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Olympian Impregnated With The Wrong Embryo

Olympic winner and motivational speaker, Jim Stovall once said “Integrity is doing the right thing, even when no one is looking.” In September 2009, I wrote about a blog about Carolyn Savage, a 40 year old woman with a poor obstetrical history. Savage married her college sweetheart and had an uncomplicated first pregnancy. However, her second child was born prematurely. She had 4 subsequent miscarriages and ten years later she became pregnant through in-vitro fertilization (IVF). Because the Savages wanted a large family, they tried IVF again. Unfortunately, Savage was impregnated with the wrong embryo. To their credit, everyone rose to the highest level of integrity. The infertility clinic informed the Savage family as soon as the mistake was discovered and then gave them the option of terminating the pregnancy or continuing it. The Savage family then had to inform the rightful parents of the embryo that were not expecting to have a baby any time soon but was now faced with that dilemma. Savage ultimately delivered the baby and then handed it over to its rightful parent, the Morrell family. Read more »

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

Hospice Patients Spend Less Overall Time In Hospital But More Days In The ICU

Chronically-ill Medicare patients spent fewer days in the hospital and received more hospice care in 2007 than they did in 2003, but their intensity of care increased as well, according to a report by the Dartmouth Atlas Project.

While in the hospital less, patients had many more visits from physicians, particularly specialists, and spent more days in intensive care units, as result of growth in intensive care and specialist capacity, the researchers said.

Intensive interventions can lower a patients’ quality of life and cost more, the researchers noted. About one-fourth of all Medicare spending stems from the last year of life, and much of the growth in Medicare spending is the result of the high cost of treating chronic disease, the authors noted. Following patient preferences for end-of-life care may reduce such spending. Read more »

*This blog post was originally published at ACP Hospitalist*

Are EMRs The Key To Improving Hand-Offs From The ER To The PCP?

Improving handoffs from the emergency room back to the primary care physician will require changing how electronic health records are used, better reimbursement to both the hospital and ambulatory doctors, and malpractice reform, according to a study. The rising use of hospitalists and larger primary care practice sizes has contributed to the difficulties faced when an ER doctors tries to reach a physician who best knows the patient.

Haphazard communication and poor coordination can undermine effective care, according to a new research conducted by the Center for Studying Health System Change. Researchers conducted 42 telephone interviews between April and October 2010 with 21 pairs of emergency department and primary care physicians, who were case-matched to hospitals so the perspective of both specialties working with the same hospital could be represented.

Among the findings in the report, telephone communication was essential in some cases, but particularly time-consuming. Both emergency and primary care physicians reported successful completion of each telephone call often required multiple pages and lengthy waits for callbacks. While placing and receiving telephone calls might seem straightforward and quick, providers said each small action multiplied across dozens of patients can become a daunting burden, with little immediate reward or reimbursement. Read more »

*This blog post was originally published at ACP Hospitalist*

So Many Patient Complaints, Not Enough Time

Primary care physicians often have to see patients with a litany of issues — often within a span of a 15-minute office visit.

This places the doctor in the middle of a tension: Spend more time with the patient to address all of the concerns, but risk the wrath of patients scheduled afterwards, who are then forced to wait. And in some cases, it’s simply impossible to adequately address every patient question during a given visit.

It’s a situation that internist Danielle Ofri wrote recently about in the New York Times. In her essay, she describes a patient, who she initially classified as the “worried well” type:

… a thin, 50-year-old educated woman with a long litany of nonspecific, unrelated complaints and tight worry lines carved into her face. She unfolded a sheet of paper on that Thursday morning in my office with a brisk snap, and my heart sank as I saw 30 lines of hand-printed concerns.

Ms. W. told me that she had recently started smoking again, after her elderly mother became ill, and she was up to a pack a day now. She had headaches, eye pain, pounding in her ears, shortness of breath and dizziness. Her throat felt dry when she swallowed, and she had needling sensations in her chest and tightness in her gut. She couldn’t fall asleep at night. And she really, really wanted a cigarette, she told me, nervously eying the door.

This is the kind of patient who makes me feel as though I’m drowning.

Dr. Ofri did as many doctors do: She listened appropriately, went over the patient’s history and physical, reviewed prior tests, and concluded that many of her symptoms were due to anxiety. Except, in this case, they weren’t. The patient eventually had a pulmonary embolus, and hospitalized. Read more »

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

Concierge Medicine: The Cost Of Healthcare “Room Service” And Other Hospital Amenities

A per­spec­tive in [a recent] NEJM con­sid­ers the Emerg­ing Impor­tance of Patient Ameni­ties in Patient Care. The trend is that more hos­pi­tals lure patients with hotel-like ameni­ties: Room ser­vice, mag­nif­i­cent views, mas­sage ther­apy, fam­ily rooms and more. These ser­vices sound great, and by some mea­sures can serve an institution’s bot­tom line more effec­tively than spend­ing funds on top-notch spe­cial­ists or state-of-the-art equipment.

Think­ing back on the last time I vis­ited some­one at Sloan Kettering’s inpa­tient unit, and I mean­dered into the bright lounge on the 15th floor, stocked with books, games, videos and other signs of life, I thought how good it is for patients and their fam­i­lies to have a non-clinical area like this. The “extra” facil­ity is privately-funded, although it does take up a rel­a­tively small bit of valu­able New York City hos­pi­tal space (what might oth­er­wise be a research lab or a group of nice offices for physi­cians or, dare I say, social work­ers) seems wonderful.

If real healthcare isn’t an even-sum expense prob­lem, I see no issue with this kind of hos­pi­tal accou­trement. As for room ser­vice and order­ing oat­meal for break­fast instead of insti­tu­tional pan­cakes with a side of thaw­ing orange “juice,” chicken salad sand­wiches, fresh sal­ads or broiled salmon instead of receiv­ing glop on a tray, that’s poten­tially less waste­ful and, depend­ing on what you choose, health­ier. As for yoga and med­i­ta­tion ses­sions, there’s rarely harm and, maybe occa­sion­ally, good (i.e. value).

But what if those resources draw funds away from nec­es­sary med­i­cines, bet­ter soft­ware for safer CT scans and phar­ma­cies, and hir­ing more doc­tors, nurses or aides? (I’ve never been in a hos­pi­tal where the nurses weren’t short-staffed.) Read more »

*This blog post was originally published at Medical Lessons*

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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