About half prescribe placebos, using saline (3%), sugar pills (2%), over the counter analgesics (41%), vitamins (38%) antibiotics (13%) and sedatives (13%). Nearly half said they use placebos monthly.
The researchers concluded, "Recommending relatively innocuous treatments such as vitamins or over the counter analgesics to promote positive expectations might not raise serious concerns about detrimental effects to patients' welfare. Prescribing antibiotics and sedatives when they are not medically indicated, however, could have potentially important adverse consequences for both patients and public health."
How are you using placebos in your practice?
Labels: ethics, placebos, rheumatology
posted by Ryan DuBosar at
9:59 AM
0 Comments
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
Send comments to ACP Internist staff at acpinternist@acponline.org.
Previous Posts
- QD: News Every Day--Considering health care reform...
- QD: News Every Day--Federal action leads to states...
- QD: News Every Day--The end is in sight (until lat...
- Coffee and the Heart - Researchers are Getting Pai...
- What if Other Parts of Life Were Like Healthcare?
- QD: News Every Day--Reform rhetoric heats up
- Is Chronic Fatigue Syndrome Caused By Retroviruses...
- QD: News Every Day--Health care reform's "endgame"...
- Medical News of the Obvious
- QD: News Every Day--Ratcheting up the pressure to ...
Archives
Blog log
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.
Clinical Correlations
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.
db's Medical Rants
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.
Getting Better with Dr. Val
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.
Kevin, MD
The alter ego of Kevin Pho, ACP Member, is the closest thing to royalty in the medical blog world.
LSUHSC-S Medical Library Evidence Alert
Major guidelines, systematic reviews, meta-analyses and/or major reviews by national and international organizations.
PLoS Blog
The Public Library of Science's open access materials include a blog.
White Coat Rants
One of the most popular anonymous blogs written by a doctor.
