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A standard for simultaneous surgeries, doctors joining unions, and exercise for knee pain

August 11, 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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In the wake of the recent Boston Globe Spotlight series on simultaneous surgeries, James Rickert, MD, of the Musculoskeletal Care Council of the Right Care Alliance was invited to send a letter to the Senate Finance Committee regarding this issue. In collaboration with Selwyn Rogers, MD, chair of the Surgery Council, he drafted the letter, cosigned by other Council members, urging the Senate Committee to direct the Centers for Medicare & Medicaid Services to adopt a standard for the common practice, in which a surgeon performs multiple operations scheduled at the same time in different ORs. Simultaneous surgeries can and do take place without patient knowledge. The RCA signatories believe the practice should not continue except in emergency situations when multiple patients need surgery and too few surgeons are available. The councils want CMS to set a transparent and patient-centered standard for these surgeries and require that hospitals tell patients—long before the day of their surgery— that their surgeon may not be present during the entire procedure and that another surgeon may step in. There is no such standard presently. The letter, sent on July 27, urges Congress to request that CMS refuse reimbursement if the standards are not met. “We believe failing to inform patients undergoing elective procedures that their surgeon may not be present during their entire surgery violates the intent of informed consent.”

Doctors are experiencing an epidemic of burnout and dissatisfaction with a changing work environment. In fact, half of the doctors surveyed recently said they have considered leaving the profession. One of the reasons is the increasingly burdensome regulatory environment that takes time away from caring for patients. The Nation, this week, reports more doctors are fighting the corporatization of medicine by increasingly joining labor unions and demanding that their voices be heard. In Minnesota, The Steelworkers Local 9460, just added an 11-member medical professionals unit, and three physicians are members. The union just secured a contract at Lake Superior Community Health Center, which serves the low-income community in Duluth. In this regard, doctors are joining nurses who have long pursued unionization as a way to protect their professional lives. Their concerns often include unsafe working conditions, inadequate staffing levels, and insufficient times for breaks. Patty Eakin, president of the Pennsylvania Association of Staff Nurses & Allied Professionals, who is featured in The Nation piece, blames the monetization of medicine for clinician dissatisfaction. “Part of the problem is,” she said, “this for-profit system is so set up to…suck dollars out of the system, and give it to health-care corporations, pharmaceuticals, Wall Street executives, instead of using that money to take care of patients…This has to change.”

In another example of Less is More, a recent study in BMJ found that exercise is just as effective as a common knee surgery performed on middle-aged patients for meniscal tears. Every year, an estimated two million people worldwide undergo knee arthroscopy surgery to relieve pain and improve movement, at a cost of several billion dollars. But research conducted in Denmark and Norway concludes that arthroscopic knee surgery offers little benefit for most patients. The randomized control trial involved 140 middle-aged men with meniscal tears, verified by MRIs, and compared exercise therapy alone with arthroscopic surgery alone. No clinically relevant difference was found between the two groups for outcomes when it came to pain, function in recreation, and knee-related quality of life. At three months, muscle strength had improved in the exercise group. A companion editorial, co-authored by Gordon Guyatt, MD, of McMaster University and a keynote speaker at this year’s Lown Institute Conference, asserted, “In a world of increasing awareness of constrained resources and epidemic medical waste, what we should not do is allow the orthopaedic community, hospital administrators, healthcare providers, and funders to ignore the results of rigorous trials and continue widespread use of procedures for which there has never been compelling evidence.”

Announcements:

  • Mark your calendars! The 5th Annual Lown Institute Conference will take place Friday though Sunday, May 5-7, 2017 in Boston. Learn more here.
  • It’s summer, but don’t forget that Right Care Action Week will be upon us soon! Our theme this year is listening, and we will be promoting three types of events—all involve listening. Learn more and sign up here.
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  • There will be no RightCare Weekly next week, but we’ll be back in your inbox on August 25.

 

Headlines:

Overuse

Ethics

Social determinants

Disparities and inequalities

Mental health

End of life

Pharma

Med ed

 Cost of care

Measurements

Insurers

Innovation

Empathy

Access

Global

Public health

Practice model

Research

 

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

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