Blog Posts (3214)
July 22, 2016
My father is 92 years old, and I am beginning to wonder whether the best thing for his health would be to stay away from doctors. That’s because well intentioned physicians often expose their elderly patients to harmful and unnecessary … Continue reading →
The post Out of Control Physicians: Too Many Doctors Doing Too Many Things to Too Many Patients appeared first on PeterUbel.com.
July 22, 2016
Two years ago, Washington state passed a rule requiring hospitals to post their policies on end-of-life care. I blogged about the policies here.
Unfortunately, the state website was not a model of clarity. Consequently, the ACLU, End-of-Life Washington, and others launched a new website, ClearHealth Washington, to decode the often murky policies.
“Providing this information at the service level, we think this is a clear and more useful way for information to be used by consumers, so that they know where they can access the services that they need,” said Margaret Chen, staff attorney at the ACLU of Washington. (HT KPLU)
Unfortunately, since the underlying policies are vague and unclear, the ClearHealth website is not yet able to answer basic access questions for consumers. Only one hospital seems to have completed a checklist designed by the ClearHealth project.
July 21, 2016
Adolescence is known to be a time of experimentation and
pushing towards the independence of adulthood. Risk taking, heightened need for
social validation, and evolving independent self-hood are hallmarks of this
important stage of life. Smoking is often viewed as a behavior that marks
adulthood, and is sometimes seen as rebellious against norms (and laws)
restricting purchase and use until age 18. Research in discreet regions of the
US shows that e-cigarettes are more likely to be the source of nicotine exposure
students in 11th and 12 grades, rather than ignited products. This same
article elucidates the psychosocial factors linked to e-cigarette use, and
finds that some of the determinants correlated with use in teens are prior
cigarette use, having a household member using e-cigarettes, and peer
endorsement of using e-cigarettes. The study found that current users did not
feel there were health risks related to using e-cigarettes.
The question asked in this NY Times blog is what the
correlation might be between e-cigarette use and combustible tobacco use.
Are e-cigarettes a new pathway to tobacco use, and therefore dangerous by
association? Just how dangerous are the vapors inhaled from e-cigarettes
themselves? The concern is that there are now simply more teens using smoking
products overall, thanks to the e-cigarette. “The numbers suggest that rather
than prompting teenagers to replace cigarette smoking with vaping, e-cigarettes
instead have enticed an entirely new group of teenagers to use nicotine” according
to the NY Times piece, and based on the most recent work by
As noted in the various articles linked here, it is unclear
what long term health effects will impact e-cigarette users and how use of
these products will correlate to combustible tobacco products, though the early
data suggests there is a connection. Addressing e-cigarette use may require
special, creative initiatives to reach the youths who would not otherwise have
exposed themselves to a nicotine smoking product. Healthcare providers caring
for adolescents will need to join in the effort to understand the factors
influencing the decision to use e-cigarettes in order to address the uncertain
health effects and serve as a resource for teens who believe that e-cigarettes
pose a lower risk avenue to participate in smoking activities.
July 21, 2016
The King's Fund is producing an conference on September 22, 2016 in London: "Innovative Approaches to End-of-Life Care."
This event will look at innovative approaches to palliative and end-of-life care. It will give you an overview of some of the national programs of work in this area and share lessons from good practice case studies in palliative care and local end-of-life care commissioning and delivery.
You'll learn about measures including shared electronic records, partnerships between hospitals, hospices and services delivered in the community, and advance care planning, and how these can help you deliver the national ambitions for how palliative and end-of-life care should be delivered locally.
Opening session: End-of-life care – the national pictureTracey Bleakley, Chief Executive, Hospice UK
National programme for end-of-life careHear about the work taking place at NHS England to support the delivery of end-of-life care across the country.Jacquie White, Deputy Director for Long Term Conditions, Older People and End of Life Care, NHS England
Current and future challenges on death and dying in older adultsJulia will explore the challenges in improving end-of-life care for older people who make up over 70% of those who die.Professor Julia Verne, Clinical Lead, National End of Life Care Intelligence Network, Public Health England
Making end-of-life care everybody’s businessSimon will talk about the work of Dying Matters and the National Council for Palliative Care in promoting public awareness of dying, death and bereavement.Simon Chapman, Director of Policy and External Affairs, The National Council for Palliative Care and Dying Matters
Session two: Commissioning good end-of-life care
Making end-of-life care a priority in MertonLearn how NHS Merton Clinical Commissioning Group went about developing a local end-of-life care strategy in partnership with health and social organisations, both statutory and voluntary.You'll hear how they engaged with clinicians, managers, local people, patients and carers in the development and improvement of end-of-life services.Dr Caroline Chill, Clinical Director for Integration, Older and Vulnerable Adults and End of Life Care, NHS Merton Clinical Commissioning Group
End-of-life care commissioning checklistA resource for end-of-life care commissioners to review their existing services and to use those parts that are most relevant or needed locally.Dr Caroline Stirling, Clinical London Director, NHS England
Breakout sessions: Innovative models in end-of-life careA: Driving care coordination using electronic recordsB: Partnership working with hospicesC: Working with patients and familiesD: Working with communities to improve end-of-life careE: Improving end-of-life care in acute hospitals
Closing session: Working together to prepare people for the end-of-lifeProfessor Keri Thomas, Founder and National Clinical Lead, Gold Standards Framework
Panel session: Facilitating Advance Care Planning: enabling difficult conversations at the end-of-lifeLiz Alderton, District Nurse and Queen’s Nurse, North East London NHS Foundation TrustDr Harriet Preston, Consultant in Palliative Medicine, Blackpool Teaching Hospital NHS Foundation TrustDr Catherine Millington-Sanders, Marie Curie National Clinical End of Life Care Champion, Royal College of General PractitionersLucy Sutton, End of Life Care Project Lead, Health Education England
July 20, 2016
I saw two patients last week on the same morning for identical tests whose divergent stories generated an interesting debate amongst my staff regarding healthcare rights and the cost of providing the same. For some background pertinent to this discussion, I perform a diagnostic test in my office called an Electromyogram (EMG) which quantifies the electrical function of muscles and nerves, and is used by... // Read More »
July 20, 2016
Richard Selzer and Ten Terrific Tales by Tony Miksanek, MD Family Physician and Author, Raining Stethoscopes If there were a Medical Humanities Hall of Fame, physician-writer Richard Selzer (1928-2016) would be a first-ballot selection. And likely by a unanimous vote. The diminutive doctor had a very large presence in the […]
July 20, 2016
Bioethics Commission member Col. Nelson Michael was recently interviewed by BioEdge, a bioethics news site, about the Commission’s capstone report Bioethics for Every Generation: Deliberation and Education in Health, Science and Technology. Col. Michael discussed lifelong bioethics education, which the Commission supports in its report.
July 20, 2016
This week, the Jahi McMath family filed a new brief in its federal lawsuit against the State of California. The purpose of this brief is to apprise the U.S. District Court of developments in the state medical malpractice lawsuit.
|Chris Dolan, McMath attorney in federal case |
In a nutshell, the state courts have repeatedly ruled that the McMath family may present evidence that Jahi is now alive. They are not barred by 2013 court rulings that Jahi is dead. But despite winning at the trial and appellate levels in state court, in this week's federal brief, the family argues that "the issue of whether Jahi McMath is alive or not will not necessarily be resolved in the malpractice action."
This is true. After all, Jahi's life/death status is relevant only to the issue of money damages. And the issue of damages will be addressed only if the elements of duty, breach and causation are first proven. (On the other hand, the court has been asked to bifurcate the trial such that damages could be tried first.)
In short, the McMath family further argues that the federal lawsuit is still necessary, because the state lawsuit is unlikely to resolve the life/death issue. Why? Because plaintiffs lose most medical malpractice cases. And they take a very long time to litigate in any case (maybe 5 years).
"There is, at best, a possibility that Jahi’s status as live or dead will ever be decided in the state court action. Even if a jury or judge ever reach this issue, an appeal could drag on for years."
"Jahi and her mother should not have to pin their hopes of reunion with their family during Jahi’s lifetime on the statistically improbable likelihood that the state court malpractice action will resolve the issue of her life.
July 19, 2016
We now have a completely revised and updated AMA Code of Medical Ethics.
In introducing the revision, the AMA notes that the "Code, over the years, became more fragmented and unwieldy. Opinions on individual topics were difficult to find; lacked a common narrative structure . . . ." Therefore, "in the revision, when 2 or more existing opinions provided substantially similar guidance on closely related topics, key content was consolidated into a single, more comprehensive opinion."
For example, 2.035 (Futile Care) and 2.037 (Medical Futility in End-of-Life Care) were combined and revised into 5.5 (Medically Ineffective Interventions.)
I do not see any substantive change in AMA guidance on this issue. But Wesley Smith rightly notes that even vocabulary choice signals some judgments. The term "ineffective" sounds objective and scientific. But the situations anticipated in 5.5 are almost always value-laden. The AMA might have aligned the vocabulary here to that recommended, last summer, by five other medical societies.
July 18, 2016
By Emily Anderson Medical school curricula now emphasize evidence-based medicine. We also need to prioritize evidence-based educational strategies. There are some great educational innovations happening at our medical school, but too few publications highlighting these. Conducting research on medical education faces many barriers, not least of all, lack of funding. Publication in any peer-reviewed academic […]
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