Princess Health and Lawyers Sue Hospital Based on What it Advertised. Princessiccia

Princess Health and Lawyers Sue Hospital Based on What it Advertised. Princessiccia

Gusty 11:56 Add Comment

Lawyers have noticed how hospitals are making exaggerated claims about their services, as reported by the Boston Globe.
The story involves the unfortunate case of a patient who died after bariatric surgery (i.e., after a procedure meant to reduce stomach size, and so induce weight loss). In Massachusetts, the law limits the damages collectable from civil suits against not-for-profit organizations, including hospitals, to $20,000. However, in this case, the plaintiff's lawyers are contending that "these stomach banding procedures are profit centers, that the hospitals advertise, they make promises, they do all things businesses do." Based on this argument, they initially asked Beth Israel Deaconess Hospital for a settlement of $8.5 million, and then filed a law-suit naming the hospital, as well as three members of the hospital's anesthesia staff.
The article also noted that other states are abolishing restrictions on the damages that can be collected from hospitals, based on reasoning that "the legal system should not treat hospitals differently than other corporations, especially as hospitals merge into large organizations that increasingly market their products and compete for patients."
Health Care Renewal has posted examples of hospitals (and other health care not-for-profits) acting more like for-profit businesses, and of some hospitals exhibiting unethical business practices. In particular, we have posted about questionable hospital advertising claims here and here. The second link is to a study of advertising done by prominent academic medical centers. The authors concluded, "Many of the ads seem to place the interests of the medical center before the interests of the patients."
The law may be a somewhat blunt tool to change these practices, but if we in health care cannot come up with a more nuanced approach, it is a tool likely to be increasingly employed.

Princess Health and Lawyers Sue Hospital Based on What it Advertised.Princessiccia

Princess Health and Lawyers Sue Hospital Based on What it Advertised.Princessiccia

Gusty 11:56 Add Comment

Lawyers have noticed how hospitals are making exaggerated claims about their services, as reported by the Boston Globe.
The story involves the unfortunate case of a patient who died after bariatric surgery (i.e., after a procedure meant to reduce stomach size, and so induce weight loss). In Massachusetts, the law limits the damages collectable from civil suits against not-for-profit organizations, including hospitals, to $20,000. However, in this case, the plaintiff's lawyers are contending that "these stomach banding procedures are profit centers, that the hospitals advertise, they make promises, they do all things businesses do." Based on this argument, they initially asked Beth Israel Deaconess Hospital for a settlement of $8.5 million, and then filed a law-suit naming the hospital, as well as three members of the hospital's anesthesia staff.
The article also noted that other states are abolishing restrictions on the damages that can be collected from hospitals, based on reasoning that "the legal system should not treat hospitals differently than other corporations, especially as hospitals merge into large organizations that increasingly market their products and compete for patients."
Health Care Renewal has posted examples of hospitals (and other health care not-for-profits) acting more like for-profit businesses, and of some hospitals exhibiting unethical business practices. In particular, we have posted about questionable hospital advertising claims here and here. The second link is to a study of advertising done by prominent academic medical centers. The authors concluded, "Many of the ads seem to place the interests of the medical center before the interests of the patients."
The law may be a somewhat blunt tool to change these practices, but if we in health care cannot come up with a more nuanced approach, it is a tool likely to be increasingly employed.

Princess Health and Fewer Physicians Interested in Generalist Careers. Princessiccia

Princess Health and Fewer Physicians Interested in Generalist Careers. Princessiccia

physicians primary care

Gusty 14:28 Add Comment

There is more information available about the decreasing number of physicians interested in being generalists.
A detailed survey based study of internal medicine residents' career choices just appeared in Academic Medicine, and was discussed in the American Medical News. [The article citation is: Garibaldi RA, Popkave C, Bylsma W. Career plans for trainees in internal medicine residency programs. Acad Med 2005; 80: 507-512.]
The article shows that the proportion of residents who go into general internal medicine has fallen from 54% in 1998 to 27% in 2003 (34% if hospitalists are added to general internists.) Reasons for going into sub-specialties admitted by survey respondents included higher income, and narrow practice area.
The American Medical News did not try to white-wash these results. It quoted a third year resident, chair of the AMA Resident's and Fellow's Section, who is going into gastroenterology because, "I'll be paid what my education is worth," and contrasted that situation with the lot of the general internist who makes "$110,000 a year.... That's a salary someone with less education and training can earn in other fields, without the debt of medical school, years spent training and commitment to a lifetime of being on call."
Steve Fihn, past President of the Society of General Internal Medicine, said "It's a pretty daunting task trying to reverse this trend when the economic forces are so strong."
On the other hand, the ASP Observer featured an article about the results of this year's internship match, i.e., how many medical students chose internal medicine training. The article was mainly positive, since the numbers choosing internal medicine have gone up slightly. "That's good news," since the numbers were dropping from 1998 to 2003.
However, the report also included the observation that internal medicine training program directors report that the proportion of residents going into general internal medicine has dropped from about 50% to about 20-25%, similar figures to those in the article by Garibaldi et al. But Steven E. Weinberger, ACP Vice President for Medical Knowledge and Education, suggested that the solution for dropping interest in general internal medicine would be the ACP's efforts to "fix Medicare reimbursement, for instance, and to help craft new chronic care models.... Creative models of high quality, team-based care offer a real opportunity to address the lifestyle issues." What sort of "chronic care models" he envisions, and how they will help generalists practice medicine, was not very obvious.
So the big question is whether our health care leaders and policy makers will make an effective attempt to reverse the decline of the generalist physician before the species becomes extinct.
At least some show understanding of the severity of stresses on generalists. Dr. Fihn, for example, is frank about the economic incentives.
However, as demonstrated by the issues discussed on this blog, not only are generalists at the bottom of the economic pecking order, they seem particularly impacted by the huge rise in health care bureaucracy, and particularly vulnerable to challenges to physicians' professional values instigated by large organizations lead by leaders with conflicting interests. They will need more than new "chronic care models" to survive these threats.

Princess Health and Fewer Physicians Interested in Generalist Careers.Princessiccia

Princess Health and Fewer Physicians Interested in Generalist Careers.Princessiccia

physicians primary care

Gusty 14:28 Add Comment

There is more information available about the decreasing number of physicians interested in being generalists.
A detailed survey based study of internal medicine residents' career choices just appeared in Academic Medicine, and was discussed in the American Medical News. [The article citation is: Garibaldi RA, Popkave C, Bylsma W. Career plans for trainees in internal medicine residency programs. Acad Med 2005; 80: 507-512.]
The article shows that the proportion of residents who go into general internal medicine has fallen from 54% in 1998 to 27% in 2003 (34% if hospitalists are added to general internists.) Reasons for going into sub-specialties admitted by survey respondents included higher income, and narrow practice area.
The American Medical News did not try to white-wash these results. It quoted a third year resident, chair of the AMA Resident's and Fellow's Section, who is going into gastroenterology because, "I'll be paid what my education is worth," and contrasted that situation with the lot of the general internist who makes "$110,000 a year.... That's a salary someone with less education and training can earn in other fields, without the debt of medical school, years spent training and commitment to a lifetime of being on call."
Steve Fihn, past President of the Society of General Internal Medicine, said "It's a pretty daunting task trying to reverse this trend when the economic forces are so strong."
On the other hand, the ASP Observer featured an article about the results of this year's internship match, i.e., how many medical students chose internal medicine training. The article was mainly positive, since the numbers choosing internal medicine have gone up slightly. "That's good news," since the numbers were dropping from 1998 to 2003.
However, the report also included the observation that internal medicine training program directors report that the proportion of residents going into general internal medicine has dropped from about 50% to about 20-25%, similar figures to those in the article by Garibaldi et al. But Steven E. Weinberger, ACP Vice President for Medical Knowledge and Education, suggested that the solution for dropping interest in general internal medicine would be the ACP's efforts to "fix Medicare reimbursement, for instance, and to help craft new chronic care models.... Creative models of high quality, team-based care offer a real opportunity to address the lifestyle issues." What sort of "chronic care models" he envisions, and how they will help generalists practice medicine, was not very obvious.
So the big question is whether our health care leaders and policy makers will make an effective attempt to reverse the decline of the generalist physician before the species becomes extinct.
At least some show understanding of the severity of stresses on generalists. Dr. Fihn, for example, is frank about the economic incentives.
However, as demonstrated by the issues discussed on this blog, not only are generalists at the bottom of the economic pecking order, they seem particularly impacted by the huge rise in health care bureaucracy, and particularly vulnerable to challenges to physicians' professional values instigated by large organizations lead by leaders with conflicting interests. They will need more than new "chronic care models" to survive these threats.

Princess Health and Guideant's Short Circuit. Princessiccia

Princess Health and Guideant's Short Circuit. Princessiccia

Guidant ICD manufacturing problems

Gusty 14:03 Add Comment

The New York Times reports yet another story of flawed implantable cardiac defibrillators (ICDs). This time, Guidant Corporation revealed that its ICDs manufactured from 2000 to 2002, can short circuit, fail, and thus become unable to prevent cardiac arrhythmias. Guidant corrected the design flaw that allowed these failures to occur in ICDs manufactured after mid-2002.
However, it only got around to notifying physicians and the public about the problem recently, after the company was informed that the Times was working on an article about the problem. The company's argument was that short-circuits are rare: only 25 cases of short-circuts are known. Furthermore, replacing the ICD requires an invasive procedure, and hence is not risk-free.
However, doctors and patients ought be able to decide about whether to take this risk, based on full disclosure of the relevant data.
This is the third problem with ICDs that has appeared in this blog. The others involved problems in devices manufactured by Access Cardiosystems, and by Medtronic.
The NY Times article notes that ICDs cost about $25,000 a piece, and that Guidant sold about $1.9 billion worth last year. Given the low cost of very sophisticated modern electronics, this unit price seems very high. IT should at least buy unimpeachable reliability. Why managed care has not been able to bargain down the prices of such devices remains an open question. But meanwhile they surely account for some of the seemingly inexorable rise of health care costs.
But regardless of what $25,000 ought to buy, there seems to be no good excuse to hide data about this device's flaws from the public and from doctors.

Princess Health and Guideant's Short Circuit.Princessiccia

Princess Health and Guideant's Short Circuit.Princessiccia

Guidant ICD manufacturing problems

Gusty 14:03 Add Comment

The New York Times reports yet another story of flawed implantable cardiac defibrillators (ICDs). This time, Guidant Corporation revealed that its ICDs manufactured from 2000 to 2002, can short circuit, fail, and thus become unable to prevent cardiac arrhythmias. Guidant corrected the design flaw that allowed these failures to occur in ICDs manufactured after mid-2002.
However, it only got around to notifying physicians and the public about the problem recently, after the company was informed that the Times was working on an article about the problem. The company's argument was that short-circuits are rare: only 25 cases of short-circuts are known. Furthermore, replacing the ICD requires an invasive procedure, and hence is not risk-free.
However, doctors and patients ought be able to decide about whether to take this risk, based on full disclosure of the relevant data.
This is the third problem with ICDs that has appeared in this blog. The others involved problems in devices manufactured by Access Cardiosystems, and by Medtronic.
The NY Times article notes that ICDs cost about $25,000 a piece, and that Guidant sold about $1.9 billion worth last year. Given the low cost of very sophisticated modern electronics, this unit price seems very high. IT should at least buy unimpeachable reliability. Why managed care has not been able to bargain down the prices of such devices remains an open question. But meanwhile they surely account for some of the seemingly inexorable rise of health care costs.
But regardless of what $25,000 ought to buy, there seems to be no good excuse to hide data about this device's flaws from the public and from doctors.

Princess Health and No More Free Viagra for Sex Offenders. Princessiccia

Princess Health and No More Free Viagra for Sex Offenders. Princessiccia

Gusty 13:52 Add Comment

There are so many stories popping up now that I am having a hard time keeping up, but here goes...
Unintended flaws of bureaucratic decision-making department, government agency division:
This is not, repeat not a bad joke.
Per the Associated Press, available in many newspapers, e.g., the Washington Post.
The US government Centers for Medicare and Medicaid Services has begun notifying states that they do not hve to pay for Viagra and other drugs for "erectile dsyfunction" for convicted sex offenders. A New York State audit had shown that 198 convicted sex offenders in that state had received Viagra paid for Medicaid.