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Doctors And Patients Wish Their Relationship Was Better

Physicians said in a survey that noncompliance with advice or treatment recommendations was their foremost complaint about their patients. Most said it affected their ability to provide optimal care and more 37 percent said it did so “a lot.”

Three-quarters of patients said they were highly satisfied with their doctors. But they still had complaints ranging from long wait times to ineffective treatments.

Those are just some of the findings from two surveys, the first a poll of 660 primary care physicians conducted by the Consumer Reports National Research Center in September 2010 and the second a poll of 49,000 Consumer Reports subscribers in 2009. The magazine reported its results online.

In the doctors’ poll, physicians named these top challenges:

— 76 percent of doctors said when it came to getting better medical care, forming a long-term relationship with a primary care physician would help “very much.”

— 61 percent said being respectful and courteous toward doctors would help “very much,” while 70 percent said respect and appreciation from patients had gotten “a little” or “much” worse since they had started practicing medicine. This was a two-way street, since patients reported the same feelings.

— 42 percent physicians said health plan rules and regulations interfered “a lot” with the care they provided.

Also noted in the poll, 37 percent of physicians thought they were “very” effective when it comes to minimizing pain and discomfort for their patients, though 97 percent thought they were “somewhat” effective. But, 79 percent of patients said their doctor helped to minimize their pain or discomfort, according to the Consumer Reports blog. The gap might be explained by doctors thinking of their overall effectiveness with all of their patients, including those with chronic pain conditions that are difficult to diagnose and treat, and who are as a group less satisfied with their physicians. Read more »

*This blog post was originally published at ACP Internist*

“Difficult” Patients

Physicians see nearly one in five patients as “difficult,” report researchers. Not surprisingly, these patients don’t fare as well as others after visiting their doctor.

Researchers took into account both patient and clinician factors associated with being considered “difficult,” as well as assessing the impact on patient health outcomes. They reported results in the Journal of General Internal Medicine.

Researchers assessed 750 adults prior to their visit to a primary care walk-in clinic for symptoms, expectations, and general health; for how they functioned physically, socially and emotionally; and whether they had mental disorders. Immediately after their visit, participants were asked about their satisfaction with the encounter, any unmet expectations, and their levels of trust in their doctor. Two weeks later, researchers checked symptoms again.

Also, clinicians were asked to rate how difficult the encounter was after each visit. Nearly 18 percent were “difficult.” They had more symptoms, worse functional status, used the clinic more frequently and were more likely to have an underlying psychiatric disorder than non-difficult patients. These patients were less satisfied, trusted their physicians less, and had a greater number of unmet expectations. Two weeks later, they were also more likely to experience worsening of their symptoms.

But the label works both ways, as physicians with a more open communication style and those with more experience reported fewer difficult encounters, researchers said.

On a lighter note, TV’s comedy “Seinfeld” dedicated an entire plotline from one of its many episodes to Elaine, her doctor, and the label of being a difficult patient. It’s worth watching here.

*This blog post was originally published at ACP Internist*

Putting Your Heart Into The Super Bowl

Sports fans may literally live and die on their team’s victories, according to researchers who examined cardiac mortality rates after the home team won and lost the Super Bowl.

Total and cardiac mortality rates in Los Angeles County increased after the football team’s 1980 Super Bowl loss but overall mortality fell after the 1984 the team’s Super Bowl win, researchers concluded from a review of death certificates reported in Clinical Cardiology.

First, authors gave a clinical review. Stress causes a cardiac cascade. The sympathetic nervous system increases and releases catecholamines. This triggers a rise in heart rate and blood pressure, and ventricular contractility increases oxygen demand, causing blood the sheer against and fracture atherosclerotic plaque, the authors explained. Stimulation of alpha receptors in the vasculature further constrict coronary vessels, increasing oxygen demand while limiting oxygen supply to the heart.

Next, they gave a sporting review. Los Angeles has played twice in the Super Bowl, the first time losing to the Pittsburgh Steelers (who play in this Sunday’s Super Bowl, incidentally) in 1980. The Los Angeles Rams, as they were known then, were a long-time hometown team and played the game in nearby Pasadena, Calif. “This game was high intensity,” wrote the authors, “with seven lead changes before Los Angeles lost a fourth-quarter lead and the game.”

Later, a new football franchise arrived in town, the Los Angeles Raiders. In 1984 the Los Angeles Raiders traveled to Tampa, Fla. to beat the Washington Redskins in a more mundane affair.

Now, the review of findings. Researchers combed death certificates based on age, race and sex to compare mortality rates for Super Bowl-related days with non-Super Bowl days and created regression models predicting daily death rates per 100,000. Read more »

*This blog post was originally published at ACP Internist*

Accountable Care Act Unconstitutional? The Fate Of Americans’ Health

A Florida’s judge’s ruling that the Accountable Care Act (ACA) is unconstitutional doesn’t resolve the underlying constitutional issue (which will ultimately have to be decided by the U.S. Supreme Court) but it has introduced new uncertainty for the $2.3 trillion health care industry, and emboldened the law’s critics to push even harder for repeal (not that they weren’t trying already).

The Wall Street Journal’s (WSJ) health blog reports that “states and companies that are supposed to be implementing the law trying to figure out what to do next. The WSJ reports that the 26 states that are parties to the suit are considering whether to ask the Supreme Court to take up the case now, before it has fully wended its way through the legal system. The New York Times (NYT) quotes the governor of Florida as saying that until the fate of the law is clear, “we’re not going to spend a lot of time and money” to implement it. Other states, even if part of the suit, will move ahead,” the NYT says. The WSJ also reports that most health care companies plan to “stay the course” and continue to plan for the law’s implementation. Meanwhile, the Obama administration says that the judge’s ruling will have no effect on the implementation of the law or the requirement that states (including those who brought the suit) comply with its mandates and claims that most constitutional experts agree with the administration.

Now, I am not a lawyer, so I don’t have any expertise on the legal arguments over the ACA’s constitutionality. For those of you who want to hear more about the constitutional questions from people who might actually know what they are talking about, I recommend this Health Care Blog post from attorney Mark Hall, a critic of the Florida judge’s ruling. He notes that “at least half of the relevant part of the opinion is devoted to discussing what Hamilton, Madison, Jefferson and other Founding Fathers would have thought about the individual mandate” (Judge Vinson concluded that they would not have approved of it) but “the same Founders wrote a Constitution that allowed the federal government to take property from unwilling sellers and passive owners, when needed to construct highways, bridges and canals.” The Washington Post’s Ezra Klein — a supporter of the Affordable Care Act — has posted an excellent overview of what legal experts are saying about the ruling, pro and con, including a link to a posting that argues Judge Vinson ruled correctly. Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

Cardiovascular Care: Costs Could Triple By 2030

Real total direct medical costs of cardiovascular disease (CVD) could triple, from $273 billion to $818 billion (in 2008 dollars) by 2030. Real indirect costs, such as lost productivity among the employed and unpaid household work, could increase 61 percent, from $172 billion in 2010 to $276 billion.

Results appeared in a policy statement of the American Heart Association.

CVD is the leading cause of mortality and accounts for 17 percent of national health expenditures, according to the statement. How much so? U.S. medical expenditures rose from 10 percent of the Gross Domestic Product in 1985 to 15 percent in 2008. In the past decade, the medical costs of CVD have grown at an average annual rate of 6 percent and have accounted for about 15 percent of the increase in medical spending.

The spending is associated with greater life expectancy, “suggesting that this spending was of value,” the authors wrote. But as the population ages, direct treatment costs are expected to increase substantially, even though lost productivity won’t, since seniors are employed at lower rates.

If current prevention and treatment rates remain steady, CVD prevalence will increase by about 10 percent over the next 20 years. The estimate reflects an aging population, and one that is increasingly Hispanic. To prepare for future cardiovascular care needs, the American Heart Association projected future costs. By 2030, 40.5 percent (116 million) of the population is projected to have some form of CVD. Read more »

*This blog post was originally published at ACP Internist*

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