Interview with Flint doctor-heroine, drug rationing unbeknownst to patients, and costly communication failures

February 4, 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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Chronic lead poisoning is a problem for developing countries, which suffer an estimated $1 trillion in economic losses because children are routinely exposed to the toxic metal through gasoline, paint, and other products. So how is it that a third world problem is now plaguing a city in the richest country in the world? Residents of Flint, MI continue to rely on bottled water for drinking and bathing, and the Detroit News reports that some water filters being distributed as a stop gap measure to city residents aren’t effective in removing the high levels of lead. Americans have reached out to help, among them hundreds of volunteer union plumbers going door-to-door installing new faucets over the weekend. On Tuesday, according to the Washington Post, a Baltimore law firm filed a lawsuit seeking water bill payment refunds for all 31,000 Flint households. Meanwhile, Flint’s mayor is calling for replacement of the city’s lead service lines, estimated cost, $3,000 per home. All that pales in comparison to the health consequences, some unknown as of now, for children and their families. Again, we give kudos to pediatrician Mona Hanna-Attisha, MD, who first sounded the water alarm. Read our interview with her here and learn why she believes that public health and medicine should work in tandem.


More problems in the land of plenty: The New York Times reports there is a shortage of certain pharmaceuticals used in the hospital setting and a practice of quiet rationing. Painkillers, anesthetics, cancer treatments and other drugs are in short supply for a host of reasons, including federal safety crackdowns to pharma doing away with its low-profit drugs. Decisions regarding which patients get the drugs in short supply and which ones get only half doses are raising red flags among clinicians and ethicists. Few patients are being told they are not getting a standard dose of a drug, or that a drug that could benefit them has gone to someone younger who may have a longer life span. Rationing effects can quickly become apparent as patients suffer from preventable pain or nausea. “Physicians say that many of the changes they are compelled to make appear to do no harm. But, they acknowledge, typically no one is tracking outcomes in patients who get a drug and others who get a substitute or delayed treatment,” the article states. Ivan Hsia, MD, an anesthesiologist, is quoted calling the practice “the paternalistic model—like I’ll inform them when I think it’s unsafe enough to inform them.” We think that’s way too late.


Failures in communication, both among clinicians and between clinicians and patients, are extremely harmful and costly. That was the recent finding from CRICO Strategies, a research group with ties to the insurer of Harvard-affiliated hospitals. Researchers analyzed medical malpractice claims and lawsuits to probe the role of communication as a clinical skill. Out of 23,658 cases filed from 2009-2013, communication was a factor in 30 percent. This resulted in 1,744 potentially avoidable deaths and a total of $1.7 billion in losses. The impact of poor communication on medical errors is likely even greater than CRICO reports, as this data set included only malpractice cases. STAT explains that the report highlights contributing factors, “such as heavy workload, hierarchical workplace culture, cumbersome electronic health records, and constant interruptions.” While patient safety interventions, for example the I-PASS handoff program, have shown positive outcomes, it will take deeper systemic change to truly move the needle.




  • Be part of our second annual Right Care Vignette Competition. We are seeking clinical vignettes written by trainees that describe harm or near harm caused by medical overuse. The deadline to apply is 11:59pm PST Monday, February 8. The top two vignettes will be eligible for up to two scholarships to participate in the fourth annual Lown Institute Conference. To learn more or to submit a vignette, visit our Right Care Vignette Competition page.


  • Join us for what promises again to be a great conference. Don’t miss our 4th Annual Conference, April 15-17 at the JW Marriott Chicago. You’ll hear from our renowned speakers: Jeffrey Brenner, MD; Gordon Guyatt, MD; John Ioannidis, MD; Joanne Lynn, MD; and Rita Redberg, MD.  Register now. Space is limited.


  • Welcome to Stephanie Aines who joins the Lown Institute this week as Network Development and Organizing Manager. She previously worked as a teaching assistant for Marshall Ganz, PhD at the Harvard Kennedy School, and most recently was the Lead Organizer and Outreach Manager at Primary Care Progress. At Lown, she is responsible for organizing activities and campaigns and forging new partnerships for the Right Care Alliance.  She’s looking forward to meeting as many members of the network as possible in the next few weeks, so please drop her a line to introduce yourself! E-mail:






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