December 16th, 2009 by DrCharles in Better Health Network, Health Tips
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With all the controversy about the utility of mammography, optimal Pap smear intervals, and risks of prostate cancer screening, you have to ask yourself – what are the most beneficial and cost effective preventive services we should be focusing on?
Here are the top 10 preventive services. These items were chosen by the National Commission on Prevention Priorities, and highlight those preventive services including immunizations, screenings, preventive medications, and counseling that give “the most bang for the buck.” For an in depth discussion of methods and results, read Am J Prev Med 2006;31(1):52–61
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*This blog post was originally published at The Examining Room of Dr. Charles*
November 18th, 2009 by Dr. Val Jones in Audio, Expert Interviews, News, Research
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Dr. Avrum Bluming is a medical oncologist and clinical professor of medicine at the University of Southern California. He is also a dear friend, scientist, and careful analyzer of data. I asked him to help me understand the current mammogram guidelines debate, and what women (now faced with conflicting recommendations) should do about breast cancer screening. Please listen to his fascinating discussion captured here:
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What I learned is that the guidelines must be tailored to each woman’s unique situation. The variables that must be considered are incredibly complex, as breast cancer risk factors include everything from when and if one has given birth, to a history of smoking, drinking, overweight, breast cancer in the family and even the age of your parents when you were born. Beyond risk factors, new research suggests that some breast cancers spontaneously resolve without treatment, but our technology is not advanced enough to distinguish those from others that will go on to become life-threatening tumors – so we treat all cancers the same. Read more »
November 17th, 2009 by Emergiblog in Better Health Network, Opinion
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Browsing through my October ENA Connection the other day, I noticed the theme was “Government and Advocacy”. Came across an article on domestic violence. It’s a short article, written by Carrie Norman, RN, CEN, member of the Government Affairs Committee. The quotes below are taken from Carrie’s article.
“The CDC estimates that 37 percent of women who sought emergency department care were victims of domestic violence.”
What? 37 out of every 100 women I have triaged?
Seriously?
“Domestic violence victims are more likely to seek treatment for chronic and psychological conditions.”
Okay. But no way have I been taking care of victims of domestic abuse – I mean, hello, wouldn’t it be obvious? The hovering, overbearing abuser who answers all the questions for the patient? The bruises that aren’t explained by the story? Read more »
*This blog post was originally published at Emergiblog*
November 4th, 2009 by DrRich in Better Health Network, Health Policy, Opinion
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As a class of human beings, cardiologists do not enjoy subtlety or nuance. Indeed, the reason most of them chose to specialize in cardiology, as opposed to specializing in some other organ system, is that the heart is the most unsubtle organ in the body. Unlike, say, the liver or the kidneys or even the brain (which, after all, just sit there), the heart does something quite obvious, and furthermore it does it 50 – 100 times per minute (so that even a physician with a very short attention span is likely to notice).
So perhaps it is not surprising that cardiologists seem to have entirely failed to mark certain emerging – and quite subtle – currents in the “preventive health” movement, and accordingly, continue to unabashedly seek more and more “preventive tools,” whatever the cost, with all the sensitivity and social awareness of the cousin who obliviously shows up at the funeral of the family priest wearing a pro-choice lapel pin. Read more »
*This blog post was originally published at The Covert Rationing Blog*
June 10th, 2009 by EvanFalchukJD in Better Health Network, Health Policy
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The OSHA-ization of health care quality continues.
A research group and a consulting firm have been hired by the state of Massachusetts to head up a new initiative to publish cost and quality information on Massachusetts doctors. But the quality measures they will use are the same old ones we have seen for a long time. They mean very little to most patients, and even less to doctors as a measure of how good their work may be.
To understand what I mean, look at what is being measured.
For the category “Adult Diagnostic and Preventative Care,” there are only four quality measures. They are:
- rates of colorectal screening tests
- the number of patients in an insured population who lowered their blood pressure in a given year
- correct imaging test use for lower back pain
- rates of use of a spirometry test for COPD
The good news is Massachusetts doctors do better than the national average on these measures. The bad news is it’s hard to say what that means as far as how good any doctor is who is measured this way.
Maybe it’s better in women’s health. There, the four quality measures are:
- rates of breast cancer screening for women 40-69
- rates of cervical cancer screening for women 21-64
- rates of chlamydia screening for women 16-20
- rates of chlamydia screening for women 21-25
Hmm. So if I am a 30 year-old woman trying to figure out how good my doctor is, the only thing that is being measured is whether he does a cervical cancer screening on me or not. How about pediatrics?
- rates of well visits
- correct antibiotic use for upper respiratory infections
- follow-up with children starting medications for ADHD
I could go on, but there’s a pattern. All of these “quality” measures are crunching medical billing data and styling it as a quality metric. And so every metric is going to be focused on things that are easily measurable by a review of those bills.
But there’s a more disturbing pattern. The information is simply not valuable to consumers. Worse, I think it is deeply misleading. A medical group that does chlamydia screenings on 100% of its patients may be good or bad – or it just may be smart enough to know that if they do the state of Massachusetts will rate them with five gold stars. But consumers won’t be able to tell the difference. All they will know is that practice A is “high quality,” while practice B isn’t. Some doctors are starting to sound the alarm about this.
And this is the larger point. Our health care is organized in a way that systematically undervalues the thinking, processing and deciding aspects of medicine- the things that really matter to you when you’re a patient who is sick trying to get help. Our system treats medicine as an assembly-line process amenable to assembly-line metrics. But it’s not.
Doctors, like others in professions requiring judgment and reflection, need time to think, and ought to be judged by how well they do that. Since the leading cause of misdiagnosis is a failure of synthesis – a failure by the doctor to put together available information in a way that leads them to the right conclusion – our system ought to be built around helping make sure this happens each and every time.
So, instead of a web site where you could see how often a medical practice does chlamydia screenings, imagine you could find out how often doctors at a hospital got their patients the right diagnosis and treatment? Now that would be a useful way to measure quality.
*This blog post was originally published at See First Blog*
