His review gives a strong sense of the professional satisfactions of serving in Federally Qualified Health Centers.
He told ConvergenceRI that “some have to do with the challenges and rewards of practicing medicine cross-culturally.
“Others include the pleasure of interacting with so many wonderful healthcare workers and physicians.”
If they do, of course, it would obviously have huge effects on the healthcare system.
Reports reports that new experimental drugs from Eli Lilly and Co. and Biogen “have shown promise in slowing down the progression of the mind-wasting disease, attracting the attention of investors and patients.
“Those drugs are still very early in their development and could still join the scrap heap. But the field has gained a major understanding of how the brain changes with Alzheimer’s and better insight on how and when to intervene medically.”
The Lilly and Biogen drugs block beta amyloid, a protein that causes toxic brain plaques that are markers of the disease.
“‘This year is different because multiple mechanisms are being explored and there’s a tremendous revival of faith in the anti-amyloid approach,’ said Reisa Sperling, M.D., director of the Center for Alzheimer’s Research at the Harvard Medical School, told Reuters.
An officially estimated 5 million people have the disease in the United States, but some experts think that the real number is considerably higher. The Alzheimer’s Association projects that up 28 million Americans will develop the disease by 2050 and eat up 25 percent of Medicare spending by 2040.
That is, unless effective drugs are found.
So here’s more data for patients to go shopping with.
It found that overall complication rates, based on hospital readmissions within 30 days of the surgery and death during the initial stay, were 2-4 percent during the five-year study period.
Medscape reported that “Remarkably, almost 800 surgeons who performed at least 50 procedures had no complications to their name, proof that their colleagues have room for improvement,” ProPublica said.
The procedures in question are knee and hip replacement, gallbladder removal, prostate removal, prostate resection and three types of spinal fusion — one involving the neck, and two involving the lower back. ProPublica selected these eight procedures because they are typically performed on healthy patients and “are considered relatively low risk.”
MedScape reported that “The database excludes trauma and other high-risk cases more prone to complications as well as procedures performed on patients admitted from a hospital emergency department or some other healthcare facility.”
Some physicians worry that the inability to fully account for individual patient differences in the study could motivate surgeons to turn down complication-prone cases to avoid poorer numbers on Surgeon Scorecard.
MedScape reported that Donald Goldmann, M.D., chief medical and scientific officer at the Institute for Healthcare Improvement, said that Surgeon Scorecard doesn’t go far enough in helping patients choose a surgeon.
‘”This is just about readmissions and deaths,’ said Dr. Goldmann, who is also a clinical professor of pediatrics at Harvard Medical School. ‘”That’s interesting, but that’s not going to drive my decision.”
“If I’m having a prostate procedure, I want to know my risk of winding up impotent, or incontinent. If I have a knee replacement, I want to know what my functional status is likely to be a year from now. That’s what matters to the patient.”
Roy Poses, M.D., writes in his Healthcare Renewal blog about the “Anechoic Effect,” with the example of the American Society of Clinical Oncology (ASCO) fearing to offend Big Pharm and complain about its very high prices and other rapacious practices.
Anechoic in this context means the deadening of discussion.
He writes: “So because pharma gives ASCO a lot of money, at best, only the most distinguished ASCO members can gently question pharma, but cannot criticize, much less ‘trash’ the source of their mammon.”
Robert Pearl, M.D., writes in Forbes on how to cut back on unneeded healthcare.
He offers four steps:
1. “Empower patient decision-making. New tools, including interactive videos, can help patients objectively evaluate the pros and cons of procedures and treatments. ”
2. “Shift to value-based pay practices. Paying for the value of care, rather than for the volume of services, would eliminate the perverse incentives in the current fee-for- service reimbursement system. A major step in that direction was the announcement from the U.S. Department of Health and Human Services to shift 50 percent of Medicare reimbursements to reward higher quality and pay based on clinical outcomes by 2018. ”
3. “Determine when new approaches are really better. To help accomplish this, every medical journal should require authors to compare new procedures, devices and drugs to current, often lower-cost alternatives. In a similar vein, the FDA should revise its charter to enable it to require that existing therapies be compared to new drugs and devices prior to approval.”
4. “Reform medical malpractice. Changes to litigation for medical malpractice would lessen the burden of unnecessary care associated with defensive medicine. What motivates many doctors to do too much for patients, including much they would never choose to do for themselves, is fear of missing an extremely unlikely problem and being sued.”
Dr. Topol says physicians should’t fear the “creative disruption” that’s underway in healthcare, pushed by new technologies such as smartphones that engage patients much more deeply than before in their own care.
Normal breast at left, cancerous one at right.
Peter A. Ubel, M.D., writing about his wife’s breast-cancer treatment, says: “Often medical facts — such as data on rates of cancer recurrence versus rates of fibrosis — don’t point toward an objectively superior treatment but instead reveal trade-offs, whereby the best choice for an individual patient depends on her preferences, on how she weighs the relative pros and cons of her alternatives.”
“This distinction between facts and value judgments has long been emphasized by experts on decision making, and not just in the medical domain. ”
“In some cases, I expect that the value judgments physicians and professional societies make are shared by their patients. But sometimes physicians’ values differ in important ways from those of many patients. When such value judgments are incorporated into professional treatment guidelines, without any explicit acknowledgment that a reasonable patient might choose an alternative course of treatment, they take potential choices away from patients.”
Sandeep Jauhar, M.D., writes in The New York Times about the exhausting life of medical interns:
“Of course, we must end the exploitation of interns and residents by teaching hospitals. Hospitals should hire more physician assistants to relieve young doctors of the routine work and heavy patient loads with which they are still burdened. Residency directors should give interns more research opportunities to foster scholarship so that postgraduate training doesn’t devolve into mere vocational instruction.
“But rigid work-hour limits are not the answer to the ills of internship. In trying to get interns a bit more rest, we may have come up with a cure that is worse than the disease.”
Herewith six steps that hospitals can take to deal with difficult, defiant doctors.
1. “Seek out a clinical champion” to “engage both the heads and hearts of fellow docs so that they are hit with the reality of the problem.”
2. “Establish a common purpose and vision.”
3. “Engage other doctors to develop the intervention and implementation strategy: Hospitals should start off small, and make it easy at the beginning.”
4. “Communicate, communicate and communicate: Hospitals must create plenty of opportunities to talk with their physicians….”
5. “Identify barriers: Seek out any potential hurdles that might get in the way of your efforts, and determine how to overcome them….”
6. “What‘s in it for me? Tune into what makes such efforts meaningful for physicians. People are resistant to loss, not change, so try to mitigate the perceived loss.”
Elaine Cox, M.D., writes in USNews & World Report that to “accomplish this task, they completely destroyed the previous box and built a new one with three radical foundations: agreement to have no competition regarding patient safety; complete transparency in data sharing around safety; and adoption of an ‘all teach all learn philosophy.”’
Thus the Ohio Children’s Hospitals’ Solutions for Patient Safety network was born.
“In two years,” she wrote, “the project had garnered such great results in its home state that the team was asked to lead a national effort in pediatric patient safety. That year, they brought in 25 additional hospitals. Within a year, the collaborative, now simply known as SPS, grew to 78 hospitals in 33 states and the District of Columbia. Now at 88 hospitals, the collaborative can boast of a membership of nearly every children’s hospital in America.”
Dr. Cox notes (in partial reference to cost issues), that “Nearly 55 percent of children are on Medicaid and the reimbursement is generally less than 25 cents on the dollar. In similar circumstances, corporations would be guarding their data and innovations with every means possible. After all, no money no mission. And yet, SPS shares all. Why? Because in this case, the mission means more than the money.
“The major premise behind the efforts of SPS is to build children’s hospitals as high-reliability organizations, or HROs, similar to the nuclear and aviation industries. These are groups that operate under extremely high-risk situations but have less than their expected number of adverse events. ”
“The work of the collaborative has been focused in two major areas: reducing hospital acquired conditions (HACs)…. and transforming hospitals into places that uphold a culture of safety that permeates every aspect of care, well beyond the bedside in fact. The HAC work has centered on standardizing processes put in place to guide care. Much of this work has involved the ‘bundle concept’ – small interventions that when used together can have a major impact in preventing the common ways patients are harmed in hospital settings – such as infections, adverse drug events, falls, pressure ulcers and blood clots. The culture of safety work includes classes on error prevention and eight easy tools to decrease errors in less than five minutes a day.”
Good models for adult care, too!
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