Tuesday, April 29, 2014

Falsified Mammography Reports

AP News reported that a mammography technologist in Perry, GA had falsified mammogram reports for nearly 1,300 women over an 18-month period.

From the article:
She [Rachael Rapraeger] told police she had personal issues that caused her to stop caring about her job, that she had fallen behind processing the piles of mammogram films that stacked up. So she went into the hospital's computer system, assumed the identities of physicians, and gave each patient a clear reading, an investigative report says. That allowed her to avoid the time-consuming paperwork required before the films are brought to a reading room for radiologists to examine, her lawyer Floyd Buford told the AP.

Her actions were uncovered in April 2010 after a patient who'd received a negative report had another mammogram three months later at another hospital that revealed she had breast cancer. As hospital staff began to investigate, it was determined that the doctor whose name was on the faulty report had not been at the hospital the day the report was filed. Rapraeger quickly confessed to her supervisor that she was responsible and was fired from her job about a week later, according to an investigator's report.

Rapraeger told police she knew what she was doing wasn't right, but that she didn't consider the consequences until she realized a patient with cancer had been told her scan was clear...
Sadly, ten women had cancers that weren't diagnosed because of her actions.  For example:
Sara Bailey also received a false-negative report. By the time it was discovered, her breast cancer progressed to the point that doctors had to remove her entire breast rather than just going in and removing a lump, she said.

The surgery was successful and the cancer hasn't returned, but Bailey carries a bitterness inside her that surfaces when she talks about her experience.
Rapraeger did plead guilty to 1 felony count and 10 misdemeanor counts, although some victims think her sentence was too light (6 months in a detention center, 10 years probation during which she is banned from working in health care,  and a $12,500 fine).

I feel terrible for the affected women.  We may never know exactly how much unnecessary suffering (and how many years of lost life) Rapraeger's actions cost them.

On a related note, there is currently a push by powerful political forces to limit routine mammography for American women on the grounds that it's not sufficiently cost-effective.  This includes the federal government's US Preventive Services Task Force (USPSTF).  I hope this case of criminal denial of potentially life-saving mammography services gives some of those advocates pause.

(AP News story via Ari Armstrong.)

Monday, April 28, 2014

Mandates Killing California Solo Practice

The San Diego Union-Tribune reports, "Obamacare deals blow to one-doctor medicine".

One major problem has been the mandated electronic medical records.  From the article:
In a slow-motion version of the problems that crippled online insurance “exchanges” for months, doctors who see patients under Medicare and Medi-Cal programs have been forced by the phase-in of a 2009 federal "stimulus" law to install expensive, complex software systems that sharply reduce time for patients...

Nearly 70 percent of physicians say digitizing patient records has not been worth the cost, according to a survey by Medical Economics magazine. This negative cost-benefit view comes even after $27 billion in subsidies to health care providers for the systems.

One big problem is the dozens of systems don’t talk to each other, because the feds didn’t mandate interoperability before the rollout.

So communication gains among hospitals, clinics and doctors offices aren’t happening. Adding insult, doctors can be criminally liable if hackers get hold of patient data.

Worse is the hit to productivity. Doug says he once aimed to see four patients an hour for normal office visits. Now he struggles to see three each hour, and colleagues report much the same...
The article also notes: "Still, the mandates clearly shift advantage to large doctor groups and health systems that can amortize costs over more patients" and "So far, nobody knows if the move to factory-style medicine will improve the quality or cost of care."

We'll find out soon enough.

Wednesday, April 23, 2014

Quick Links: Catron, Rushing Patients, Poor Coverage

David Catron takes a closer look at the various claims that, "ObamaCare is working".

USA Today: "You're on the clock: Doctors rush patients out the door".

 (Note that this is a problem with the standard model, not with concierge medicine practices which allow doctors and patients ample time to discuss medical issues in depth.)

CBS San Francisco: "Some Covered California Patients Say They Can't See A Doctor".

(As always, "coverage" does not equal actual medical care. Politicians can promise the former, but can't decree the latter.)

Monday, April 21, 2014

Hsieh Forbes OpEd: Should Doctors Limit Medical Care To Save Money For "Society"?

My latest Forbes piece is now up: "Should Doctors Limit Medical Care To Save Money For 'Society'?"

Here is the opening:
Can your doctor serve two masters at once?

That's the question American physicians are grappling with. The New York Times recently reported on a growing debate within the medical profession as to whether doctors should make treatment decisions in the best interests of their individual patients -- or if they should limit care to save money for "society."

This would represent a seismic shift in standard medical ethics. Traditionally, a doctor's primary ethical duty is to the patient. Patients literally put their lives in our hands, trusting that their physician will always act as their advocate. But with health care costs currently consuming 18% of the US economy (and an enlarging share of government budgets), some doctors are openly calling for fellow physicians to limit their use of more expensive tests and therapies to save money for "the larger society."

As Dr. Martin Samuels (chairman of neurology at Brigham and Women's Hospital in Boston) warned in the Times piece, doctors risk losing patients' trust if they say, "I'm not going to do what I think is best for you because I think it's bad for the health care budget in Massachusetts."

We don't expect our lawyer to balance our legal interests against saving money for "the court system" or our real estate agent to balance our housing preferences against what's best for "the regional housing market." Shouldn't our doctors adhere to the same code of ethics?...
I also discuss how this conflict of interest will worsen under ObamaCare as well as how adapting an idea by UCLA law professor Russell Korobkin may help avoid this problem and protect the doctor-patient relationship.

For more details, read the full text of "Should Doctors Limit Medical Care To Save Money For 'Society'?"

Thursday, April 10, 2014

Adalja AMA on Infectious Diseases, Antibiotic Resistance, and Biosecurity

Dr. Amesh Adalja, an infectious disease expert, recently did a Reddit Science AMA: "Ask me anything about biosecurity, emerging infectious diseases (e.g., Ebola, MERS, H7N9), influenza, polio, norovirus, antibiotic resistance, measles, mumps, STDS, and related history, science and policy issues".

Wednesday, April 9, 2014

Future Medical Advances

Vivek Wadhwa explains that, "Why our medicine will soon be cooler than Star Trek's".

If we can keep our economy relatively free and allow medical innovation to progress, many of his predictions might come true!

Tuesday, April 8, 2014

BRI Calendar

The Benjamin Rush Institute has an exciting series of talks and debate scheduled around the country this spring. Check out their calendar for more details!

(You can support their work via this link.)

Monday, April 7, 2014

Primary Care Doctors Burning Out

The 3/31/2014 Washington Post (in conjunction with Kaiser Health News), reported on the growing burn-out problem with primary care doctors.

A few key quotes from the article:

* "Perhaps the single greatest source of frustration for many physicians is a tool that was supposed to make their lives easier: electronic medical records."

* "[N]early half of more than 7,200 doctors responding to a survey published in 2012 by the Mayo Clinic reported at least one symptom of burnout. That’s up from 10 years ago, when a quarter of doctors reported burnout symptoms in another survey."

* "[O]ne of the drivers of physician dissatisfaction is their sense that they are shortchanging patients: that they are too rushed, don’t have time to listen and aren’t always providing good care."

I'm very glad that more people are recognizing the hazards of government-mandated electronic medical records (EMRs) -- for both doctors and for patients.

(For more on the hazards EMRs pose for patients, see my recent Forbes piece, "Can You Trust What's In Your Electronic Medical Record?")

The article also notes that burnt-out doctors provide lower quality care for their patients.  In contrast, Dr. Martin Kanovsky noted that when he switched to a "concierge" practice model, he was happier -- and so were his patients.

For more details, read the full text of the Washington Post piece, "A growing number of primary-care doctors are burning out. How does this affect patients?" (The story is also mirrored on the Kaiser Health News site under the title, "Burnt Out Primary Care Docs Are Voting With Their Feet".)

Wednesday, April 2, 2014

Tuesday, April 1, 2014

Catron: Put the ACA Out Of Its Misery

In the American Spectator, David Catron says we should do the humane thing and just end ObamaCare: "Obamacare: They Shoot Horses, Don't They?"

One of the many good points he makes is on the difference between "coverage" and actual access to care:
What about all those people who are signing up for Medicaid in the states that expanded coverage? As I pointed out here last January, those individuals will discover that Medicaid coverage has reduced their ability to access primary care. Why? Because Medicaid pays primary physicians less than it costs to see patients. Thus, fewer and fewer doctors will accept Medicaid patients, who will be forced to seek care in the local ER.

So, Obamacare has not merely failed to provide relief in the two areas where the public most wanted help — cost and access — it has actually made matters worse...
 For more, read the full text of "Obamacare: They Shoot Horses, Don't They?"