October 1, 2015
In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.
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A new patient safety report, part of the Quality Chasm series by the Institute of Medicine, finds that nearly every American, at least once in his or her life, will receive a diagnosis that is wrong or late. These errors could be the result of a number of causes, Lena H. Sun of The Washington Post explains, including poor communication between clinicians, patients, and their families, a lack of feedback provided to clinicians on the accuracy of their diagnoses, a lack of transparency in healthcare, and a culture that frowns on disclosure of errors. Though the authors did not emphasize excessive testing, this is also a cause of misdiagnosis that leads to both over- and underuse. The authors of the report are clear that this is not a problem of individual physicians making mistakes; “Often [a diagnostic error] happens because of errors in the health care system. Fixing the problem will require nothing short of a fundamental overhaul of the entire process.” Despite significant challenges in measuring and preventing diagnostic errors, the report identifies a way forward. Authors suggest that healthcare organizations implement better systems to catch diagnostic errors and near misses and that they establish space for open discussion.
While it’s nothing new that grateful patients and families often donate to individual physicians and healthcare institutions, it is becoming increasingly common for development offices at major cancer centers to train doctors in soliciting donations from their patients. A survey by Jennifer Walter, Kent Griffith, and Reshma Jagsi, MD published this week in the Journal of Clinical Oncology asked 400 oncologists at 40 leading cancer centers about their role in philanthropy. They found that nearly half of all respondents had been trained to identify wealthy patients who might be donors. A third had been explicitly asked to solicit a donation. And 74 percent said they felt this would interfere with the patient-physician relationship. Jagsi, a radiation oncologist and ethicist at the University of Michigan, discusses her concern about this trend with The New York Times. There are a number of ethical pitfalls, warns Arthur L. Caplan, head of the division of medical ethics at NYU Langone Medical Center. While the debate continues over the ethics of involving physicians in fundraising, Harvard Medical School is currently reviewing whether its conflict of interest regulations are too strict. Marcia Angell, MD, retired Harvard Medical School professor and former NEJM editor, worries that this shift is a sign of the times, “and the times are that everything is for sale.”
A hearty salute to Laura Esserman, MD, a breast cancer surgeon at the University of California, San Francisco, who espouses the very principles of right care. Featured this week in a New York Times piece, Esserman asserts that an uptick in increasingly sensitive breast cancer screenings is leading to frequent over-diagnosis and overtreatment and often driving aggressive treatments that are unnecessary. In fact, stage 0 “cancers,” called ductal carcinoma in situ (DCIS), now account for nearly a quarter of all breast cancer diagnoses. While conventional therapy calls for surgery and radiation, Esserman prefers placing patients on active surveillance, diverting them from invasive biopsies, lumpectomies and mastectomies, when possible. A recent study suggests that intervention may make little or no difference in outcomes. In an accompanying editorial, Esserman and a co-author suggest patients should feel reassured by the data. “For years, I operated on people (with DCIS) and felt that what I was doing was helpful,” Esserman told the Times. “But the evidence started to show that we had made a mistake.” She believes even the word “cancer” should be stricken from the diagnosis, and instead, DCIS should be renamed “indolent lesions of epithelial origin.”
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