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Connecting symptoms to side effects, breaking down health care spending, and more

January 5, 2017

Happy new year! To start the year, we are unveiling a new look for RightCare Weekly. We’re changing our format so that you can read shorter summaries of more top stories. And as always, we are providing links to the many other articles and editorials relating to moving our healthcare system toward the right care for all patients.

Join the conversation: Post your comments in our new section at the bottom of this page.

 

Marlene Beggelman, MD, a member of Right Care Boston, writes on NPR’s CommonHealth about clinicians not connecting symptoms patient report to side effects of prescribed medications. Beggelman blames short office visits and lack of information about drug dangers, which is made worse when side effects go unreported. Her first-person piece provoked hundreds of comments on NPR’s facebook page, many from patients with their own stories of unexpected side effects caused by medications and doubting doctors.

Do you want to know where the $3.2 trillion we spend on health care is going? A recent study in JAMA breaks down health care spending from 1996-2013 by condition, patient age, and type of care. Overall, chronic conditions, many of them preventable, such as diabetes, ischemic heart disease, and low back and neck pain were the most expensive conditions in 2013, although drivers of spending varied by age, sex, type of care and year.

Overuse in adult medical care is getting lots of attention, but it gets short shrift in pediatrics, according to lead author Eric Coon, MD, writing in Pediatrics. Coon, the recipient of last year’s Best Abstract Award at the Lown Institute Annual Conference, and co-authors Alan Schroeder, MD and Ricardo A. Quinonez, MD, co-chairs of the Right Care Alliance Children’s Health Council, cite numerous examples of over-diagnosis and overtreatment. They argue that some routine practices, such as head circumference screenings, should be reconsidered.

Intensive care units provide vital care for severely ill patients, but many patients end up there unnecessarily. In a study in JAMA-IM, researchers categorized patients admitted to the ICU at the Harbor-UCLA Medical Center for a year, and found that over 50% of these patients were either too sick to benefit from intensive care, or were well enough not to need it.

The New York Times Editorial Board asks why do we keep the old and sick behind bars? Treating the sick and aged in prison is costly; some need more staff assistance than is available and facilities need infrastructure improvements like wheelchair access. Many were put away based on “draconian sentencings,” and too few are freed through compassionate release programs—even when they pose no danger to the public.

Announcements

In case you missed it, our Right Care Vignette Competition launched last month! If you are a trainee or student in the health professions, we want to hear your stories! The top clinical vignettes will get a chance to submit their piece for JAMA Internal Medicine’s “Teachable Moments” column and receive a scholarship to attend the 2017 Lown Institute Conference. Submit your vignette here.

Join us at the 5th Annual Lown Institute Conference, where you can hear world-renowned speakers, participate in skills-building workshops, and network with hundreds of clinicians, researchers, and members of the public from around the world who believe in right care! The conference will take place on May 5-7 in Boston, MA and registration is now live. Early bird registration ends on February 10, so register soon!

Headlines

Overuse

Access

Caregivers

Cost of care

Disparities

Ethics

Evidence

Med ed

Mental health

Model of care

Public health

Safety

Social determinants

 

RightCare Weekly is made possible through the generous support of the Robert Wood Johnson Foundation.

 

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