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Understanding Treatment: The Communication Disconnect Between Doctors And Patients

November 30th, 2010 by Elaine Schattner, M.D. in Better Health Network, Health Policy, News, Opinion, Research

Tags: Accuracy of Medical Decision Making, Angioplasty, Annals Of Internal Medicine, Cardiology, Communication Disconnect, Communication Gap, Doctor-Patient Communication, Doctor-to-Patient Communication, Dr. Elaine Schattner, General Medicine, Healthcare Decision Making, Informed Consent, Medical Lessons, Medical Procedures, Patient Education, PCI, Percutaneous Coronary Intervention, Reason For Treatment, Risks vs. Benefits, Shared Decision-Making, Surgical Procedures, Therapeutic Misconception, Treatment Decision-Making, Why A Procedure Should Be Done

Over the long week­end I caught up on some read­ing. One arti­cle* stands out. It’s on informed con­sent, and the stun­ning dis­con­nect between physi­cians’ and patients’ under­stand­ing of a procedure’s value.

The study, pub­lished in the Sept 7th Annals of Inter­nal Med­i­cine, used sur­vey meth­ods to eval­u­ate 153 car­di­ol­ogy patients’ under­stand­ing of the poten­tial ben­e­fit of per­cu­ta­neous coro­nary inter­ven­tion (PCI or angio­plasty). The inves­ti­ga­tors, at Baystate Med­ical Cen­ter in Mass­a­chu­setts, com­pared patients’ responses to those of car­di­ol­o­gists who obtained con­sent and who per­formed the pro­ce­dure. As out­lined in the article’s intro­duc­tion, PCI reduces heart attacks in patients with acute coro­nary syn­drome — a more unsta­ble sit­u­a­tion than is chronic sta­ble angina, in which case PCI relieves pain and improves qual­ity of life but has no ben­e­fit in terms of recur­rent myocar­dial infarc­tion (MI) or survival.

The main result was that, after dis­cussing the pro­ce­dure with a car­di­ol­o­gist and sign­ing the form, 88 percent of the patients, who almost all had chronic sta­ble angina, believed that PCI would reduce their per­sonal risk for hav­ing a heart attack. Only 17 percent of the car­di­ol­o­gists, who com­pleted sur­veys about these par­tic­u­lar patients and the poten­tial ben­e­fit of PCI for patients fac­ing sim­i­lar sce­nar­ios, indi­cated that PCI would reduce the like­li­hood of MI.

This strik­ing dif­fer­ence in patients’ and doc­tors’ per­cep­tions is all the more sig­nif­i­cant because 96 percent of the patients “felt that they knew why they might undergo PCI, and more than half stated that they were actively involved in the decision-making.” Read more »

*This blog post was originally published at Medical Lessons*

How Medicare Pays For Inpatient Care

November 29th, 2010 by Happy Hospitalist in Better Health Network, Health Policy, News, Opinion

Tags: Government-Paid Healthcare, Happy Hospitalist, Healthcare Costs, Healthcare Economics, Healthcare Price-Fixing, Hospital Reimbursement, How Doctors Are Paid By Medicare, medicaid, Medicare, Medicare Reimbursement, Medicare's Acute Care Inpatient Payment, New York Times, Payment For Inpatient Care

Have you ever wondered how hospitals get paid by Medicare? The New York Times has an excellent and simple explanation of this highly complicated process. It’s simple really.

First the hospital labor component is adjusted for geographic location and then added to the capital depreciation expenditures adjusted for geographic location and then a medical severity adjusted diagnosis related group multiplier is added (MS-DRG).

Once this adjusted payment rate is calculated, the hospital is given a bonus to cover the costs incurred if they are a teaching hospital, through the indirect medical education payment. Added to that is the disproportionate share payment for hospitals that see a lot of uninsured or Medicaid patients (strange that Medicare subsidizes Medicaid, isn’t it?) If you have a patient that is extremely sick or spends mulitple extra days in the hospital, they may get an extra outlier payment. Read more »

*This blog post was originally published at The Happy Hospitalist*

Medical Journals: Do Peer Reviewers Get Worse With Experience?

November 29th, 2010 by GarySchwitzer in Better Health Network, News, Opinion, Research

Tags: Annals of Emergency Medicine, Dr. Ivan Oransky, Evidence-Based Health Reporting, Gary Schwitzer, Health Journalism, HealthNewsReview.org, Medical Journalists, Medical Journals, Medical Peers' Professional Opinions, Medical Reporting, Peer Review System, Peer Reviewers, Peer-Reviewed Journals, Peer-Reviewed Publications, Retraction Watch, Science Journalists

Interesting post by the Retraction Watch blog, pointing to an interesting paper published last week in the Annals of Emergency Medicine. An excerpt from the blog post:

Over 14 years, 84 editors at the journal rated close to 15,000 reviews by about 1,500 reviewers. Highlights of their findings:

…92% of peer reviewers deteriorated during 14 years of study in the quality and usefulness of their reviews (as judged by editors at the time of decision), at rates unrelated to the length of their service (but moderately correlated with their mean quality score, with better-than average reviewers decreasing at about half the rate of those below average). Only 8% improved, and those by very small amount.

How bad did they get? The reviewers were rated on a scale of 1 to 5 in which a change of 0.5 (10%) had been earlier shown to be “clinically” important to an editor. Read more »

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

WikiLeaks: What It Means For Healthcare Privacy

November 29th, 2010 by DrWes in Better Health Network, Health Policy, News, Opinion

Tags: Diplomatic Cables, Dr. Wes Fisher, Electronic Medical Record, EMR, General Medicine, Government-Funded Healthcare, Healthcare Policy, Healthcare Privacy, Patient Confidentiality, Patient Privacy Laws, Personal Health Records, Private Healthcare Information, Unauthorized Disclosure, WikiLeaks

From the official White House statement yesterday regarding WikiLeaks disclosure of diplomatic cables:

“By releasing stolen and classified documents, WikiLeaks has put at risk not only the cause of human rights, but also the lives and work of the individuals. We condemn in strongest terms, the unauthorized disclosure of classified documents and sensitive national security information.”

No matter what people think of WikiLeaks disclosure of approximately 250,000 classified diplomatic cables to the Internet yesterday with the help of the New York Times, The Guardian, Der Spiegel, and Le Monde, the implications to electronic healthcare information security are significant.

Day in and day out, I type huge volumes of information on my patients on a computer and my fellow physicians do the same. As a result, vast healthcare information warehouses are at the disposal of the government, insurers, and major healthcare institutions eager to become more efficient, strategic, or competitive. We are promised the information is private, confidential, and even stripped of its identifiers for group analysis. It is even protected to remain so by law. Read more »

*This blog post was originally published at Dr. Wes*

Healthcare Reform Law Is Gaining Public Support

November 29th, 2010 by Shadowfax in Better Health Network, Health Policy, News, Opinion, Research

Tags: Denied Coverage, Dr. Liam Yore, Election 2010, Everyone Must Buy Health Insurance, Healthcare Insurers, Healthcare Law, Healthcare Policy, Healthcare Politics, Healthcare reform, Kaiser Family Foundation, McClatchy-Marist Poll, Movin' Meat, Pre-Existing Conditions, Public Support, Repeal or Replace, Shadowfax

GOP hardliners soon to be in control of the House have made repeal of the detested healthcare reform law a cornerstone of their agenda, despite the impossibility of actually being able to repeal it, politically, at least until an election or two has passed, and despite the fact that their ascent to power had more to do with the terrible economy and high unemployment than any mandate to repeal the law.

It seems that, finally, there may be movement towards increased public support for the law. A new McClatchy poll shows a majority of Americans now in favor of the law:

A majority of Americans want the Congress to keep the new health care law or actually expand it, despite Republican claims that they have a mandate from the people to kill it, according to a new McClatchy-Marist poll.

The post-election survey showed that 51 percent of registered voters want to keep the law or change it to do more, while 44 percent want to change it to do less or repeal it altogether.

Driving support for the law: Voters by margins of 2-1 or greater want to keep some of its best-known benefits, such as barring insurers from denying coverage for pre-existing conditions. One thing they don’t like: the mandate that everyone must buy insurance.

Of course, it is the mandate that makes the whole thing hang together. And it’s hardly news that people like the individual provisions and protections found within the law. Read more »

*This blog post was originally published at Movin' Meat*