U.S. Health Care Lags Worldwide for Those Over 65
By PAULA SPAN
Don’t Homogenize Health Care
By SANDEEP JAUHAR
IN American medicine today, “variation” has become a dirty word. Variation in the treatment of a medical condition is associated with wastefulness, lack of evidence and even capricious care. To minimize variation, insurers and medical specialty societies have banded together to produce a dizzying array of treatment guidelines for everything from asthma to diabetes, from urinary incontinence to gout.
At some level, this makes sense. Some types of variation are unwarranted, even deadly. For example, we know that ACE inhibitor drugs improve quality of life and survival in heart-failure patients, but only two-thirds of American physicians prescribe these drugs to such patients. A study by the National Committee for Quality Assurance, a nonprofit organization focused on health care, reported that 57,000 Americans die each year because the care they get is not based on the best available evidence.
But the effort to homogenize health care presumes that we always know which treatments are best and should be applied uniformly. Unfortunately, this is not the case. The evidence for most treatments in medicine remains weak. In the absence of good evidence recommending one treatment over another, trying to stamp out variation in care is irrational.
Even in my field, cardiology, a paragon of evidence-based medicine, most treatment recommendations are based on expert opinions, not randomized controlled trials. Rarely is there one best option.
Patient preferences have to be taken into consideration, too. Medical decisions necessarily involve value judgments, and who better to make those decisions than the patient? If a fashion model doesn’t want curative surgery because it will scar her face, that may make sense in the context of her priorities. As a doctor, I may not agree with her, but I have to try to understand her reasoning and abide by her decision.
The weaker a treatment recommendation, the more patient preferences should enter into medical decision making, and the more variation you should expect to see. This is a basic conflict in modern medicine: treatment uniformity, which aims to optimize population health, versus treatment variation, which aims to respect individual choice. There is no obvious solution to this conflict, but the resolution will determine what medical care is going to look like in 10 or 20 years.
Holiday injuries prompt ER doctors to warn of confusion over urgent care
By Jackie Farwell, BDN Staff
Posted Dec. 11, 2014, at 11:06 a.m.
As the holidays approach, emergency room physicians once again are girding for an influx of seasonal injuries. Falls from ladders while stringing lights, lacerations from broken glass ornaments and other holiday-related afflictions send about 250 patients a day to the hospital every November and December, according to the U.S. Consumer Product Safety Commission.
But some ER doctors worry too many patients are confused about whether to seek care at their local urgent care center or the hospital, according to a new poll by a major medical specialty society.
More than 75 percent of ER physicians harbor concerns patients with serious medical conditions will visit urgent care centers that are unequipped to treat them, according to the online poll conducted by the American College of Emergency Physicians. Ninety percent said patients are redirected to emergency departments because their medical conditions were more serious than urgent care centers could handle.
“It’s hard for patients to know two things: when is their problem more serious and the capabilities of the different places,” Dr. Charles Pattavina, head of the emergency department at St. Joseph Hospital in Bangor, said.
More than 2,800 emergency physicians responded to the poll, including 19 in Maine. The margin of error was 1.8 percent.
The poll adds a new twist to an ongoing move in health care toward greater reliance on urgent care centers. The facilities, along with clinics operated by retail chains including Wal-Mart and CVS, have gained popularity with consumers seeking to avoid long waits and limited hours at the doctor’s office and the high bills from emergency room visits.
Health advocates have encouraged their use as a way to stem the flow of patients who visit costly emergency rooms with less serious illnesses and injuries. The median cost of a visit to the ER is $1,233, 40 percent more than the typical American pays in monthly rent, a 2013 study found.
While urgent care centers save money by treating patients who otherwise would wind up in the ER, they also raise health care spending by diverting patients from their primary care doctors, according to a study by the Center for Studying Health System Change.
Urgent care centers in several states have siphoned patients from hospitals, competing for more lucrative insured patients, while hospitals continue serving uninsured populations that stress their bottom lines.
Just over half of ER physicians reported local urgent care centers market themselves as alternatives to the emergency department, the poll found.
Kaci Hickox among Ebola fighters, survivors named ‘Person of the Year’ by Time
FORT KENT, Maine — Kaci Hickox, the nurse who made national headlines recently when she defied Maine Gov. Paul LePage’s efforts to quarantine her after she returned from treating Ebola patients in Sierra Leone, is among those honored as Time Magazine’s 2014 “Person of the Year.”
The magazine named those fighting Ebola its 2014 “Person of the Year,” applauding the work of medical relief teams, doctors, nurses, ambulance drivers and burial teams working in western Africa, where an outbreak of the virus has killed thousands.
“For tireless acts of courage and mercy, for buying the world time to boost its defenses, for risking, for persisting, for sacrificing and saving, the Ebola fighters are Time’s 2014 Person of the Year,” the magazine said in a statement.
Efforts to reach Hickox Wednesday were not successful.
But Hickox told the BDN last month, “There is no humanity in Ebola.”
Hickox was interviewed then at the Fort Kent home she shared with her boyfriend Ted Wilbur, a former University of Maine at Fort Kent nursing student, a few days before the couple moved to southern Maine.
While in west Africa, Hickox ran a 35-bed clinic in Bo, Sierra Leone, supervising a 50-member medical and support staff.
“One of the difficulties in west Africa is there were not enough beds and definitely not enough beds in facilities equipped to take care of Ebola patients well,” she said. “We were a referral facility, so patients already diagnosed with Ebola were transferred to us.”
Every morning, Hickox said, she would get calls from health care workers at five other facilities telling her each had at least 10 Ebola patients they needed to send to her.
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