Trauma surgeon Peter C. Jenkins, M.D., and a team of researchers from Indiana University and elsewhere developed the Trauma Surge Index (TSI) scoring system.
The TSI, scaled to an individual hospital’s profile, represents the severity of each patient’s injury, and the time and date of each patient’s admission to the hospital. It ranks surge activity on a scale from 0 to 8 (including “greater than 8” as the highest score).
“Even though personalized medicine will be useful to better understand rare diseases and identify novel therapeutic targets for some conditions, the promise of improved risk prediction, behavior change, lower costs, and gains in public health for common diseases seem unrealistic,” wrote Michael J. Joyner, M.D., of the department of anesthesiology at the Mayo Clinic, in Rochester, Minn., and Nigel Paneth, M.D., of the department of epidemiology and biostatistics, at the College of Human Medicine, Michigan State University.
The authors say that proponents must explain how personalized medicine will actually change healthcare and be more realistic about what the public can expect.
As she notes, “Miscommunication between a patient’s physicians is a major contributor to treatment and diagnostic mistakes. And too often, doctors who care for a patient in the hospital fail to communicate at discharge with the patient’s primary care provider, sowing confusion about what happened in the hospital and the plan moving forward.”
As The Boston Globe notes: “Tufts … straddles the ground between an elite academic medical center and a safety net hospital. Tufts surgeons, for example, perform more heart transplants than at any other hospital in the state. Still, about 60 percent of its patients are covered by … Medicare and Medicaid, a higher portion than at many other hospitals.”
“If Tufts fails to grow, it risks losing business to larger systems that can serve more patients and use their market clout to extract higher payments from insurers.
The Globe says: “Tufts executives say the end of the BMC talks underscores that the hospital’s future lies beyond Boston, where they will seek to link up with other hospitals and expand their network of doctors. They point to the merger with Lowell General as a model.”
How about a merger with Providence-based Lifespan? Or does Partners HealthCare want that for itself?
“Our goal is not to be a big megamedical center in downtown Boston that would require pulling patients into Boston to basically fill the beds. Our goal is to be a nimble, small, academic medical center that works in partnership with the community,” Michael Wagner, M.D., told The Globe.
Richard Gunderman, M.D., a professor of radiology, pediatrics, medical education, philosophy, liberal arts, and philanthropy, and vice-chair of the Radiology Department at Indiana University in Bloomington, describes how hospital-physician relationships can go bad.
Becker’s Hospital Review reports on “six of the most influential things in any hospital-physician relationship and how they can go awry — as inferred by Dr. Gunderman.”
1. Financial support. “When EHRs and billing and coding systems are costly, physician practices have few places to turn. If physicians feel forced to rely on the hospital for financial support and muscled into relationships with hospitals, the relationship can hold resentment and turn sour.”
2. Job security and compensation. “When physicians feel their job security and pay is being toyed with or held over their heads, this undermines confidence and can push physicians to feel beholden to hospital administration.”
3. Decision-making. “Dr. Gunderman says the best way to discourage a physician is to refer to such their decisions as ‘anecdotal, idiosyncratic, or simply insufficiently evidence-based.’ Hospital administrators are wise to avoid this.”
4. Productivity expectations. “Physicians are not factory workers. Increasing or establishing exorbitant caseload expectations can wreak havoc. ”
5. Authority. “If physicians actually possess limited control over their work, they may fall victim to ‘learned helplessness,’ which Dr. Gunderman defines as a sense that physicians cannot meaningfully influence healthcare.”
6. Priorities. “Physicians don’t do the work they do for the benefit of the hospital — they do what they do for the patient….When priorities get mixed and hospital interests supersede patient interests, the entire healthcare model gets warped.”
Carol A. Cunningham, M.D., state medical director for the Ohio Department of Public Safety’s division of emergency medical services and an emergency physician at Akron General Medical Center, told Health Leaders Media that a saline-solution shortage left her feeling “like we were practicing medicine in a Third World country.”
David L. Brown, M.D., an anesthesiologist and a leading expert on pain management, has joined Cambridge Management Group (cmg625.com) as a senior adviser. He survived his own prolonged life-threatening illness related to military-acquired hepatitis C, which gave him a particularly deep understanding of the needs of patients and their families facing end-of-life decisions. The experience led Dr. Brown, an Air Force veteran, to found Curadux — a firm dedicated to pioneering a revolutionary decision-support model for those facing advanced illness.
Dr. Brown’s research has focused on acute pain relief in post-surgical patients, as well as relief of pain related to pancreatic cancer. He and colleagues are investigating a novel cannabinoid-2 compound (MDA-7) that shows promise for Alzheimer’s disease symptom management and relief of neuropathic pain.
He recently retired academically and clinically from the Cleveland Clinic, where he was professor and chairman of the Anesthesiology Institute.
Previously, he led the departments of anesthesiology at the University of Texas’s M.D. Anderson Cancer Center; the University of Iowa Hospital and Clinics, and the Virginia Mason Medical Center, as well as serving as professor of anesthesiology at the Mayo Clinic.
Dr. Brown is past president of the American Society of Regional Anesthesia and Pain Medicine; past editor-in-chief of the journal Regional Anesthesia and Pain Medicine; past president of the Association of University Anesthesiologists, and past chairman of the Accreditation Council for Graduate Medical Education’s (ACGME) Residency Review Committee for Anesthesiology. He was also a member of the ACGME board.
He has been a director of the American Board of Anesthesiology and chairman of the Foundation for Anesthesia Education and Research.
Dr. Brown received his medical degree in 1978 as a member of Alpha Omega Alpha, the medical honor society, at the University of Minnesota, after undergraduate work at Iowa State University and the University of South Dakota. In 1982 he completed his anesthesiology residency at Wilford Hall U.S. Air Force Medical Center, in San Antonio. Before that, he was a flight surgeon in the USAF for the 319th Bombardment Wing.
Karen L. Miller, M.D., an obstetrician and gynecologist, has joined Cambridge Management Group (cmg625.com) as a senior adviser. She brings many years of experience in serving a wide range of patient populations as well as extensive research and teaching. She brings to Cambridge Management Group particularly strong expertise and experience with low-income and other disadvantaged populations.
She is currently providing outpatient gynecologic services at the Maliheh Free Clinic, in Salt Lake City, while conducting genetics research to develop a noninvasive test for endometriosis. Meanwhile, she continues to teach obstetrics and gynecology at the University of Utah Medical School, with which she has been associated for many years as a professor whose work has included, besides teaching, mentoring and research, helping to develop certain national guidelines for gynecological care.
Dr. Miller has a broader clinical background than most ob-gyns. This has included a year of training in general surgery, and serving as urgent-care physician for the Industrial Medical Center, National City, Calif., where she treated victims of industrial accidents, and as general medical officer for the Indian Health Service at the Unitah and Ouray Reservation, in Roosevelt and Ft. Duchesne, Utah. Other activity for underserved populations has included doing ob-gyn work in American Samoa
She received her medical degree from the University of Oklahoma and a B.A., in German and a B.S. in general science from Oklahoma City University.
She writes: “As we learn more about the impact of visit frequencies and get better at nontraditional visits, we can start to tailor care for individual patients with their unique medical problems, personalities, goals, and attitudes about health and healthcare. Rather than lamenting the uselessness of the annual physical (a popular target these days), we can examine the traditional visit and strip it for parts: What aspects are useful for a patient like Larry? Today, it might be managing his knee pain from afar. Two years from now, if his prostate cancer recurs and metastasizes, it might be a frank discussion — in person — of how he wants to spend his final months.”
