A year old paper shows that physicians are slower to adopt new medications that might show benefit than they are to drop old medications that might show harm. I suspect this is a standard manifestation of loss aversion, old hat to psychologists. But it’s interesting to me, because doctors are so quick to cite the harsh malpractice climate for the practice of defensive medicine. This study doesn’t speak to that, but the similarity of the findings to well described facets of human behavior seems to me to hint strongly that the intuitions of most doctors about the nature of defensive medicine are wrong. I wonder to what degree you’d find the same behavior in Texas?
PS: the lead author of that study has a blog which is well worth following.
The inexplicable behavior and poor judgments teens are known for almost always happen when teens are feeling high emotion or intense peer pressure, conditions that overwhelm the still-maturing circuitry in the front part of brain, Giedd said.
Curious, how a field full of nerds seems to forget that some cliques managed to survive high school with a much lower temporal discount rate.
A very good sentence here:
Although we’re not very good at washing our hands, we are terrific at washing our hands of patients who leave our medical radar screens.
The article is about the transition from inpatient to outpatient care, which is hard on patients, especially when they are cared for by a discrete medical team (ie, a hospitalist/resident/intern), separate from their outpatient physician. Medication changes are made/ignored inappropriately, consultations missed, information lost in the shuffle.
More generally, though, we can say with some certainty that whenever care is transferred between physicians risk is assumed — not just at discharge, but daily at teaching hospitals, which have answered the 80 hour work week largely by putting night shift residents in house to cover patients they aren’t actively caring for, and allowing the day team (the “primary” team) go home for some much needed sleep.
We have tried to come up with systems to improve the transition of care: residents have a “sign out” sheet they use to deliver the relevant information about their patient cohort to a covering team; discharge summaries (when they are completed in a timely fashion) are ritualized pieces with a fixed skeleton of information: hospital course, diagnoses dealt with during the stay, relevant studies, medications changed at discharge, follow up consulations), but within those frames there’s considerable variability as to how much information is actually included (and there’s no reason for thinking that problems are less likely to occur when too much information is given, rather than not enough).
I know of no data that actually lets us know whether the things we do to facilitate transfer of care are useful (possibly because I haven’t looked). But I’d like to see some. I have a strong suspicion that less is more, more than we are inclined to think.
Weitz is a severed adult.
An interesting discussion between DB and My Med Body on the ethics of retainer medicine — a model of primary care medicine where patients (generally an affluent subset) pay out of pocket for a physician to attend to them. Because each patient pays more for their care, the physician has a lighter load, more time available for examination, can make house calls, etc. Generally rates high for both physician and patient satisfaction, in an era in which maintaining a primary care practice is becoming increasingly difficult.
(more…)
Young doctors and medical students are frequently reminded that half of what we learn today is wrong, usually part an exhortation to become lifelong learners. The other part of the equation, also frequently taken as axiomatic, is that we don’t know which half. But that’s just lazy.
A good bet is that most change will follow the money (cancer, pharmaceuticals, neuroscience, surgical/interventional technology).
On another level, medicine continues to cry out for solid epistemological foundations
Anyways, more fictions here
Laughable is how JoshMD refers to a proposal to encourage organ donation by offering free medicare to givers (actual, I believe, and not prospective).I find it hard to believe that anyone finds Medicare laughable. I understand that some people find incentivizing organ donation unconscionable, but that’s hardly the same as laughable (after all, life is at stake). And, despite requiring government intervention, it’s not so grossly illiber(al)(tarian) as mandating organ donation. So, why laughable?