June 9, 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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Our 4th annual conference in April is still getting buzz. In Medscape this month, Ricardo Quinonez, MD, and Alan Schroeder, MD, pediatricians on the Right Care Alliance’s Children’s Health Council, discuss lessons learned from the meeting, the impact of medical overuse, strategies to right-size specific tests and treatments. Quinonez said “The meeting had some innovative ways of looking at overuse…I was struck by one of the poster sessions presented by [Harry] Cho, MD suggesting that overuse be considered a medical error. Schroeder’s takeaway message from the conference: “I think we must help patients, families and healthcare providers understand that detection of abnormalities is not always synonymous with patient benefits.” Also this month, Modern Healthcare magazine published an interview with Vikas Saini, MD, president of the Lown Institute, which was conducted at the conference. He stressed the importance of patients being involved in decision-making. “Because so much care is not based on hard science,” he said, “we have to include and involve patients in decision-making. You can’t have right care for the vast majority of what we do unless the patient doesn’t just consent, but also understands why and how to move forward with a particular test or procedure.”
Next month a controversial study will end, one that has taken place at dozens of hospitals across the country, involving hundreds of thousands of patients who don’t even know that they have been part of it. The study, iCOMPARE, is examining whether longer shifts worked by young doctors are linked to more patient deaths. Limits on consecutive hours worked for interns are now capped at 16, but residents work longer hours, some as many as 28 at a time. Last February, Jeanne Lenzer reported in The BMJ that Public Citizen, a public interest watchdog group, had asked the Office for Human Research Protections to stop the study, calling it unethical. On Full Measure this week, Michael Carome, MD, an ethicist with the group, cites concerns about patient safety and lack of informed consent for both physicians and the patients. Carome argues that residents who are sleep deprived make more mistakes, some fatal; and patients being treated by these doctors aren’t being told that the clinician at their bedside has been up all night, which might prompt them to ask for one who is refreshed. Residents, considered cheap labor at hospitals, are automatically part of the study, without giving consent. “There is substantial evidence in literature that tired residents are more likely to have motor vehicle accidents, are more likely to injure themselves while caring for patients, poking themselves with a needle that was maybe used to draw blood…,” said Carome. Robert Klitzman, MD, a bioethicist at Columbia University Mailman School of Public Health, disagrees. He says fewer hand-offs allow for continuity of care, and that the study poses little risk to patients. “If you were to ask people in a surgery, ‘Do you want to have one doctor be the one who sees you from the beginning or end, or doctors coming and going, each turning over the knife to the next one?’, I think most patients would say they prefer to have one doctor.”
Last month we reported on Theranos, the blood-test start-up that was supposed to revolutionize the field, but turned out to be smoke and mirrors. Theranos may be fading from view, but there is no shortage of other companies hoping to cash in on the testing market, which was valued at $131 million last year. This week a story in The New York Times, highlights a blood- testing venture, InsideTracker, which offers to analyze dozens of hormones and biomarkers for consumers, including vitamin levels, cholesterol and inflammation. Are consumer-based services like these good for patients? The Times story quotes 49-year-old Kristi Wood, who described feeling tired and achy two years ago. After InsideTracker reported that her Vitamin D level was excessive, she cut back on a supplement she was taking and “immediately felt better.” Not surprisingly, medical professionals are concerned that these direct-to-consumer blood testing ventures will at best simply cost money and cause well people to worry needlessly. At worst, they may increase over-treatment and unnecessary follow-up testing.
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Conflicts of interest
RightCare Weekly is made possible through the generous support of the Robert Wood Johnson Foundation.