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Blog Posts (3269)

July 13, 2016

Nice Coverage of Our Robot Study

My student and colleague, Karen Scherr, recently published an excellent article showing that physicians don’t always describe robotic surgery in an unbiased manner. Here is a nice write up of that work: Author Peter Ubel referred to a study done … Continue reading

The post Nice Coverage of Our Robot Study appeared first on PeterUbel.com.

July 13, 2016

Having a Positive Outlook - Cancer and Trains

I like this colorful comment in a recent post by Joe Imperato. "A positive outlook in the face of a very advanced cancer is about as useful as having a positive outlook while standing in front of an Amtrak train going 70 miles an hour."
July 13, 2016

Introducing the Bioethics Commission’s New Educational Module: Community Engagement in Ethics and Ebola

The Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) has released a new module titled “Community engagement in Ethics and Ebola.” This module is designed to introduce the role and demonstrate the importance of community engagement in public health preparedness.
July 12, 2016

Jahi McMath - State Lawsuit Can Move Forward

Jahi McMath's medical malpractice lawsuit may move forward in the state trial court.  And she will have the opportunity to prove that she is alive. Twice, the medical defendants demurred to claims in the complaint that require a determinat...
July 12, 2016

A Journey to the Border: A Reflection of the Other Side

By Jeff Ni “A nation that cannot control its borders is not a nation.” ― Ronald Reagan Today, immigration is a multifaceted topic, and oftentimes, the political narrative surrounding immigration is rife with dread. Much of the conversation is driven by fear, not of the Mexican, but of the even more terrifying unknown. I would venture that […]
July 12, 2016

Things Other Than Transplant Surgeons

Hearing the Call:  A Feature on How Physicians and Medical Educators Came to Understand Their Vocation By Sarah E. Stumbar Sometime during middle school, I became engrossed in a series of young adult novels about children dying of tragic diseases: heart failure (saved by a heart transplant!) leukemia, cystic fibrosis. I wanted to be a […]
July 12, 2016

The Final Year - Where Will You Die? (graphic)

Nick Stepro has a remarkable graphic at the Arcadia Data Gallery.

For all our efforts to preserve and maintain health and quality of life, an equally important but often overlooked conversation surrounds how our lives come to an end. Approximately 30% of Medicare costs are attributed to the 5% of beneficiaries who die each year, with 78% of those costs stemming from life-sustaining acute care during the final thirty days of life. Compounding the considerable financial cost is the emotional cost of difficult choices made during this time, sometimes without full knowledge or awareness of options and likelihoods.

In this figure, the artist visualizes that final year of life, highlighting one of those difficult questions – Where will I die? – at the end of what is sometimes a difficult and painful path, and sometimes, by fortune or by planning, less so.

Across the horizontal axis, each of 2,398 patients who died within a five year span is represented by a single column, the columns grouped by the estimated environment in which the individual died. The columns are composed of a series of points representing interaction with the healthcare system, as identified through clinical and claims records, and colored by the place of service for the event.

The most obvious difference experienced by the patients studied here is the difference in their final month across the different places of death. Most immediately obvious is that those who die at home or hospice – in this analysis, some of those who died at hospice may be assigned to home due to lack of activity – appear to have a tapering of healthcare activity toward the end, whereas those whose end-of-life occurs in the hospital tend to spend their last days and weeks there.

A summary of costs, conditions, and prescriptions for each of these groups follows the figure. Although the artist does not try to answer some important questions about the experiences of the individuals portrayed here, and what they may have wanted their final year to be like, this visual at least offers the viewer a look into these last moments, and perhaps a bit of insight into how and where we would want our final year to be.



July 11, 2016

Does your primary care physician actually provide your primary care?

You’ve just moved to a new city for a new job, and before you can find a primary care practice, you get sick.  So you visit an urgent care center.  The doctor examines you, treats you, and urges you in not-so-subtle (and sometimes judgmental) terms to quickly find and follow up with a PCP.  And so the search begins.

 

Step 1: Consult Google.  Find 150 doctors within 50 miles.  Realize you know nothing about any of the doctors on the list.

Step 2: Ask colleagues for recommendations.  Receive great reviews of 2 doctors.

Step 3: Call the recommended doctors.  None are taking new patients.

Step 4: Realize you have insurance that limits your options.  Scrap your Google search and search on your insurance company’s website for “find available doctors taking new patients.” Results: 3 doctors.

Step 5: Call the doctors listed.  Doctor 1 isn’t taking new patients at all.  Doctor 2 is taking new patients in 4 months.  Doctor 3 may be able to fit you in in two weeks.

Step 6: Give up the search.

Step 7: Symptoms return. Call a PCP office to beg for an earlier visit.  They agree to fit you in in 4 days.  In the meantime, they suggest visiting an urgent care facility for timely treatment. 

 

It has been widely discussed among bioethicists and health care policy experts that emergency departments are overcrowded, urgent care centers are rapidly becoming a substitute for the traditional primary care doctor, and that the number of new physicians specializing in primary care medicine has been declining in favor of other, higher-paying specialties. (See Dr. Wayne Shelton’s blog)  Despite the push for establishing a “medical home” and centralizing care around the primary care physician, demand for urgent care or emergency services is still high.

 

Lack of access to primary care is often blamed on financial issues, especially lack of insurance, but even well-insured patients are affected by the PCP shortage.  A patient may be able to afford the PCP visit, but they either cannot find a practice accepting new patients or, if they are already a patient, may have to wait several days to get a sick visit appointment.  For a patient with strep throat or another easily diagnosable and treatable illness, an extra 4-5 days is too long – the patient suffers longer, risks complications or worsened illness, and must take more time off of work, which can have significant consequences.

 

Faced with this dilemma, why would a patient wait days for their PCP appointment when they could go somewhere else to receive care the same day?  Are patients really to blame for their failure to find a medical home?  If PCPs only see patients for a well visit 1-2 times per year, do they have a comprehensive picture of a patient’s overall health?  Are primary care physicians actually the primary doctors for their patients, or have their offices essentially become a warehouse for patient medical records from other practitioners? 

 

Urgent care centers are rapidly bridging the gap between PCPs and emergency departments, increasing access to care for acute illnesses while avoiding high costs in the ER, but potentially decreasing interactions between patients and PCPs.  Because of this, many patients are left wondering, how can they find comprehensive primary care while still being able to be seen quickly for acute illnesses? Is it reasonable to expect PCPs to be able to provide all primary care for patients, sick and healthy, or do we need to reconsider what is needed for a patient’s “medical home?”

July 11, 2016

Determination of Legal Death - Financial Tests

A brief clip from the Tonight Show on ethical issues with the determination of death.  In 1981, brain death was not yet settled in many states.
July 10, 2016

Thaddeus Pope - 2 Minute Video Introduction