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Tension Between Physician Autonomy And Adherence To Protocols

Doctors are professionals.  But are doctors cowboys or pit crews?  Recently, physician writer, Dr. Atul Gawande, spoke about the challenges for the next generation of doctors in his commencement speech titled, Cowboys and Pit Crews, at Harvard Medical School.  Gawande notes that advancement of knowledge in American medicine has resulted in an amazing ability to provide care that was impossible a century ago.  Yet, something else also occurred in the process.

“[Medicine’s complexity] has exceeded our individual capabilities as doctors…
The core structure of medicine—how health care is organized and practiced—emerged in an era when doctors could hold all the key information patients needed in their heads and manage everything required themselves. One needed only an ethic of hard work, a prescription pad, a secretary, and a hospital willing to serve as one’s workshop, loaning a bed and nurses for a patient’s convalescence, maybe an operating room with a few basic tools. We were craftsmen. We could set the fracture, spin the blood, plate the cultures, administer the antiserum. The nature of the knowledge lent itself to prizing autonomy, independence, and self-sufficiency among our highest values, and to designing medicine accordingly. But you can’t hold all the information in your head any longer, and you can’t master all the skills. No one person can work up a patient’s back pain, run the immunoassay, do the physical therapy, protocol the MRI, and direct the treatment of the unexpected cancer found growing in the spine. I don’t even know what it means to “protocol” the MRI.”

Despite all of the advancements in medicine, the outcomes and consistency in treatment and care are not as good as they could be.  Doctors are not doing basic things.  The fact that Gawande, author of The Checklist Manifesto, spoke at one of the finest medical schools in the country indicates how much more the profession needs to go.

“We don’t have to look far for evidence. Read more »

*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*

Many Parents Still Lack Confidence In Vaccines

Some parents remain unpersuaded that all childhood vaccines are safe or even necessary, a new survey published in Health Affairs shows.

Photo by James Gathany via the CDCWhile most parents vaccinate their children, they lack confidence in them, researchers pointed out. Parental education should include thorough explanations why infants should be fully immunized before age two.

Vaccination levels for most recommended vaccines were above 90% of national immunization goals in 2009, reported the CDC’s National Immunization Survey. But, researchers wrote, high immunization rates aren’t the same as high confidence in the vaccines.

Using data from the 2010 HealthStyles survey of 6,253 households (response rate 67%), researchers identified Read more »

*This blog post was originally published at ACP Internist*

Pregnant Moms: Beware Of Shift Changes In The Hospital

At one time, a hospital would be called a 24-hour institution but now it’s a business. Within this business are shift workers that include nurses, technicians, clerical staff and even hospital employed doctors who are now called hospitalists.  In a teaching hospital resident physicians also work in shifts so the responsibility of patient care is always being transferred from one group of healthcare providers to another. Do they always communicate effectively? Regrettably, “no.”

Sign-outs, handoffs, shift changes, nurses’ report. These are the multiple names for the process where a departing  provider is responsible for letting the arriving provider know what’s going on with the patient.  According to statistics, 80% of medical mistakes occur during shift changes and 50 to 60% of them are preventable. Listed below is an excerpt from The Smart Mother’s Guide to a Better Pregnancy that teaches pregnant moms what things should be known during a shift change. Read more »

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

Safe Injection Protocols Are Not Being Followed By Clinicians

Thanks to Laura Landro for shining light on unsafe injections in her WSJ blog, “Unsafe Injection Practices Persist Despite Education Efforts.”

Landro writes:

“A new push is underway to eliminate unsafe injection practices, which remain a persistent safety problem despite years of efforts to educate clinicians about the risks of re-using needles, syringes and drug vials.

In the U.S., failure to follow safe practices in delivering intravenous medications and injections has resulted in more than 30 outbreaks of infectious disease including hepatitis C, and the notification of more than 125,000 patients about potential exposure just in the last decade, according to health-care purchasing alliance Premier Inc.”

As a registered nurse this is unthinkable.  Learning to administer injections safely is “patient care 101.”  There is no excuse for any health care professional to unsafely inject patients.

Patients in the hospital, ambulatory surgical centers or outpatient settings, should expect that their nurses, doctors and other clinicians are administering injections safely. Read more »

*This blog post was originally published at Health in 30*

Excellent, Quality Phlebotomy? Kudos To A Lab In Manhattan

Last week I had some blood tests taken before a doctor’s appointment. I went to a commercial lab facility, one of several dozen centers for collecting specimens have opened up in otherwise-unrented Manhattan office spaces lately.

I have to say I really like getting my blood work done at this place, if and when I need blood tests. And it’s gotten better over the past few years.

First, pretty much all they do in the lab center is draw blood and collect other samples based on a doctor’s orders. So the people who work there are practiced at phlebotomy, because it’s what they do most of the time. The guy who drew my blood last week did the same a year or two ago, and he was good at it back then. He used a butterfly needle and I didn’t feel a thing.

Second, they seem organized and careful about matching specimens to patients. The man who drew my blood didn’t just confirm my name and date of birth, but he had me sign a form, upon my inspecting the labels that he immediately applied to the tubes of blood he drew from my right arm, that those were indeed my samples and that I was the patient named Elaine Schattner with that date of birth and other particulars. 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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