Nursefriendly.com: Defensive Medicine

Saturday, February 19, 2011

Why medical students are burning out and lacking altruism, KevinMD.com

Recently, AAFP News Now released an article titled, Unprofessional Conduct Among U.S. Medical Students Linked to Burnout.
It focused on an article recently released in JAMA entitled, Relationship Between Burnout and Professional Conduct and Attitudes Among US Medical Students.
I had the opportunity to be interviewed for this article and was featured on an inset within the article that shared a minority of my interview. As I am currently rotating on inpatient medicine at a local community hospital, I am once again experiencing our health care system at its finest – a lot of wasteful spending and unnecessary testing. I am taking a look back at what I had wrote down for the interview and decided to paraphrase the majority of my response into the following blog post regarding the health care system and medical education.
When looking at the advances we have made in biochemistry, genetics, and molecular biology, we are being asked to know so much more information in much greater detail – and still within these 4 years worth of medical school.As more requirements are created and more scientific advances are brought forth, more time is needed in lecture and studying for tests like the USMLE and shelf exams. Most traditional programs are 4 years with 2 years of foundational science and 2 years of clinical experience.

via kevinmd.com

click on the "via" link to read the rest of the article.

Any questions, please drop me a line.

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Wednesday, February 9, 2011

Patient test follow-up often lacking, medcitynews.com

As discussed recently (Let’s not forget patient safety in med mal reform) I don’t buy the idea that excessive testing is mainly attributable to ’defensive medicine,’ i.e., doctors doing too much for fear of frivolous lawsuits. Rather, there are other reasons for ordering unneeded tests, such as profit motive on the part of the doctor or hospital, a desire for more information for decision making, habit, lack of familiarity with low-tech techniques, patient preference, and diagnostic company sales efforts. If med mal reform happened tomorrow, I’d be willing to bet plenty of excessive testing would still occur and that some other excuse would be given to explain it. Only payment reform, provider education and changes in patient demand are likely to make a big difference.
An article out today (Follow up lacking on a majority of hospital tests) in FierceHealthcare adds credence to my assertion.
Follow up on patient tests is often poor, according to a review of international studies, an article published in BMJ Quality and Safety reports. Up to 61 percent of inpatient test results and 75 percent of tests on ER patients saw no follow up after discharge, the researchers found.
Poor or inadequate care of patients after discharge can have serious implications for patients, among them missed or delayed diagnoses, or even death. For hospitals, when a patient’s transition to outpatient care features poor test follow-up, a readmission down the road is possible.
Providers that order tests and don’t follow them up open themselves up to charges of negligence. If they really ordered the tests as a defensive practice to reduce liability, wouldn’t they make sure someone followed up on the results rather than leave themselves vulnerable to lawsuits?
It’s unreasonable to expect all tests to be followed up. After all, sometimes the information is irrelevant by the time it’s received. And communications across settings are notoriously poor. Still, the percentage not followed up seems awfully high.

via medcitynews.com