[Article] BBC News – Do doctors understand test results?

BBC News – Do doctors understand test results?.

From the 6 July 2014 article

By William KremerBBC World Service

Continue reading the main story

Are doctors confused by statistics? A new book by one prominent statistician says they are – and that this makes it hard for patients to make informed decisions about treatment.

In 1992, shortly after Gerd Gigerenzer moved to Chicago, he took his six-year-old daughter to the dentist. She didn’t have toothache, but he thought it was about time she got acquainted with the routine of sitting in the big reclining chair and being prodded with pointy objects.

The clinic had other ideas. “The dentist wanted to X-ray her,” Gigerenzer recalls. “I told first the nurse, and then him, that she had no pains and I wanted him to do a clinical examination, not an X-ray.”

These words went down as well as a gulp of dental mouthwash. The dentist argued that he might miss something if he didn’t perform an X-ray, and Gigerenzer would be responsible.

But the advice of the US Food and Drug Administration is not to use X-rays to screen for problems before a regular examination. Gigerenzer asked him: “Could you please tell me what’s known about the potential harms of dental X-rays for children? For instance, thyroid and brain cancer? Or give me a reference so I can check the evidence?”

Gerd Gigerenzer

The dentist stared at him blankly……

 

Related articles

• Do doctors understand test results?
• Are Doctors confused by Statistics? Do Doctors understand Test Results?
• Gerd Gigerenzer’s heuristic on medical advice

How algorithm driven medicine can affect patient care

How algorithm driven medicine can affect patient care

From the KevinMD article of  Mon Jan 30, 2012

 

Whenever someone is scheduled for an operation, the assigned nurse is required to fill out a “pre-op checklist” to ensure that all safety and quality metrics are being adhered to. Before the patient is allowed to be wheeled into the OR we make sure the surgical site is marked, the consents are signed, all necessary equipment is available, etc. One of the most important metrics involves the peri-operative administration of IV antibiotics. SCIP guidelines mandate that the prophylactic antibiotic is given within an hour of incision time to optimize outcomes. This has been drilled into the heads of physicians, health care providers, and ancillary staff to such an extent that it occasionally causes total brain shutdown.

Let me explain. For most elective surgeries I give a single dose of antibiotics just before I cut. For elective colon surgery, the antibiotics are continued for 24 hours post-op. This is accepted standard of care. You don’t want to give antibiotics inappropriately or continue them indefinitely.

But what about a patient with gangrenous cholecystitis or acute appendicitis? What if, in my clinical judgment, I want to start the patient on antibiotics right away (i.e. several hours before anticipated incision time) and then continue them for greater than 24 hours post-op, depending on what the clinical status warrants? I should be able to do that right?

Well, you’d be surprised. You see, at two different, unaffiliated hospitals I cover, the surgeons have seen that decision-making capability removed from their power….

Doctor Rating Web Site Health Grades is a Time Magazine “Best 50” – How Trustworthy Is the Content??

HealthGrades has been rating doctors, dentists, and hospitals on five star scales for over ten years. Ratings include communication skills, time spent, trust, and office environment. There are also links to board sanctions.

This past August Time Magazine rated Health Grades as one of the 50 best Websites of 2011.

Recently there was a lively discussion on this topic at the medical librarian listserv (Medlib-L).
Among the responses…

• Two people noted contact information for their doctors was not correct
• “The self selection process creates a huge bias. The people who are angry and disappointed are the ones motivated to write.”
• “patient rating is 4.5 stars out of 5, but he’s only had 4 patients comment on him. In skimming through other doctors in Fargo, very few have more than 4 patient comments and everyone has between 4 and 5 stars.”
• “My doctor is in private solo practice and when you look at the lists by highlighted or popularity they are very institutionally presented. The independents come at the end of the list so this is not a fair representation”
• “the physician she replaced upon his retirement in April 2008 is still listed (with one review), although he has been gone for almost 4 years”

Although these comments do not compromise an in depth critique of Health Grades they do raise questions about its currency, contact information correctness, and basis of comparison (basically unsolicited input from patients). It would be wise to use Health Grades in conjunction with other sources of information to make good decisions on choosing or evaluating a doctor, dentist, or hospital.

Some additional sources of information

• Leapfrog Group Hospital Quality and Safety Survey  compares” hospitals’ performance on the national standards of safety, quality, and efficiency that are most relevant to consumers and purchasers of care”
• The CAHPS Hospital Survey  -Centers for Medicare & Medicaid Services, programs and information.
• Hospital Compare – A quality tool provided by Medicare
• Comparing Health Care Quality: A National Directory (Robert J. Woods Foundation) -Web-based resources to help them choose a doctor or hospital in their town based on whether patients received recommended tests and treatment, the outcomes of their care, their experience with providers, or the overall cost of care. Not comprehensive, geared mostly to large urban areas.
• Choosing a Doctor or Health Care Service (Medline Plus) includes numerous resources on  how to find a specific doctor and general guidelines
• State Medical Boards usually provide only the basics: contact information, specialties if any, and any formal actions

Related articles

• Patients’ Grades to Affect Hospitals’ Medicare Reimbursements (nytimes.com)
• Medicare launches ‘hospital compare’ (seattletimes.nwsource.com)
• Isn’t it time for a patient rating system for doctors? (kevinmd.com)
• HealthGrades to Merge with CPM Marketing – Will Their Data and Questionable Algorithms Will Be Improved For Consumers? (ducknetweb.blogspot.com)
• Social Media Physician Referrals – Whichdoc Recommends Doctors Using Facebook (TrendHunter.com) (trendhunter.com)
• Limits to the Active Health Care Consumer (josephineensign.wordpress.com)

The day our hospital lost its heart (value of “tea time” among health care professionals)

by DR. MARTIN YOUNG  in an article at KevinMD.com, where he recalls 10:00 am teatime at his hospital. Doctors , medstudents, and others would gather to discuss, mentor, and informally teach and learn…http://www.kevinmd.com/blog/2011/12/day-hospital-lost-heart.html

From the article

In about 1985, as I remember it, my training hospital underwent a pivotal change. In Cape Town, at the southern tip of Africa, Groote Schuur Hospital was world famous for being the place where in 1967 an arrogant, brash and brilliant surgeon by the name of Christiaan Barnard stunned the world by performing the world’s first heart transplant. Nearly twenty years later, Groote Schuur (Dutch for “Big Barn”) still retained the same aura of celebrity. As a medical student I walked the wards where history had and was being made. Members of the surgical team from that historic event were still to be seen on ward rounds, in the ICU’s, in the operating rooms, and in the communal tearoom. Even Barnard, although no longer operating, maintained a presence – although he missed every lecture scheduled with my class without apology.

 

The tearoom was in the heart of the hospital, close to all wards, departments and lecture rooms. It was bright and roomy, with faded but comfortable lounge chairs and large wooden tables. And at 10am every day tea and coffee was served without charge in huge pots and white cups to every doctor and medical student who wanted it.
Barnard aside, professors and specialists from all departments would sit in the tea room alongside junior medical students, continue case discussions, answer questions, greet colleagues, accept referrals, or debate completely non-medical issues….

How Social Media Has Changed a Doctor’s Practice

Last summer, I joined millions of others in the deluge of social media. I committed one year of effort to see if social would enhance or distract from my pediatric practice.

That was my goal, just one year.

At that time, I wanted to dip my foot in the pool, and see if it made any ripples. The unexpected consequence was how much social media has changed my medical practice, and me. Ripples have returned as tidal waves.

My practice has seen tangible, real valuable benefits. I have been intellectually challenged, and have professionally grown.
Read the rest of How social media has changed my medical practice on KevinMD.com.

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State Medical Boards Fail to Discipline Doctors with Hospital Actions Against Them

State Medical Boards Fail to Discipline Doctors with Hospital Actions Against Them

March 15, 2011 19:18

Source: Public Citizen

From the press release:

State medical boards have failed to discipline 55 percent of the nation’s doctors who either lost their clinical privileges or had them restricted by the hospitals where they worked, a new Public Citizen analysis of data from the National Practitioner Data Bank (NPDB) shows.Of 10,672 physicians listed in the NPDB for having clinical privileges revoked or restricted by hospitals, just 45 percent of them also had one or more licensing actions taken against them by state medical boards. That means 55 percent of them – 5,887 doctors – escaped any licensing action by the state. The study examined the NPDB’s Public Use File from its inception in 1990 to 2009.

“One of two things is happening, and either is alarming,” said Dr. Sidney Wolfe, director of Public Citizen’s Health Research Group and overseer of the study. “Either state medical boards are receiving this disturbing information from hospitals but not acting upon it, or much less likely, they are not receiving the information at all. Something is broken and needs to be fixed.”

Hospital disciplinary reports are peer-review actions and, as such, are one of the most valuable sources of information for medical board oversight. Subsequent state medical board action against a physician’s license is a crucial next step to protect patients. Boards have the authority to oversee and even limit the practice of a disciplined physician, which not only yields a more complete record for the purpose of patient safety but also serves to inform other state boards and future employers.

 

Related Articles

• University of Wisconsin Health is Investigating Fraudulent Sick Notes Written by Physicians for Protesting Public Employees (flapsblog.com)
• Doctor acquitted of rape gets license back (knoxnews.com)
• How to become a licensed, board certified doctor (kevinmd.com)
• Doctors should ask the people what they want for health care (kevinmd.com)
• Michael Jackson’s doctor could also lose medical license in other states (latimesblogs.latimes.com)

Paid Caregivers Struggle to Follow Doctor’s Orders

Struggling to follow doctor’s orders
Paid caregivers may lack the skills to take on health-related tasks in senior’s homes

From a February 22, 2011 Eureka news alert

CHICAGO — Paid caregivers make it possible for seniors to remain living in their homes. The problem, according to a new Northwestern Medicine study, is that more than one-third of caregivers had difficulty reading and understanding health-related information and directions. Sixty percent made errors when sorting medications into pillboxes.

The study will be published in the Journal of General Internal Medicine. It has been published online.***

In a first-of-its-kind study, nearly 100 paid, non-family caregivers were recruited in the Chicago area and their health literacy levels and the health-related responsibilities were assessed, said Lee Lindquist, M.D., assistant professor of geriatrics at Northwestern University Feinberg School of Medicine and physician at Northwestern Memorial Hospital.

“We found that nearly 86 percent of the caregivers perform health-related tasks,” said Lindquist, lead author of the study. “Most of the caregivers are women, about 50 years old. Many are foreign born or have a limited education. The jobs typically pay just under $9.00 per hour, but nearly one-third of the caregivers earn less than minimum wage.”

Lindquist found that despite pay, country of birth or education level, 60 percent of all the caregivers made errors when doling medication into a pillbox. This is an alarming statistic, because patients who don’t take certain medications as prescribed could end up in the hospital, Lindquist said.

“Many of these caregivers are good people who don’t want to disappoint and don’t want to lose their jobs,” Lindquist said. “So they take on health-related responsibilities, such as giving out medications and accompanying clients to the doctor for appointments. Most physicians and family members do not realize that while the caregiver is nodding and saying ‘yes’, she might not really understand what is being said.”

Right now there isn’t a standard test family members or employment agencies can use to gauge a caregiver’s ability to understand and follow health-related information, Lindquist said.

“Currently we are developing tests consumers can use to evaluate caregiver skills as well as studying the screening processes caregiver agencies use,” Lindquist said. “But, if you really want to know if the caregiver is doing a good job and is taking care of the health needs of your senior, start by going into the home, observing them doing the tasks, and asking more questions.”

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The title of the study is “Inadequate Health Literacy Among Paid Caregivers of Seniors.”***

For suggestions on how to get this article for free or at low cost click here.

 

 

Related Articles

• Managing Medications: Tips for Family Caregivers (homecareminneapolis.wordpress.com)
• How to Create a Pill Card to Keep Track of Meds

Physicians on Twitter

Physicians on Twitter

From the Dr. Shock MD PhD Blog

In the latest issue of the JAMA the results of a survey is published. The authors did a search on physicians using twitter. They extracted the public profile pages of the physicians using twitter with 500 or more followers between May 1 and May 31, 2010. They analyzed the tweets of these professionals.

Of the 5156 tweets analyzed, 49% (2543) were health or medical related, 21% (1082) were personal communications, 14% (703) were retweets, and 58% (2965) contained links. Seventy-three tweets (1%) recommended a medical product or proprietary service, 634 (12%) were self-promotional, and 31 (1%) were related to medical education.

But what is somewhat worrying were their findings of potential patient privacy violations andconflicts of interest. Thirty-eight tweets (0.7%) represented potential patient privacy violations, of the 27 users responsible for these privacy violations 25 were identifiable by full name on the profile, by photo or link to their personal website. Twelve tweets were about a product they were selling on their Web site or repeatedly promoting specific health products, 10 were statements about treatments not supported by the official guidelines.

Using social media by physicians does broadcast useful medical information, unprofessional content in tweets by physicians is rare.
Chretien KC, Azar J, & Kind T (2011). Physicians on twitter. JAMA : the journal of the American Medical Association, 305 (6), 566-8 PMID: 21304081 ***

*** The abstract of this article may be found here.

For suggestions on how to get the full text of this article (letter to the editor) for free or at low cost, click here

 

 

When Doctors Admit Mistakes, Fewer Malpractice Suits Result, Study Says

Michigan hospital finds an apology, offer of compensation led fewer patients to sue