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Why Comparing The Performance Of Doctors Is Trouble

Who do you think is likely to be a better doctor: A board certified graduate of one of the top medical schools in America, or a non-certified doctor trained in a foreign country?

If your answer is “I have absolutely no idea,” then you’re probably spending a lot of time looking at the “report cards” that pass for measures of health care quality. And you’re probably confused.

Researchers in Pittsburgh studied 124 process-based quality measures in 30 clinical areas. These process measures are the state-of-the-art ways in which government and private insurers are checking up on the quality of medical care. They include things like making sure patients with heart problems are prescribed aspirin, and that women get Pap smears. The researchers compared these measures against other, simpler measures, like medical education, board certification, malpractice claim payments, and disciplinary actions.

The result? You couldn’t tell the differences among doctors. Read more »

*This blog post was originally published at See First Blog*

Breaking Oncology News: Can It Spread Socially?

I [recently] received a press release from a friend in the Bay Area. Investigators at UCSF have published a study in the New England Journal of Medicine showing that less chemotherapy can be effective at treating some childhood cancers.

The paper was the result of an eight-year clinical study in children with neuroblastoma. In this particular population, researchers were able to reduce chemotherapy exposure by 40 percent while maintaining a 90 percent survival rate. You can read about it here.

The press release sparked a brief email exchange between me and my friend: Who might be interested in writing about this study and is there any way to get it to spread?  What would make it sticky in the eyes of the public?

Here are a few ideas:

Figure out who cares. Sure it’s niche news, but there are people who would think this is pretty darn important. Think organizations centered on parents of children with cancer, adult survivors of childhood cancer, pediatric hematology-oncology physicians, pediatricians and allied professionals in pediatric medicine like nurse practitioners and hematology-oncology nurses. Networks form around these groups. Find them and seed them.

Make a video. Offer powerful, visual content beyond a press release. A four-minute clip with the principal investigator, Dr. Matthay, would be simple and offer dimension to what is now something restricted to print. The Mayo Clinic has done this really well. Read more »

*This blog post was originally published at 33 Charts*

Mammography: An Important Discussion To Keep Alive

This is a thoughtful “sounding board” piece in the New England Journal of Medicine this week: Lessons from the Mammography Wars.

It is so important to keep this discussion alive. The miscommunication that took place last November of what the U.S. Preventive Services Task Force tried to convey, and the complicity of some news organizations in adding to that confusion, provide lessons from which we simply must learn to do better.

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

Physician Burnout: Doctors And Patients Deserve Better

A new patient recently said he was referred to me after his last doctor had left medicine. His old doctor always looked unhappy and burned out, he noted.

Burnout affects more than half of doctors, according to researchers at the University of Rochester School of Medicine. Beyond mere job dissatisfaction, these doctors are emotionally exhausted to the point where they lose focus. They tend to be more depressed — perhaps one reason why doctors have a higher suicide rate than the general population.

While burnout can happen in any profession, the performance of stressed-out doctors can hurt someone else: Patients. Read more »

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

Accountable Care And Doctor-Patient Communication Go Hand In Hand

Accountable Care Organizations (ACOs) figure prominently in the new Patient Protection and Affordable Care Act (PPACA). The concept behind ACOs is that by tying both physician and hospital compensation to outcomes via a bundled fee (say for pneumonia) we can expect to see an improvement in quality and value.

In principal, accountable care makes a lot of sense. Practicality speaking, however, doctors and hospitals must address a huge challenge before they can expect benefit financially. Before doctors can be held accountable for the care they deliver, they must first be held accountable for the quality of their communication with patients.

Take hospital readmissions, which are a big healthcare cost driver today. According to a recent study in the New England Journal of Medicine, 20 percent of all Medicare patients discharged from hospitals were readmitted within 30 days, and 34 percent percent within 90 days. The Joint Commission and others rightly believe that inadequate communication between physicians — as well as between physicians and patients — is a major contributing factor. Read more »

*This blog post was originally published at Mind The Gap*

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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