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Showing posts with label doctors. Show all posts
Showing posts with label doctors. Show all posts

Wednesday, January 18, 2012

Doctors Required to Report Payments from Drug and Device Firms


UPDATE: 26 January
Dialing for Doctors - 

18 January
To head off medical conflicts of interest, the Obama administration is poised to require drug companies to disclose the payments they make to doctors for research, consulting, speaking, travel and entertainment.
Many researchers have found evidence that such payments can influence doctors’ treatment decisions and contribute to higher costs by encouraging the use of more expensive drugs and medical devices.
Consumer advocates and members of Congress say patients may benefit from the new standards, being issued by the government under the new health care law. Officials said the disclosures increased the likelihood that doctors would make decisions in the best interests of patients, without regard to the doctors’ financial interests.  

Thursday, July 29, 2010

The patient is the best historian

Medical education is a form of brainwashing, not too different than educating future lawyers.  Most higher education is not far removed, because it is the major way, just as in the days of the Guilds, that a trade or profession was continued.  Keeping the education process in a narrow perspective fosters the culture in that field, and perpetuates the lack of growth and change, new ideas, or new approaches.

One thing that used to be a Golden Rule in health care was the importance of listening to your patient.  Today, this is not always possible because of the tight control of the bottom line over health care practices by administrators and insurers, as well as the pharmaceutical companies. 

I listen to my clients and often hear them tell me of their frustration with doctors who look at a computer, not at them, and type while talking. Others just say that the doctor just doesn't listen.  I another case the person has told me that the doctor forces her beliefs against natural treatment and makes this person feel demeaned.  The complaints and horror stories fill a book.

This recent UPI article points to this concern, so perhaps you'll see some effort to begin listening to patients come around once again.

Physicians often misjudge patient beliefs


HERSHEY, Pa., July 28 (UPI) -- Doctors often guess wrong about their patients' health beliefs, U.S. researchers found.

Dr. Richard Street from Texas A&M University in College Station and Dr. Paul Haidet of Pennsylvania State University College of Medicine in Hershey found patients' health beliefs differ from their physicians' perception of these beliefs, and suggest doctors pay more attention to what their patients have to say.

The study, published in the Journal of General Internal Medicine, found physicians generally do not have a good understanding of patient's health beliefs, but their understanding is significantly better when patients more actively participate.

"If physicians had a better understanding of their patients' beliefs about health, they could address any misconceptions or differences of opinion they had with the patient regarding the nature, severity, and treatment of their illnesses as well as make treatment recommendations better suited to the patient's life circumstances," Street said in a statement. "Encouraging the patient to be more involved in the consultation by expressing their beliefs and concerns is one way physicians can gain this understanding."

Street, Haidet and colleagues analyzed 207 audio-recorded physician-patient consultations as well as surveys about the cause, treatment and other aspects of the patients health condition conducted by both physicians and patients after the consultation. Physicians were also asked about how they thought the patients responded.

© 2010 United Press International, Inc. All Rights Reserved.

Wednesday, July 14, 2010

Docs and Attorneys: Fear Whistleblowing on Colleagues

There's an attorney in Seattle that has a sickening public file at WSBA yet his colleagues won;t come forward to see that he is disbarred. Even a judge coached him during a trial because he was so incompetent. This is only one example and the same goes for prosecutors and judges.

In health care it is often the same, not just for docs but other health professions too.

I'm still waiting for a nurse to be investigated from a whistleblower complaint by WSNA, but she's so cozy with that group that WSNA and WA state refuse to act. So I guess putting patients at risk, insurance fraud, and falsifying medical records is quite ok in Washington.

Reading this article takes me back to how I learned the importance of integrity from my doctor father.

In the 50s he told me about a group of his medical colleagues who had set up a group to monitor the members. These doctors had ethics and integrity, and they cared about their fellow physicians. They all agreed to confront a colleague if their was any concern.

Sure was real-time peer-review if you ask me.

All were AMA members.

Maybe now AMA needs to bring this back into vogue.

Certainly the health professions need to do so as well. And attorneys too!
Docs don't blow whistle on colleagues
By CARLA K. JOHNSON, AP Medical Writer

July 13, CHICAGO – Your doctor could be drunk, addicted to drugs or outright incompetent, but other physicians may not blow the whistle.

A new survey finds that many American physicians fail to report troubled colleagues to authorities, believing that someone else will take care of it, that nothing will happen if they act or that they could be targeted for retribution.

A surprising 17 percent of the doctors surveyed had direct, personal knowledge of an impaired or incompetent physician in their workplaces, said the study's lead author, Catherine DesRoches of Harvard Medical School.

One-third of those doctors had not reported the matter to authorities such as hospital officials or state medical boards. The findings, appearing in Wednesday's Journal of the American Medical Association, are based on a 2009 survey of 1,891 practicing U.S. doctors.

Reporting a problem doctor can trigger important changes. Twenty-one years ago, a colleague smelled alcohol on a young physician's breath and anonymously reported him to the head of the residency program. A now-sober Dr. A. Clark Gaither is grateful.

"I wish I knew who reported me," Gaither said. "I'd like to give them a big ol' hug and thank them for saving my life."

Programs exist for retraining doctors with weak skills and getting addicted ones into treatment. But the survey results suggest doctors are not confident in the system, DesRoches said.

The American Medical Association and other professional groups say doctors have an ethical obligation to make such reports. And many states require doctors to tell authorities about colleagues who endanger patients because of alcoholism, drug abuse or mental illness.

Despite that, many doctors do not know what to do or where to start, DesRoches said.

In an accompanying editorial, one ethics expert called the findings "jarring."

"I don't think there's any excuse for less than 100 percent of physicians holding true to these ideals," said Dr. Matthew Wynia, director of the AMA Institute for Ethics.

He called for better protections for whistleblowers and more education for doctors on how to report a colleague.

The survey did not specify the type or severity of the impairment or incompetence, asking: "In the last three years, have you had direct, personal knowledge of a physician who was impaired or incompetent to practice medicine in your hospital, group, or practice?"

Most states have programs that not only get doctors into treatment but also advise their colleagues how to intervene. Most will keep reports anonymous. Some use the threat of medical board sanction to persuade doctors to go to rehab.

For Gaither, the first confrontation with concerned colleagues was in medical school. He reassured his fellow students he was fine. Even the second confrontation, from the program head who had heard the report of Gaither's alcohol-scented breath, did not take. Gaither signed a contract promising to stay sober, go to Alcoholics Anonymous meetings and submit to testing.

"I went home and drank that night," he said. "I was thinking with an addicted brain, and I was an alcoholic."

Finally, a third confrontation and the temporary loss of his training license forced Gaither into what he calls "a state of surrender." With help from the North Carolina Physicians Health Program, he got into a residential rehab program.

His last drink was Jan. 21, 1990. Gaither, now 55, finished his residency and became a family doctor. He practices in Goldsboro, N.C., where he started a free mobile clinic for the uninsured.

In 2002, the North Carolina Academy of Family Physicians named him Physician of the Year. He thanked AA and all the colleagues who confronted him and supported him in his acceptance speech.

He now urges others to report what they know. "It is our duty," he said.

Dr. Warren Pendergast runs the North Carolina program, which cooperates with the state medical society and state disciplinary board. About 200 doctors a year are referred for alcoholism, drug addiction, anger-management problems and depression.

Ninety percent of addicted doctors who've been through the program remain clean and sober five years after treatment, Pendergast said.

"They're motivated. They have a lot to lose," he said. Their reputations and careers depend on their participation in treatment. Colleagues of troubled doctors "can feel comfortable getting peers help rather than sticking their head in the sand," he said.

Gaither, who speaks publicly about the program, said doctors worry that their troubled colleagues will lose their licenses and livelihoods if reported.

"I ask them, 'Would it be better if they lost their money, their marriage, their home, their cars, their license and then their life?'" he said. "Does that sound better than getting them the help that they need?"

Online: JAMA: http://jama.ama-assn.org

Wednesday, April 07, 2010

More doctors switching to flat fee service

This move has been fairly popular in the Puget Sound area for many years -
Some doctors using flat-fee system
by KING5.com

Posted on April 5, 2010 at 3:53 PM

Family physician Lee Adkins runs a unique practice.

"About three years ago, I found out there was an increase in missed appointments and when I talked to the patients, I found out many of them had lost their insurance," he said.

So Dr. Adkins set up a flat-fee system where patients pay $75 a month for a year.

"It's a very easy way to perform in the office," said Adkins.

Patients get 15 visits a year and access to all services, including blood tests, EKGs and pap smears.

Adkins says the flat-fee system has helped his bottom line.

"Last month, we were up 30 percent over last year," he said.

While it's difficult to track, one estimate reveals several hundred primary care physicians have begun to offer prepaid plans. Critics say some doctors who use flat-fee services are operating like insurance companies, without proper licensing. But Dr. Adkins says he's just offering patients a way to get care.

"If the doctors don't get active and do something, we'll have less qualified people making our decisions for us," he said.

Mike Scott lost his insurance when he lost his job. Thanks to Dr. Adkins, his health isn't suffering.

"It offered an opportunity to recheck for my diabetes, to keep it in control, and that's what I wanted to be able to do," said Scott.

Kim Turano also used to have insurance. When she lost it, her health took a back seat.

"What this program allows is for me to get the care that I had been ignoring in the past," she said.

Dr. Adkins says the flat-fee approach saves him money by eliminating administrative costs that come from dealing with insurance companies.

Locally, Qliance offers a similar approach, charging a monthly fee and bypassing insurance.

Saturday, March 20, 2010

Nutritional training for doctors too long overdue

LONDON, March 19 (UPI) -- Nutritional training is important to every area of clinical practice but has been long neglected, researchers in Britain said.

Dr. Penny Neild of St. George's Hospital in London and colleagues said the profession must take advantage of changes in medical education to ensure that all health professionals, but especially gut specialists, are given adequate training in nutrition.

The evidence shows healthcare professionals in general know little about how to assess and manage poor nutrition and gastroenterologists in particular need to be able to provide advice and expertise in general nutrition, artificial nutrition support, and intestinal failure, the researchers said.

"It is to be hoped that the requirement for more standardized and structured core nutrition training will be recognized and included in the revised curriculum for gastroenterology to be published in 2010," the researchers concluded.

The article is published in Frontline Gastroenterology, a new quarterly companion journal to Gut.
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