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Aggressive Care: When Is It Better For Patients?

The recurring narrative among health reformers is that hospitals that provide more care raise health costs, but don’t necessarily improve quality. This has lead to a backlash against so-called “aggressive” hospitals and doctors, with upcoming financial penalties to match. But the situation, as always, appears to be more nuanced than that.

In her column in the New York Times, Dr. Pauline Chen looks at one subset of patients who actually may benefit from aggressive care: Those who suffer surgical complications. The study,

found no difference in the rate of complications for aggressive and nonaggressive hospitals. But when they looked at all the patients who had complications and examined their outcomes, the researchers found that regardless of the urgency of their operations, those patients who were cared for at more aggressive hospitals were significantly more likely to survive their complications than those who had their operations at less aggressive hospitals.

In addition, the investigators found that characteristics associated with intensity of care treated surgical complications better:

… a hospital’s failure or success in treating surgical complications correlated consistently with factors that also characterized intensity of care — general expenditures, intensive care unit use and the total days of hospitalization — they found that benefits of this more aggressive care extended well beyond the time of the operation.

I constantly remind readers of this blog that more medicine isn’t necessarily better. The counter-intuitive findings from the Dartmouth Atlas study have been instructive in convincing patients that they are, in many cases, overtreated. Read more »

*This blog post was originally published at KevinMD.com*

Cesarean Section: 6 Ways To Prevent Complications

Although I’ve been a proponent for the prevention of medical errors for years and wrote a book to address those issues, I think my obstetrician-gynecologist (OB/GYN) colleagues are finally catching on.

Dr. Patrick Duff of the University of Florida’s OB/GYN department wrote an article in the December issue of the journal Obstetrics & Gynecology that caught my attention. In his article, “A Simple Checklist for Preventing Major Complications Associated with Cesarean Delivery,” Duff outlines steps that OB/GYNs should take in order to reduce complications during and after a cesarean section. Duff patterns his list after Dr. Atul Gawande’s book, “The Checklist Manifesto: How to Get it Right,” which has set the standard regarding reducing complications after surgery. According to Duff, the following steps should be taken in order to reduce complications after a cesarean section:

1. Clip hair at the surgical site just before making the incision to reduce wound infections. Duff states that there is a greater chance of promoting infections when the hair is shaved the night before the procedure. He also recommends clipping hair as opposed to shaving which reduces the rate of would infections.

2. Cleanse skin with chlorhexidine solution rather than iodine because medical studies have demonstrated a reduction in infections using chlorhexidine solution.

3. Give broad spectrum antibiotics before the surgical incision as opposed to after the newborn’s umbilical cord is clamped. Read more »

*This blog post was originally published at Dr. Linda Burke-Galloway*

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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