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U.S. Health System Performance Falls Short Of Attainable Goals

Why doesn’t the US have the best health care system in the world?  That’s the question The Commonwealth Fund Commission on a High Performance Health System asks in its report, “Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2011.” Excerpt:

“U.S. health system performance continues to fall far short of what is attainable, especially given the enormity of public and private resources devoted nationally to health. Across 42 performance indicators, the U.S. achieves a total score of 64 out of a possible 100, when comparing national rates with domestic and international benchmarks. Overall, the U.S. failed to improve relative to these benchmarks, which in many cases rose. Costs were up sharply, access to care deteriorated, health system efficiency remained low, disparities persisted, and health outcomes failed to keep pace with benchmarks. The Affordable Care Act targets many of the gaps identified by the Scorecard.” Read more »

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

Faces Of Medical Error: The Story Of Michael Skolnik

I was very sad and quite angry after watching a powerful video this weekend entitled ”The Faces of Medical Error: From Tears to Transparency.” It’s the story of Michael Skolnik. His mother, Patty, gave me the video when I met her recently. Michael had what may have been unnecessary brain surgery in 2001 and died three years later.

The Skolniks worked on this video as part of an educational campaign on medical error, and they created an organization now named Citizens for Patient Safety. Here’s a trailer to the video:

You can also watch a Today Show segment that profiled the Skolniks from a few years ago:

While much of the message is about medical errors and malpractice, the Skolniks also promote a message of the “critical need for shared decision-making.” In fact, I met Patty at a shared decision-making conference.

If you haven’t heard Michael Skolnik’s story, you should. And if you’re like me, you’ll need a tissue box close by for the sadness, and something else to help with the ensuing anger.

Thanks to Patty Skolnik for sharing the story and the video with me.

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

False Positives In Medical Tests: How They Can Kill Patients

I’ve written in the past that more medicine and tests do not necessarily reflect better care.

There is no test that is 100 percent specific or sensitive. That means tests may be positive, when, in fact, there is no disease (“false positive”), or tests may be negative in the presence of disease (“false negative”).

It’s the latter that often gets the most media attention, often trumpeted as missed diagnoses. But false positives can be just as dangerous. Consider this frightening case report from the Archives of Internal Medicine:

A 52-year-old woman presented to a community hospital with atypical chest pain. Her low-density lipoprotein cholesterol and high-sensitivity C-reactive protein levels were not elevated. She underwent cardiac computed tomography angiography, which showed both calcified and noncalcified coronary plaques in several locations. Her physicians subsequently performed coronary angiography, which was complicated by dissection of the left main coronary artery, requiring emergency coronary artery bypass graft surgery. Her subsequent clinical course was complicated, but eventually she required orthotropic heart transplantation for refractory heart failure. This case illustrates the hazards of the inappropriate use of cardiac computed tomography angiography in low-risk patients and emphasizes the need for restraint in applying this new technology to the evaluation of patients with atypical chest pain. Read more »

*This blog post was originally published at*

Sudden Death In Young Athletes And Routine Cardiac Screening

It’s the dog days of what seems to have been an unusually hot summer (though DrRich does not know whether it has been sufficiently warm to affect the global cooling trend we’ve been in for the past decade), and as is all too common at this time of year, we are seeing extraordinarily heartbreaking stories (like this one) about healthy, robust young athletes dying suddenly on the practice fields.

Most of these tragic sudden deaths are due to a heart condition called hypertrophic cardiomyopathy. Hypertrophic cardiomyopathy often does not produce any symptoms prior to causing sudden death. But it can be easily diagnosed, before exercise-induced sudden death occurs, by screening young athletes with electocardiograms (ECGs) and echocardiography.

A couple of summers ago, the New York Times wrote about such an athletic screening program at the University of Tennessee. Based on the U of T’s results, “cardiologists and other heart experts say that the screenings could help save the lives of the 125 American athletes younger than 35 who die each year of sudden cardiac death.” Read more »

*This blog post was originally published at The Covert Rationing Blog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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