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Finally, the Ultimate Hospital Rating System

Finding out which hospitals are best is like “a riddle, wrapped in a mystery, inside an enigma.” Are you tired of seeing conflicting ratings from such once respected sources as Leapfrog, Medicare Compare, HealthGrades, and Yelp? Does it confuse you when a hospital is ranked in the top 10 by US News and World Report, but is “god-awful” according to Consumer Reports? The Skeptical Scalpel Institute for Advanced Outcomes Research is proud to unveil a new rating system for hospitals. Advanced metrics and creative statistics are linked with secret Bayesian methodologies, patient surveys, and publicly available databases to yield the most powerful and accurate hospital ratings ever imagined. Just kidding. Based on word of mouth, innuendo and rumors that have come to our attention through the back channels of the Internets, Skeptical Scalpel Ratings Plus offers unparalleled accuracy in hospital ratings. For the low, low price of just $29.99, you will receive the Skeptical Scalpel Hospital Ratings Plus Guide But wait, there’s more. Here’s the plus part of Skeptical Scalpel Ratings Plus. At no extra charge, we will send you information about a weird trick that will enable you to undergo open heart surgery for just $8.00. Insurance companies are furious. That’s not all. The first 127 people to buy the guide will get a set of the sharpest kitchen knives known to man as our gift. Are you a hospital administrator? Here are some special features of our ratings just for you. If your hospital’s ranking is not what you think it deserves, don’t do what all the others do and waste time with in-house task forces or...
A Focus on Diagnostic Errors in Malpractice Claims

A Focus on Diagnostic Errors in Malpractice Claims

Studies have shown that about 5% of autopsies in hospitals in the United States reveal lethal diagnostic errors, accounting for 40,000 to 80,000 deaths annually that could have been averted with a correct diagnosis and prompt and appropriate treatment. Despite the significant impact of diagnostic errors, the problem has received relatively little attention in clinical research. Analyzing Long-Term Malpractice Data In BMJ Quality and Safety, my colleagues and I published a study that sought to characterize the consequences of diagnostic errors by analyzing closed, paid malpractice claims. We reviewed data from the National Practitioner Data Bank (NPDB), an electronic repository of payments made on behalf of physicians with medical liability settlements or judgments. The NPDB also includes adverse peer review actions against licenses, clinical privileges, and professional society memberships. Diagnostic errors were defined as missed, wrong, or delayed as disclosed by subsequent tests or findings. After analyzing more than 350,000 medical malpractice payments over 25 years, the most common and costly involved diagnostic errors. About 29% of these medical malpractice payments resulted from diagnostic errors, which also accounted for the largest fraction of total payments. Another 27% were from treatment errors, and 24% were from surgery-related errors. Diagnostic errors cost $38 billion in malpractice claims payouts over the past 25 years, with an average per-claim payout of more than $380,000. About 93% of payments were made on behalf of allopathic and osteopathic physicians, as opposed to nurse practitioners or other healthcare providers. Death was the most frequent outcome resulting from diagnostic errors, followed by significant permanent injury, major permanent injury, and minor permanent injury. Our study also showed that...
Even in Medicine, There’s an App for That

Even in Medicine, There’s an App for That

The launch of the iPhone and Android smartphone platforms spurred a boom in medical application use, thanks to the ability to run much more complex medical apps at the point of care than earlier, text-based apps used on personal digital assistants, or PDAs. “Physicians can now explore disease pathology and review medical literature anywhere and anytime,” says Iltifat Husain, MD. “Physicians can use medical apps to enhance their own learning as well as teach patients at the bedside and improve the patient–physician relationship.” What’s the App Adoption Holdup? Despite the potential benefits, smartphone app use is far from ubiquitous among physicians. “Many physicians don’t know how to use mobile devices,” says Dr. Husain. “In some cases, physicians may be concerned that patients will look at them in a different way if they need to look up information. There is a stigma; patients expect their providers to be able to recall any medical information immediately and precisely.” “App use can actually introduce new information to the conversation.” Another stigma associated with smartphone app use occurs among colleagues. “There’s a concern among some physicians that they’ll give the appearance of being disengaged if they pull out their phone to use a medical app when conversing with colleagues,” Dr. Husain says. “The other way to look at these situations is that app use can actually introduce new information to the conversation.” Dr. Husain believes that time is the biggest barrier to overcoming these stigmas. “It’s mostly a generational issue,” he explains. “Fortunately, the incoming generation of physicians has grown up with computers. As this group moves from medical school or residency into longer-term...
Early Detection & Treatment of Breast Cancer

Early Detection & Treatment of Breast Cancer

One in eight women will be diagnosed with breast cancer in their lifetime, and two-thirds of women diagnosed with breast cancer are aged 50 and older. Known risk factors include radiation exposure and never being pregnant or having a first child after age 35. Other risk factors include menopause after age 55, postmenopausal hormone therapy, obesity, and having dense breast tissue. Hereditary factors can also be a cause. BRCA1 and BRCA2 gene mutations account for about 20% to 25% of hereditary breast cancers and about 5% to 10% of all breast cancers. A woman whose mother, sister, or daughter had breast cancer—especially if the cancer was bilateral, pre-menopausal, or occurred in more than one first-degree relative—is two or three times more likely to develop breast cancer. Genetic counseling should be considered for women with this history. Reviewing Recent Data on Breast Cancer Diagnosis-Related Failure A recent review of claims data from The Doctors Company revealed that 92% of breast cancer cases involved a diagnosis-related failure, and about 30% of these cases included misinterpreting a diagnostic test, such as a mammogram or breast biopsy. Research suggests that screening mammograms miss 10% to 20% of breast cancers. A study in the New England Journal of Medicine compared traditional mammograms to digital mammograms and found that the digital screenings were superior for women younger than 50, those with dense breast tissue, and women who were premenopausal or in their first year of menopause. Getting on the Same Page: Beginning Screening Mammography There may be some confusion about when screening mammography should begin because recommendations vary. The American Cancer Society recommends that women...
Managing Pain in Patients With IBD

Managing Pain in Patients With IBD

Among patients with inflammatory bowel disease (IBD), abdominal pain is a common and frustrating symptom with multifaceted pathophysiology and can be associated with significant emotional suffering, disability, and high medical costs. “One of the challenges with managing pain in IBD is that many overlapping factors influence patients’ perception of pain in IBD,” explains Arvind Iyengar Srinath, MD. “These include inflammatory, obstructive, psychological, psychosocial, and neurobiological factors.” Abdominal pain has traditionally been attributed to gut inflammation during a disease flare. However, studies suggest that many patients have disabling abdominal pain even while they are in remission. “We are currently learning more and more about the complex nature of pain in IBD,” says Dr. Srinath. “Considering the multifaceted causes of abdominal pain in patients with IBD and its potentially devastating consequences, it is essential that individualized management approaches be utilized to address the various contributions of each of these factors.” Caring for Patients: IBD vs IBS Dr. Srinath recommends that all clinicians recognize and appreciate the potential overlap of symptoms between IBD and irritable bowel syndrome (IBS). “Pain management should be customized,” he says. “There has been an influx of improved medical treatments for disease activity in IBD, but there is also a growing recognition of functional abdominal pain, as in IBS, within the IBD population.” Currently, there is a paucity of data on pharmacologic, behavioral, and procedural methods to alleviate abdominal pain in IBD. However, Dr. Srinath notes that there is a wide spectrum of potential treatments that can be considered in patients depending on the contributions of factors that are associated with abdominal pain perception in IBD (Figure 1)....

A Purse More Contaminated Than a Toilet Seat? Really?

I’ve been pondering that question ever since this revelation splashed across the Internet. Like most of these groundbreaking discoveries, this one got plenty of media attention. Despite the numerous articles mentioning the purse-toilet seat connection study and its sponsor, the Initial Washroom Hygiene Solutions company, I wasn’t able to locate the full text or even an abstract of the investigation itself. What I have pieced together from several different reports and the company’s press release is that 25 handbags were examined and 100 objects were swabbed. It seems that only one in five of the purses had excessive contamination. And here’s more interesting stuff from the press release: “Initial Washroom Hygiene, one of the UK’s leading hygiene and washroom services companies, today unveiled research showing that the handles of women’s handbags are home to more bacteria than the average toilet flush.” So the contamination was with the handles of the bag and the comparison was to a toilet flush, not the toilet seat, which was the focus of many headlines. For example, this is what New York’s CBS News outlet said, “Study: Handbags May Have More Bacteria Than A Toilet Seat.” Or here’s video from Slate which compares handbag contamination to both a toilet seat and a toilet (exact area of comparison not stated). Let’s talk about some other problems. The study was small. It was sponsored by a maker of hygiene products. It turns out that the term “toilet flush” is British for the handle with which one activates the flushing of a toilet, not the swirling water. It is possible that a woman’s purse is more contaminated...
Should My Small or Solo Practice Join a Larger Physician Group?

Should My Small or Solo Practice Join a Larger Physician Group?

Over the past several years, mid-sized and large practices have become more of the norm. More recently, the Health Information Technology for Economic and Clinical Health (HITECH) Act and the Patient Protection and Affordable Care Act (ACA) have made consolidation an even more attractive option for solo providers and small practice groups. The HITECH Act has led to increased costs for physicians who have had to implement electronic health record (EHR) systems and increase data security to protect patient information. The ACA has been increasing demands for healthcare, especially for primary care doctors. With this rise in demand comes more pressure to operate efficiently. As a result, the consolidation that has been occurring in recent years is forecast to continue. Cost Sharing Financial considerations are one of the main drivers of this trend. The larger the group, the more you are able to divide expenses across a larger revenue base. Instead of carrying all the costs of support staff, professional fees, EHR systems, insurance, billing services, IT, office rent, etc., you can share the expenses with several other physicians. And with more purchasing power, a larger group is often able to negotiate group discounts on medical supplies and equipment as well as better health insurance rates for employees. All of these factors lead to an increase in profitability. Other advantages to joining a large group include brand awareness. For example, an independent otolaryngologist who joins a 100-physician group that is well known in the community will benefit from increased brand recognition and better exposure than she would have been able to generate as a solo practitioner. Some physicians consider...
Opioid Backlash Threatens Sickle Cell Care

Opioid Backlash Threatens Sickle Cell Care

The well-meaning push to curb opioid prescribing could worsen healthcare for sickle cell patients. Clinicians tend to undertreat the substantial pain experienced by many sickle cell patients and treat them as drug addicts. However, research does not support increased risk of addiction in this patient population. Challenging Pain, Few Options A 2008 study in Annals of Internal Medicine revealed a vast undercurrent of chronic pain in sickle cell disease, with 29% of patients reporting pain—which is often severe—nearly every day. On top of that, vaso-occlusive episodes can trigger excruciating pain and life-threatening complications, such as organ damage. These crises prompt most ED visits for sickle cell disease. Hydroxyurea, the one drug approved by the FDA to treat the disease, is used infrequently despite being effective. The drug lessens the frequency of pain crises but does not eliminate them. In any case, opioids remain essential for treating sickle cell pain. Clinical trials testing these agents in sickle cell populations are lacking, but even less is known about possible alternatives. Inaccurate Assumptions of Pain A recent study found that most sickle cell patients delay seeking treatment until their pain nears 9 on a 10-point intensity scale. When they finally go to the ED, they face longer waits for care than others in less pain. In some research, these patients report that healthcare providers sometimes treat them without respect. Indeed, clinicians often wrongly suspect them of exaggerating their pain or abusing drugs. A Patient-Centered Approach to Treating Sickle Cell Pain Treating sickle cell pain starts with assessment, but no laboratory test or physiological marker can measure this pain. Nor can clinicians gauge...
Skinny Snowman

Skinny Snowman

“Sudden weight loss, profuse sweating … I’m sorry, I’m afraid you’re melting.”    ...

If You’re Going to Criticize, Get Your Facts Straight

I just found out about an article that appeared in Forbes online 7 months ago. It said that a certain hospital system’s postoperative infection rate was 5% and then said, “For US hospitals, this is not an unusual rate of error—even though it is about 100 times higher than most manufacturing plants would tolerate. No automaker would stay in business if 5% of their cars had a potentially fatal mechanical flaw.” The piece was written by Leah Binder, who is president of The Leapfrog Group, a well-known patient safety advocacy organization. I’m sure Ms. Binder is a smart woman. After all, she follows me on Twitter. And advocating for patient safety is a good thing. But the two sentences I quoted are so misguided that it is hard to know where to start. Comparing infections to a manufacturing plant’s error rate is not appropriate, nor is the automaker analogy. Of all the possible industrial references, the use of automobile manufacturers as a comparator is almost laughable. For example in the year 2012, Toyota, the paragon of Lean methods, sold 9.75 million vehicles worldwide and recalled 10.1 million in the months of October and November of that year alone. That’s a little more than 5%. By the way, this has been going on for years, as I noted back in 2010. Infections, which are not always preventable, are not all the result of errors. Yes, the incidence of infection can be decreased by good practices, but it is not possible to completely eliminate them. Several recent research papers have shown that even near perfect adherence to the Surgical Care Improvement...
Child Passenger Safety Resources in EDs

Child Passenger Safety Resources in EDs

Each year in the United States, more than 130,000 children younger than age 13 are treated in EDs after motor vehicle collisions (MVCs). MVCs are a leading cause of death in U.S. children, in part because child passengers continue to be inappropriately restrained. Studies have shown that 20% of children aged 1 to 3 years and nearly 50% of those aged 4 to 7 years do not use the recommended restraint for their age. MVC-related ED visits for children offer a chance for ED personnel to convey tips for proper use of child passenger restraints to prevent future injuries. Missing Key Opportunities Recently, my colleagues and I published a study in Pediatric Emergency Care that examined emergency physician awareness of and referrals to child passenger safety resources. Our results suggest that many EDs aren’t taking advantage of opportunities to educate families on child passenger safety. The survey, which included responses from more than 600 emergency physicians drawn from a national sample, found significant variability by practice setting in the availability of child passenger safety resources. More than one-third of responding ED physicians reported uncertainty about whether their departments provided child passenger safety resources to parents. Less than half of respondents said that a parent of a 2-year-old being discharged following an MVC would be provided with discharge instructions that include advice about car seats. Our analysis also revealed that only half of pediatric trauma center physicians would always recommend replacing a 3-year-old’s car seat following a roll-over MVC, and even fewer adult and non-trauma center physicians would do so. Children seen in general EDs without pediatric specialization were least...
Guidelines for Managing Exercise-Induced Bronchoconstriction

Guidelines for Managing Exercise-Induced Bronchoconstriction

Exercise-induced bronchoconstriction (EIB) describes the acute air­way narrowing that occurs as a result of exercise. The condition occurs in a substantial number of patients with asthma but may also present in those without known asthma. According to current estimates, EIB may affect about 15% to 20% of patients without diagnosed asthma. For Olympic and elite athletes, the prevalence estimates are even higher, ranging between 30% and 70%. Given its high prevalence, evidence-based guidelines for EIB management are of critical importance. In the American Journal of Respiratory & Critical Care Medicine, the American Thoracic Society (ATS) published a clinical practice guideline to help clinicians manage patients with EIB. To develop the guidelines, a multidisciplinary panel of stakeholders was convened to review the pathogenesis of EIB. Recommendations were established for the diagnosis and management of EIB as well as its environmental triggers. The document also contains special considerations for managing elite athletes. Diagnosis & Treatment of Exercise-Induced Bronchoconstriction To diagnose EIB, the ATS recommends that clinicians focus their attention on exercise-induced changes in lung function rather than symptoms. Serial measurements of FEV1 after a specific exercise or hyperpnea challenge are preferred. A drop in FEV1 of at least 10% defines EIB. Several effective treatments and preventive measures, both pharmacologic and non-pharmacologic, are available for EIB. It’s strongly recommended that all patients with EIB use an inhaled short-acting β2-agonist about 15 minutes before exercise. For those with persistent symptoms or who use short-acting β2-agonist therapy daily or more frequently, the guidelines strongly recommend using a daily inhaled corticosteroid, a daily leuko­triene receptor antagonist, or a mast cell–stabilizing agent before exercise. The guidelines...
Improving Care for Persistent Pediatric Asthma

Improving Care for Persistent Pediatric Asthma

About 7 million children in the United States suffer from asthma, and most are typically dependent on caregivers to administer their medications, often via metered-dose inhalers (MDIs). To ensure that the appropriate dose is inhaled, a spacer is commonly used. “The spacer device is generally prescribed for kids with asthma in the U.S., but incorrect use can result in decreased drug delivery to distal airways and poor asthma outcomes,” says Marina Reznik, MD, MS. Caregiver Technique for Pediatric Asthma Few studies have examined whether caregivers of young minority children with persistent asthma use the proper technique when applying an MDI-spacer delivery system. To address this void, Dr. Reznik and colleagues had a study published in the Journal of Asthma that surveyed and evaluated 169 caregivers of urban minority children with persistent asthma who were prescribed daily medication with MDIs. The researchers monitored the administering technique among caregivers using a 10-step checklist that outlined guideline recommendations on appropriate methods for delivering adequate medication. Five of the 10 steps were deemed essential for adequate delivery of asthma medication. The majority of caregivers who administered daily asthma medication used the incorrect MDI-spacer technique, according to Dr. Reznik. “Only one of 169 caregivers accurately carried out all 10 steps outlined in national guidelines as the appropriate method to deliver adequate medication. Fewer than 4% of study subjects were able to complete five essential steps.” Caregivers whose children had been admitted for asthma in the past year were more likely to exhibit correct use, suggesting that they were retrained during the hospitalization. Higher caregiver educational level also correlated with proper use of the MDI-spacer...
Diabetics & Ethnic Minorities: Going Beyond Black & White

Diabetics & Ethnic Minorities: Going Beyond Black & White

According to 2010 United States Census data, the number of Asians and Pacific Islanders (APIs) in the country has risen 43% since 2000. The three largest API subgroups included people of Chinese, South Asian, or Filipino ancestry. A recent report from the U.S. National Health Interview Survey aggregated API subgroups and found substantive differences in diabetes prevalence. “Unfortunately, there is still a paucity of published data on diabetes in API subgroups in the U.S.,” says Maria Rosario Araneta, PhD. “APIs have been a population group that has largely been neglected in diabetes research.” New Insights on Ethnic Differences in Diabetes In 2013, researchers in the Diabetes Study of Northern California (DISTANCE) had an analysis published in Diabetes Care that estimated racial and ethnic differences in the prevalence and incidence of the disease. The DISTANCE study involved a large, multi-ethnic cohort of patients receiving care in an integrated health delivery system. It included more than 2 million adult members of Kaiser Permanente Northern California. According to findings, there was considerable variation among the seven largest API subgroups. Pacific Islanders, South Asians, and Filipinos had the highest prevalence (18.3%, 15.9%, and 16.1%, respectively) of diabetes. These groups also had the highest incidence (19.9, 17.2, and 14.7 cases per 1,000 person-years, respectively) of diabetes among all racial and ethnic groups, including minorities who are traditionally considered high risk, such as African Americans, Latinos, and Native Americans (Figure). “Findings from this study are consistent with previous research, but there was substantial variation across the API subgroups,” adds Dr. Araneta. The Role of BMI at Diabetes Diagnosis Another key finding from the DISTANCE study...
Forecasting Heart Failure’s Impact

Forecasting Heart Failure’s Impact

Heart failure (HF) is the leading cause of hospitalization for people aged 65 and older in the United States. The disease is an important healthcare issue due to its high prevalence, mortality, morbidity, and cost of care. The prevalence of HF increases with age, and research has shown that about half of all Medicare beneficiaries with the disease do not survive for up to 3 years after hospitalization. “The number of hospitalizations for HF has decreased slightly in recent years,” says Paul A. Heidenreich, MD, MS, “but the cost of caring for the disease remains high and will continue to be a major concern for the U.S. healthcare system.” If present care practices continue, it is expected that costs for managing HF will increase significantly. Several factors fuel this expectation, most notably the likely increase in the number of patients who will survive longer as more life-prolonging therapies are developed. The aging population and greater numbers of people with underlying conditions that contribute to the development of HF (eg, ischemic heart disease, hypertension, and diabetes) will also have an impact. Evaluating Trends of Heart Failure Costs In an American Heart Association (AHA) policy statement published in Circulation: Heart Failure, Dr. Heidenreich and colleagues provided an in-depth look at how the changing demographics in the U.S. will impact the prevalence and cost of care for HF. According to findings, more than 8 million Americans—or one in every 33 people—will have HF by 2030. This represents a 46% increase from the estimated 5 million people who had HF in 2012. Because of aging of the population, the increase in HF will...
Harvard Med School Video Parody: What Does the Spleen Do?

Harvard Med School Video Parody: What Does the Spleen Do?

Harvard Medical School and Harvard School of Dental Medicine class of 2016 students parody “The Fox” by Ylvis for the 107th Annual Second Year Show with “What Does the Spleen Do?” The video is a parody of the hugely popular and trending video “The Fox,” which has nearly 300 million views on YouTube as of this writing. See below: More Information on “What Does the Spleen Do?” Written by Will Lewis, Lydia Flier, Eddie Grom, and Ariana Metchik-Gaddis Directed by Eddie Grom, Lydia Flier, and Ben Rome Sound Production by Will Lewis Filmed and Edited by Ben Rome Choreography by Richard Ngo Costumes by Lenka Ilcisin & Emily Simons Singer 1: Will Lewis Singer 2: Dan Brein Surgeon: Ben Brush Spleen: Richard Ngo Patient: Molly Siegel Students: Eddie Grom & Ariana Metchik-Gaddis Dancers: Madelyn Ho, Jean Junior, Erica Kiemele, Snowy Liu, Alex Power-Hays, Kai Qiu, Margaret Soroka, Susan Wang, Leah Wibecan Lyrics: Lungs go whoosh Help you breathe Kidneys filter, make your pee Gut digests All your food And turns it into poo The heart fills up With lots of blood Pumps it out like lub dub dub But there’s one thing That no one knows… What Does the Spleen Do? Ring-ding­-ding­-ding-­dingeringeding! Gering­-ding-­ding­-ding­-dingeringeding­! Gering-­ding-­Secret Male Uterus! What the spleen do? Wa­-pa­-pa­-pa-­pa-­pa-­pow! Wa-­pa-­pa-­pa-pa-­pa-­pow! Wa­-pa-pa-pa-Magic Powers! What the spleen do? Hatee-­hatee-­hatee-­ho! Possibly a backup tongue! Hatee-­hatee-­hatee-­ho! What the spleen do? Joff­-tchoff-­tchoffo-­tchoffo­-tchoff! Tchoff­-tchoff-­tchoffo-­tchoffo­-tchoff­! Joff­-tchoff-­tchoff-Vestigial Fin! What does the spleen do? Big blue veins Lymphy nodes Lots of blood in lots of  holes Kind of shaped like Brazil And your texture’s such a thrill Your pulp is red So beautiful Like a kidney in disguise If you can live without your spleen Can your spleen live without you-­ou-ou-­ou-­ou? You-­ou-­ou-­ou-­ou? You-­ou-­ou-­ou-­ou? How could your spleen live without you-ou-ou-ou-­ou? You-­ou-­ou-­ou-­ou? You-­ou-­ou-­ou-­ou? What does the spleen do? Jacha-­chacha­-chacha­-chow! Chacha-­chacha-­chacha-­chow! Storage for your extra teeth! What the spleen do? Fraka-­kaka-­kaka-­kaka-­kow! Fraka-kaka-kaka-Making Babies! Fraka-kaka-kaka-Babies Babies! What the spleen do? A-­hee-­ahee ha­hee! A-­hee-­ahee ha­hee! A-­hee-­ahee ha-Third eye! What the spleen do? A­-oo-­oo-­oo-­ooo! A­-oo-­oo-­oo-­ooo! What the spleen do? The secret of the Spleen Ancient mystery Somewhere behind the stomach I know you’re hiding What is your role? Will we ever know? Will always be a mystery What do you do? You’re my guardian organ Hiding in the peritoneum What do you do? Will we ever know? I want to… I want to… I want...

Performance Goals for Hospital CEOs Discourage Change

A big problem with changing the focus of healthcare in the United States is that hospital chief executive officers (CEOs) are incented to produce profits for their institutions. This chart from Kaiser Health News shows that the goals for most of the CEOs of major hospitals and health systems are profits. Growth and more specifically, admissions growth, are also mentioned. It also lists CEO compensation figures, which are quite impressive. In addition to their hefty salaries, most CEOs also command large performance bonuses based on meeting financial goals. According to Becker’s Hospital Review, CEO pay has risen over 4% per year since 2009 with an increase of 4.8% this year. The current rate of inflation in the United States is about as low as it gets, 1%. All this in the era of the $546 charge for 6 liters of saltwater, the $500 charge per suture for a facial  laceration, and the $73,002 charge for an emergency department visit for a urinary tract infection. If you were a hospital CEO, why would you want to emphasize preventive care and outpatient services when your bonus is tied to profits, admissions, and growth? Everyone is entitled to make a living, and for sure most doctors do very well. But doctors are being squeezed on many fronts—declining reimbursements, need to purchase expensive and time-sucking electronic medical records software, dealing with more ICD codes, and rising overheads to name a few. No one has a clue about the effects of the Affordable Care Act on physician practices, but it’s unlikely that reimbursements will rise. Doctors are being forced to sell their practices to...
Practicing What We Preach?

Practicing What We Preach?

It has been largely assumed that healthcare workers (HCWs) take better care of themselves than the patients they treat because they have greater knowledge of appropriate healthcare choices than the general public and because of their position as role models for patients. “HCWs represent an important group in which to study individual health behaviors,” explains Kenneth J. Mukamal, MD, MPH. “Empiric evidence suggests that HCWs who appear to adhere to the advice they give to their patients may have their advice taken more seriously than from HCWs who are less healthy. Unfortunately, little data exist from long-term studies to confirm this association.” In many respects, HCWs represent a best-case scenario for public health research, according to Dr. Mukamal, because of their access to the best health knowledge available. He adds that when physicians are successful in achieving certain health-related goals, it may indicate what accomplishments can be expected in the general public if efforts are made for greater education on that topic. However, he says the pendulum swings both ways, warning that if HCWs are not meeting a certain goal, it suggests that societal pressures may be difficult to overcome. A Deeper Look into Healthcare Worker Lifestyle Dr. Mukamal and Benjamin K. I. Helfand, MSc, had a research letter published in JAMA Internal Medicine that further investigated the healthcare and lifestyle practices of HCWs. The study team used the CDC’s Behavioral Risk Factor Surveillance System, an annual telephone survey of adults in the United States. HCWs were identified as respondents who replied “yes” when questioned if they provided direct patient care as part of their routine work. The authors...
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