There is a new project underway to test whether it is helpful or hurtful if patients can read their doctors’ notes. In addition to technical information, records include observations about the patient’s mood, worries or other personal information. The question is whether the cost of transparency is a loss of it. Doctors could start putting less in the record, making it less valuable to other care-givers. The fear of litigation also could make doctors more guarded about their notes. This is not an easy call, even for people who believe patients should know the truth.

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Everyone agrees bad doctors should be stopped. The hard part is figuring out how best to do that. In a JAMA study, researchers found that 64% of doctors participating supported the profession’s commitment to police itself. That number should be much higher. On the other hand, 69% said that they were ready to deal with impaired physicians in their own practices, the medical equivalent of home. That is a much more encouraging number, almost 70%. Reporting bad doctors—sick or unskilled—is essential to safe, quality care. It is not possible to pay too much attention to this topic. Read here about what patients can do when they feel they have seen a doctor with serious problems.

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Talk therapy has fallen out of favor in many places because medications have become the mainstay of many psychiatric patients’ treatment. Health plan reimbursement favors pills over talk. However, talk therapy has an important place in treatment. It’s faster than medication, as you will read about here, when the patient is in real difficulty.

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A new category of hospital—the acute care, long-term care hospital—has been developed for patients who need longer to recover from a critical illness than is usual for a short-stay hospital. Those are the hospitals in your community which have been there for years. Why do these new ones exist? General acute care facilities need the beds and may have a financial incentive to discharge patients sooner, says the comment on this Journal Watch summary. The survival rates one year after discharge are extremely low. In 2008, Medicare put a 3-year hold on any new construction of these hospitals. Be aware. Beware of your family member’s being transferred to one without knowing what their outcomes are. Get the patient’s own doctor involved in this process, too.

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This study, while it has a number of limitations, suggests that patients and families need to have much more clinical information than they get from care-givers.

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An innovative health care system in Pennsylvania is paying for chronic disease nurses to work in primary care offices to help alert the doctor to patients who need to come in quickly and to help prevent avoidable hospitalizations.

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The full Reuters story quotes the lead researcher as saying that this study does not show causality—early menopause directly causes heart events.
It does show that early menopause is a potential risk factor for heart disease.
Women who had an early menopause, in this study set at age 46, and their doctors should discuss ways to reduce [...]

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DB’s Medical Rants
“… If you tried to create the most illogical payment system with the most unintended consequences, then you would likely not create anything quite this bad.
“Outpatient medicine will not succeed until physicians abandon the insurance model.  The current insurance model increases overhead, encourages shorter visits, discourages phone [...]

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The primary care shortage is only going to get worse as physicians retire, the population has more Medicare beneficiaries and the combined effects of younger people with chronic diseases mean more patients than ever need care. The Prevention and Public Health Fund has released $250 million to be spent over the next five years to produce more primary care-givers—doctors, nurses and physicians’ assistants.

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A new movement in medical education is seeking to restore “humanism,” the ideals which bring young people into medicine in the first place. Everything is working against this goal.

Topics: How To Speak Doctor