Your doctor has sold his practice: 6 tips for patients (tips are also good for doctors not selling their practice!)
I’m not sure I’d have the chutzpah to ask about performance requirements or conflicts of interest.
But maybe if I went to an office visit with these types of questions written down, I would be more likely to ask them!
(As an aside, I accompanied my mom to outpatient surgery yesterday. The only way I could assure myself I would
ask the surgeon a few questions while mom was in post-op…was to write them down and have them “on display” in what is now called the “interview room”. The surgeon did take note of the scrawled questions and was ever so patient and answered each one completely.
Granted, these were questions related to how to take care of my mom, not his performance requirements or conflicts of interest.
Still, I think I could build on writing down questions about how to take care of oneself or others to include questions relating the necessity of a medical test or procedure.)
I am not sure about two of the points.
Would anyone in the doctor’s office really be candid about performance requirements? Or even know about them?
The office staff has at least the potential about conflict of interest. They work for the doctor (and by extension any health organization the doctor belongs to which could be the source of a conflict of interest!) Maybe it would be best to ask the doctor directly.
Online databases and forums are most likely not objective. They only record input from folks. And the input is not evaluated for “truth”.
Crowdsourcing at times can point to the truth, but I believe at times crowds can be misinformed (and act on rumors). And I don’t think that online databases/forums can readily distinguish when reports are based on fact or falsehoods.
When doctors sell their practices to hospitals or networks, the practices are typically restructured. When they restructure, the new arrangement can put the doctor under more pressure to treat you (the patient) more “economically,” so as to generate more income. This can mean ordering tests or prescribing medicines that you may or may not need – things that are more for “let’s just be safe” and would be avoided in a private practice.
What does this all mean for you as a patient? Other than potentially higher medical costs, possible deterioration in treatment, and a lack of personal attention as a person, it boils down simply to a conflict of interest. In other words, there is greater potential for disagreement regarding what is in your best interest according to convention and how the doctor or hospital treats you…
- First, when your doctor is recommending tests or treatments or hospitalization for you, take the time to ask if you really the treatments – ask if the doctor would do the same for a family member
- Second, ask for a second opinion to determine if you need the recommended care – this should be your standard reaction when tests are ordered…
- Doctors took money, wrote treatment guidelines (HeraldReview.com)
- Doc faulted for overmedicating patient made big bucks teaching other docs how to prescribe (Syracuse.com)
- Physicians Cautioned about Divided Loyalty between Patients and Hospitals (labsoftnews.typepad.com)
- Physicians fail to disclose conflicts of interest on social media (medicalxpress.com)
- Patient power troubles GPs (theage.com.au)
- The empowered patient (theage.com.au)
- Follow the Money: Hospitals and Doctors Put Profits over Care (mcntalk.com)
- UVa Med Center Gets “D” Grade for Patient Safety (newsplex.com)
- AMA Reaches Out to Doctors To Remind Them Patient Welfare Must Come First As Rising Pressures From Insurers and Hospitals Can Surmount At Times (ducknetweb.blogspot.com)
- One in three have online medical record, many without knowledge – Telegraph [del.icio.us] (telegraph.co.uk)
- Medical bill saga is tip of morass of healthcare issues (gazette.com)
- Beyond Informed Consent: Shared Decision-Making|Harriet Hall|Science-Based Medicine (sciencebasedmedicine.org)
As a doctor, I appreciate that I am at an advantage when I seek medical care. Knowing terminology and basic medical principles helps a lot. In addition, when you’ve been practicing medicine for a while you get a feeling from how a doctor discusses options if the care seems valid or if a second opinion is in order. Other things I look for are board certification and a doctor who explains their treatment plan in the context of recommended guidelines.
Summarizing everything that combines to make good medical care is very hard. However, from time to time I take unfortunate histories from patients or hear stories of medical misadventures from friends and I just cringe. Actually, they make me want to shout, “Your doctor did/said what?!” These are red flags, because not only are these recommendations potentially harmful, but if your doctor recommends one thing that is so flagrantly bad, well, uh, um, how can you trust the rest of their care?
So, these are six red flags that would make me stop and not pass go. They would make me get up, get dressed, and say, “Thanks but no thanks,” and walk out the door looking for a second opinion:
1. A prescription for estrogen containing birth control (pills, patch, or ring) with no inquiry about migraines. Why? Migraines with aura are an absolute contraindication to estrogen containing birth control (do to an increased risk of stroke) and if your doctor were up to date on the WHO/CDC guidelines he/she would know that. I want my doctor to be up to date on guidelines, you know?
- 6 warning signs you’re seeing the wrong gyno (drjengunter.wordpress.com)
- Migraine 101: Menstural Migraine (somebodyhealme.dianalee.net)
- Prolonged Periods: A Cause for Concern? (everydayhealth.com)
Yesterday I reflagged an item about the Free UMSkinCheck Mobile App.
While these self check apps are wonderful consumer and patient tools, they are not without “problems”.
This KevinMD.com post outlines health app use challenges as folks gathering data without knowing what to do with and reimbursement issues (physician consultations outside of the office).
Article ends with statement “Until our system puts more value on avoiding unnecessary treatment and keeping people well we will be stuck in this struggle between patients who want to avoid seeing the doctor and doctors who can’t afford to let patients do that.”.
by ROB LAMBERTS, MD(KevinMD.com post, 17 July 2012)
Eric Topol wrote a post on The Health Care Blog where he looks to a future enabled by emerging technology: “Just as the little mobile wireless devices radically transformed our day-to-day lives, so will such devices have a seismic impact on the future of health care. It’s already taking off at a pace that parallels the explosion of another unanticipated digital force — social networks….
large number, if not the majority, of ear infections are undiagnosed and clear on their own at home without intervention. Now add to this a technology which gives us the ability to see all of those undiagnosed ear infections, and we have to muster even more willpower to resist the urge to treat them all. This is the same problem as we have encountered with PSA testing: be careful gathering data you don’t know how to handle.
But even without considering this important objection to improved data-gathering, there is another problem which stands in the way of this type of technology: reimbursement. It sounds great to enable people to avoid visits to the doctor’s office by having tools that previously were only accessible at an office visit. It sounds like a very good way to save money and wasted time spent in waiting rooms with outdated magazines. But this technology presumes that doctors will be willing to act on this information without seeing the patient in the office. It presumes we will be willing to offer free care. If the time I spend sifting through patient-collected data rises exponentially, the payment I get for that time cannot remain at the present level: zero.
If our goal (as it should be) is to spend less money on unnecessary care, we will get to it much faster if we somehow give proper incentive. Our encounter-based payment system stands in the way of any progress in this area. The only way most of us get paid is to see people and deal with problems. This makes doctors reluctant to offer any care outside of this setting, and puts undue pressure on intervention (to justify the encounter to the payors). Until our system puts more value on avoiding unnecessary treatment and keeping people well we will be stuck in this struggle between patients who want to avoid seeing the doctor and doctors who can’t afford to let patients do that….
Will Information Technology Squeeze Physicians Out Of Their Central Role In Health Care? (the healthcareblog.com, July 11, 2012)
“Turns out that while most of us (90%) would like be able to make a doctor’s appointment and check lab results online….85% of us also still want the option of be able to talk to our physician face-to-face. These are the finding from a recent 2012 study conducted by Accenture.”"
What is significant about the finding cited above is that patients at least get it. They understand the value of a having a relationship with a knowledgeable physician or similar health care provider. In spite of, and for some, because of the plethora of health information outlets on the web people want to know that they always have access to your family doc when the chips are down.”
“Here’s what I mean…based upon some 20+ years working in health care:
From the get go…going back to Hippocrates…health and health care delivery has been about the relationships between people starting with the physician-patient.relationship.
The most important diagnostic tool a physician has at their disposal is not a smart phone…but their ability to talk with and observe patients verbal and non-verbal behavior.
“Talk” is not only how physicians diagnose problems and recommend the appropriate treatments…talk is also how patients are able to engage in the health care. Perhaps the most overlooked aspect of talk (and touch) during the medical exam is the therapeutic benefits patients derive from being able to express heart-felt fears and concerns to someone who hopefully cares.”
- Now Your Smartphone Can Be Used To Diagnose Ear Infections At Home (singularityhub.com)
- Now Your Smartphone Can Be Used To Diagnose Ear Infections At Home (forbes.com)
- Back to the Future: Predicting the Future of Healthcare (Part I) (drchrono.com)
- Three mobile tools that could transform how cardiovascular disease is managed (medcitynews.com)
- Company developing #mhealth ECG device for iPhone, ipad raises $10.5M (medcitynews.com)
- Dr Topol to med students: “When I was in medical school, the term “digital” was reserved for the rectal examination” (casesblog.blogspot.com)
From Choosing Wisely – a Web site that aims to “aims to promote conversations between physicians and patients by helping patients choose care that is:
Supported by evidence
Not duplicative of other tests or procedures already received
Free from harm
Nine United States specialty societies representing 374,000 physicians developed lists of “Five Things Physicians and Patients Should Question” in recognition of the importance of physician and patient conversations to improve care and eliminate unnecessary tests and procedures.
These lists represent specific, evidence-based recommendations physicians and patients should discuss to help make wise decisions about the most appropriate care based on their individual situation. Each list provides information on when tests and procedures may be appropriate, as well as the methodology used in its creation.
What tests and procedures should patients and physicians talk about? Read the lists:
[Links at http://choosingwisely.org/?page_id=13]
American Academy of Allergy, Asthma & Immunology
American Academy of Family Physicians
American College of Cardiology
American College of Physicians
American College of Radiology
American Gastroenterological Association
American Society of Clinical Oncology
American Society of Nephrology
American Society of Nuclear Cardiology
- 5 Things Doctors And Patients Should Question (boston.cbslocal.com)
- Six Common Medical Procedures You Probably Don’t Need (businessinsider.com)
- Medical societies list unneeded tests to reduce healthcare costs (medcitynews.com)
- Physician Groups Call for Fewer Medical Tests (cherished79.wordpress.com)
- Physician Groups Call for Fewer Medical Tests (news.health.com)
- U.S. doctors advised to reduce routine tests, treatments (ctv.ca)
- Which Medical Tests Are Really Needed? (connecticut.cbslocal.com)
- Choosing Wisely, Continued… (rjwh617dotcom.wordpress.com)
- US doctors urge fewer tests‚ less costly treatments (thehimalayantimes.com)
- Doctor Panels recommend fewer tests for Patients (maryannebachia.wordpress.com)
…Bloch points to a growing body of research evidence showing the impact of financial struggle on the risk of a variety of diseases (this research is largely Canadian, so US statistics will differ, though the themes are likely similar):
Cardiovascular disease: there is a 17% higher rate of circulatory conditions among the lowest income quintile versus the average
Diabetes: prevalence among the lowest income quintile is more than double the rate in the highest income quintile
Mental Illness: the suicide-attempt rate of those living on social assistance is 18 times higher than higher-income individuals
Cancer: low-income women are less likely to access screening interventions like mammograms or Pap Smears
Development: infant mortality is 60% higher in the lowest income quintile neighborhoods
Regardless of this compelling evidence, why is there a need to screen for poverty? “Simply because we don’t know which patients live in poverty and if we don’t ask, we won’t find out,” says Dr. Bloch. Since the recession of 2008, many hard-working people have been squeezed out of the middle class. A November 2011 report by Wider Opportunities for Women entitled, “Living Below the Line,” highlighted the fact that nearly half of Americans struggle to make ends meet. …
NCAAM (National Center for Complementary and Alternative Medicine) recently published these pages/articlers
- Director’s Page – It’s Time to Talk (March 13, 2012)
Time to Talk is a recently launched NCAAM series which encourages folks to discuss complementary health practices with their health care providers
The director notes the following
- We know that nearly 40 percent of Americans use some kind of complementary health practice. But we also know that most patients do not proactively disclose use of complementary health practices to their health care providers. Likewise, most providers don’t initiate the discussion with their patients. As a physician, I strongly believe that patients and their health care providers need to talk openly about all of their health care practices to ensure safe, coordinated care. Talking not only allows fully integrated care, but it also minimizes risks of interactions with a patient’s conventional treatments.
- This month’s Time to Talk includes these tips
- List the complementary health practices you use on your patient history form. When completing the patient history form, be sure to include everything you use—from acupuncture to zinc. It’s important to give health care providers a full picture of what you do to manage your health.
- At each visit, be sure to tell your providers about what complementary health approaches you are using. Don’t forget to include over-the-counter and prescription medicines, as well as dietary and herbal supplements. Make a list in advance, or download and print this wallet card and take it with you. Some complementary health approaches can have an effect on conventional medicine, so your provider needs to know.
- If you are considering a new complementary health practice, ask questions. Ask your health care providers about its safety, effectiveness, and possible interactions with medications (both prescription and nonprescription).
Don’t wait for your providers to ask about any complementary health practice you are using. Be proactive. Start the conversation.
NCCAM TiwtterChate – Join us for monthly Twitter Chats that cover a variety of health topics and complementary approaches. Each month, a different topic will be selected. An expert in scientific and health issues will be available to answer your questions. Most chats will occur on the last Thursday of each month at 1 p.m. ET. Dates, times, and topics may change, and will be announced on this page and through Twitter and Facebook.
Find us on Twitter: @NCCAM. To participate, use the hashtag: #nccamchat.
Upcoming ChatsMarch 30, 2012 Time to Talk
Time to Talk Campaign—an educational campaign to encourage patients and their health care providers to openly discuss the use of complementary health practices.April 26, 2012 Asthma and Complementary ApproachesMay 31, 2012 Yoga
- Is it Time to Talk? (lynnawiensmd.com)
- The Holistic Nurse: What’s So Awful About the Placebo Effect? (makingsofanurse.com)
Am thinking…how does one be compassionate to a doctor who lacks good communication skills?
And how does one draw out needed information from the same doctor when one is in a confused state of mind?
Maybe a communication and or/ life skills class in high school should be required that includes body language?
…For nearly two decades, teaching good communication skills has beenmandatory for medical schools because of research showing that good patient-doctor communication can lead to improved patient satisfaction and better health care outcomes. To this end, medical educators have developed a host of communication courses and workshops that combine lectures, self-assessments, video recordings and “standardized patients,” or actors in the role of patients.
More recently, many schools have broadened their courses to include “cultural competency,” or the ability to communicate with those from different racial, ethnic and social backgrounds. Studies have shown that while a patient’s race and ethnicity can be linked to sharply different treatment courses and quality, better communication between doctors and patients of different backgrounds can reduce the disparities.
Despite these tremendous efforts, there is one area of communication to which few schools have devoted significant time or resources: body language and facial expressions.In this recent study, for example, a group of medical sociologists analyzed the interactions between 30 primary care doctors and more than 200 patients over age 65 and found that white physicians tended to treat older patients similarly, regardless of race. Black physicians, on the other hand, often gave white patients contradictory signals, mixing positive nonverbal behaviors, like prolonged smiling or eye contact, with negative ones, like creating physical barriers by crossing the arms or legs….
- What Doctors Are Telling Us Even When They’re Not Talking (well.blogs.nytimes.com)
- Doctors may paint overly rosy prognosis (cbc.ca)
- Study Finds Doctors Not Always Honest With Patients (dfw.cbslocal.com)
- Study finds doctors aren’t always honest with patients (mercurynews.com)
- 1 in 10 Doctors Admit Lying in the Past Year (livescience.com)
- Many doctors in survey admit they have lied to their patients (seattletimes.nwsource.com)
- Study finds MDs not always honest with patients (seattletimes.nwsource.com)
- Skills in medicine (slideshare.net)
- Doctors’ Honesty Put to the Test (webmd.com)
- Some physicians do not agree with, uphold standards on communication with patients (Eureka News Alert)
A significant minority of physicians responding to a national survey disagreed with or admitted not upholding accepted standards of professionalism for open and honest communication with patients. In the February issue of Health Affairs, investigators from the Mongan Institute for Health Policy at Massachusetts General Hospital (MGH) report that, among other findings, one fifth of respondents indicated they had not fully disclosed a medical error out of concern for malpractice lawsuits and about one tenth admitted telling a patient something that was not true during the preceding year….
Five questions on the survey specifically addressed attitudes related to communication – including whether physicians should fully inform patients of the risks and benefits of their treatments, disclose all significant medical errors to patients and always keep patient information confidential – and four addressed what respondents had actually done in the preceding year. The survey was sent to 3,500 U.S. physicians – 500 each in internal medicine, family practice, pediatrics, cardiology, general surgery, psychiatry and anesthesia – and almost 1,900 surveys were completed and returned.
The overhelming majority of respondents agreed that physicians should completely inform patients about risks and benefits, never disclose confidential information and never tell a patient something untrue. While 66 percent agreed that all significant medical errors should be disclosed to affected patients, one third did not completely agree. Also, about one third did not agree that financial relationships with drug and device companies should always be disclosed. When asked about their own behavior in the preceding year, almost 20 percent admitted not fully disclosing a medical error for fear of being sued,[my emphasis] 28 percent admitted revealing a patient’s health information to an unauthorized person, and 11 percent responded that they had told a patient or the parent of a child something that was not true.
Unnecessary reliance on screening tests and the underuse of personalized medicine are two major concerns I have with the present practice of medicine. Hence the selection of this article for a blog item.
Mayo’s Dr. Victor Montori and his team argue that medical intervention success is best be measured in holistic terms as death, quality of life, and ability to function. This is in direct opposition to current industry and professional guideline standards which emphasizes narrow (and often misleading) outcomes as blood pressure reduction, lipid levels, and glucose levels.
The team’s analysis with “10 commandments” for physicians is published in the 28 December 2011 article The idolatry of the Surrogate. The article, unfortunately, is only available through paid subscription through the BMJ (British Medical Journal – Helping Doctors Make Better Decisions).***
The commandments basically encourage physicians to be careful with statistical results from clinical trials, information from industry experts, and to treat and respect the patient as individual with treatment related statistics as guides.
On a related note, I am very impressed with folks who empower themselves in treatment decisions by keeping up with biomedical breakthroughs, new treatments, and new ways of looking at diseases. I have posted related blogs as ePatients: The hackers of the healthcare world and Meet e-patient Dave – a voice of patient engagement.
Here is the abstract of the article
Easier to measure surrogate outcomes are often used instead of patient important outcomes such as death, quality of life, or functional capacity when assessing treatments. John Yudkin, Kasia Lipska, and Victor Montori argue that our obsession with surrogates is damaging patient care
Diabetes care is largely driven by surrogates. The US Institute of Medicine defines surrogates as “biomarker[s] intended to substitute for a clinical endpoint [and] expected to predict clinical beneﬁt (or harm . . .) based on epidemiologic, therapeutic, pathophysiologic, or other scientiﬁc evidence.”1 In diabetes, concentrations of glycated haemoglobin (HbA1c) are used as a surrogate marker for outcomes that are important to patients, such as blindness or amputation. Other surrogates such as blood pressure, lipids, albumin excretion rates, and C reactive protein have been used to predict outcomes of cardiovascular disease and to guide clinical practice in people with or without diabetes. Much of the evidence for clinical interventions is based on their effect on surrogate outcomes rather than those that matter to patients such as quality of life or avoidance of vision loss or renal failure. Moreover, because these “hard” end points generally show much smaller responses to interventions than surrogate markers, many of the widely accepted strategies for diabetes may be based on artificially inflated expectations.
Recent studies have challenged the assumption that reliance on surrogates can accurately predict the effect of treatment on hard outcomes. There are the oral hypoglycaemic drugs that reduce HbA1c but increase the risk of cardiovascular events,2 antihypertensive drugs that do not reduce the risk of stroke,3 and drugs that improve cholesterol profiles but do not reduce cardiovascular events.4 Explanations for such phenomena include unwanted effects of the drug or an incomplete understanding of the pathophysiology of the disease.5 But why have …
Below are listed the the ten commandments**** with definitions and paraphrasing. I have forgotten much more than I have remembered from a college statistics class 30+ years ago! The “explanations” are a result of finding quality information on the Internet.
(For a great “translation” with less math, please go to the blog posting …Get Your Doctor to Treat You Right)
The New Therapeutics: Ten Commandments
- Thou shalt treat according to level of risk rather than level of risk factor.
Level of risk - these levels are experienced by everyone, not just those having the disease being treated [good summary of risk levels (minimal, less than minimal, greater than minimal) ]
Risk factor -anything that makes it more likely you will get a disease, either something you do (smoking)or something you have no control over (as being over 50 makes it more likely you will get colon cancer. People should be given treatments based on the risks associated with the treatment on anyone,not individual factors (age, blood pressure, other conditions)
- Thou shalt exercise caution when adding drugs to existing polypharmacy.
Polypharmacy - (poly is Greek for many) Whenever a person is taking a drug, any additional drugs may interact and cause bad reactions, including death.
- Thou shalt consider benefits of drugs as proven only by hard endpoint studies.
Endpoint study – research study involving humans where the outcomes (results) directly address the question. For example, if a drug was tested on how it reduced heart disease, the hard endpoint would be the reduction of heart disease. However, hard endpoint studies are usually not accomplished in short periods of time, because it takes time for diseases to develop. This paragraph sums up endpoint workarounds well.
From Deciphering Media stories on Diet (Harvard.edu)
4. Did the study look at real disease endpoints, like heart disease or osteoporosis? Chronic diseases,
like heart disease and osteoporosis, often take many decades to develop. To get around waiting that
long, researchers will sometimes look at markers for these diseases, like narrowing of the arteries or
bone density. These markers, though, don’t always develop into the disease.
- Thou shalt not bow down to surrogate endpoints, for these are but graven images.
Surrogate endpoint – a substitute endpoint in a clinical trial. It is not the item being measured directly (as heart disease), but an item related to what is being studied (as blood pressure). During the study these substitutes will be used to check on the health of the people in the clinical trial, the usefulness of the drug being treated, and if there are any complications. Surrogate endpoints are substitutes for (true) clinical endpoints (as survival for 5 years after the treatment). Surrogate endpoints don’t always guarantee a clinical endpoint (just because blood pressure goes down, heart disease may not be treated). However studies with good endpoints are expensive (require testing on many people) are take long periods of time. [Adapted from an eHow article with good references]
- Thou shalt not worship Treatment Targets, for these are but the creations of Committees.
Correlation doesn’t always meant causality!A treatment target is a goal of a treatment intervention. An example would be to reduce a specific protein in order to prevent a specific cancer (Potential New Treatment Target for Retinoblastoma, 13 January 2012 Medscape article) . The “cause/effect” relationship between something measurable (as a protein) and a disease may not truly exist. It is also possible that the presence of the protein and the onset of a disease may be due to other factors in a web of events.
- Thou shalt apply a pinch of salt to Relative Risk Reductions, regardless of P values, for the population of their provenance may bear little relationship to thy daily clientele.
Relative Risk - The number of times more likely (RR > 1) or less likely (RR < 1) an event is to happen in one group compared with another. [From the BMJ glossary] P value – a number used to show how a variable (as a drug treatment) has a different result thano variable (no treatments). So, a high P value would seem to point to an effective drug treatment.
- Thou shalt honour the Numbers Needed to Treat, for therein rest the clues to patient-relevant information and to treatment costs.
The Numbers Needed to Treat (NNT) tells how many patients need a specific treatment in order to prevent an additional bad outcome (as a heart attack or stroke). So if a drug has an NNT of 10, 10 people have to be treated with the drug in order to prevent one additional bad outcome.
For example, if a drug is found to reduce the risk of a bad outcome from 50% to 40%, the absolute risk .1 (the difference). And the NNT is the inverse of the absolute or 10. [From Numbers Needed to Treat (Patient.co.UK)
- Thou shalt not see detailmen, nor covet an Educational Symposium in a luxury setting.
Detailmen are pharmacy representatives who present doctors with their company's drug information with the aim of persuading the doctor to presribe their drugs. These representatives often sponsor educational talks (often "focusing" on conditions rather than drugs) at physician meetings. These "luxury settings" may included free buffets and hospitality rooms. [From Influencing Doctors :How Pharmaceutical Companies Use Enticement to 'Educate' Physicians (ABC News)]
- Thou shalt share decisions on treatment options with the patient in the light of estimates of the individual’s likely risks and benefits.
- Honour the elderly patient, for although this is where the greatest levels of risk reside, so do the greatest hazards of many treatments.
*** Click here for suggestions on how to get this article for free or at low cost.
In past blogs I have posted items on initiatives for the wider sharing of scientific articles to the public with subsidies, open access, etc.
****Richard Lehman’s Journal Review – 3 January 2012
amednews: Why patients are turning less to media and friends for health information :: Dec. 26, 2011 … American Medical News
Excerpts from the 26 December 2011 news item of the American Medical Association (AMA)
Consumers’ access to physicians and the quality of information available are affecting their level of interest in seeking outside guidance on their conditions.
By PAMELA LEWIS DOLAN, amednews staff. Posted Dec. 26, 2011.
As patient visits to physicians have declined, so has their interest in finding information relating to their health.
The waning interest in information-seeking as patient visits fall is what the Center for Studying Health System Change called a “surprising” conclusion to a survey of 17,000 patients released in November. Visits to physicians dropped 4% between 2007 and 2010. Meanwhile, the percentage of American adults seeking information about a personal health concern in the previous 12 months decreased from 55.5% to 50% in the same period, it said.
Analysts said there probably are multiple reasons for that. The trend could reflect that when patients are less able to see a physician, they are less likely to be engaged in their health. It could be that with physician visits down, patients have more time to spend with their doctor, meaning they have less of a need for outside sources of information.
And they said the decline could reflect that so much information is available — and so much of it conflicting — that some overwhelmed patients may be opting out altogether from researching their health.
For physicians, analysts said, the implication of the study is that when patients come into their offices, they are going to rely on them more than ever for help in managing their health.1 in 5 patients has delayed or canceled a doctor visit, medical test or procedure in the past year.
The sources of information the center studied were the Internet, print media, television and radio, and friends and relatives. Internet was the only source that went up, to 32.6% from 31.1%. But center researcher Ha T. Tu wrote that the growth failed to keep pace with a strong rise in residential broadband Internet access, which went up from 47% to 66% between 2007 and 2010….
- How much guidance do patients want with their medical decisions? (jflahiff.wordpress.com)
- Epatients: The hackers of the healthcare world [O'Reilly Radar] (jflahiff.wordpress.com)
[While I have some major concerns about this video, since it was at the blog item, I decided to add it anyway.
In my humble opinion the background music is too gloomy, the use of some declatatory statements seem to false imply "all", and it seems to foster an "us" versus "them" mentality that in the long term may be unhelpful...
Still, it does emphasize that people can be empowered through reputable information and interacting with other like-minded and similarly educated folks]
A quick reference for becoming an empowered patient
Excerpts from the blog item by Fred Trotter at O’Reilly Radar- Insights, Analysis, and Research about Emerging Technologies
help build open source software tools that patients can use to have greater control and influence over their own healthcare (like the Direct Project and Your Doctors Advice). As as result, I’ve become quite familiar with other tools that do the same sorts of things. There is a community of patients who are deeply interested in the ways in which they can become more engaged and how they can specifically use technology to achieve this. This community calls themselves epatients. The epatient community asked me to write a short collection of resources for “becoming an epatient.”
The “e” in epatient is intentionally obscure. The initial assumption is that the “e” stands for “electronic,” as it does in “email.” But in fact, the “e” stands for “engaged” or “empowered.” Nonetheless, reference to email is intentional: The epatient community recognizes that leveraging data is a critical part of empowering a person who happens to be sick. Patients must be “electronic” to become fully “engaged.” I think of epatients as the healthcare equivalent of makers and hackers. More importantly, they are the people I have in mind when I write software….
Let’s go over some simple concepts that the rest of my epatient advice and resources are based on:
- Your doctors are probably not managing your healthcare information. You should assume it is your responsibility. Otherwise, the people involved in your treatment process will often presume that this information simply does not exist.
- Other patients, with similar conditions to yours, can have better information about your health problem than your doctors have.
- Like the highway system, the healthcare system is generally beneficial, but there are dangers, and you need to learn to avoid them.
And here are two things you should keep in mind:
- Whenever I say “patient,” I actually mean “the patient/caregiver team.” Often, the patient will not have the energy to do what is necessary to be fully engaged. It is critical that when the patient cannot be an epatient, that at least the patient’s team be an epatient proxy.
- In regard to the “better information” I mentioned above, I don’t mean that your doctor is typically wrong and another patient is typically right about your diagnosis or treatment options. While that does happen on occasion, it is not the norm. Another patient’s information is “better” because your doctor typically does not have the visceral experience of being a patient. Your doctor doesn’t understand which lotion can make all of the difference or what position might let you get some sleep after a rough procedure. There is simply no substitute for experience. Sometimes that experience can make your life a little easier, and sometimes it can help you get the right treatments that literally will save your life. (This is the gist of epatient Dave deBronkart’s story.)
Read the entire blog item (including descriptions and links to epatient communities)
- The slow integration of community into health care (The Health Care Blog)
For a long time now patients have been meeting in online (and offline) communities, sharing experience, advice and more recently data and measurements. And the health care system–which knows that communities improve health–has done virtually nothing–other than some doctors having doctors answer questions on MedHelp. That is just starting to change. Last year Geisinger did a small trial with dLife that showed improvement in diabetics outcomes. More recently Aetna inked partnerships withMindBloom and OneRecovery, two communities focused on spirituality and addiction, and today Diabetic Connect (part of Alliance Health) announced a deeper integration with the Joslin Diabetes Center. It’s been a while, but the heart of Health 2.0 (communities) are starting to move towards the mainstream.
- Are you an ePatient? (enbloommedia.com)
- The Rise of the e-Patient: Slideshow (ScienceRoll)
“It’s always good to see the trends about the growing number and importance of e-patients. Lee Rainie, director of the Pew Internet Project, presented this wonderful overview of the Project’s health findings at Providence St. Joseph Medical Center in Burbank, CA, on January 12.”
- Why patients are turning less to media and friends for health information (jflahiff.wordpress.com)
- Can differential diagnosis be crowdsourced to Facebook Friends?(medgadget)
- ePatient Connections: A Patient Checks In. (sixuntilme.com)
- From E-patient Hackers to Health Games on Mobiles (scienceroll.com)
- The end of social – O’Reilly Radar (queuniversidade2.wordpress.com)
- Meet e-patient Dave – a voice of patient engagement (and related resources) (jflahiff.wordpress.com)
- 2020 Vision: The ePatient Evolution Over the Next 10 Years (prweb.com)
- ePatients Come Together to Brainstorm and Share (brassandivory.org)
- 6 P’s Of Social Health (socialmediaclub.org)
- The Rise of the ePatient – presentation by Pew Internet Project (casesblog.blogspot.com)
From the 5 January 2012 posting by PATRICIA SALBER, MD at KevinMD.com
I am a big fan of DIY (do-it-yourself) healthcare, at least for the bulk relatively minor issues that plague people. I think the days when doctors were needed to control, interpret and dole out health data and information are waning. There are simply too many ways, primarily via the internet, to get good, reliable, easy-to-understand information about our own health.
The Quantified Self (QS) people who use sensors, mobile apps, and other devices to collect data on themselves may be taking it to what some would consider extreme, but I think it is the wave of the future.
Now, no one would question who “owns” the data collected in this manner, but how about data collected via a medical laboratory? Is that somehow different and something we, the patients, should not be allowed direct access to lest we harm ourselves by misinterpretation. Interesting question!
The issue is explored in a commentary in the December 14, 2011 issue of the Journal of the American Medical Association.*** Traber Davis Giardina, MA, MSW and Hardeep Singh MD, MPH, ask the question: “Should patients get direct access to their laboratory test results?” They find that it is “an answer with many questions.”…
The reason to raise this question now is that there is a proposed rule by the Department of Health and Human Services in conjunction with the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention and the Office for Civil Rights, that would allow individuals the ability to access their test results directly from the laboratory by written or electronic request. …
There are a number of reasons why direct access is a good idea:
- Between 8 and 26% of abnormal test results, including those suspicious for cancer, are not followed up in a timely manner. Direct access could help reduce the number of times this occurs
Self-management, particularly of chronic illness has known benefits. Just like the QS people, many folks with chronic illness obtain and manage to self-acquired lab results every day via glucometers, home pulmonary function tests, blood pressure measurements, and so forth. Direct access to laboratory-acquired data, one could argue is a continuation of that personal responsibility…
The arguments against direct access discussed by Giardina and Singh include the following:
- Studies show that patients prefer their physicians contact them directly when they have abnormal test results, although the studies, published in 2005 and 2009, preceded the extraordinary use of the internet to access health information that exists today.
- There is concern over whether patients will know what to do when they receive the results – will they make erroneous interpretations or fail to contact their docs? …..
***Article available online to paid subscribers only.
- Should Patients Get Direct Access to Their Laboratory Test Results? An Answer With Many Questions (jflahiff.wordpress.com)
- Proposal on access to lab tests should be revised, doctors say (kboreilly.com)
- Progress Made on Direct Patient Access to Lab Results (projecthealthdesign.typepad.com)
- Getting Lab Results Directly to Patients (blogs.wsj.com)
- Becoming a master diagnostician – Step 3 – lab test interpretation (medrants.com)
- Dentists Could Screen 20 Million Americans For Chronic Physical Illnesses (medicalnewstoday.com)
- Support Your Right to Access Your Clinical Lab Results (spittoon.23andme.com)
- Docs Don’t Want Lab Results Going To Patients (informationweek.com)
- HHS wants to give patients test results straight from the lab (kboreilly.com)
- HHS Proposed Regs Would Give Patients Direct Access to Lab Results (physicianlaw.foxrothschild.com)
From the 19 December 2011 Beth Medical Newsletter
Study gauges baseline interest in three-site OpenNotes trial
BIDMC Contact: Jerry Berger
BOSTON – Patients are overwhelmingly interested in exploring the notes doctors write about them after an office visit, but doctors worry about the impact of such transparency on their patients and on their own workflow, a Beth Israel Deaconess Medical Center (BIDMC) study suggests….
While many of the more than 100 primary care doctors who volunteered to participate in this experiment predicted possible health benefits from allowing patients to read their notes, the majority of those who declined participation were doubtful about positive impacts. And among the 173 doctors completing surveys, the majority expressed concerns about confusing or worrying patients with the content. Doctors also anticipated that they would write their notes less candidly and that responding to patient questions might be exceedingly time-consuming.
In contrast to the doctors surveyed, the nearly 38,000 patients who completed the baseline survey were almost uniformly optimistic about OpenNotes, and few anticipated being confused or worried
“The enthusiasm of patients exceeded our expectations,” wrote Walker. “Most of them were overwhelmingly positive about the prospect of reading visit notes, regardless of demographic or health characteristics.”
More than 90 percent favored making the notes available. Well over half anticipated improved adherence to their medications, 90 percent expected to feel more in control of their care, and four out of five predicted they would take better care of themselves….
- Doctors are cautious, patients enthusiastic about sharing medical notes (eurekalert.org)
- Patients eager to see doctor’s notes; physicians, not so much (seattletimes.nwsource.com)
- Patients Want to See What Doctors Write about Them, Says Survey (onehealthyblog.wordpress.com)
- Patients, Docs Differ on Online Notes (abcnews.go.com)
- Patients Want Electronic Link To Doctor’s Notes (informationweek.com)
- How much guidance do patients want with their medical decisions? (jflahiff.wordpress.com)
Do You Really Need a Yearly Checkup? | Yahoo! Health By Lisa Collier Cool
Typically, a routine visit with your primary care doctor involves a slew of tests and screenings. While patients are often told that all this poking and prodding is crucial to protect their health, is there any scientific evidence to support that? A decade ago, the US Preventative Services Task Force (USPSTF), an independent group of medical experts appointed by Congress, concluded that yearly physicals are unnecessary for healthy, symptom-free adults.
What’s more, a new study published in Archives of Internal Medicine*** reports that primary care doctors often order unnecessary and inappropriate tests, screenings and treatments, costing the healthcare system—and patients—$6.8 billion in 2009. The annual checkup is a prime culprit in needlessly driving up medical bills, the researchers found, with dubious or worthless tests ordered in up to 56 percent of these exams.
Instead of a yearly checkup, the new thinking is that healthy patients should “check in” with their doctors periodically, on a schedule tailored to their individual needs, to discuss any medical concerns and which tests truly are appropriate for their age, gender, and family history. Here’s a look at routine screenings that primary care doctors are most likely to use needlessly, according to analysis by the National Physicians Alliance (NPA)—and when these tests are worthwhile….
- How much guidance do patients want with their medical decisions? (jflahiff.wordpress.com)
- Top 5” Lists Top $5 Billion in Potential Savings (National Physicians Alliance)
- How much guidance do patients want with their medical decisions? (kevinmd.com)
- What Makes Patients Complex? Ask Their Primary Care Physicians (medicalnewstoday.com)
- What makes patients complex? Ask their primary care physicians (eurekalert.org)
- Let physician assistants be part of the primary care answer (kevinmd.com)
***The article, “Top 5″ Lists Top $5 Billion, is available online only through paid subscription.
Click here for suggestions on how to get this article (and other science/medicine articles) for free or at low cost
Minal S. Kale, MD; Tara F. Bishop, MD, MPH; Alex D. Federman, MD, MPH; Salomeh Keyhani, MD, MPH
Arch Intern Med. 2011;171(20):1856-1858. doi:10.1001/archinternmed.2011.501
Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.
The Good Stewardship Working Group presented the top 5 overused clinical activities across 3 primary care specialties (pediatrics, internal medicine, and family medicine), as chosen by physician panel consensus.1 All activities were believed to be common in primary care but of little benefit to patients. We examined the frequency and associated costs of these activities using a national sample of ambulatory care visits.
We performed a cross-sectional analysis using data from the 2009 National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS). The NAMCS and NHAMCS survey patient visits to physicians in non–federally funded, non–hospital-based offices and non–federally funded hospital outpatient departments, respectively.2
We limited our sample to visits by patients to their primary care physicians. Visits for each “top 5″ primary care activity were identified . . . [Full Text of this Article]
by KEVIN PHO, MD at KevinMD.com
The following column was published on November 10, 2011 inMedical Economics.
I recently saw two patients in my primary care clinic, each with new-onset hypertension.
The first, a middle-aged executive, brought printouts from the Internet and already had researched the various treatment options for high blood pressure. During the visit, we discussed this information, and I gave my thoughts on what to do next. He considered and appreciated my input but made it clear that the ultimate decision was his.
The second was an elderly gentleman in his 70s. Again, I discussed the various management approaches and then gave my opinion on what we should do. In contrast to the other patient, he said, “I want to do whatever you suggest. After all, you’re the doctor.”
As a publisher of a social media health Web site, I’ve observed closely the growth of the patient empowerment movement, facilitated by the Web making health information more accessible. According to the Pew Internet and American Life Project, 80% of Internet users go online to research their health, and this effort gives patients a greater voice in their care. Paternalistic decision making that traditionally drove the doctor-patient relationship slowly is being replaced by shared decisions. But not all patients embrace their new decision-making role.
In a recent study from the Journal of Medical Ethics, researchers interviewed more than 8,000 patients. Almost all wanted doctors to offer choices and help consider their options, but two-thirds preferred that the final medical decision to be left to the physician.
According to Farr A. Curlin, MD, an associate professor of medicine at the University of Chicago and one of the authors of the study, “the data [say] decisively that most patients don’t want to make these decisions on their own.”
There is a spectrum of how much physician involvement patients want. Some may want physicians only to suggest and inform but leave the ultimate decision to them. Others prefer doctors to have the final say.
The only way to know a patient’s preference is through a continuous relationship where that comfort level can be developed over time. After several encounters, a clinician should have a sense of how much, or how little, direction a patient needs.
Sadly, two factors in healthcare today work against such a sustained doctor-patient relationship. One is the fragmentation of medical care. More patients are seeing not only a primary care physician (PCP) in a clinic, but also a hospitalist when admitted to a hospital, along with an array of specialists both in the hospital and the clinic. According to a New England Journal of Medicine study, Medicare beneficiaries saw an average of two primary care physicians and five specialists working in four different practices. Without knowing the patient well, each provider may differ with his or her input in the medical decision process, which can frustrate patients who may have their own ideas of how much their doctors should be involved.
Next, consider the decay of primary care itself. There is a profound shortage of PCPs, with the American College of Physicians noting that “primary care, the backbone of the nation’s healthcare system, is at grave risk of collapse.” Patients who cannot schedule timely primary care appointments go to the emergency department, where they encounter clinicians they’ve never met before. The shortage is compounded by what is shown in the results of an Annals of Internal Medicine survey, which revealed that 30% of PCPs were likely to leave the field, citing burnout from time pressures, a chaotic work pace, and little control over their work. Both the shortage and attrition of primary care providers worsen the odds of forming long-term relationships with patients.
Having known my two patients with hypertension for years, I anticipated how much physician involvement they would need to make a treatment decision and was able to tailor my approach to meet their individual expectations. During this turbulent period of healthcare reform, we cannot lose sight of the importance of a continuous relationship between doctors and patients. Otherwise, our fragmented health system and deterioration of primary care will make it challenging to provide the proper amount of guidance for patient medical decisions.
- The Social Life of Health Information(Pew Internet Report)OVERVIEW
The internet has changed people’s relationships with information. Our data consistently show that doctors, nurses, and other health professionals continue to be the first choice for most people with health concerns, but online resources, including advice from peers, are a significant source of health information in the U.S.
- Predictors of hospitalised patients’ preferences for physician-directed medical decision-making (Journal of Medical Ethics, June 2011)
Background Although medical ethicists and educators emphasise patient-centred decision-making, previous studies suggest that patients often prefer their doctors to make the clinical decisions…Conclusions Almost all patients want doctors to offer them choices and to consider their opinions, but most prefer to leave medical decisions to the doctor. Patients who are male, less educated, more religious and healthier are more likely to want to leave decisions to their doctors, but effects are small.
- Choosing Wisely (an initiative of the ABIM Foundation)
- What Makes Patients Complex? Ask Their Primary Care Physicians (medicalnewstoday.com)
- What makes patients complex? Ask their primary care physicians (medicalxpress.com)
- Letting Doctors Make the Tough Decisions (jflahiff.wordpress)
- What makes patients complex? Ask their primary care physicians (eurekalert.org)
- Make an informed judgment on the abilities of your surgeon (kevinmd.com)
- Let physician assistants be part of the primary care answer (kevinmd.com)
- Patients eager to see doctor’s notes; physicians, not so much (seattletimes.nwsource.com)
- The primary care doc fix is in (kevinmd.com)
- Letting Doctors Make the Tough Decisions (New York Times)
As part of its ongoing efforts to ensure safe, effective and appropriate medical imaging, the American College of Radiology has joined the ABIM Foundation and eight other medical specialty societies in Choosing Wisely. The new campaign promotes wise choices by physicians and patients to improve health outcomes, avoid unnecessary interventions and make efficient use of healthcare dollars.
The ACR will develop a list of five things to reduce unnecessary imaging exams ordered by physicians and improve quality of care. The list names imaging exams whose necessity should be discussed before being ordered. The list also equips providers with steps to help ensure safe, appropriate use of scans.
“Medical imaging exams are a perfect fit for Choosing Wisely. Scans lower healthcare costs by replacing more invasive surgeries and allowing for shorter hospital stays. Although imaging use is down significantly since 2008 and Medicare spending on imaging is the same as in 2004, opportunities remain to ensure appropriate ordering of scans. As greater access to imaging is directly tied to increased life expectancy, ACR will identify areas where care can be improved without restricting patient access,” said John A. Patti, MD, FACR, chair of the ACR Board of Chancellors……
The ACR list, and those of other Choosing Wisely partners, will be released in April 2012. To learn more, visit ChoosingWisely.org.
This series of six video vignettes featuring physicians and patients emerged from research the ABIM Foundation conducted to better understand public and professional attitudes about stewardship of finite resources. Watch the videos.
- ACR in Choosing Wisely campaign to promote wise use of resources among physicians and patients (medicalxpress.com)
In the outpatient setting, between 8% and 26% of abnormal test results, including those suspicious for malignancy, are not followed up in a timely manner.1,2Despite the use of electronic health records (EHRs) to facilitate communication of test results, follow-up remains a significant safety challenge. In an effort to mitigate delays, some systems have adopted a time-delayed direct notification of test results to patients (ie, releasing them after 3 to 7 days to allow physicians to review them).3,4
On September 14, 2011, the Department of Health and Human Services jointly with the Centers for Medicare & Medicaid Services, the Centers for Disease Control and Prevention, and the Office for Civil Rights5 proposed a rule allowing patients to access test results directly from the laboratory by request (paper or electronic). …
- When patients see their medical record (kevinMD.com, January 2012)
“The study found that doctors worried that open visit notes would result in greater confusion and worry among patients and they anticipated more patient questions between visits. But the patients overwhelmingly wanted to see the notes and were not worried about being confused. They thought seeing their own record would provide information that would help them be healthier. They could see the treatment plans and the test results directly.”
Risks and benefits of direct access to lab results (jflahiff.wordpress.com)
- Should Patients Get Direct Access to Their Laboratory Test Results? An Answer With Many Questions (jflahiff.wordpress.com)
- Risks and benefits of direct access to lab results (kevinmd.com)
A 1 1/2 minute cartoon where a nurse slowly convinces a doctor on why the Internet is useful in patient education.
Often it’s easier to just say yes. But there are ways to say no that are better for both physician and patient
Doctors routinely meet with patients who make requests for specific medicines, tests and referrals to specialists. In this era of the Internet, consumer-driven healthcare and direct-to-consumer drug marketing, this is no surprise. And while an informed patient is a good thing, what may surprise you is just how hard it is for doctors to say no when a patient makes a specific request for something he or she doesn’t really need.
Right now, Dr. Conrad Murray sits in jail because he couldn’t say no to Michael Jackson when Propofol came up in conversation between them. But even doctors who aren’t tempted by an enormous monthly retainer and access to one of the world’s biggest celebrities are challenged by the word “no.”
American medicine is a business — but a weird one. In any other sector of our economy, businesses are determined to give their customers what they want, however they want it. But in medicine, the “have it your way” mind-set doesn’t always jive. First, physicians have a duty to avoid doing harm. The choice of a drug or test based solely on a patient’s request can undermine that. Second, as everybody knows, we spend a big slice of our GDP on healthcare. Since the person who has control over expensive tests and the prescription pad is your doctor, there’s ever-increasing scrutiny to be responsible stewards of healthcare dollars….
The lesson here is that it’s best for the doctor and the patient to get everything out in the open, and for a healthcare system that affords the right amount of access and time — especially in primary care — to make that to happen.
- Dr. Conrad Murray Sentenced to Four Years Behind Bars in Death of Michael Jackson (foxnews.com)
- Why doctors need to be better negotiators (kevinmd.com)
1. Mobile health technology will increase patient engagement. Most patients do not take the responsibility they should for their own health. They are likely preoccupied with all the stresses of everyday life and might therefore take the ‘I feel good, so I must be’ approach. They possibly mutter these words after wiping their faces, hurriedly walking out of McDonald’s for lunch. Or is it because of mistrust of their physician who they get to see for a big 15 minutes that the electronic record time slot permits? Or that they are caregivers to others and sacrifice their own well-being for that higher purpose?…
- 10 IT challenges for physician practices in 2012 (listahit.wordpress.com)
- Dermatologists, Medical Oncologists are the Top Physician Specialist Groups Communicating with Patients Online (prweb.com)
by MAGGIE KOZEL, MD at KevinMD.com (November 27, 2011)
Imagine what health care in the United States could look like if we devised a system that was based on sound medical practice and proven cost effectiveness. What if we put our brains, energies and passion behind designing the smartest health care system possible?
That was the question that kept poking through my train of thought as I read a study that appeared in the most recent issue of Pediatrics, the official journal of the American Academy of Pediatrics. Thestudy, out of UCLA, examined the association between length of well-child visits and quality of the visits, including things like developmental screening and anticipatory guidance. No big surprise that the longer the duration of the well child visit, the greater the likelihood that the content of the visit was aligned with recommended practice guidelines from the AAP. The discouraging news however is that one third of visits were reported as being less than 10 minutes in duration; these occurred to a greater degree in private practice. Longer visits of 20 minutes or more made up 20% of the encounters, and were more likely to occur in community health centers.
The big winners in the pinch for time? Guidance on immunizations and breastfeeding were offered in 80% of even the shortest visits. The biggest loser: developmental assessments, which don’t even achieve a mediocre occurrence of 70% until we pass the 20-minute mark for visit duration….
Our fee for service approach to health care dictates that procedures and tests pay well while addressing a child’s emotional problem gets a doctor little more than a backed up waiting room. From the patient’s view, underinsured children have to rely too much on emergency rooms, while insured parents can only get basic child rearing advice from someone with a medical degree. Health insurance companies and the pharmaceutical industry shape medical practice – and our collective health – through their reimbursement policies, marketing and aggressive lobbying. So 25% of US children are on chronic medications, while half the children in pediatric practice are not receiving basic screening and advice. The obsolete business models that the health care industries rely on are like the tyrannosaurus-rex in the room, emphasizing expensive, short term quantity rather than cost-effective long term quality, while cognitive care – a high level of skill and expertise delivered face to face in a personal manner – is what is becoming extinct.
- Maggie Kozel, M.D.: Modern Pediatrics Needs Health Care to Evolve (huffingtonpost.com)
- Why can’t the United States have a smarter health care system? (kevinmd.com)
- The culture of medicine needs to change (jflahiff.wordpress.com)
- Four Major Flaws in Our Healthcare System (triplepundit.com)
- CareSource Teams Up with the Ohio Chapter, American Academy of Pediatrics to Support Asthma Pilot Project (prweb.com)
’ve been involved in clinical medicine for more than 20 years and during this time I’ve come across numerous situations that created stress, or emotional upheaval within myself, and even times of burnout. At one point, I came close to permanently leaving my chosen profession. The culture of medicine is not geared towards allowing health care providers to de-stress, acquire emotional support, or discuss in an encouraging environment various conflictive work scenarios with their colleagues. The end result of this culture of medicine leads providers to either leave their chosen profession, have professional burnout, deal with work conflict and/or become emotionally broken (i.e. having a lack of integrity, honesty, emotional connectedness with others, etc.)
An example of medicine’s culture which needs to be changed and causes conflict is one of its many unwritten rules of professional conduct. It states that the hospital attending is the only one who is supposed to go in and tell a patient their medical diagnosis and treatment. Anyone else on the medical team is just supposed to pretend as though they don’t know anything until after the attending has discussed the diagnosis with the patient. Usually this works out, but it can also lead to a breakdown in patient’s trusting their providers and/or asking team members to lie to patients until the attending has this discussion. This can lead to dishonesty and a lack of integrity on the part of the providers…..
- The culture of medicine needs to change (kevinmd.com)
- Short waits, long consults keep most patients very happy with their physicians (Eureka news alert)
- Intuition saved this patient from a potentially fatal diagnosis (kevinmd.com)
- 6 reasons why doctors won’t call patients (with possible solutions) (jflahiff.wordpress.com)
- Patients have a part to play in their own medical care (kevinmd.com)
by GABRIEL H. TENINBAUM in the 20 November edition of KevidMD.com
To deal with the aftermath of medical errors, an increasing number of providers are encouraging injured patients to participate in “medical apology programs.” The idea, proponents say, is for patients to meet with facility representatives to learn what happened and why. It gives the patient a chance to ask questions and it gives providers a chance to apologize, and as appropriate, offer compensation. These programs are promoted as humanitarian, and, at least in terms of providing an emotional outlet for patients, they are.
The evidence also suggests that they are about something else: money. Every aspect of how they operate – from who risk managers involve, to what those involved are told to say – suggests a key goal is to dissuade patients from seeking compensation by creating an emotional connection with them. …
- We’re Only Human, Even Our Doctors and Nurses (hcfama.org)
- Patient Safety Must Be Improved (medicalnewstoday.com)
- In Touch With Patients (1 Letter) (nytimes.com)
- Medical Error Prompts Doctor to Push for Safety Measures (prweb.com)
- Health IT May Be Cause Of Patient Errors (baravaida.wordpress.com)
- How much physician guidance do patients want with medical decisions? (kevinmd.com)
From the 18th November posting by DOMINIC A. CARONE, PHDat KevinMD.com
- Useful tips when looking for a new doctor (kevinmd.com)
- Beware Picking Your Dentist (evelyngarone.wordpress.com)
- The impact of unnecessary testing and treatment on patients (jflahiff.wordpress.com)
The art of medicine, the most important part of medicine, involves several components:
- Caring for patients, showing honest concern and compassion
- Giving patient’s time, not rushing in and out of the exam clinic room, being patient with them, having a great bedside manner
- Using the evidence based medicine algorithms as a guideline, as we apply them to each and every patient we see. Understanding that every patient is an individual who has individual circumstances that affect their lives
- Helping every patient to acquire the best outcome they can for themselves by working with them, educating them, coming up with a mutually agreed upon plan of action
Evidence based medicine does not teach us how to apply them to the patients we see, only the art of medicine does that. [Flahiff's emphasis] Much unlike evidence based medicine we don’t learn the art of medicine in a classroom. We learn the art of medicine by seeing patients, one by one, year after year. As new research comes out and the evidence based medicine algorithms change, hopefully we have refined our art of medicine skills to such a fine point that we have attained the stature of a wise mentor….
- Evidence based medicine removes a physician’s autonomy (kevinmd.com)
- Compassionate care is a crucial component of care (kevinmd.com)
- Using Social Media For Practicing Evidence Based Medicine (drneel.wordpress.com)
- Substitutes for evidence based (and science based) medicine (doctorrw.blogspot.com)
- 5 tips to evaluate medical websites (kevinmd.com)
Dr. Mohammodieza Hojat and a multidisciplinary team at Jefferson Medical College in Philadelphia have previously published 5 articles validating an objective and reproducible measure of empathy exhibited by physicians in the context of medical education and patient care. They hypothesized that a physician’s empathy would positively effect clinical outcome, not just patient satisfaction.
To test their theory, they chose patients with diabetes, a chronic disease that requires frequent engagement between patient and doctor, much patient education and communication as well as strict compliance to designated treatment protocols. Moreover, there are definable and easily measurable indicators of improved clinical outcomes. Appropriate statistical controls were used to separate the effect of empathy from other know determinants of outcome such as gender, age and socioeconomic status.
They followed 891 diabetic patients for 3 years and conclusively showed that physicians’ empathy itself resulted in a 40-50% improvement in the measured results. Finally, in their concluding remarks, the researchers acknowledged any limitations to their methodology, but stated that their results do provide sufficient evidence warranting replication of this line of investigation at other institutions and with a variety of diseases….
- Doctors can learn empathy through a computer-based tutorial (eurekalert.org)
- Is medical school an empathotoxin? (mindhacks.com)
- We need to talk about Kevin’s lack of empathy (guardian.co.uk)
- ¿Do you have empathy? (vae20.wordpress.com)
(CNN) – As much as she would like to, Dr. Lissa Rankin, a gynecologist, will never forget the woman who planned her wedding while lying naked on her examining table.
“Every 15 seconds, her cell phone was going off, and she was answering it!” Rankin recalls. “It was like, ‘That’s not the cake I ordered,’ and, ‘No, it’s the other gown,’ and I said to her, ‘Is this a bad time? Should I come back later?’ “
From the Hospitals and Health Networks summary (at http://www.hhnmag.com)
House calls have arrived
Sue Paone, Executive IT Director at University of Pittsburgh Medical Center, talks to H&HN senior editor Suzanna Hoppszallern about UPMC’s use of e-visits, which patients use to connect with physicians online on more than 20 conditions and earned UPMC a 2011 Most Wired Innovator Award. Video running time: 4:47.
- Doctors Screen for Cervical Cancer Too Often (nlm.nih.gov)
- Why is it so difficult for doctors to stay on time? (kevinmd.com)
- iPads used for diagnosis and treatment in Texas hospital (tuaw.com)
- The value of time in medicine (medrants.com)
Patients want to know why they can’t get a return call from their doctor’s office – here are six reasons why the calls have increased and physician offices are having trouble meeting the needs of their patients.
- Medication questions and requests for a prescriptions change. The average number of retail prescriptions per capita increased from 10.1 in 1999 to 12.6 in 2009. (Kaiser Family Foundation calculations using data from IMS Health, http://www.imshealth.com.) Because it is not easy to access prescription cost by payer in the exam room, medical practices get lots of callbacks from patients asking to change their prescriptions once they arrive at the pharmacy and find out how much the prescription costs. Related issue: Many national-chain pharmacies have electronic systems that automatically request a new prescription when the patient is out of refills. Also related: Patients calling to ask for additional medication samples.
- Patients are delaying coming to the physician’s office by calling the practice with questions. Patients want to forestall paying their co-pay or their high-deductible by getting their care questions answered without coming to the doctor’s office.
- Patients call back with questions about what they heard or didn’t hear in the exam room.They may not remember what the physician told them, they may not have understood the medical jargon, or they may have a hearing problem and were not comfortable asking the physician to repeat something….
- Implications of a Technology-Based Medical Encounter (medicineandtechnology.com)
- How to Save on Prescription Drug Costs (savings.com)
- Medication Dispensing is Now Available to Patients Before They Leave the Office (prweb.com)
- Medical Docotors Will Issue You A Prescription With No Prescription Ahead Of Time (bigsexymedia.com)
- Pharmacists’ role could expand (cbc.ca)
- Doctors’ use of e-prescriptions soars (seattletimes.nwsource.com)
There are multiple costs to non-compliance, including financial, both personal and societal, and physical-emotional. When patients fail to comply with treatment protocols, fail to get prescribed tests, or fail to stop destructive behaviors, there is a societal cost.
Today, I want to address the physical and emotional costs of non-compliance. I just read a brilliant article by Roxanne Sukol, MD. Dr. Sukol’s article discussed the fact that diabetes starts 10 years prior to your doctor making a diagnosis and, if addressed early, often can be avoided. In her article, Dr. Sukol states, “I like my patient vertical. Not horizontal.” Most doctors have favorite sayings. My favorite is, “May you be so blessed as to never know what disease you prevented.” I’ll add Dr. Sukol’s to my favorite list.
Another one of my favorite sayings is “There is no such thing as pre-diabetes. Pre-diabetes is like being pre-pregnant.” …
(readers responses here, along with responses to other cases)
When patients develop this trust, they are more likely to comply with doctors recommendations and therefore get better care. If you passively take in what the doctor tells you, you’re not involved and less likely to be on-board with your treatment and less likely to follow her instructions. So, it was not surprising how doctors responded to a survey from Consumers Report, and reported in the Washington Post, about their professional challenges and about what patients could do to get the most out of their “relationship” with their doctors….
- What this doctor learned when he was a patient (kevinmd.com)
- Measuring physician trust in patients (kevinmd.com)
- Is it okay to have two family doctors? (theglobeandmail.com)
I interviewed about 150 medical leaders just a few years ago for my book The Future of Medicine – Megatrends in Healthcare. Not one mentioned wireless devices as a coming megatrend. How fast the world changes! Nowadays everyone has a cell phone and we rarely stop to think that just two decades ago almost no one had them. We have a laptop or tablet computer that can access information from the web at very high rates of speed; again it is hard to remember when this wasn’t so. And those with smart phones have numerous “apps” – to check traffic conditions, find the nearest Starbucks, or play games. But these and other devices that use wireless technology will lead to major changes in the delivery of health care in the coming years. This is another of those coming medical megatrends.
Read the rest of Wireless devices will dramatically change how medicine is practiced on KevinMD.com.
- Unintended consequences of patient portals (kevinmd.com)
- Invasion of the Body Hackers? Wireless Medical Devices Susceptible to Attacks (tjantunen.com)
- Mobile Security Requires More Than Secure Wireless Devices (aviatnetworks.com)
The US Agency for Healthcare Research and Quality is working to empower us through an ad campaign and online materials.
The Questions are the Answers campaign also features these Web pages
- Reducing Medical Mistakes with questions to ask your health care provider, how to prevent medical errors, and more
- Talking with Your Clinician with tips on how to give and get information, get quality care and more
- Planning for Surgery with questions to ask and tips
- Getting a Prescription with tips on keeping track of meds, how to take medicine safely, and more
- Links to Additional Patient Safety Resources
- Your Health Priorities Tool (AHRQ) (jflahiff.wordpress.com)
- I’m happy that patients use the internet (ScienceRoll)
- IOM Report: Government Should Consider Public Health Implications Of All Major Legislation (jflahiff.wordpress.com)
- Question Authority (centerforhealthmediapolicy.com)
If you don’t share details about your life and what is important to you, you may not get the treatment that is best for you. Think about it this way: If you are a student who lives near a bus stop, you might be able to take a medicine that makes you a little sleepy because you do not need to drive. But if you are a truck driver, that medicine might make you too sleepy to do your job. Sharing details about your daily life and what’s important to you can help your doctor recommend a treatment that helps you get better and improves your quality of life.
Answer the questions below to get your own health priorities snapshot to share with your doctor.
Visit the Full Effective Health Care Program here
This program includes
- Guides for Patients and Consumers (as research reviews and research reports)
- Explanation of Comparative Effectiveness Research
- Personalization and Social Media Tools to be used with the Effective Health Care Program
(Mobile device option, email lists, Facebook, Twitter, and more)
Recently, we expressed concern about the effects on the accuracy of the diagnostic process of the increasing numbers of well and worried well entering the medical care system.
One of the consequences of this influx of well people (and the concomitant reduction in disease prevalence) is the generation of more false positive test results and false diagnoses of nonexistent diseases.
The medical literature is filled with studies on the accuracy of specific disease diagnoses but the focus has been exclusively on missed diagnoses. These studies have often used autopsy data to discover how many patients died with specific diseases overlooked in life.
While missed diagnoses certainly deserve our attention, the opposite error has been almost completely ignored: How many patients with specific diagnoses of disease do not have the named disease? How prevalent are false diagnoses of disease? And which ones?
We are puzzled that these questions are not only unanswered but seem ignored in the literature.
- The Wrong Results (everydayhealth.com)
All over the world, patients with chronic pain struggle to express how they feel to the doctors and health-care providers who are trying to understand and treat them.
Now, a University at Buffalo psychiatrist is attempting to help patients suffering from chronic pain and their doctors by drawing on ontology, the branch of philosophy concerned with the nature of being or existence.
The research will be discussed during a tutorial he will give at the International Conference on Biomedical Ontology, sponsored by UB, that will be held in Buffalo July 26-30.
“Pain research is very difficult because nothing allows the physician to see the patient’s pain directly,” says Werner Ceusters, MD, professor of psychiatry in UB’s School of Medicine and Biomedical Sciences, and principal investigator on a new National Institutes of Health grant, An Ontology for Pain and Related Disability, Mental Health and Quality of Life.
“The patient has to describe what he or she is feeling.”
- What Doctors don’t know about pain (thehandiestone.typepad.com)
- Well: Giving Chronic Pain a Medical Platform of Its Own (well.blogs.nytimes.com)
The emerging literature on chronic disease management suggests that successful programs rely on patient self management skills. Having been in the primary care role for 20 years, that initially seemed self evident and a bit “so what?” to me, thinking it meant that we just need to teach our patients a bit more in the primary care office.
However self-management skills refer to specific curricula of skills that can be taught to patients in formal programs, without doctors. Coordinating these activities with what goes on a primary care office, and the community, and other care-giving settings is critical. These specific skills involve patients setting their own goals, and then creating plans to reach those goals with the assistance of their primary care team and others, but not at the direction of their primary care team. This is a real mind shift for the primary care doctor also.
- The benefits of successful patient self-management programs (kevinmd.com)
- Summary Box: Trying a new approach to primary care (seattletimes.nwsource.com)
- New Brief Outlines Strategies to Put Patients at the Center of Primary Care (jflahiff.wordpress.com)
Antibiotic overuse and resistance have emerged as major threats during the past two decades. Following an outbreak of Clostridium difficile infections, which often result from antibiotic use, health care professionals in Quebec, Canada targeted physicians and pharmacists with an education campaign that reduced outpatient antibiotic use, according to a study published in Clinical Infectious Diseases and now available online.
The Quebec Minister of Health and the Quebec Medication Council collaborated with designated physicians and pharmacists to develop guidelines to improve prescribing practices. First issued in January 2005, the guidelines emphasized proper antibiotic use, including not prescribing antibiotics when viral infections were suspected and selecting the shortest possible duration of treatment. Approximately 30,000 printed copies of the original recommendations were distributed to all physicians and pharmacists in Quebec. An additional 193,500 copies were downloaded from the Medication Council’s website.
(The current versions of the guidelines are available online: http://www.cdm.gouv.qc.ca/site/aid=166.phtml.)
During the year after the guidelines were initially distributed, the number of outpatient antibiotic prescriptions in Quebec decreased 4.2 percent. In other Canadian provinces, the number of these prescriptions increased 6.5 percent during the same period.
According to study author Karl Weiss, MD, of the University of Montreal, “It is possible to decrease antibiotic consumption when physicians, pharmacists, state governments, etc., are working together for a common goal. This is the key to success: having everybody involved and speaking with a common voice.”
Dr. Weiss added, “Simple, short, easy-to-use guidelines have an impact on physicians when they are readily available. The web is an increasingly important tool to reach our audience and should now be used as such in the future. With handheld electronic devices available for all health care professionals, these downloadable guidelines can be accessed and used at any time and any circumstance.”
- Superbug gonorrhoea found in Japan (newscientist.com)
- Drug-resistant STD prompts global warning (independent.co.uk)
- (Reuters) – Scientists have found a “superbug” strain of gonorrhea in Japan that is resistant to all recommended antibiotics and say it could transform a once easily treatable infection into a global public health threat. (theboldcorsicanflame.wordpress.com)
WEDNESDAY, July 20 (HealthDay News) — The behavior of surgeons in the operating room affects more than their patients’ health, new research indicates.
It also plays a part in determining health-care costs, the number of medical errors and patient satisfaction, according to a commentary in the July issue of The Archives of Surgery. Surgeons who are civil, the report claimed, can more effectively help their patients and reduce costs…
- Polite doctors ‘make for healthier patients’ (telegraph.co.uk)
- Fewer Surgical Errors Reported at VA Medical Facilities (nlm.nih.gov)
- Medical Errors Down at U.S. Veterans’ Hospitals (nlm.nih.gov)
From the press release
AHRQ has released a new brief, The Patient-Centered Medical Home: Strategies to Put Patients at the Center of Primary Care, highlighting opportunities to improve patient engagement in primary care. The brief focuses on involvement at three levels: the engagement of patients and families in their own care, in quality improvement activities in the primary care practice, and in the development and implementation of policy and research related to the patient-centered medical home (PCMH). Strategies to Put Patients at the Center of Primary Care provides a clear and concise definition of the patient-centered medical home and outlines six strategies that can be used to support primary care practices in their efforts to engage patients and families. This brief and other resources, including white papers and a searchable database of PCMH-related articles, is available from AHRQ’s online PCMH Resource Center at PCMH_Patients at the Center of Primary Care (PDF File, PDF Help).
- Health-care model improves diabetes outcomes, health (eurekalert.org)
- More On The Synergies Between the Patient Centered Medical Home (PCMH) and Remote Telephonic Disease Management (diseasemanagementcareblog.blogspot.com)
The US Agency for Healthcare Research and Qualtiy (AHRQ) publishes a wealth of information for consumers and patients on staying healthy, choosing medical care, understanding diseases and conditions, and comparing medical treatments.
For example, Explore Your Treatment Options gives sound advice on
- Why one should explore treatment options
- Tips on how to start the conversation about treatment options with doctors
- Rating health priorities through a check list type tool. The questions ask you to rate ease of every day activities, concerns about treatment side effects, and basic questions about treatment time, cost, and effort. Results may be printed to share with your doctor.
- Links to Treatment Guides (cancer, diabetes, heart conditions, and more)
Ever since the Institute of Medicine issued its landmark report “To Err Is Human” in 1999, significant attention has been paid to improving patient safety in hospitals nationwide.
However, a high number of adverse events, including major injury and even death, occur in private physician offices and outpatient clinics as well. In a new study — the first of its kind — researchers at Weill Cornell Medical College found that the number and magnitude of events resulting from medical errors is surprisingly similar inside and outside hospital walls.
Published in today’s Journal of the American Medical Association (JAMA), the study ***uses malpractice claims data to assess the prevalence of adverse events in the outpatient setting. The researchers compared malpractice claims paid on behalf of physicians in hospitals versus doctors’ offices, relying on data from the National Practitioner Data Bank from 2005 through 2009.
In 2009 alone, close to 11,000 malpractice payments were made on behalf of physicians. Analysis of the data showed that about half of these were for errors that occurred in the hospital setting and half for adverse outcomes resulting from errors at the doctor’s office.
The researchers also found that adverse events in hospitals largely have to do with unsuccessful surgery, while negative outcomes in the outpatient setting are most often related to errors in diagnosis.
(Garrison, NY) In a feature article in The New Republic,(subscription only, check your local public library for availability) Daniel Callahan and Sherwin Nuland propose a radical reinvention of the American medical system requiring new ways of thinking about living, aging, and dying. They argue that a sustainable—and more humane— medical system in the U.S. will have to reprioritize to emphasize public health and prevention for the young, and care not cure for the elderly.
An interesting twist on their argument, which would aim to bring everyone’s life expectancy up to an average age of 80 years but give highest priority for medical treatment to those under 80, is that Callahan and Nuland are themselves 80 years old. Daniel Callahan, Ph.D., is cofounder and president emeritus of The Hastings Center and author most recently of Taming the Beloved Beast: How Medical Technology Costs Are Destroying Our Health Care System. Sherwin Nuland, M.D., is a retired Clinical Professor of Surgery at the Yale School of Medicine and author of How We Die and the Art of Aging. He is also a Hastings Center Fellow and Board member.
“The real problem is that we have medicine excessively driven by progress, which aims to rid us of death and disease and treats them as the targets of unlimited medical warfare,” said Callahan and Nuland. “That warfare, however, has come to look like the trench warfare of World War I: great human and economic cost for little progress. Neither infectious disease nor the chronic diseases of an aging society will soon be cured. Cancer, heart disease, stroke, and Alzheimer’s disease are our fate for the foreseeable future. Medicine and the public must adapt it to that reality, one that has mainly brought us lives that end poorly and expensively in old age.”
The article notes that the Affordable Care Act might ease the financial burden of this system, but not eliminate it. It reports, for example, that the cost of Alzheimer’s disease is projected to rise from $91 billion in 2005 to $189 billion in 2015, and to $1 trillion in 2025 – twice the cost of Medicare expenditures for all diseases now.
“We need to change our priorities for the elderly. Death is not the only bad thing that can happen to an elderly person,” the authors write. “An old age marked by disability, economic insecurity, and social isolation are also great evils.” They endorse a culture of care, not cure, for the elderly, with a stronger Social Security program and a Medicare program weighted toward primary care that supports preventative measures and independent living.
Callahan and Nuland point the way to a more sustainable path that reprioritizes the entire system. Among their recommendations:
- improve medicine at the level of public health and primary care, while reducing its use for expensive high-tech end-of-life care;
- shift resources for the elderly to greater economic and social security and away from more medical care;
- subsidize the education of physicians, particularly those who go into primary care, and decrease medical subspecialization;
- train physicians better to tell the truth to patients about the way excessively aggressive medicine can increase the likelihood of a poor death;
- shift the emphasis in chronic disease to care rather than cure;
- conduct a top-down, bottom-up, long-range study of the entire American system of health care, including the training of physicians, with a view toward reconstituting it along systematic lines that take science, humanistic concerns, economics, and social issues into account.
- Andrew Reinbach: Health Care Could Kill Us: We Don’t Have to Let It (huffingtonpost.com)
- New at Reason: Ronald Bailey on Health Care Reform (reason.com)
Studies Evaluate Criteria For Detecting Potentially Inappropriate Medications In Older Hospitalized Patients
Using the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) criteria was associated with identification of adverse drug events in older patients, according to a report in the June issue of Archives of Internal Medicine, one of the JAMA/Archives journals. The article is part of the journal’s Less Is More series.
According to information in the article, adverse drug events (ADEs) are a significant issue in the older population, and are thought to represent an important cause of hospitalization and account for substantial health care expenditures. Some ADEs are associated with potentially inappropriate medications (PIMs): agents that may cause problems in older patients “because of the higher risk of intolerance related to adverse pharmacodynamics or pharmacokinetics or drug-disease interactions.” During the last two decades, the Beers criteria for judging whether a medication is appropriate for use in an older patient have become the leading standard. Nevertheless, the authors write, research into whether the Beers criteria are associated with avoidable ADEs has not generated consistent results….
…According to the authors, the results suggest that STOPP criteria were more likely than Beers criteria to reveal ADEs in general, avoidable or potentially avoidable ADEs, and ADEs that may have factored into the patient’s hospitalization. “We believe that this finding strengthens the argument for the use of STOPP criteria in everyday clinical practice as a means of reducing the risk of ADEs in older patient,” they write. …
shift toward more conservative medication-prescribing practices would serve patients better, according to a review article published Online First today by Archives of Internal Medicine, one of the JAMA/Archives journals***. The article is part of the journal’s Less Is More series.
As background, the article notes that the majority of patients under age 65 years receive at least one prescription drug annually. However, according to the authors, not every patient visit needs to result in a prescription. They point to “the recent spate of revelations of undisclosed and unexpected adverse effects of drugs in multiple therapeutic categories” as just one reason to take a more measured approach to medication usage…
…Among the steps they recommend for conservative prescribing:
- Think beyond drugs. Would other interventions help? Would a medication simply mask symptoms without treating the problem? Can a condition be prevented instead of treated? Would waiting to see if the symptoms self-resolve be wise?
- Practice more strategic prescribing. Do you have a solid understanding of medication choices? Is there a valid reason to switch to a new drug? Is it the right drug for your patient? Can you avoid using multiple medications?
- Maintain heightened vigilance regarding adverse effects. Do you check with patients about potential drug reactions? Do you teach them the warning signs? Are the drugs you’re choosing prone to withdrawal symptoms or relapse?
- Approach new drugs and new indications cautiously and skeptically. Where do you get your information about new treatments? Can you wait until a new drug has had a longer track record? Does the drug actually help resolve the core problem? Is it actually indicated for this problem? Does it deliver what it promises? Do studies tell the whole story on a drug?
- Work with patients for a more deliberative shared agenda. Can you persuade patients not to demand drugs they have seen or heard advertised? Is a patient’s noncompliance with therapy the source of the problem? Has the patient already tried this drug without success? Can you encourage healthy skepticism in your patients?
- Consider longer-term, broader effects. Would a different therapy be less likely to cause future harm? Can you find a way to make the prescribing system better?
Harmful effects of medication bring an estimated 4.5 million patients to doctors’ offices and emergency rooms yearly, according to a new study, and people who take multiple medications are particularly vulnerable to unpleasant or dangerous side effects, allergic reactions and toxicity.
Such medication mishaps are a widely recognized problem in health care, but until now, most research has focused on their incidence in the hospital.
“The outpatient setting is where 80 percent of medical care takes place-where we would expect the real burden of the problem to be,” said Urmimala Sarkar, M.D., lead study author, at the University of California, San Francisco.
Analyzing data from 2005 to 2007 from the National Center for Health Statistics, the researchers found that 13.5 million outpatient visits during this three-year period had links to negative effects from prescription medications, in the study appearing online in the journal Health Services Research. …
…While some unwanted effects are inevitable with drug treatment, “many are preventable,” Sarkar said. To reduce their incidence, she said, “medical counseling in doctors’ offices and pharmacies has to be better. Patients need to know what medications they’re on and their possible side effects, and to understand what they’re allergic to.”
Steps to alleviate drug-related problems ultimately should include changes in the health care system, such as coordinated electronic medical records to facilitate information sharing between clinicians, Sarkar said.
Sarkar U, et al. Adverse drug events in U.S. adult ambulatory medical care. Health Services Research online, 2011.
- Prevent Medical Errors With Health Records (everydayhealth.com)
- What Is a Drug Allergy? (everydayhealth.com)
ScienceDaily (Apr. 11, 2011) — The act of making a recommendation appears to change the way physicians think regarding medical choices, and they often make different choices for themselves than what they recommend to patients, according to a survey study published in the April 11 issue of Archives of Internal Medicine, one of the JAMA/Archives journals…
[For suggestions on how to get this article for free or at low cost, click here]
..”In conclusion, when physicians make treatment recommendations, they think differently than when making decisions for themselves,” the authors conclude. “In some circumstances, making recommendations could reduce the quality of medical decisions. In at least some circumstances, however, such as when emotions interfere with optimal decision making, this change in thinking could lead to more optimal decisions. In debating when it is appropriate for physicians to make treatment recommendations to their patients, we must now recognize that the very act of making a recommendation changes the way physicians weigh medical alternatives.”
By Cole Petrochko, Staff Writer, MedPage Today
***Off-label use: In the United States, the regulations of the Food and Drug Administration (FDA) permit physicians to prescribe approved medications for other than their intended indications. This practice is known as off-label use [MedicineNet.com definition]
- Top Three Off-Label Marketing Strategies and Tactics (goodpromotionalpractices.com)
- Off-label marketing of medicines in the US is rife but difficult to control (eurekalert.org)
- More on Off-Label Promotion and the False Claims Act (druganddevicelaw.blogspot.com)
- A Godzilla Of A New Third Party Payer Dismissal (druganddevicelaw.blogspot.com)
- Off-label marketing of medicines in the US is rife but difficult to control (physorg.com)