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Are Urologists Being Seduced By Robots?

Maggie Mahar’s Health Beat blog tipped me off about a Bloomberg opinion piece by an Oregon urologist that begins by stating:

“The decision to opt for medical care that relies on the most costly technology is often based on blind faith that newer, elaborate and expensive must be better.”

Later, he focuses specifically on robotic surgery devices:

“They are costly and require significant re-training for surgeons. Yet consumers hungrily seek out surgeons versed in their use. If a surgeon recommends an older, less expensive technology, many patients will shop for a surgeon willing to use the newest and costliest devices, even if the added benefits are unproven and the risks may be greater.

Hospitals do nothing to discourage this and engage in the kind of tawdry marketing more familiar on late-night infomercials by using patient testimonials. “I cannot believe how quickly I recovered,” a vigorous-looking patient is quoted as saying.

As a surgeon I have to ask: Where is the data? Was the recovery any quicker than in a procedure done without a robot? Would another surgical approach have served the patient as well? And cost a lot less?

We are all keepers of the health-care system treasury. In making treatment choices, physicians and patients alike would do well to ask: “If I were paying for this out of my own pocket would I choose this treatment, or am I just being wowed by the cool factor at someone else’s expense?”

In the first decade of practice I was enthralled with the amazing new technology. Moving into my second decade I hope to temper some of that enthusiasm with a bit of good old-fashioned fiscal responsibility.”

It should be noted that the urologist/author discloses in the editorial that he is is founder of a medical device company with its own surgical system.

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

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*

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*

What A ’68 Chevy Impala Can Tell Us About Primary Care

When I was a much younger man I had a 1968 Chevy Impala. I loved its V-8 engine and spaciousness, but I paid a steep price for it. It consumed gas like a drunk on a binge. It was prone to breakdowns, usually in the left lane of a busy highway. Even as it consumed my limited financial resources, I couldn’t count on it to reliably get me to where I wanted to be. Yet I held onto it. One day, though, its transmission gave out, and I finally had to resign myself to buying a new, more reliable, more modern, and efficient vehicle. Yet to this day, I miss my clunker.

I am reminded of this when I think about the state of primary care today. Many of us are attached to a traditional primary care model that may no longer be economically viable — for physicians, for patients, and for purchasers.

We hold onto a model where primary care doctors are paid based on the volume of visits, not the quality and value of care rendered. We hold onto a model where patient records are maintained in paper charts in voluminous file folders, instead of digitalizing and connecting patient records. We hold onto a model that generates enormous overhead costs for struggling physician-owners but generates insufficient revenue. We hold onto a model that most young doctors won’t buy, as they pursue more financially viable specialties and practices. Read more »

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

Why Patients Are Unsure Of The Primary Care “Medical Home”

Say the words, “Patient-centered medical home,” and you’re bound to get a variety of opinions.

On this blog alone, there are a variety of guest pieces critical of the effort, saying it does not increase patient satisfaction, nor does it save money. And that’s not good news for its advocates, who are pinning primary care’s last hopes on the model.

Medical homes hit the mainstream media recently, with Pauline Chen focusing one of her recent, weekly New York Times columns to the issue. She discussed the results of a demonstration project, showing some positive results. Read more »

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

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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