Articles Posted in Medical Practice Management

roulette-300x188Although Americans may love to wager on ponies, lotteries, and even church bingo games, they’re getting restive and confused about playing the odds with their health — and doctors need to step up their game a lot to help patients better cope with medical uncertainties.

Dhruv Khullar, a physician at NewYork-Presbyterian Hospital and a researcher at the Weill Cornell Department of Healthcare Policy and Research, has written an excellent piece for the New York Times’ evidence-driven “Upshot” column, detailing a modern, thorny part of doctor-patient relationships:

Medicine’s decades-long march toward patient autonomy means patients are often now asked to make the hard decisions — to weigh trade-offs, to grapple with how their values suggest one path over another. This is particularly true when medical science doesn’t offer a clear answer: Doctors encourage patients to decide where evidence is weak, while making strong recommendations when evidence is robust. But should we be doing the opposite? Research suggests that physicians’ recommendations powerfully influence how patients weigh their choices, and that while almost all patients want to know their options, most want their doctor to make the final decision. The greater the uncertainty, the more support they want — but the less likely they are to receive it.

walmartclinic-300x209Americans are showing with their feet and their money how they feel about doctors’ offices and  shiny hospitals, places they’re shunning more and more. They’re racing to neighborhood clinics and urgent care centers that seem to be popping up on every suburban street corner and shopping mall.

Before these facilities transform U.S. health care, would it be worth asking what this trend might mean, not just for profit-seeking retailers, drug store chains, and, yes, also hospitals and doctors who are shifting into new lines of business?

The New York Times found that:

jetsons-300x231Although big, rich hospitals and their sprawling campuses jammed with shiny new buildings may be reaching a point where they’re unsustainable for competitive cost, safety, and efficiency reasons, a rising health care alternative already may be hitting its own major woes that can’t be ignored.

The Wall Street Journal and New York Times have put up pieces with intriguing projections about the future of hospitals, including how economics may force them, as is occurring now, to spin off major functions, including many kinds of surgery, which will be handled, instead, in smaller, free-standing surgical centers.

At the same time, USA Today and the independent and nonpartisan Kaiser Health News Service have presented their investigation into dangers and deaths that patients encounter at the such centers, which already are burgeoning nationwide.

medpricehikes-210x300With Americans spending more than $3 trillion annually on health care, the corrosive and crazy effects of all that big money can become almost common place. Even still, hospitals, doctors, and Big Pharma still manage to come up with plenty of, Aw, really, c’mon kinds of financial situations.

Recent news reports, for example, have focused on such dubious dollars and cents concerns like: bedside loans, disparities (price gouging) in cancer care, and, of course, skimpy health insurance plans.

Caveat emptor? Not already infuriated by some recent visual depictions of the upside-down state of costs in the U.S. health care system (see figures*) Read on:

womenmds-300x200The profession of medicine gets mixed reviews in rolling back the centuries of  chauvinism, arrogance, and boorish behavior of top (male) doctors.  It’s now generally if grudgingly recognized that health care, though it may be a life-and-death practice, needn’t be a rude and obnoxious one. Nurses, many of them women but many men, too, shouldn’t be bullied and demeaned by doctors. It makes for mistakes and malpractice and bad patient outcomes, for one thing.

As health care leaders look around at mighty male leaders who are falling left and right in the entertainment, news and political industries, they may wish to look closely at their own talent and its treatment. Women doctors, for example, get a bad deal on a matter as basic as pay: They earn, on average, 20 percent less than men do, even within various specialties, data from 36,000 self-reporting MDs has found. Male vascular surgeons earn $89,000 more than their female counterparts, while male pediatric rheumatologists get about $45,000 more than their female peers do.

The American Medical Association has reported that only 12 percent of internal medicine, 1 percent of surgical, and 22 percent of obstetrics and gynecology department chairs at important, prestigious academic medical centers are women—figures that also are tough to reconcile because 83 percent of obstetrics and gynecology residents are women.

eyedropWhether it happens in the drip, drip, drip of costly eye drops or it occurs in the flash of a pricey imaging scan, patients get gouged by modern medicine’s wasteful practices. The inefficiencies can be traced to many and different causes. But Americans need to keep asking whether they can allow or tolerate profit-seeking enterprises to keep getting bigger and ever more expensive.

It’s good to see that two online news organizations, Vox and Pro Publica, are digging into soaring costs for medical goods and services.

Vox is aiming to crowd-source some of its investigation, and it has tantalized its audience with a motivating source of outrage—a story detailing a sky-high bill for a 30-minute imaging scan for Elodie Fowler, an ailing 3-year-old girl. The site says her parents got socked with a $25,000 tab for her test. That sum was far higher than they expected, even after they researched and shopped around to find their most affordable option, given their insurance and various providers operating the service.

anesthesia-300x153Some of the very medical specialists who are supposed to put patients to sleep experience big problems themselves staying awake, with more than half of anesthetic trainees reporting in a new national survey in Britain that they had crashed their cars or nearly done so while headed home after long night shifts.

American doctors’ social media responses to this new research indicate that work weariness and drowsy driving are perils for practitioners on this side of the Atlantic, too.

The doctors’ complaints also underscores the irrationality of recent decisions by American medical educators to reinstate long shifts for interns and residents, trainees who play important—and sleep-deprived— front-line roles in providing medical services to too many patients in academic medical centers and hospitals nationwide.

clockYour time is precious, and when you are a patient, you may feel it’s more so, especially if you’re ill or even in the end stage of your life.

So why do health care providers keep us waiting, or worse, why must doctors and hospitals act downright oblivious to how valuable our time might be as opposed to theirs—and what might be done about it?

Take a look at a thoughtful piece on how one health system has tried to keep true to the idea that patients matter above everything else and the delivery of care needs to focus on them:

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