Misdiagnosis

March 9, 2020

As virus spreads, concerns surge about testing, hospitals, and nursing homes

The coronavirus outbreak spreading across the globe may be providing Americans with an unhappy view of the dirty downsides of the too-often dysfunctional U.S. health care system as it grapples with spiking Covid-19 infections.

Congress has appropriated more than $8 billion, so the federal government can provide the nation the support it needs in battling the respiratory illness that exploded out of central China a few weeks ago. Almost 100,000 people globally have been infected with the virus, which has killed thousands. The deaths in this country are rising into the dozens, while infections are increasing into the hundreds. In Italy, the government took a drastic step in dealing with steeply rising infections and ordered a virus-related quarantine of much of the northern part of the country — a tough lock down because the Lombardy area is the largest economic powerhouse of the nation.

In the U.S., federal efforts to stockpile needed medical supplies, notably masks, gloves, and gowns — personal protective equipment or PPEs — continue to lag. The administration is under fire for its slow and ineffectual roll-out of virus testing kits. Vice President Pence promised that big numbers of screening supplies would be available quickly — at least 1 million, asap — but he since has been forced to walk back that pledge. Even as he talked about 75,000 test kits becoming available soon, the Atlantic magazine reported that as few as 1,895 Americans have been tested so far for the virus.

February 27, 2020

That $ —.99 sale isn’t a deal. ‘Left-digit bias’ isn’t great for health care, either.

by Patrick A. Malone

Highly 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:”

February 16, 2020

Battle may be in new phase against the virus now named Covid19

by Patrick A. Malone

The spreading virus that has sickened tens of thousands and killed thousands — mostly in central China in Hubei province and its big capital city, Wuhan — now has a name: Covid19.

Public health officials hope that this moniker, along with new images of the virus, will make talking about this disease easier and reduce the exploding stigma that’s attaching to it, with mis- and dis-information fueling unwelcome panic, racism, and xenophobia.

The disease continues to batter China, with the cases in two dozen or so other countries limited to a few hundred and deaths in the single digits. The Chinese remain in a sweeping lockdown or quarantine that has brought much of the most populous nation in the world to a standstill since at least the start of the lunar new year, a major travel holiday across Asia. Officials now also are conducting dragnets and round-ups of those potentially ill.

February 13, 2020

A top U.S. health official can’t get his. Which is why we need records reforms.

by Patrick A. Malone

Federal 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.

February 11, 2020

Crucial doctor-patient relationships showing distressing signs of fraying

by Patrick A. Malone

Although 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.”

February 9, 2020

As coronavirus pummels China, concern rises about U.S. health care supplies

by Patrick A. Malone

The toll of the coronavirus outbreak in China keeps worsening, with the infections exceeding tens of thousands and the deaths spiking toward 1,000, also claiming the first American and Japanese lives of people in the disease epicenter of Wuhan.

The illness’ most significant harms continue to afflict China, particularly its central province of Hubei and regional capital Wuhan.

But the infection has raised global alarms, in part because its death toll, for example, has far exceeded in China the fatalities recorded with the 2003 disease incident involving Severe Acute Respiratory Syndrome, or SARS. That infection killed hundreds in China.

January 10, 2020

Need simple, clear, and direct ideas to be healthier? Heed these 48 words

by Patrick A. Malone

Bravo, brevity. Four dozen words is all it takes for a doctor and noted writer on diet and obesity to offer plenty of sound advice on how to get and stay healthy.

Here are the suggestions from Yoni Freedhoff, associate professor of family medicine at the University of Ottawa, founder and medical director of Ottawa’s Bariatric Medical Institute, blogger at Weighty Matters, and author of “The Diet Fix: Why Diets Fail and How to Make Yours Work:”

“Don’t smoke. Get vaccinated. Avoid trans fats. Replace saturated fats with unsaturated if you can. Cook from whole ingredients — and minimize restaurant meals. Minimize ultra-processed foods. Cultivate relationships. Nurture sleep. Drink alcohol at most moderately. Exercise as often as you can enjoy. Drink only the calories you love.”

January 8, 2020

Hospital mergers and acquisitions aren’t great for patients’ care, study finds

by Patrick A. Malone

Big hospitals keep getting bigger. But, contrary to what the suit-wearing MBAs may claim, the rising number of institutional mergers and acquisitions isn’t necessarily better for patients and their care.

At hospitals subjected to corporate wheeling and dealing, the quality of care got worse, or, at best, it stayed the same and didn’t improve, a new study in the New England Journal of Medicine reported.

Researchers scrutinized federal data “from 2007 through 2016 on performance on four measures of quality of care … and data on hospital mergers and acquisitions occurring from 2009 through 2013,” they said. These measures, the Wall Street Journal reported, included: patient satisfaction; deaths within a month of entering the hospital; return trips to the hospital within a month of leaving; and how often some heart, pneumonia, and surgery patients got recommended care. They looked at 246 hospitals involved in M&A activity, controlling their findings with data from 1,986 institutions not similarly affected.

October 24, 2019

Seniors are getting urine over-tested and joints over-injected

by Patrick A. Malone

It’s the 21^st century, and excellent information is more available than ever due to communication and technology advances. But doctors and hospitals keep harming patients by testing and treating them in ways that are unsupported by rigorous medical evidence, and by carrying out safety recommendations in extreme ways.

Just consider:

Hospitals have become so obsessive about protecting seniors from falls while under their care that they’re all but lashing them to their beds, damaging their already shaky fitness, according to Melissa Bailer, a Kaiser Health News reporter whose work appeared in the Washington Post. She quotes experts as warning of an “epidemic of immobility” for older patients.

October 1, 2019

Health care plagued by cases of a persistent pathology — unmitigated gall

by Patrick A. Malone

There seems to be a never-ending outbreak of a certain kind of pathology in the United States. Big Pharma has it and spreads it around, a lot. So, too, do public health figures. Let’s call this scourge what it is — unmitigated gall.

The problem with this nasty condition is that it afflicts the rest of us. Just consider how stomach-churning these shenanigans can be:

Penalties for bogus prescribing of ‘little red pills’ on elderly dementia patients