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Hospitals love new technology and new treatment initiatives because using them can result in better outcomes for patients. But hospitals also like them because they can charge more for an expensive or complicated surgical tool or protocol, and leverage that use for promotional purposes.

Unfortunately, as we’ve often pointed out, new and complicated treatments sometimes don’t work right. Sometimes they’re used by people insufficiently trained. Sometimes they cause grievous harm to patients and qualify as malpractice. So, many policy experts are calling for hospitals to prove they’re capable before they engage in certain surgical practices.

“As the U.S. health-care landscape advances toward rewarding quality rather than quantity, just buying a new high-tech surgical tool or hiring skilled surgeons may not be enough to support offering the new service,” according to a recent story in Modern Healthcare. “Facilities should more frequently be asked to prove not only the ability to achieve good clinical outcomes, but that there is a community demand for the service in the first place, [health quality and policy leaders] say.”

Twelve in 100 Americans will be diagnosed at some point in their lifetimes with a thyroid disorder. Hypothyroidism, or under-active thyroid gland, is treated with the drug levothyroxine, which has been called the second-most frequently prescribed drug in the U.S.

As a long and interesting article in discussed, one of the hottest controversies in endocrinology is hypothyroidism and its treatment. Thyroid disorders are off-the-charts more common in women than men, and possibly as many as 2 million people, according to some estimates, have a thyroid disorder that hasn’t been diagnosed.

“Some might lack access to or money for doctors,” according to the story, “but for many, it’s just that the symptoms of hypothyroidism are so vague. Who doesn’t feel tired, fat and depressed sometimes?”

In theory, people support the presence of trainees for medical procedures. But when it comes to personal practice … not so much.

So says a study in the Archives of Surgery, which examined patient perceptions and willingness to participate in resident education. More than 8 in 10 patients consented to having an intern participate in their surgical procedure, and more than 9 in 10 consented to the presence of a resident. But when presented with a real situation of trainee participation, not even 1 in 5 said OK.

More than half of the survey respondents said that knowing that their operation was a trainee’s first would affect their consent negatively.

The Occupational Safety and Health Administration (OSHA), the main federal agency charged with the enforcement of workplace safety and health, is looking at limiting the number of hours medical residents can work to 80 hours a week.

The decision to consider such limits came after OSHA received a petition filed by Public Citizen; the Committee of Interns and Residents/SEIU Healthcare; the American Medical Student Association; Dr. Charles Czeisler, Baldino professor of sleep medicine and director of the division of sleep medicine at Harvard Medical School; Dr. Christopher Landrigan, assistant professor of pediatrics and medicine at Harvard Medical School; and Dr. Bertrand Bell, professor of medicine at Albert Einstein College of Medicine.

Petition signatories noted their concerns about medical residents working extremely long hours,” anc cited evidence linking sleep deprivation with an increased risk of needle sticks, puncture wounds, lacerations, medical errors, and motor vehicle accidents.

Nurse anesthetists have been proven to deliver about as safe and high quality care as physician anesthesiologists, but there’s still a key question every patient should ask before being put to sleep by a nurse anesthetist.

“Is there a doctor anesthesiologist nearby in case there’s an emergency during my surgery?”

That’s the question you need to get answered. In most hospitals and many free-standing surgery centers, the answer will be, “Of course, we wouldn’t dream of putting patients to sleep without an anesthesiologist supervising the anesthetists.” But in other facilities, particularly same-day surgery centers, the answer will be, “No, we don’t think it’s necessary.”

A newly minted M.D. doctor wandering the halls of a hospital, working long hours with little sleep as he or she begins years of residency training, can be a potential disaster waiting to happen. That’s the source of the old bromide about July being the most dangerous month to get sick, since that’s when residency programs start their new year.

In theory, all junior doctors receive careful supervision from senior doctors in training and from full-fledged “attending” physicians. But in practice, in busy institutions junior doctors can work long hours with little supervision, and mistakes that cause injuries to patients can result.

In 2003, residency programs accredited by the official supervisory body, the ACGME, were required to cut resident work weeks from 120 to 80 hours. But in December 2008, the Institute of Medicine, part of the National Academies of Sciences, recommended more changes to improve patient safety in residency programs.

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