Articles Posted in Doctor-Patient Relationship

primary-care-300x199The U.S. health system is in dire need of dramatic reforms to put patients first, most notably by ensuring that everyone in this country has a formally designated primary care physician to help monitor, navigate, and oversee their medical treatment.

That is the latest recommendation of yet another blue-chip experts’ group: the National Academies of Sciences, Engineering and Medicine, a self-described collective of “private, nonprofit institutions that provide expert advice on some of the most pressing challenges facing the nation and the world.”

An expert panel from the academies, after deep research and in issuing a 448-page report, has expressed disappointment that policy makers seemingly ignored the 1996 recommendations of its independent, nonpartisan sister group, the respected Institute of Medicine. The institute offered a blueprint for moving Americans into an approach, built on primary care, that has shown major benefits elsewhere in the world.

surgerylown-300x196When it comes to hospitals performing low-value tests or procedures and putting older patients at increased risk, Dixie may have little to whistle about.

The Lown Institute, a respected and nonpartisan think tank that says it “believes a radically better American health system is possible,” has published a new hospital index that puts dozens of southern institutions in a dubious light.

That’s because institute researchers scrutinized federal Medicare records on more than 1.3 million fee-for-services provided to older patents at more than 3,300 hospitals nationwide. They reported in findings published in an online part of the Journal of the American Medical Association that “hospitals in the South, for-profit hospitals, and nonteaching hospitals were associated with the highest rates of overuse” of health care services.

cdcvax7may2021-300x165The campaign to quell the coronavirus pandemic is a lot like a Herculean tug of war now, with the prospect tantalizingly near of  pulling a big measure of success over the line.

The Biden Administration, to its credit, is not easing a bit in conveying the urgency of its task in dealing with a disease that has infected more than 32 million in this country and killed at least 576,000 — roughly equivalent to the population of Baltimore.

At the same time, more than 148 million Americans older than 18 have received at least one dose of the coronavirus vaccine, roughly 57% of the adult population. Those statistics, as shown in the chart above from federal experts, were reported as of May 7.

bauchner-150x150dredlivingston-150x150While the federal Centers for Disease Control and Prevention has declared racism a serious threat to the nation’s health, establishment medicine finds itself mired in an angry scandal over doctors’ inability to recognize the term, much less its existence, or its considerable harms.

An uproar at a leading medical journal might seem a tempest in an ivy-covered tower. But patients will want to track even a little the professional furor falling on the leaders of the respected Journal of the American Medical Association.

Its website recently featured a podcast, for which doctors could get continuing professional education credit, in which host Ed Livingston (photo above left), JAMA’s deputy editor for clinical content and “a white editor and physician, questioned whether racism even exists in medicine,” Usha McFarling, a Pulitzer Prize-winning journalist reported for Stat, the medical-science news site.

stop-150x150Although state licensing boards have taken more than their fair share of criticism for failing to discipline bad doctors as quickly and severely as circumstances merit, regulators appear to be trying to get ahead of a problem that especially plagues women patients and women health staff: doctors’ sexual misbehavior.

This inappropriate conduct can encompass a range of bad acts — all of which are unacceptable and should result in serious consequences for offenders, a viewpoint in the Journal of the American Medical Association argues. The article describes a review and consensus reached by the Federation of State Medical Boards, representing the 71 state medical and osteopathic regulatory boards — commonly referred to as state medical boards — in the United States, its territories, and the District of Columbia.

The authors wrote this:

waitingroom-2-300x202Patients packed in their doctors’ waiting rooms in pre-pandemic times may have looked around and wondered: Why are there so many seniors here receiving medical care?

It isn’t just age that gets older Americans in numbers to treatment for illness or injury or preventive care — it’s also, of course, their qualification at 65 for government-supported medical insurance, aka Medicare. That, perhaps, unsurprising conclusion has been affirmed by Stanford doctors and researchers in newly published research. The study also offers important insights on delayed treatment and the crucial role played by health insurance.

The work involved running down a hunch of Dr. Joseph Shrager, a cardiothoracic surgeon who wondered why so many older patients he saw were diagnosed with lung cancer at age 65 — and not, say, at 61, or 64? He discussed the observation with colleagues who concurred in their curiosity about Medicare eligibility and its role in disease diagnosis. As the university news service reported of the insurance hypothesis:

cancerexam-300x225One consequence of the coronavirus pandemic may be showing up in tragic fashion: Cancer specialists say they are treating a wave of advanced cases in which patients might have benefited from earlier care had fear of Covid-19 infection not kept them away from doctors’ offices and hospitals.

The information about the harms of missed appointments, especially for important cancer tests and screenings, is, at present, more anecdotal than quantifiable in hard data, the New York Times reported. But the newspaper quoted doctors across the country reporting this:

“While it is too early to assess the full impact of the delays in screenings, many cancer specialists say they are concerned that patients are coming in with more severe disease. ‘There’s no question in practice that we are seeing patients with more advanced breast cancer and colorectal cancer,’ said Dr. Lucio N. Gordan, the president of the Florida Cancer Specialists & Research Institute, one of the nation’s largest independent oncology groups. He is working on a study to see if, overall, these missed screenings resulted in more patients with later-stage cancers.”

corridorhospital-300x200Although politicians have obsessed for a decade about affordable health insurance, frustrated patients have seen little or no relief on another crucial concern — the skyrocketing costs of medical services. What policy paths could best offer dollars-and-cents help to struggling people with health care prices?

New research from the independent, nonpartisan RAND Corporation offers intriguing clues about billions of dollars in annual savings, based on complex modeling of actual options confronting the public and policy makers.

These choices, the experts say, may come to the political fore with new force due to the economic shocks the U.S. health system has been hit with due to the coronavirus pandemic.

advanced-300x158Many Americans took a good step for themselves and their loved ones after getting shocked by learning about treatments, like prolonged machine ventilation, that coronavirus patients may undergo. Not for me, the healthy may have decided. They committed to determining end-of-life wishes, committing these to “advance directives” or POLST (portable orders for life-sustaining treatment) forms.

That may just the start of what people need to do with these formal documents, now easily found online, reported Paula Span, the New York Times’ “New Old Age” columnist. They need to do more. (Hint: Some of this even may be covered under older adults’ health insurance, especially Medicare).

They need to ensure that their doctors and their lawyers, too, support their recording of their end-of-life plans. These must be as clear, specific, and concise as possible, so there can be no mistaking what patients want with vague discussions, such as avoiding “heroic” or “unusual” interventions. They need loved ones to know where they may be stored, especially knowing how to locate them and give them to health workers, including first responders.

negron-150x150melgen-150x150bernadett-150x150President Trump’s term ended with a spree of executive clemency to health care crooks who ripped off taxpayers and harmed patients.

His last-minute actions infuriated advocates for health care reform and patient protection, as well as federal prosecutors. They were aghast by the inexplicable largess shown to Medicare and medical miscreants included in Trump’s last-minute, public pardons of 73 people and commutations for 70 others. 

The white collar crooks not only got get-out-of-jail-free cards from Trump, but also saw their debts to the government canceled to the tune of millions of dollars.

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