Why pay for end-of-life conversations?

A story by Pam Belluck in the New York Times left me with mixed feelings.  Here's an excerpt:Five years after it exploded into a political conflagration over “death panels,” the issue of paying doctors to talk to patients about end-of-life care is making a comeback, and such sessions may be covered for the 50 million Americans on Medicare as early as next year.Bypassing the political process, private insurers have begun reimbursing doctors...

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Playing politics

Here's a very clever ad from Don Berwick, who is running for governor in Massachusetts.  Even if you are voting for someone else--or live out of state--it's worth a smi...

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Oops, too much morphine

A resident noticed a human factors problem that led to an accidental overdose of morphine to a patient.  It wasn't fatal, but it led to some concern, and as he notes could be more problematic in other cases.  A good catch for sure by an alert young professional!The problem is with this drug choice given on the Epic electronic ordering system at his hospital:What...

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Factoring in human factors

This article in Crain's Detroit Business (originally from Modern Healthcare) notes:Recent studies have found that rapid implementation of new medical technology — electronic health records, patient monitoring devices, surgical robots and other tools — can lead to adverse patient events when it is not thoughtfully integrated into workflow. The right processes require understanding the devices and the users. Testing in controlled environments...

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Union attacks one buyer, supports private equity firm

The plot thickens.  Remember my story from yesterday about an SEIU corporate campaign against a health system?  Now, Beth Kutscher at Modern Healthcare adds a new report:The Service Employees International Union-Healthcare Workers West is stepping up its campaign to block the sale of Daughters of Charity Health System to Prime Healthcare Services, which is accusing...

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Point, counterpoint, rebuttal

Laura Beil at Men's Health published a story in July about the risks of robotic surgery for men.  The summary:American medicine has a history of embracing new technology first and asking questions later, Dr. Lotan says. "Our health care system is in financial distress, and it's important to understand why. Doctors are removing gallbladders robotically, and it makes...

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So, ask her to withdraw the deal!

The two Democratic candidates for Attorney General agree on one thing, that the current Attorney General's proposed deal with Partners Healthcare System will not achieve controls over rising healthcare costs from the dominant market player.Here is the Youtube of a recent debate.  Start at 34:04 and listen through 36:09. Or read the transcript here at Commonheal...

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They should have tried a blog instead!

As we approach Labor Day, an important story.  Beth Kutscher reports in Modern Healthcare that "Prime Healthcare Services is suing a union it says is waging an ongoing smear campaign to pressure the chain into unionizing its workforce."  Here's more:In the 69-page lawsuit filed Monday in U.S. District Court in San Francisco, Prime accuses the SEIU chapter of violating...

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In-flew-enza

Wow, here's the story of how the great flu epidemic of 1918 started in Boston:One this day in 1918, two sailors housed at Boston's Commonwealth Pier reported to sickbay. The men were the first Americans stricken with a strain of influenza that would prove far more dangerous than the German army. By the end of the week, 100 new cases a day were being reported among the sailors at the pier. The disease spread with terrifying speed through both...

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Is it all right to inform patients about unclear evidence?

What happens when patients are informed about the evidence, especially when the evidence is not totally conclusive?Golly, perhaps it seems silly to ask, but let's give credit to Matthew Maurice and Robert Abouassaly for doing so in a rigorous way.  A current article in Urology 84 (2), 2014, is entitled "Patient Opinions on Prostate Screening are Swayed by the United States Preventative Task Force Recommendations."The answer, simply, is that...

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Hey, there's an election coming!

With two weeks to go to the primaries, how could it be that all major media outlets in Massachusetts have failed to asked the Attorney General candidates their opinions on the efficacy and enforceability of the proposed AG-Partners Healthcare System deal? After all, one of them will have to live with it if it is approved by the Court. This is the major antitrust and health care issue facing the Commonwealth. Let's get them on record before...

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Fueled by patient demand? No way.

I frankly expected better from HealthLeaders Media, which usually has well researched and thoughtful stories.  This one, though, reads like a press release from the investment bankers and law firms that make a bundle from proton beam projects.Here's the most troubling statement:As more American patients have become aware of the less invasive technology, they are emerging as a key driver of proton beam center growth in the United States,...

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A very productive hospitalist

Brad Flansbaum writes the story of a very productive hospitalist.The physician profiled has 3000 discharges.  Just counting Medicare patients.Most hospitalists I know run a daily census of 8 to 15 patients.  If this fellow is working at a very high level of 25 (and recall, that would imply no commercial or Medicaid patients) with an average length of stay of five days, that would imply 5 discharges per day.At that rate, if you worked...

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Depressing thoughts

The US and Canada differ on many aspects of health care delivery, but one area in which they have a common approach is inadequate care for mental health.  I was reminded of this when I met with a colleague who works at the British Columbia Division of the Canadian Mental Health Association.  She related several stories about slow and inappropriate treatment of patients--both in crisis and in chronic states--in the provincial health system.Meanwhile,...

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The femtosecond laser: Paying for the attendant in the washroom?

If there is a clear winner in the health care field--in terms of increased efficacy and lower cost over the decades--it has to be cataract surgery.  I remember my grandmother's cataract removal in the 1960s. An expensive, laborious procedure requiring days of unmoving bed rest afterwards while the eye healed, and a lifetime of thick glasses.  Now, the procedure takes...

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Slow learning, poor context, and disloyalty

As I ease back in after a lovely vacation horseback riding in the isolation of the British Columbia mountains, I'd like to take one moment to comment on items that have piqued my curiosity as I've caught up on recent newspaper articles.  (Don't worry: Health care topics return soon, but this post also relates to my other favorite topics--leadership, cognitive errors, and negotiation.)First, there's Thomas Friedman's August 8 interview with President...

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Combatants for Peace

If you are feeling frustrated and powerless with regard to the current state of relations between Israeli and Palestinians, here's a way to help.The “Combatants for Peace” movement was started jointly by Palestinians and Israelis who have taken an active part in the cycle of violence; Israelis as soldiers in the Israeli army (IDF) and Palestinians as part of the violent struggle for Palestinian freedom. After brandishing weapons for so many years,...

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It's too crowded here!

Hi, I'm back from a trail-riding trip in the Chilcotin Mountains of British Columbia. Long quiet days on the horses, through woods and flower-filled meadows.Expansive views.  Not many people.  It's a bit hard to come back . . .But lots of blog topics have piled up.  Watch this space next we...

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Off duty

I'm taking a blogging break for several days.  Comments on old posts are still welcome, but they will not be moderated (i.e, published) until I get back on du...

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Finally, we hear from the AG candidates

We are fortunate in Massachusetts to have two excellent Democratic candidates for Attorney General.  With just 30 days to go until the primary election, you'd have thought the local press would have asked them for their opinions of the proposed deal inked by the current AG and Partners Healthcare System.  After all, it is the biggest antitrust and health care matter...

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That's "informed" consent

My friend and colleague, Doug Hanto (a world class transplant surgeon) reports on Facebook about the birth of his grandson at St. Vincent Carmel Hospital in Indiana:Interesting. Lindsay is about to have a C-section this morning, and we will welcome John Douglas into the world. The nurse handed Lindsay informed consent for C-section, anesthesia, blood transfusion, circumcision, and HBV vaccine with no explanation. Like signing the agreement you...

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Maybe the AG could help

Bruce Mohl at Commonwealth Magazine reports:Steward Health Care is refusing to turn over to state officials its audited financial statements, setting off a behind-the-scenes tug of war that could lead to fines being assessed on the for-profit company. Steward, which is owned by the New York private equity firm Cerberus Capital Management, is notoriously tight-lipped about its finances. The only reliable source of information...

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What residents teach us about residency programs

Medscape has issued its 2014 Residents Salary and Debt Report.  Here are some interesting charts, along with their associated description and my commentary:  Although 25% of residents have no debt, over a third (36%) still owe more than $200,000 after five years in residency. The Association of American Medical Colleges (AAMC) reports that the median four-year...

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Safety is joy

Brian Daily is a medical student (class of 2017) at Georgetown University School of Medicine. After attending our Telluride-East summer patient safety camp, he saw this construction truck on campus at Georgetown the other day and sent it to several of us faculty members because he thought we’d appreciate the bumper sticker.And indeed we do.  Safety in the clinical setting,...

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Post #4038, eight years later

The eighth anniversary of this blog slipped by on August 2.  That's 4038 posts, including this one, drawing several million page views.  From time to time, I've thought about stopping, but then a whole new set of topics emerge, and I say, "Not just yet!" Thank you all, especially the regulars, for reading.My purpose is to serve as an advocate for patient-driven care, eliminating preventable harm, fostering transparency of clinical outcomes,...

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What Mona learned

Mona Beier attended last week's patient safety camp in Maryland (aka, Telluride East) and posted some deep thoughts after the experience.  Here's an excerpt:I have had some really negative realizations of myself during these past few days. I hate to admit this, but during a lot of the talks and the videos, I saw things that I had done, and I have seen my colleagues do time and time again. It is almost a daily occurrence that I hear people...

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How to make RI a healthier state. Any takers?

Richard Asinof at Convergence RI challenges people in the state to map a future of sustainable health care.  Will anyone step up to the challen...

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Hooper's Store

A now for a totally different subject, a little bit of Americana:Many of us with children--and our children--recall Hooper's Store on Sesame Street. Wikipedia summarizes:The fictional store was said to be founded by Mr. Harold Hooper in 1951 as a general store. The food menu was extensive and suited to the different characters that lived on Sesame Street, a fictional Manhattan...

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They said what?

The health care world is full of companies that make outrageous unsupported assertions as they pursue profitability.  Generally, the media accept what is said and don't ask hard questions.Now somebody is asking.Al Lewis has started a blog called They Said What?, on which he posts the assertions made by companies and asks questions that probe the accuracy.  He offers the company an advanced chance to respond.  Here's the summary:TheySaidWhat?...

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Summation

A reminder from David Mayer to medical students participating the Telluride East Patient Safety progr...

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