Unnecessary Tests and Procedures in the Health Care System

The Choosing Wisely article noted “Physicians Say Unnecessary Tests and Procedures Are a Serious Problem, and Feel a Responsibility to Address the Issue.”

“Physicians say unnecessary tests and procedures represent a serious problem in the health care system. A majority of physicians feels a strong responsibility to help their patients avoid unnecessary care.”

“84 percent of physicians are interested in learning more about evidence-based recommendations that address when tests and procedures may be unnecessary. Physicians with exposure to the Choosing Wisely campaign are 17 points more likely to have reduced the number of tests or procedures they have done in the last 12 months. 45 percent of primary care physicians say they have seen or heard about the Choosing Wisely campaign after a description.”

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“Incidentalomas” + – Concerns about Overdiagnosing and Overtreating Cancer

The Wall Street Journal article noted “Removing the word ‘cancer’ from the terminology used for many slow-growing lesions in the breast, prostate, lung, skin and other body areas could ease patients’ fears and reduce the inclination of doctors to treat them aggressively, says a panel of experts advising the National Cancer Institute.”

“…new diagnostic technology is finding ever smaller abnormalities that are unlikely to be lethal, but are being labeled cancer and treated as if they were. The result: billions of dollars in unnecessary surgery, radiation and chemotherapy.”

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“…Medical Trials —Often Fail to Include Older Participants.”

A Boston Globe article noted for older patients the “cardiologist must develop a treatment plan despite little published evidence to guide his clinical decisions.”

“There are almost no data to guide cardiovascular disease management for people who are over 80 and relatively poor data for people over 70… ‘You have smart and caring doctors trying to practice evidence-based medicine, but there is little evidence.’”

“While doctors and policymakers have long recognized that translating drugs from adults to children might not be as easy as halving the dose, and that the toxicities that are common in men might be different than in women, researchers say that the same understanding lags when it comes to older adults.”

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What’s the Difference between Non-profit and For-profit Hospitals?

Almost a dozen not-for-profit hospitals in New Jersey have been bought by for-profit companies. The debate is on n New York and Connecticut where for-profit ownership is basically “prohibited.”

A recent article Ct Mirror article noted “State law makes it difficult, if not impossible, for for-profit hospitals to operate in Connecticut. But Tenet Healthcare, a national, for-profit hospital chain, is in the process of acquiring four Connecticut hospitals. That’s inspired two competing efforts in the legislature. One push is to change state law to make it easier for hospitals to be run by for-profits. The other is to restrict the ability of hospitals to become for-profit.”

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“From the Moment She Was Hospitalized They Never Left Her Side. Or, More Precisely, They Never Left Her by Herself — It Turns out There Is Actually Bit of a Difference between the Two.”

Some interesting advice on “visiting hours”…

The New York Times blog vignette read: “For 15 years Anna was a solitary figure sitting at the far end of our waiting room for her annual checkups, having shaved a half-hour off her workday so she could hustle over before we locked our doors.”

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“Many Medical Ethicists Frown on the Practice of Doctors Accepting Money from Drugmakers – Arguing They Can Develop a Bias toward One Company’s Drug and Fail to Recommend the Best Possible Medications for Patients.”

The Newsday investigation: “Three Long Island doctors selected to lead a committee that recommends the drugs two Suffolk hospitals stock for patients accepted tens of thousands of dollars from pharmaceutical companies while serving on the advisory panel.”

“The doctors — affiliated with John T. Mather Memorial and St. Charles hospitals in Port Jefferson — accepted about $125,000 from drugmakers between 2009 and 2013, company records show.” They… ” received most of the payments for speeches promoting the companies’ drugs…”

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“I’m Here, Doc, to Make Sure I Don’t Have Anything Serious. I’m Not Sure My Regular Doctor Was Listening to Everything I Was Trying to Tell Him.”

The New York Times article included the following vignette:

“According to the nurse’s note, the patient had received a clean bill of health from his regular doctor only a few days before, so I was surprised to see his request for a second opinion. He stared intently at my name badge as I walked into the room, then nodded his head at each syllable of my name as I introduced myself.

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“…Many Decisions about Discussing Errors with Patients … Involve Situations in Which Other Clinicians Were Primarily Responsible for the Error.”

Have you ever wondered what your physician should say to you if a medical error by another physician is identified?

A New England Journal of Medicine article focused on this question.

“Although a consensus has been reached regarding the ethical duty to communicate openly with patients who have been harmed by medical errors physicians struggle to fulfill this responsibility …”

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“The Sudden Termination of a Close Doctor-Patient Relationship Is a Wrenching Scenario …”

A major source of emotional and spiritual suffering among patients who are nearing the end of life is the abandonment they feel when they stop being cared for by a physician to whom they have become attached.

The New York Times article noted “’I can tell you, it happens all the time and it breaks the heart of patients and families and oncologists,’ said Dr. Diane Meier, director of the Center to Advance Palliative Care at Mount Sinai’s Icahn School of Medicine in New York City.”

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With Hospitals: Does A Great Reputation Mean High-Quality Care?

A conundrum: go to your local community hospital or an academic medical center?

An article in Becker’s Hospital Review reported on a study published in Health Affairs which “raised questions about whether hospitals’ reputations match the quality of care they provide. The study examined the differences between high-price and low-price hospitals and found the more costly providers were the clear winners in U.S. News & World Report rankings, which are partly (32.5 percent for the Best Hospitals 2013-14) based on their reputation with specialists. However, low-price hospitals performed better on certain outcomes-based readmissions and patient safety measures, such as postoperative blood clots. If high-price hospitals tend to have better reputations, the study raises the question of whether there’s a disconnect between how hospitals are perceived and how they perform and whether reputation should play a part in lists such as Truven Health Analytics’ 100 Top Hospitals, Becker’s Hospital Review’s “100 Great Hospitals” and U.S. News’ Best Hospitals.”

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