Patient Safety Blog

Rocky Delgadillo, the Los Angeles City Attorney, is suing the insurance company Health Net. Delgadillo accuses the company of using misleading forms to get customers to make errors or admissions that could then be used as an excuse for canceling their insurance policies when they need expensive treatments. From the article:

The suit states that the Woodland Hills-based insurer used untrained salespeople to collect people's medical histories, used purposefully misleading forms and did not review the information until after they filed claims....The city attorney says Health Net went as far as to create a secret unit in its organization to cancel policies, and that it provided benchmarks -- including goals for numbers of rescissions per year and dollars in claims denied -- and bonus payments to employees for reaching company goals.

Interestingly, Delgadillo is pursuing a criminal investigation of individuals involved in these cancellations, in addition to filing a civil suit. If his allegations are substantiated, this is a very good thing. There should be strong disincentives against such dishonesty on the part of insurers.

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Accessibility of Healthcare

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When AIDS was first discovered and little was known about it, that ignorance resulted in a great deal of paranoia, ostracism and cruelty towards AIDS patients.

Now, more than two decades after we have known about AIDS and during which the disease has been studied and treated if not cured, we might be tempted to say that AIDS no longer carries its stigma. But we would be mistaken. A new study shows that AIDS patients continue to be insulted and demeaned by doctors, nurses and other health care professionals who ought to know better. From the article:

Examples include doctors who would not visit a patient's hospital room, neurologists who avoid looking patients in the eye, and ambulance personnel who madly threw bloodied gloves into the street after learning the injured patient carried the virus.

These instances of stigmatic events are described in the study conducted by Lance S Rintamaki of the University at Buffalo and colleagues. The study participants report several of these events, which include a wide variety of health-care personnel. "Clinicians should have the training and common sense to avoid a lot of these behaviors, but perhaps we shouldn't be surprised when hearing about nonclinical staff caught up in these events. They're likely relying on the same stereotypes and misinformation about HIV that are commonplace among the general public, which may lead them to act in fearful and stigmatizing ways toward HIV-positive patients," says Rintamaki.

This is discouraging news in the year 2008. AIDS patients and their loved ones should be prepared for these reactions and should take special care to insist on proper treatment.

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Standard of Care--Hospitals

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A new project, conceived of by Google and the Cleveland Clinic, will try to give patients the ability to access and control their health information.

This project would hopefully enable patients to give their information quickly and easily to multiple physicians and pharmacies. Such a thing would be beneficial because, as we have discussed often on this blog, lack of communication between physicians is a frequent cause of medical error. Patients might assume that doctors would automatically share relevant facts with each other in their medical histories, and this is indeed what is supposed to happen, but too often it does not. This new project would give the patient some control over making sure that doctors know important details.

The New York Times also has some comments on this, quoting Dr. John Halamka on the importance of "consumer-oriented health care."

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Posted In: Communication , Disclosure

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Bedsores, a common hospital problem, are not just ugly nuisances. They can turn into deep and extremely painful wounds that go clear to the bone, and can be fatal when infected.

That is why it is encouraging to find that hospitals and nursing homes are beginning to take a highly effective collaborative approach towards preventing bedsores. From the article:

New research is suggesting that the battle against bedsores requires a team approach, enlisting everyone from nurses and nursing assistants to laundry workers, nutritionists, maintenance workers and even in-house beauticians.

For instance, laundry workers can be in a position to notice when patients' garments are restrictive and ill-fitting, which increases the likelihood of bedsores. All staff can help by repositioning patients during waits for food and other services. Proper nutrition goes a long way towards helping this problem as well, research suggests.

As this blog has discussed in the past, collaborative efforts can be helpful to all kinds of medical problems. Evidently such approaches are useful in dealing with this painful issue as well.

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Posted In: Standard of Care--Hospitals

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Most scientists are extremely unwilling to part with the raw data of the studies they perform on cancer and other life-threatening illnesses.

The author of the article speculates that this reluctance is due to convenience and careerism, specifically the fear of having others (especially layfolk) analyze their work and possibly find flaws in it. This may be an uncharitable speculation but it is difficult to disagree with, especially when one considers the pathetic reasons scientists cite for hiding their data. From the article:

Dr John Kirwan, a rheumatologist from the University of Bristol in England, has studied researchers’ attitudes on sharing data from clinical trials. He found that three-quarters of researchers he surveyed, as well as a major industry group, opposed making original trial data available. It is worth restating this finding: most scientists doing research on how best to help those in pain, or at risk of death, want to keep their data a secret.

Dr. Kirwan went on to ask his subjects why. Their reasons were entirely trivial: one cited the difficult of putting together a data set (wouldn’t this have to be done anyway in order to publish a paper?); another was concerned that the data might be analyzed using invalid methods (surely a judgment for the scientific community as a whole). This is something of a clue that the real issue here has more to do with status and career than with any loftier considerations. Scientists don’t want to be scooped by their own data, or have someone else challenge their conclusions with a new analysis.

As the author points out, however, new analyses are exactly what cancer patients (and patients in general) need. We all need all the information available that pertains to our health, so we can look at it and think about it and use it to safeguard ourselves. This reluctance to part with information is contrary to the spirit of scientific openness and inquiry. It is also unsafe and unfair to patients.

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Cancer , Communication , Disclosure

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One-third of new HIV cases in the U.S. are due to injection drug use, and HIV/AIDS has decimated the African-American community in particular. That is why it is no surprise that the NAACP and other advocacy groups chose Thursday--which was National Black HIV/AIDS Awareness Day--to call on Congress to repeal a ban on federal funding for needle exchange programs. There is some political controversy over this ban, because many politicians are afraid to look like they are supporting drug use, but public health advocacy groups are generally in favor of repealing the ban because of the demonstrated effects of needle exchange programs.

A quote from a supporter of repeal from the article:

Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, on Wednesday said that he supports needle-exchange programs. In a separate statement, Fauci said the high rates of HIV/AIDS among blacks require "drastic action." He added, "In particular, black leaders -- religious, secular and political -- have a key role to play in reducing the stigma often associated with HIV/AIDS and influencing African-Americans to get tested, counseled and treated" (Crary, AP/Seattle Times, 2/6).

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Infections

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Those who drink a can of diet soda a day are 34% more likely to develop metabolic syndrome than those who don't.

"Metabolic syndrome" is a cluster of symptoms that are risk factors for heart disease.

The reason for this link is still unknown: it might be chemical or it might have something to do with other behaviors that are, for whatever reason, common to diet soda drinkers.

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Product Safety

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A depressed medical resident is six times more likely to make a medication error than one who is not depressed, according to a new study published in the British Medical Journal.

The study's findings are not absolutely conclusive, as the authors note. But the common problem of medication errors is often correctly attributed to the brutal schedule imposed on most medical residents. The authors advocate further study of doctors' working conditions with an eye to improving them.

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Posted In: Medical Error

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The Centers for Disease Control and Prevention (CDC) has an article on hand hygiene. Much of it is somewhat technical, categorizing different types and levels of sterilization precautions and measurements of efficacy.

If you scroll down, however, there are quite a few practical details that may be helpful. Much of it is common sense: fingernails that are long or artificial, for instance, have been linked to outbreaks of infections and the presence of pathogens. If you wear a ring, the skin under the ring is more likely to be colonized with bacteria than the rest of your hand. And, of course, wearing gloves play an important role in maintaining good hygiene.

If you scroll down even further, you'll get to Part II of the report, which is the CDC's recommendations about how to maintain hygiene in various professional contexts.

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Posted In: Standard of Care--Hospitals

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