The Medical Professionalism Blog
Bad Gold Drives Out Good Gold – The Effect of Overuse on Quality
Recent reports of the shortage of Ritalin for individuals who suffer from Attention Deficit Disorder made me think of the effects overuse has on the quality of care provided.
According to a Dartmouth Atlas report, overuse results in:
- worse access
- lower patient satisfaction and
- poorer outcomes.
The authors also note that “disorganized, poorly coordinated, and inefficient care… results in the underuse of effective medical interventions and the overuse of physician visits, consultations, hospitalizations and stays in intensive care units, particularly in treating chronic illness.” (my italics)
Recommended Reading – February 13-17, 2012
This week, journal articles abounded on the potential contributors to health care costs. What’s patient satisfaction, defensive medicine or treatment guidelines got to do with it? Read some of the latest studies and see what you think:
Inspired by the Youthful
Maybe the awareness of cost and effective decision-making in health care will be propelled by the next generation of physicians and clinicians. After all, it was the American Medical Student Association that propelled the conflict-of-interest “movement” by grading their academic medical centers’ conflicts of interest with the pharmaceutical and device companies. The generation now in medical training, deeply concerned about their children’s education, smartly looks at waste in health care spending as diverting investment from that in their children’s education. Aren’t these house staff members and students the ones that see unnecessary care performed by their attendees and question what another test or procedure will add to the outcome of a patient?
State of Emergency
During a recent talk at the Families USA conference, the Reverend Edward Livingston led an animated discussion regarding his groundbreaking work with the Camden Coalition of Healthcare Providers and Camden Churches Organized for People. (This work became well-known through Atul Gawande’s piece in The New Yorker, “The Hot Spotters.”) In the course of his talk, he described a simple yet critical piece of their team’s work to design a functional primary care system for frequent Emergency Department users: They asked these patients why they used the Emergency Department rather than seeing a primary care physician and used their responses to shape the intervention.
Recommended Reading – February 6-10, 2012
As the ABIM Foundation embarks on its Choosing WiselyTM campaign, it hopes to stimulate conversations about the need to use resources wisely. This week’s JAMA Viewpoint, The Harms of Screening: New Attention to an Old Concern, discusses why limitations should be set on screenings—both to prevent harm to patients and manage resources.
But how ready are physicians and patients to have conversations about wise use of health care resources and ultimately, change behavior?
What’s All the Fuss about Conflict of Interest in Medical Care?
A couple of weeks ago, the New York Times published a story entitled I Disclose…Nothing by Elisabeth Rosenthal. The premise of the article dealt with conflicts of interests in several professions, including those in medicine. It got me thinking about whether or not the concept of disclosure can successfully manage conflicts of interest in medicine as much as people expect it to.
The conclusion I came up with, in short, was no.
Recommended Reading – January 23-27, 2012
ABIM Foundation staff tracks news stories, blog posts and journal articles related to professionalism, with a specific focus on physicians’ stewardship of resources. Recently, there has been a sharp increase in the number of stories, posts and articles on stewardship. Our new Recommended Reading posts will help keep you informed of the latest news in this area.
Extremist Proposal Shocks the Medical Establishment
I suspect many were shocked, even disturbed, upon reading the article, Professionalism, the Invisible Hand, and a Necessary Reconfiguration of Medical Education by distinguished professor of medical education at Mayo Clinic, Fred Hafferty, and his two colleagues, Drs. Brennan and Pawlina. In the article, the authors call for all medical students to achieve competency in the economics of care prior to seeing their first patients. They state:
“There will be no traditional ‘patient care’ contact until students are fully able to decode and explain the highly cryptic billing statements that encumber patients. As students enter the bio-medical side of their training, patient meetings will begin to add explanations of diagnosis and treatment options to those of cost.”
Trying to Make Professionalism Real And Parsimonious
There has been a lot of both positive and negative reaction by physicians and others to the recently released American College of Physicians (ACP) Ethics Manual that states:
“Physicians have a responsibility to practice effective and efficient health care and to use health care resources responsibly. Parsimonious care that utilizes the most efficient means to effectively diagnose a condition and treat a patient respects the need to use resources wisely and to help ensure that resources are equitably available.”
Some have reacted to the notion of “parsimonious care” as it relates to cost effectiveness. Others have reacted to the idea of equitable availability of resources. The latter concept refers to a societal obligation to treat patients within a just system. ACP’s Manual describes the need to provide services to the uninsured and underinsured and not to deny care based on the inability to pay.
Putting the Charter into Practice Grantee: American College of Physicians Center for Ethics and Professionalism
This is the final entry in a series of posts written by the ABIM Foundation’s Putting the Charter into Practice grantees, which describes their motivation to pursue projects related to stewardship of resources.
The ACP Ethics, Professionalism and Human Rights Committee recently completed the sixth edition of the ACP Ethics Manual, published in the Annals of Internal Medicine on January 3, 2012. During its development, I was struck by how the more things change, the more they stay the same. Certainly, many topics are new, like:
- Online professionalism and the use of social media by physicians
- Confidentiality and electronic health records
- Health system catastrophes
But the principles that guide us are not. The challenge lies in applying them to emerging concerns, dealing with change and reaffirming what is fundamental. The stewardship of health care resources is a major concern and is commented on throughout the Manual.
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