January 16th, 2011 by DavedeBronkart in Health Policy, Opinion
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From the Medscape Medical Ethics article entitled “‘Some Worms Are Best Left In The Can’: Should You Hide Medical Errors?“:
Consequences aside, from a strictly ethical perspective, if a patient doesn’t realize that his physician made a mistake, should the physician fess up?
Before you jump to conclusions (as I did), look at the article’s three parts. It’s about a survey. The title is on the inflammatory side; the article is a window into physicians’ views. The introduction continues:
Evidence of the complex prisms through which physicians view these issues was apparent in the replies to four questions asked in Medscape’s exclusive ethics survey. More than 10,000 physicians responded to the survey in 2010.
Subheads:
— Mistakes that don’t harm patients. “Are there times when it’s acceptable to cover up or avoid revealing a mistake if that mistake would not cause harm to the patient?” Sixty percent said “no;” the others split between “yes” and “it depends.”
- I personally can understand this note from a survey respondent: “If there is a mistake that would have no medical effect but would cause extreme, uncalled-for anxiety, then yes,” especially since I know people (some elders, some young) who would indeed freak out, out of proportion. But, that’s a big judgment call.
- I have a harder time accepting this comment: “Why shake the patient’s trust in the doctor for something that is irrelevant?” Irrelevant is a big judgment call, and I’d be really concerned about the natural human tendency to minimize the probable impact of a mistake — especially if a provider thinks it’s all about maintaining a patient’s trust, even when the topic is their own error.
— Mistakes that might harm patients. Ninety five percent said “no;” some still said “yes!” One commented: “If the mistake has not progressed to harmfulness, then it’s essentially a non-issue. Treatment correction takes place and you move on.” Another says if there hasn’t been harm yet, “I think a ‘wait and see’ approach is okay.” Read more »
*This blog post was originally published at e-Patients.net*
January 16th, 2011 by Dinah Miller, M.D. in Better Health Network, Opinion
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I’ve followed in bits and pieces — sometimes for Shrink Rap, sometimes because the issues fill my email inbox, sometimes because there’s no escape. Oh, and lots of the players have familiar names.
In the December 27th issue of Wired magazine, Gary Greenberg writes a comprehensive article on the debates around the revision of the American Psychiatric Association’s (APA) upcoming revision of the Diagnostic and Statistical Manual (DSM) entitled “Inside the Battle to Define Mental Illness.” Do read it. Here’s an excerpt:
I recently asked a former president of the APA how he used the DSM in his daily work. He told me his secretary had just asked him for a diagnosis on a patient he’d been seeing for a couple of months so that she could bill the insurance company. “I hadn’t really formulated it,” he told me. He consulted the DSM-IV and concluded that the patient had obsessive-compulsive disorder.
“Did it change the way you treated her?” I asked, noting that he’d worked with her for quite a while without naming what she had.
“No.”
“So what would you say was the value of the diagnosis?”
“I got paid.” Read more »
*This blog post was originally published at Shrink Rap*
January 16th, 2011 by Linda Burke-Galloway, M.D. in Health Policy, Opinion
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When the Nebraska lawmakers voted to end Medicaid prenatal care for approximately 1,500 women, their unborn babies paid the ultimate price.
Any labor room hospitalist who is responsible for the care of unassigned pregnant women will tell you that it is far easier to take care of pregnant women who have had prenatal care than it is to take care of women who haven’t. The recent vigil of the Equality Nebraska Coalition in front of their state capitol to honor five dead babies whose death can be related to the lack of access to prenatal care speaks volumes.
On or about February of 2010, Nebraska expectant mothers received a “Dear John” letter from Nebraska’s Health and Human Services stating that their pregnancies were no longer covered under Medicaid. It appeared that the rationale for making such a drastic decision involved a resistance of state politicians to pay for medical services of “illegal immigrants.”
However, when one reads the comments on a popular website called Baby Center.com, the pregnant women who were affected were U.S. citizens who were college students, wives of husbands who had lost their medical insurance, and unemployed women. Eventually all the women were able to receive government-sponsored healthcare coverage, but the panic preceding their reinstatement was palpable. Read more »
*This blog post was originally published at Dr. Linda Burke-Galloway*
January 15th, 2011 by DrWes in Health Policy, Opinion
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From CBS News:
President Obama is planning to hand the U.S. Commerce Department authority over a forthcoming cybersecurity effort to create an Internet ID for Americans, a White House official said here today.
It’s “the absolute perfect spot in the U.S. government” to centralize efforts toward creating an “identity ecosystem” for the Internet, White House Cybersecurity Coordinator Howard Schmidt said.
That news, first reported by CNET, effectively pushes the department to the forefront of the issue, beating out other potential candidates including the National Security Agency and the Department of Homeland Security. The move also is likely to please privacy and civil liberties groups that have raised concerns in the past over the dual roles of police and intelligence agencies.
No, they’re not talking about a national ID card, just an international internet ID. The announcement came at an event today at the Stanford Institute for Economic Policy Research, where U.S. Commerce Secretary Gary Locke and Schmidt spoke. The Obama administration is currently drafting what it’s calling the National Strategy for Trusted Identities in Cyberspace, which Locke said will be released by the president in the next few months. (An early version was publicly released last summer.)
“We are not talking about a national ID card,” Locke said at the Stanford event. “We are not talking about a government-controlled system. What we are talking about is enhancing online security and privacy and reducing and perhaps even eliminating the need to memorize a dozen passwords, through creation and use of more trusted digital identities.”
Imagine: Anyone registered with such a cyber-ID who conferences with their doctor via a “secure server” can also be tracked by the government with such a mechanism. And the issue of not needing more than one password? While convenient, the ramifications of multiple accounts being compromised if a data leak were to occur remains with such a mechanism. Read more »
*This blog post was originally published at Dr. Wes*
January 15th, 2011 by Iltifat Husain, M.D. in Better Health Network, Opinion
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The potential of mobile phones to improve health is most acutely visible in developing countries. iMedicalApps covered the recent mHealth Summit, where there were many inspiring demonstrations of how voice and simple text messages can have a profound effect on the health of those countries’ citizens. Jhpiego has successfully worked on these problems for three decades and was recently awarded a $100m grant. James Bon Tempo has extensive experience in this field and we are thrilled that he is sharing his insights with the readers of iMedicalApps.
This is a guest post from James BonTempo.
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Mobile Health In Developing Countries
I am a user and an implementer of technology, not an inventor or developer, so my constraints, challenges and requirements are different than those of many attendees of the recent mHealth Summit. And for others like me who work in international aid and development, mobile technology is simply a tool, and one of many in a large toolbox that includes various best practices and proven approaches. At Jhpiego (an affiliate of Johns Hopkins University), we have piloted a number of different mobile interventions — from simple SMS to Java & smartphone-based applications — but the challenge for us is to identify the most appropriate technologies, the tools that will help us to strengthen health systems in limited resource settings most effectively and most efficiently. Read more »
*This blog post was originally published at iMedicalApps*
