Doctor-Patient Relationship

September 12, 2019

Go figure: In era of Big Data, numbers and statistics still bedevil medicine

Big data and numbers may seem to drive the world these days, but human factors can play a dizzying role when it comes to statistics and medical treatments.

For those fascinated by numeracy in health care, writer Hannah Fry, in a readable New Yorker essay, details how medicine and patients alike have been bedeviled by attempts to quantify life-and-death decision making.

She tracks centuries of investigators experiments in applying rationality, logic, and mathematics to human lives and their care by doctors and others, reporting about Adolphe Quetelet, an 1830s Belgian astronomer and mathematician:

August 30, 2019

When young adults outgrow their pediatricians, tough life lessons may follow

by Patrick A. Malone

Moms and dads, please don’t gawk at the college-aged and older men and women parked in the pastel-colored, animal-themed pediatrician’s waiting room. Sure, they stick out among the runny-nosed, bawling babies and wiggly little children. But these older patients are part of a reported trend that says a lot about contemporary health care and the current difficulties of growing up.

As Caren Chesler reported in the Washington Post, a popular and important aspect of the Affordable Care Act allows parents to keep their sons and daughters on their health insurance plans up to age 26. That has proved a boon for those in the Millennial and Generation Z age groups, providing parent-supported health coverage to more than 2 million young adults between 2010 and 2014 alone.

But along with health insurance from the ‘rents, many young adults also have kept their medical care givers, chiefly their beloved pediatricians. These specialists in some cases have treated them almost from birth. They know well their patients and their medical conditions. This can be important, Chesler reported:

August 27, 2019

For women, medicine can be about miscommunication and mistreatment

by Patrick A. Malone

Doctors and medical scientists have their hands more than full these days, struggling to get out vital, evidence-based information to benefit the public’s health. They must cope with challenges ranging from battles with the growing problems of infections and vaccine “hesitance” to how to debunk celebrity humbug on diet and well-being.

The medical establishment’s communication nightmares, though, may be especially bad with women — a group that makes up half the population and plays a huge role in most households with medical decision making. Just consider two recent news reports, including on:

August 22, 2019

Do health care’s perverse incentives lure MDs into deliberate misdiagnosis for profit?

by Patrick A. Malone

When doctors become medical outliers, shouldn’t hospitals, colleagues, insurers, and the rest of us ask how and why an individual practitioner diverges so much from the way others provide care?

Olga Khazan details for the Atlantic magazine the disturbing charges involving Yasser Awaad, a pediatric neurologist at a hospital in Dearborn, Mich. As she describes him, for a decade he racked up hundreds of cases in which he is accused by patients of “intentionally misreading their EEGs and misdiagnosing them with epilepsy in childhood, all to increase his pay.” Khazan says his case “shines a light on the grim world of health-care fraud—specifically, the growing number of doctors who are accused of performing unnecessary procedures, sometimes for their own personal gain.”

In the malpractice cases that are unfolding against him, Awaad’s pay has become a central issue, with evidence showing his hospital contract rewarded him for boosting the number of screenings he ordered and diagnoses he made. Jurors have been told that Awaad, whose salary increased from 1997 to 2007 from $185,000 annually to $300,000, “turned that EEG machine into an ATM.” He earned bonuses exceeding $200,000, if he hit billing targets.

August 7, 2019

Loneliness, debilitation, and depression blamed for seniors’ rising suicides

by Patrick A. Malone

The nation’s rising suicide crisis torments seniors, too, with just under one out of five such deaths in 2017 occurring with individuals 65 and older. Men 65-plus, experts say, face the highest suicide risk, while seniors 85 and older, men and women, rank No. 2 in groups most likely to die by taking their own lives.

As the nation grays — 10,000 baby boomers a day turn 65, in a trend that will persist until 2029 — the already high concern about suicide, especially among seniors, is rising, National Public Radio reported.

NPR, noting that suicide already is the 10^th leading cause of death among all Americans, said that experts see loneliness, bereavement, grief, and depression as key factors in cases in which older individuals kill themselves. They find themselves isolated, overwhelmed, and with unending sadness when spouses and friends die. Their children, grandchildren, and other family members often live far away. They also struggle with their lives due to age’s increasing debilitation. As NPR reported:

July 18, 2019

Cutting resident doctors’ hours doesn’t harm quality of patient care, study finds

by Patrick A. Malone

Will the medical educators finally get that it makes no sense to force residents to toil like field animals? Yet another study, this latest from Harvard experts, finds that keeping residency training hours at more humane levels does not significantly affect quality of patient care, including inpatient mortality.

Let’s be clear: The grueling preparation for MDs is only relatively better than before, capping their training time to 80 hours a week.

Medical educators, hospitals, and doctors themselves have criticized that limit since it was imposed after long study and much argument in the profession by the Accreditation Council for Graduate Medical Education (ACGME), the group that accredits MD training programs.

June 3, 2019

As doctors warned UNC about heart surgery program, kids kept dying

by Patrick A. Malone

Although big hospitals may love to pat themselves on the back and boost their profits and professional standings by claiming to offer “comprehensive” services, children may suffer and die due to the reality versus the hubris of institutions’ excessive initiatives with specialized care.

Officials at the University of North Carolina blew past anguished warnings from their own pediatric cardiology staff of significant problems in the pediatric heart surgery program at the medical center’s children’s hospital, the New York Times reported. Brushing aside their concerns about a lack of resources within and to support the program, UNC declined to make public, as most similar specialty efforts do, key performance measures. They would show that the UNC pediatric heart surgery program had a higher death rate than “nearly all 82 institutions that do publicly report” this and other measures of patient care.

The newspaper, in a rare move, has internal tape recordings of doctors disputing among themselves whether dwindling resources, staff departures, and other problems meant that UNC should do what many of the specialists demanded — take a long hard look at what was going wrong, and, in the meantime, refer sick kids to other institutions to safeguard their care.

March 31, 2019

5 strikes and you’re not out? Only when you’re sued for bad medical care.

by Patrick A. Malone

Doctors, hospitals, and their malpractice insurers like to demonize lawsuits brought by injured patients, but these legal actions provide a powerful way to identify problem practitioners, and the medical profession should see this truth and use it to better police its own ranks.

That’s one of the recommendations from medical-legal researchers at Stanford University, who examined more than a decade of 60,000 payments for malpractice claims against more than 50,000 doctors. They found a tiny slice of doctors rack up a disproportionate share of repeated malpractice claims. They describe these MDs as “frequent flyers,” a term familiar to the medical community because it often is applied to indigent and homeless patients who rack up big bills for repeated emergency room visits.

Profs. David Studdert and Michelle Melloound found that 2% of physicians accounted for 40% of the paid malpractice claims over a 13-year period. Further, in the report of their study in the New England Journal of Medicine, they offered details on doctors who lose, and keep losing, malpractice cases due to problem care:

March 25, 2019

Electronic records mess threatens patient safety, investigation finds

by Patrick A. Malone

Tempting though it may be to dismiss doctors’ howls about electronic health records—maybe they’re Luddites or they’re just another group of high-paid workers beefing about their job tools—the persistent and significant nightmare of the complicated computer systems has been this: Do they harm patient care?

The answer now may be: Yes, billions of taxpayer and private dollars spent on EHRs may be reducing patient safety.

That’s the finding of the independent, nonpartisan Kaiser Health News Service, based on its extensive investigation in partnership with Fortune Magazine. The two media operations reported that:

January 24, 2019

Savvy Rx from a resident: Docs, know why and what you’re ordering, please

by Patrick A. Malone

Well, just because.

That isn’t a great answer for cranky toddlers with too many questions. It’s also an unacceptable but real reason why too many hospitalized patients get woken up in the middle of the night and subjected 24/7 to expensive, invasive, and often unnecessary tests and procedures.

Abraar Karan (right), an internal medicine resident at the Brigham and Women’s Hospital/ Harvard Medical School, has blogged with welcome candor about doctors’ casual acceptance of medical routines that not only discomfit but also can harm patients. As he wrote online for BMJ (aka the British Medical Journal): “The reality of medicine is that there are many things we as doctors do for absolutely no reason. That is to say, there is no evidence (randomized controlled trial or otherwise) for doing them, other than ‘that’s the way we’ve always done it.’”