It’s often said that the beleaguered emergency department (ED) is the initial point of care for many patients. In this current broken healthcare delivery system, that means an umbrella which “covers” the uninsured as well as those who are underinsured. The total cost for these points of acute care notwithstanding, how is the best way to explain new numbers out of the CDC this week?

The CDC’s National Center for Health Statistics reported the numbers in its annual summary of U.S. data on disease conditions, health behaviors and use of medical services. The scan figures are based on visits to roughly 500 hospitals and 3,000 doctor’s offices and outpatient clinics.

According to this survey data, the CDC says that the use of imaging modalities in the ED has quadrupled since the mid-1990s. Besides being just another point of confirmation of the origin of skyrocketing healthcare costs in this country, the heavy emphasis placed on tech will not abate anytime soon. Issues pertaining to defensive medicine, integration of such tech into ingrained training of new physicians, and the cost of using such technology within the medical device market are all good reasons to try to begin attacking this startling — yet, unsurprising — statistic. | LINK

A hospital rating company reports that regional and community medical centers do a much better job at preventing hospital-acquired infections and complications that can result in fatalities. Preventable complications or hospital-acquired infections kill 100,000 people each year. The rigor many tertiary care centers foster in the world of academic medicine may be the culprit, as the rather mundane task of creating and maintaining systems of checks and balances often is perceived to be a less than glamorous activity. The administratively rote nature of providing acute hospital-based algorithms for the safety and preventable deaths of all hospital inpatients is just not as sexy as trumpeting the singular life saved by treating that one rare and exotic illness. | PDF LINK

To Senator Charles Grassley (R-IA) ghostwriting and plagiarism fall within the same arena of misdeed. To some bioethicists that distinction is not so clear cut. Without a doubt, Grassley and the committee he chairs in the Senate are doing the medical profession a great service by exposing the practice of medical ghostwriting — the publication of medical journal articles in which an outside writer (oftentimes paid by a drug or medical devices company whose product is being studied) has done extensive work on the article without ultimately being named on the publication.

Some argue that trying to draw similarities between plagiarizing students who willingly (or unintentionally) take credit for a scholarly academic activity without essentially performing the work behind the effort and physicians who do have knowledge of a particular drug or treatment represents a grey area. Expressing concern about the obvious harm to patients who are ultimately the target of such research, Grassley has written to administrators from at least ten medical schools asking if there is, indeed, a difference in the two scenarios.

His actions sound good in theory, but they could be hard to prove. | LINK

It’s often been a cruel joke the resident elders often passed on to their unwitting and hapless heirs — the medical interns — at the start of each new training year, July 1.

Interns fresh out of medical school don’t have a bonafide state license with which to practice medicine, but they do have a license to kill.

Such cruel indignity at the hands of newly minted senior residents seems to be steeped in myth as opposed to the perceived reality by everyone involved in post graduate medical education. This, according to a study published in the September issue of the Journal of the American College of Surgeons in which the so-called “July phenomenon” was not beset with sudden spikes in patient morbidity and mortality rates in many training institutions at the hands of reckless and inexperienced newbie interns. Of course, the only place this data really matters is probably where the research was carried out — at an academic Level 1 trauma center. After all, who would be irresponsible enough to generalize these results to include the universe of interns fresh out of med school? Certainly, not the senior resident. | LINK

It’s one thing to think of a new medical school’s entering class as embarking on a future that will, hopefully, change their lives in a very positive manner. It’s another to extrapolate that reasoning to something much greater when one realizes that the entering class is not the only virginal body embarking on the path of medical education.

The University of Central Florida welcomed its charter class of College of Medicine students today with a community event that featured a surprise announcement, record-breaking achievements and promises for the future. [...] “Today we begin a long tradition of excellence, and we will set the bar high, [med school Dean Deborah] German said. “We were looking for students with that enterprising, pioneering spirit who wanted to [build] something as they went through medical school.”

Perhaps future graduates of the nation’s newest allopathic medical school will truly become pioneers of primary care, as they get ready to join a profession whose current turmoil could use the perspective of  students who apparently want to enter it for the noblest of reasons. | LINK

In a way, the “predation” of pharma companies on medical students on their home turfs reminds me a lot of the controversies surrounding the tactics of credit card companies on unsuspecting students on college campuses.

When there’s an opportunity….

We’re all familiar with the remedies both university leadership and even some states’ legislative bodies have enforced in the past in the wake of arrgessive marketing techniques by banks designed to incur long term loyalty (in the form of massively needless student debt) at the hands of those just looking for a “free lunch”.

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Patients who are cared for in teaching hospitals in this country may or may not be aware of the dynamic process of resident physician coverage, sign-outs, and care transitions/hand-offs between training care teams; but one aspect of graduate medical education (physician residency training) should be at the forefront of site administrators, program directors, and of course, the patients themselves: resident fatigue.

The national body which accredits residency training programs across the country is looking at the results of a recently published NEJM study that finds, among other things, an actual cost of care increase in institutions which reduce the number of hours physicians-in-training actually hone their craft. The NEJM study’s authors attack findings from a 2003 Institute of Medicine (IOM) report in which halving the numbers of hours resident physicians work daily would benefit patient safety, care, and increase physician performance. The authors cite that the performance benefits would be outweighed by the risks of care disruption, significant increased costs to teaching hospitals, and overall unknown outcomes.

On the surface, teaching centers have much to lose if they are forced to pay more for patient care to make up for reduced resident training hours; they have about a year to plan for such an action, if the accrediting body agrees with IOM findings. | LINK