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Med students protest ‘useless’ test, Camden Coalition goes national, and Fukushima thyroid screenings

March 17, 2016

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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Features:

Change for the better often occurs when like-minded individuals come together and act. Last week, a group of medical students from Harvard, featured in STAT, stood up against a required licensing test designed to test their ability to take a history and perform a physical exam. Spearheading a petition calling for the National Board of Medical Examiners to abolish the Step 2 CS role-playing test involving patient actors, the HMS students galvanized 6,000 other students and faculty at 130 medical schools to sign on. Why such opposition to the test? The students believe the test, which is supposed to assess their abilities to interview patients and conduct physicals, does not weed out inept physicians. Nearly 96 percent of students pass it with little preparation on the first try, and the registration fee of $1,275 is prohibitive for most.  In addition, the test is given only in five cities, with students left to pick up the travel tab.  In the STAT piece, Isaac Jaben, a Tulane student, called into question the value of the test: “Is it worth having tens of thousands of people every year spend $2,000 to go prove that they can remember to wash their hands, introduce themselves and ask, ‘Do you have any questions?’ at the end of an interview?” Meanwhile, teaching hospitals are sending their residents to a sort of remedial doctoring course taught at Stanford by Abraham Verghese, MD, called Beyond Measure: Teaching Clinical Skills. Maybe the course is needed because, as Verghese wrote recently, “The ‘clinical skills’ exam seems to test everything but.” The National Board’s Peter Kastufrakis, MD, justifies the Step 2 CS exam, saying most medical school faculty don’t have time to observe students performing physical exams. One has to wonder if med school professors are also too busy to teach other important clinical skills. The Board is re-examining the test. We will keep you posted.

 

Jeff Brenner, MD, executive director of the Camden Coalition of Healthcare Providers, has seen time and again that, “in America, the sickest and most complex patients get lost in our [health care] system… There’s a mismatch between the services [patients] need and the services we’re delivering.” Brenner and his team at the Camden Coalition are demonstrating there’s a better way, using “data-driven, human-centered practices” to improve care and the health of patients facing the most complex medical and social challenges. Their efforts will soon expand to the national level, thanks to an award of $8.7 million from AARP, The Atlantic Philanthropies, and the Robert Wood Johnson Foundation.  Lilo H. Stainton of the NJ Spotlight describes what is to come: “The Camden Coalition will now build a national center to help spread the success of the data-driven, patient-centered model—also known as “hot-spotting” –that has worked so well here in New Jersey. The 10-year program will involve experts from around the nation, including providers from Sutter Health East Bay, an established nonprofit system in Northern California, among others.” Congratulations, Dr. Brenner and team! Read our interview with Dr. Brenner here, and don’t miss his keynote at the 2016 Lown Conference!

 

March 11, 2016 marked the five-year anniversary of the magnitude-9 earthquake in northeastern Japan, but many are still dealing with the fallout. After the earthquake caused meltdowns at the Fukushima Daiichi Nuclear Power Plant, there was significant concern about health consequences both locally and around the globe. Fukushima officials implemented a health monitoring program to quell residents’ fears and track any subsequent health problems. This included ultrasound thyroid exams for all young people. Sarah Fallon of Wired reports that the exams revealed thyroid growths in nearly half of all people screened. In 2015 Japanese epidemiologists wrote that the prevalence of cancer among the 298,577 examinees was 605 per million – hundreds of times higher than average, and presumably due to radiation exposure. But a recent piece in Science calls into question the correlation between the meltdowns and the prevalence of thyroid growths. Dennis Normile writes that, “Most scientists attribute the findings to the screening, which catches growths that would not normally be clinically identified and likely pose no health threat.”

Announcement:

  • Hurry! Our conference hotel block closes on Monday. If you haven’t already registered for the 4th Annual Lown Institute Conference, which takes place April 15-17, register here. You don’t want to miss out on the best medical conference of the year, with keynote speakers: Jeffrey Brenner, MD; Gordon Guyatt, MD; John Ioannidis, MD; Joanne Lynn, MD; Eliseo Medina and Rita Redberg, MD.

 

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