It is almost 7:00 a.m. and I carry my briefcase and lunch bag from the car to my office. I nod to some of the night shift employees heading home. Another day has begun. I type my password and check the computer, reminding myself of the twenty patients I am scheduled to see today in the cancer clinic. A few new consults with untreated or recurrent cancers occupy the longer appointment slots.
No recent internet headline or cleverly-worded web teaser caused me to click my computer mouse on it faster than one that linked to a video discussing a Consumer Reports study on hospital safety. Strangely enough, it wasn’t the subject matter that grabbed my attention. It was the tone of the headline: “Hospitals Get Low Safety Scores In New Study.”
Am I safe surgeon, or merely a board certified one? I usually spend Tuesdays fixing elective hernias. But the other day I was asked to clear a c-spine, handle an unexpected gynecologic finding, manage a pediatric trauma, resuscitate a septic ICU patient, and opine on a neck dissection. No, I wasn’t in Africa or 1985; I was sitting in front of a computer monitor.
Medical schools have traditionally relied on undergraduate science grades and the MCAT to decide which applicants to interview. They based this approach in part on numerous studies that found good correlations between science G.P.A. and MCAT scores and subsequent medical school performance. But more recent studies have also revealed that MCAT scores are significantly influenced by a student’s race, gender, and socioeconomic background.
While there are some ways in which robots can replace human involvement during surgery, it’s unlikely that robots will completely replace human surgeons. This is because human intuition, reasoning, and experience will continue to be invaluable. Robots offer doctors and surgeons a more advanced form of decision support, make them faster, and even allow them to work remotely.
Robotic technologies combined with improved sensors and sophisticated intelligence will make inroads into many aspects of medical care, including surgical centers and operating rooms. With a proven ability to automate actions with outstanding repeatability and reliability, the opportunity exists for robots to move into non-critical and routine medical procedures.
Will a universal EMR save dollars? Not right away, but in the near future, absolutely. Will it improve the safety, quality and efficiency of medical care and thereby save lives. Definitely. Is there any reason to maintain our system of primitive individual medical isolation? None at all, continued delay would be ridiculous.
A recent American College of Surgeons Bulletin article states that surgeons and liability attorneys want similar things for patients. "Both surgeons and patient attorneys are committed to patient well-being and the relief of patient suffering." Really? So for liability attorneys, it's not about the money? I see; it's about "relief of patient suffering."
Remember the good ol' days when taking a single board certification examination from the American Board of Internal Medicine (ABIM) was good enough to call yourself "board certified" in a medical specialty? Those were the days.
Attention technologists, CEO’s, and health care consultants: your decisions can be as dangerous as a nurse with a syringe of over-concentrated heparin. When EMRs are implemented that take physicians eyes and minds away from the patient without demonstrable improvement in quality of care (and cause excess spending), patients can die.
A recent paper's finding as that hospitals in Pennsylvania that had 10% more nurses with BSN degrees were found to have 2.12 fewer deaths per 1000 postop patients than those that did not. The authors extrapolated this, saying that if all the hospitals they surveyed had the same percentage of BSN nurses as the best performers, 500 deaths may have been avoided.
You can’t keep asking these young doctors to do more and more work in less time without affecting patient care. Until we address the problem of overwork, we’re just playing a shell game. Something more substantial needs to be done to deal with the problem of overwork for young doctors.
As we continue to carry out the Affordable Care Act and enter a new era of tremendous change, we must confront our natural tendencies to favor patients we find pleasant — especially when it comes at the expense of those we find less so.
There will always be controversy when it comes to using diagnostic tests for routine screening of asymptomatic patients. Ultimately, we must continue to take a reasonable and academic approach to testing. We are still going to discover the “incidentaloma."
The hospitals, many of which specialize in heart or orthopedic surgeries, have long drawn the ire of federal lawmakers and competitors. They say physicians often direct the best-insured and more lucrative cases to their own facilities, while leaving the most severely ill patients to others.