What if the Placebo Effect isn’t a trick? NY Times

The NY Times has a fascinating article on the latest research into the Placebo Effect. The Times does a good job of outlining the history of the Effect, including the beginning of modern science’s interest in it, with none other than Benjamin Franklin in the mix. The latest research helps paint a picture that if correct, could help us understand the interconnection between faith healing, eastern medicine, therapeutic touch, and western medicine. It also holds out the possibility of even making our drugs more effective. Read on…

 

Why Doctors Hate their Computers – New Yorker

Atul Gawande is one of the best writers today, writing on the subject of healthcare, end of life issues and modern medicine in general. You likely have heard him on NPR. Finally, he tackles the aggravation and lost promise of  electronic medical record systems (EMR).

EMRs have been viewed as a panacea by the medical community, primarily by politicians and government administrators lured by the promises of centralized control of medicine with rising costs of patient care, along with lawyers who are seeking to minimize risk of lawsuits. Add to that  hospital administrators, many of whom have never had to fill in a screen of medical data in their lives.

From the medical practitioners I’ve talked to about EMRs they are frustrated with the level of work they have had to do to keep up and the difficulty of finding useful information in the systems. Some patients have lost their lives due to EMRs, as specialized practitioners enter data that is not easily found, and when a patient is admitted to an ER room, often these instructions are lost to the ER techs. Or, to be more precise, they can’t take the time to find them in the mountains of screens. Yes, because of EMRs patients that otherwise may have lived are dead. Gawande alludes to this issue in his article.

Once, physicians could dictate and have the dictation sent to India overnight for translation. They’d have it the next morning. Or they wrote notes that were good enough and ended up in charts where they could be found quickly.

We are now in the worse of all worlds. EMRs are not automated enough to actually save practitioners time. Because of the use of EMRs, the expectations that medical providers can do the work faster and better mean that funding agencies drive providers to work faster and see more patients. A PA I know would spend two hours after seeing over 25 patients a day, before finishing the work of  filling out her EMR records. She was not reimbursed for this effort and she said it affected her home life as well. It’s a story I’m hearing from many practitioners.  At some point in the future dictation will be perfected and finding data that’s critical to patient care in an emergency will be easy to do. Until then, providers will continue to burn out and leave the system, just at a time when we need them more than ever.

We encounter, in Gawande’s article, an administrator who claims that the EMRs are not for the doctors but for the patients. While it’s true that patients use these systems a lot, (myself included) the results that most of us get are simply lab results and some easy to understand notes from our providers. That someone would think that the patient is the focus of all of this is misguided and shows a lack of understanding of systems.  The patient could just have easily have been given this information without the vast back end systems that affect every moment of provider time.  Think I’m wrong? It’s the backbone of every app you run on your smart phones. They are small and customer/consumer focused. We create these systems all the time. Requirements? Just listen to the customer. No need for thousands of hours of input meetings and lawyers.

It’s time to demand better EMR systems, focused on the needs of the providers and patients, not the hospital administrators, the lawyers, government and private insurers and the like. It can be done.

With all that said, Gawande’s article is the best thing I’ve read yet that gives a clear lay of the land of the frustration that physicians are feeling about EMRs. Take a read.

https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers/amp

 

 

 

On Doctor Burnout – NY Times

The NY Times magazine has a good short article on a subject that many of my friends in the medical profession talk about, burnout. The reasons documented in the story mirror their concerns, electronic medical records being among the most irritating. Many doctors and their support teams of Physician Assistants, Nurse Practitioners and others spend vast amounts of time before or after seeing patients documenting their work. It is a demoralizing let down for people who have spent years becoming highly specialized providers of care. It used to be that many physicians could dictate their notes, then send them via modem to India for overnight translation. No longer. Read about that issue and others.

 

 

Web site ads for stem cell treatments analyzed – Consumer Health Digest

The latest issue of Consumer Health Digest reports on a researcher who has identified 30 companies in Canada engaged in direct to consumer marketing of stem cells. Here’s an exerpt from the Consumer Health Digest.

Based on a series of Web searches, a researcher has identified 30 companies in Canada engaged in direct-to-consumer marketing of stem cell treatments offered at 43 distinct clinics in six provinces, with most located in Ontario. Her findings included:

  • Most of the companies advertised stem cell treatments only for orthopedic diseases and injuries, pain management, and sports-related injuries, but other companies offered treatments for cosmetic purposes, hair loss, neurological, aging, immunological diseases, muscular dystrophy, lung diseases, urological diseases, sex-related issues, and cardiac disease.
  • Sixteen of the companies disclosed no risks in Web ads, while the other 14 companies typically described only the possibility of short-term problems
  • Only two sites disclosed that serious risks were possible.
  • None provided information about long-term follow-up care.
  • Most companies advertised positive but unquantified claims, but five made explicit quantitative claims without links to supportive evidence.
  • Most of the companies did not disclose what they charge for their procedures. [Turner L. Direct-to-consumer marketing of stem cell interventions by Canadian businesses. Regenerative Medicine. Epub ahead of print, Sept 26, 2018]

To sign up for the Consumer Health Digest go to this web page.

http://lists.quackwatch.org/mailman/listinfo/chd_lists.quackwatch.org

 

 

Three take-aways from Nancy Guinto’s transparency testimony to the US Senate HELP Committee – State of Reform

Nancy Guinto, Executive Director of the Washington Health Alliance (WHA), testified before the US Senate HELP (Health, Education, Labor and Pensions) Committee last week about how price transparency initiatives can increase value in health care. Three key takeaways:

  • Congress should create incentives to align stakeholder interests in leveraging data to improve care value. Congress should look across public and private sectors to coordinate efforts to increase transparency.
  • Congress should support federal agency efforts to increase transparency by promoting initiatives that tie cost, quality, and value together and by making access to data less burdensome.
  • Congress should leverage existing networks that promote transparency, like regional health improvement collaborative, that already have the trust and support of local stakeholders and who are already working to make care improvements.

Those of us involved in the Jefferson County Healthcare Access Group (CHA) have struggled for a few years now to increase pricing transparency at Jefferson Healthcare. We have met with resistance every step of the way. Breakthroughs in the last year have led to citizens having a somewhat better understanding of the prices they face before they get into the hospital. We fully support the efforts of the Washington Healthcare Alliance.

It is clear to those of us involved in understanding the healthcare industry on a local level, that increasing centralization, decreasing independent medical providers, penalization of individual providers by Congressional funding mandates,  and a lack of transparency are creating a system the more resembles a monopoly, costs more and does not  necessarily provide better indices of health.

Read more on this at

https://stateofreform.com/featured/2018/09/three-take-aways-from-nancy-guintos-transparency-testimony-to-the-us-senate-help-committee/