Articles Posted in Doctor-Patient Relationship

amputate-300x157Although the Covid-19 pandemic may be opening more and more Americans’ eyes to the harsh effects of the country’s economic and racial inequities, the stark damage from the nation’s health disparities can be plain to see — in truly disheartening ways.

Lizzie Presser, a reporter for the Pulitzer Prize-winning investigative site ProPublica, deserves high praise for her distressing article on “The Black Amputation Epidemic.” As she wrote recently from deep in the poverty, neglect, and racial discrimination of the Mississippi Delta:

“[W]ithin months, the new coronavirus would sweep the United States, killing tens of thousands of people, a disproportionately high number of them black and diabetic. They were at a disadvantage, put at risk by an array of factors, from unequal health care access to racist biases to cuts in public health funding. These elements have long driven disparities, particularly across the South. One of the clearest ways to see them is by tracking who suffers diabetic amputations, which are, by one measure, the most preventable surgery in the country.

buckeyelogo-300x158The Buckeyes have become the latest in a sad, expanding list of colleges, universities, and other institutions to reach big settlements over students’ long sexual abuse by twisted medical staffers, with Ohio State University agreeing to pay $41 million to 162 male athletes for two decades of molestation and mistreatment by a team doctor.

After years of complaints and an outside investigation by a prominent law firm, OSU fessed up and said it should have done far more to listen to aggrieved wrestlers, football players, and others as they told coaches and other adults about the perverse conduct about assaults committed by Richard H. Strauss, a doctor to various men’s sports teams and professor from 1978 to 1998. He died by suicide in 2005.

During his time, students would testify to university trustees and investigators, the doctor’s inappropriate transgressions included activities that “ranged from groping to requiring them to strip unnecessarily to asking them questions about their sexual behavior under the guise of medical treatment,” the New York Times reported.

silence-300x192Historian Doris Kearns Goodwin highlighted a crucial strength of the 16th U.S. president as he led the nation through one of its most divisive times: Abraham Lincoln encouraged dissent and welcomed opposing points of view, going so far as to appoint three better-known political rivals to top positions in his administration.

That extraordinary lesson in crisis leadership seems to be getting lost in the nation’s battle with the novel coronavirus.

Too many doctors, nurses, and experts in science and medicine have been censored, disciplined, and dismissed for speaking truth to power, warning, for example, about unacceptable conditions for health workers treating Covid-19 infections, news organizations have reported.

drscope-300x200The public health restrictions put on much of the nation to battle the Covid-19 pandemic also have created complications for patients’ receiving other kinds of health care — a reality that the nation will need to deal with in the weeks ahead.

Doctors and hospitals will need to see whether their coronavirus case loads are such that they can begin to reconsider providing what were deemed nonessential medical services, including often performed procedures like shoulder, knee, and hip surgeries.

Most hospitals, responding to federal and state requests, put off elective procedures, notably because they did not want to put patients and heightened risk and because medical facilities nationwide have experienced desperate shortages of personal protective equipment and drugs. Some institutions have pressed ahead with operations they have deemed needed, despite questions from critics.

cjdlogoCold, hard facts — not hunches, arguments, or theories — matter most when tough health care decisions must be made. Americans have been reminded of this by painful headlines on the opioid and overdose crisis, the rise of lung injuries and deaths due to vaping, and, yes, now the rapid spread of a new coronavirus. Doctors, hospitals, insurers, Big Pharma, and other major parties in the U.S. health care system aren’t always as candid as they need to be, especially in disclosing how they harm and even kill patients.

That’s a truth (with a small “t”) that readers can discover quickly in the Center for Justice and Democracy’s latest edition of its annual “Briefing Book: Medical Malpractice by the Numbers.” The center, at New York Law School, provides evidence about a field that has become the bogeyman for politicians, policy makers, and medical practitioners eager to hide egregious errors with extreme counter factual assertions.

Malpractice cases in the civil justice system provide important insights and checks on how doctors and hospitals care for the sick, injured, and vulnerable.

cogtestsrs-300x170It sounds like a good idea. Have primary care doctors learn about older patients’ cognitive health by putting all of them, during routine office check-ups, through a few minutes of tests in which they are asked to recall lists of words, draw a clock face, describe the day and date of their appointment, talk about current events, and take on other simple tasks.

Such screenings, some advocates for the aged say, can be an important way to diagnose early and try to provide for help for patients with dementia and its most common affliction, Alzheimer’s disease. But a blue-ribbon panel of experts that advises the nation on medical testing and procedures isn’t buying the argument: The U.S. Preventive Services Task Force (USPSTF) has given such screenings the group’s letter-grade rating of I, meaning the evidence is incomplete that a test or procedure is harmful or beneficial.

The panel, updating its 2014 findings, reported on the JAMA Network (the online medical journal collection) that:

bias1999-300x169Highly educated and rigorously trained doctors may be just as susceptible to a built-in bias that bargain-seeking consumers yield to when they hit stores seeking 99 cent goods, buy into TV hype for $19.99  wares, or fall for a salesman’s pitch for a used car priced at $17,999.

Ivy League researchers call the cognitive flaw “left digit bias.” They warn that this common irrationality can have consequences with doctors and patient care.

As Anupam B. Jena of Harvard and Andrew R. Olenski of Columbia reported in the New York Times’ evidence-based column “The Upshot:”

bluereport-300x128The University of Michigan is investigating allegations that Robert E. Anderson, former head of the university health service and physician to UM football teams coached by Bo Schembechler and Lloyd Carr, sexually assaulted youthful patients across decades.

Anderson worked for the university for more than 30 years and died in 2008. As the New York Times reported:

“Michigan said its campus police department had opened an inquiry last summer, after Warde Manuel, the athletic director, received a message from a former student who said that Anderson had engaged in abuse during medical exams in the ’70s. During the investigation, Michigan said, other people described ‘sexual misconduct and unnecessary medical exams,’ including at least one allegation that wrongdoing had occurred in the ’90s.”

alexahhs-150x150Federal regulators may be on the brink of not only protecting but also advancing patients access and use of a key component of their care: their electronic health records. Or will bureaucrats fold up in the face of a muscle campaign by corporate interests and hospitals?

To its credit, the giant Health and Human Services agency has emphasized that it is moving forward in its announced plans to prepare new regulations on so-called EHRs, pressing patients’ rights and newer, and potentially more nimble tech firms’ abilities to make the information in the records more accessible and helpful.

But Epic, the giant software company that has installed electronic systems in hospitals and health systems nationwide — often for billions of dollars — is leading resistance to the new rules. It has convinced dozens of institutions and groups, some sizable, to lobby officials to oppose this federal intervention.

dochands-300x200Although health policy experts and doctors themselves may sing the praises of primary care providers — medical generalists who are supposed to be the first and important caregivers for most patients — recent studies suggest that yet another idealized aspect of the U.S. health care system has cost- and access-driven problems.

Patients, to start with, are driving a concerning trend in which they in increasing numbers are declining to tap the services of family doctors and other so-called PCPs.

Doctors in this field, as well as others, say that patients may be turning to online consultations, urgent care centers in drug stores and shopping malls, or more costly visits to highly credentialed specialists due to the spiking pressure on frontline MDs to maximize revenues by minimizing their “face time.”  Physicians describe how “bean counting” executives in health systems may require them to see more than a dozen patients a day, while also handling all the bureaucracy, consultation, research this requires — or face sizable pay cuts for their “inefficiency.”

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