Articles Posted in Surgery

calpers-headquartersWith 450,000 California members, a giant public employee group in the Golden State has successfully found one way to curb medical costs, slashing prices for a set of common procedures by 20%, and saving its members millions of dollars.

It all starts with an idea radical in many parts of American health care: that hospitals should have to disclose their true costs up front so patients have a chance to vote with their feet.

As reported by health economist Austin Frakt in the New York Times’ “Upshot” column, the California Public Employees Retirement system, aka Calpers, in 2011 put in place a new payment plan for members hospitalized for knee and hip replacement surgery, colonoscopies, cataract removal surgery and other common elective procedures. Under this “reference pricing,” Calpers capped what it would pay to hospitals for the various operations, while still allowing its members to choose where they wanted to be treated; if patients picked pricier hospitals, they paid the difference. It could amount to thousands of dollars.

Operating_theatreIf the time in a doctor’s office or the hospital isn’t  frightening enough already for most patients, some recent publications by MDs in prominent, peer-reviewed medical journals may ramp up that anxiety to new heights: Just who is skulking around, with institutional blessing, when you’re getting your medical care? And what role are these official-looking people playing?

A tip of the hat to Morning Rounds, the daily newsletter from the health news site Stat, for pointing out a newly published study on PLOS One that details how sales people for surgical device makers conduct themselves when they are routinely allowed into operating rooms. They are gowned, often wear badges like hospital staff, and they consult with the surgical team, as doctors allow. They bring laser pens that they use to point out instruments and anatomical features. They never touch patients or handle any part of the surgery.

But, the study notes that the sales reps:

meniscusSurgeons’ propensity to perform a common procedure may transfer patients’ knee discomfort to their wallets.

The New York Times, in its Upshot column, pulls together a growing body of research that indicates that surgeries for meniscus tears are “useless.” The arthroscopic procedure, however, is popular with the middle-aged and older when afflicted with knee pain, and some 400,000 Americans annually go under the knife for tears to their menisci, two C-shaped pieces of cartilage that act like a cushion between the shinbone and thighbone.

Although patients complain that meniscus injuries leave them stiff, with pain, and a joint that clicks or catches, researchers in Boston looked closer and found that many people have similar tears with no issue; they also considered that many patients failed to improve after surgery. When they weighed the results of surgery versus physical therapy, the researchers concluded that the operation produced no better results.

DiceA globally renowned seismologist, weary of recent scaremongering reports that a major fault in California was “locked, loaded, and ready to roll,” offered a pointed scientific evaluation of risk: “You’re about as likely to be shot by a toddler than die in an earthquake,” she observed. She explained that, in geologic terms with earthquakes, imminent can mean centuries, not milliseconds. Further, over the last 100 years, there have been an average of 40 temblor deaths annually in the Golden State; in 2015 alone, toddlers with guns killed roughly that same number of Americans.

Suddenly, the media fascination with an impending seismic catastrophe receded to more normal concern.

This much publicized discussion of risk underscores the private complexity that many patients confront in harsh, short time spans when they get multiple surgeons’ opinions on whether they should undergo major procedures. Why does one surgeon tell a young patient and his family to wait and try a lot of other treatments for his brain hemorrhages but not an operation? Then why does a second neurosurgeon tell them the boy needs a procedure NOW to save his life?

Here are some fast takes on some developments in health worth watching:

Good news: Birth rates among teen moms have declined to historic lows, falling most sharply (by almost half) for blacks and Hispanics, the federal Centers for Disease Control and Prevention has reported. Many factors may have contributed to this important trend, including greater access by the young to contraception and shifting mores and behaviors that lead to teens having less sex. Even with this positive news about declining teen birth rates, those for blacks and Hispanic still are double those for whites. Taking care of young parents and their kids costs the country an estimated $9 billion annually. Teen moms and their kids suffer short- and long-term health and social well-being consequences, experts say.

Back-PainQuestions on a common, painful back procedure: When U.S. patients appear to suffer “degenerative disc disease,” a condition around which a $40 billion industry has sprouted, their doctors more than 70,000 times annually subject them to a painful, costly procedure called provocative discography. Materials are injected under pressure into several discs─both those suspect and some as experimental controls─as a diagnostic technique. But new research shows this invasive procedure has no proven benefit and may lead to faster degeneration of the injected discs, says HealthNewsReview.org, a health information watchdog site. The site asks why this study, praised by experts it quotes, was ignored by media. The study potentially opens the door to further, needed inquiry about questionable, costly, painful, and potentially ineffective care given for the millions who suffer from back pain, site experts write.

bwhospitalBecause money makes such a difference in health care in the United States, what happens when it’s no object? The results aren’t pretty, a prestigious Boston hospital has found. It rolled out the red carpet and penthouse suites for a Saudi prince who stayed for seven months of therapy for a drug-resistant infection.

His lavish ways, however, ended up tainting the institution’s best practices, resulting in internal and Massachusetts state investigations. The Boston Globe said the episode, in which the unidentified prince and his entourage made unusual care demands and lavished gifts on staff in violation of hospital policies, shows the risks of so-called VIP care.

The paper said the post-mortem of the royal treatment found that: medical staff failed to adhere to best practices in wearing protective gowns when treating the princely patient who found the attire “off-putting” and dirty; nurses and others were accused of mishandling narcotics, giving them to members of the royal entourage and not administering them to the patient himself.

CR-TOC-Cover-05-2016California leads the nation in its number of practicing physicians─and some of those doctors are so awful they’re dangerous, Consumer Reports has found in its deep dive into state licensing boards and MD discipline. The magazine, in a cover story headlined “What you don’t know about your doctor could hurt you,” compiles some ghastly illustrations of bad doctors, including:

  • A pediatrician with a fetish who fondled the feet of patients’ moms during exams;
  • An ob-gyn who surgically removed the wrong ovary from a patient;

We all owe our individual and collective health not just to ourselves but to any army of Samaritans — our friends, families, colleagues, caregivers, and the many medical professionals who practice at the highest levels of skill and compassion.

It’s tempting, especially when immersed in the ways that health care in this nation falls short, to turn from healthy skepticism to corrosive cynicism. But for this holiday in particular, let’s all give special thanks for those who practice the healing arts. Many of them will leave loved ones and work long hours over Thanksgiving, and not just because of a fee or a charge but to improve the lives of the sick and needy.

With all the adverse, if not hostile reaction Americans are showing in recent days to people beyond our shores, it’s also worth reminding ourselves that the call to help humanity truly is deep and universal. We can learn and be humbled by what others accomplish, including in health and medicine, with resources so much more spare than we can marshal, spending as we do, and, as the Organization for Economic Cooperation and Development notes, at the pinnacle for healthcare and not always seeing equivalent, positive outcomes.

Thankfully, most doctors are honest, but a pattern of greed and dishonesty has popped up with disturbing frequency around the country: heart specialists putting permanent devices into healthy hearts with no medical justification.  It’s happened in California, Maryland, New Mexico and now in a Chicago suburb, Munster, Indiana.

This town of 23,000,  30 miles southeast of Chicago, now has 293 patients asserting in lawsuits that a trio of heart specialists performed needless procedures, the New York Times reports.

State Medicaid officials, the Times says, have launched an investigation and federal authorities also may be probing the physicians, who make up Munster’s most popular cardiology practice and the highest-paid heart doctors by Medicare reimbursement.

If any work places should be distraction-free, a short list would include the command post for launching nuclear arms, the control tower of a busy airport and the operating room. We have no information about the first two, but a recent study shows that the people working in the surgical suite might be monitoring their smartphones instead of monitoring you.

As KaiserHealthNews.org (KHN) and the Washington Post reported, “Cellphone use is not generally restricted in the operating room, but some experts say the time for rules has come. In interviews, many described co-workers’ texting friends and relatives from the surgical suite. Some spoke of colleagues who hide a phone in a drawer and check it when they think no one is watching.”

Sometimes a member of the surgical team might be reviewing pertinent medical data on the device, but too often, they’re being used for decidedly nonmedical purposes. As Dwight Burney, an orthopedic surgeon, told KHN/Post, “Sometimes it’s just stuff like shopping online or checking Facebook. The problem is that it does lead to distraction.”

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