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Archive for the ‘patient safety’ Category

What’s right and what’s wrong with the U.S. health care system? Does it need a major overhaul or a few tweaks?

In a two part episode, I discuss the cost of the U.S. health care system with Dr. Robert Berenson, a health care policy expert who has served as a practicing physician, the manager of a large health plan and in senior government positions, including being in charge of Medicare payment policy and private health plan contracting in the Centers for Medicare and Medicaid Services.

Dr. Berenson describes how incentives need to change to get control of our medical costs.  You can hear both of these episodes and others on my online podcast radio program, Getting Better Health Care.

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Screening for illness is promoted as a way to help identify disease at a curable stage and to keep us healthy. But is it worth the cost and risks?

I discuss the very real downside of health screening and preventive care with Dr. Gilbert Welch, author of Overdiagnosed: Making People Sick in the Pursuit of Health, from the Dartmouth Institute for Health Policy and Clinical Practice.  Dr. Welch points out that a big problem with screening is that it’s hard to make well people better, but it’s not hard to make them worse.

There’s no such thing as a free lunch.  You can hear the interview on Getting Better Health Care.

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Joe and Terry Graedon interviewed me about my book Compartments on the People’s Pharmacy: Compartments and Communication.

Our interview was about how misperceptions can lead to communication difficulties that interfere with good health care. When people are operating within their own area of expertise, they may find it hard to understand what the big picture looks like from another person’s perspective. Whether the differences lie between doctor and patient or between different health care providers, the results can be unfair judgments and missed opportunities.

This  attitude can affect the way doctors interpret the results of placebo-controlled trials and how they feel about home remedies. We also discussed the pros and cons of e-mail communication between doctors and patients, and how to choose a good doctor.

Listen here and let me know what you think.

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The FDA has announced a new program to help doctors check the approved indications and other information in drug “labels.”  These “labels” are the FDA-approved educational information sheets that drug companies package with medication. See information below:

Online Service Enables Physicians To Check FDA-Approved Medication Labeling Via EHRs.

Healthcare IT News (1/27, Merrill) reported that to “boost drug safety, a new online service has been launched that allows doctors to check the FDA -approved labeling for the most commonly prescribed drugs.” The service is part “of a new campaign” called “Know the Label,” which is being “launched in concert with the FDA’s efforts to provide up-to-date and complete prescribing information to physicians.” It is being delivered to all US physicians and providers “electronically via the websites of PDR Network, The Doctors Company and other liability carriers, via EHR systems. … ‘We congratulate The Doctors Company and PDR Network for finding a practical and novel way for physicians to access the full updated labeling through electronic means and have it available at the point of prescribing,'” said Janet Woodcock, MD, Director of FDA’s Center for Drug Evaluation and Research.

I doubt this new program to disseminate the label information is going to help patients much.  At least in my field, use of medication is based on  patients’ individual conditions and results of studies that go far beyond what’s in the FDA-approved “label.”  Medications are used for conditions other than FDA-approved uses.  Different doses are used.  Combinations that the FDA-approved label says are bad may often be exactly what a patient needs. I guess it won’t hurt to give doctors the information on FDA-approved medication labeling, unless it discourages doctors from giving patients needed treatments for unapproved conditions.

For best results, a doctor’s  good judgment is the best guide to treatment.

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Clinical trials bring us the new wonder drugs that would have been considered either magical or miraculous in earlier times. Are you interested in how drugs are tested to assure efficacy and safety?

On two episodes of Getting Better Health Care, clinical researcher Bea Abrams, PhD, with over 30 years experience in pharmaceutical development, explains the process of clinical trials done to bring a new drug to market.  She shares with us critical information that lets us know how much we can trust new drugs and what to look out for.

In a subsequent episode, I’ll be talking with Dr. Lawrence Friedhoff — author of the book, New Drugs: An Insider’s Guide to the FDA’s New Drug Approval Process for Scientists, Investors and Patients — about myths that surround new drug development.

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Medical safety — when can we be as good as the airlines?.

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Airline safety is remarkable.  USA Today reports that US airlines did not have a single fatality last year, the third year out of the last four with no air travel deaths. And that’s with U.S. carriers flying more than 10 million flights and hauling more than 700 million passengers.

Our automobile transport system isn’t that safe.  And how about our medical system? Sure, many deaths can’t be prevented by medical science, but wouldn’t it be great if we were to read a headline sometime soon that reads, “Medical System Documents a Year with No Preventable Deaths” or “No Wrong Site Surgery in 3 of the Past 4 Years”?

Airlines can do this, as there is a system in place for measuring and reporting.  The American medical non-system doesn’t even have a mechanism in place for assessing how many deaths, wrong site surgeries or other major safety issues occur, much less a system for reporting the number or a systematic approach to achieving 100 percent safety.

We may be heading in that direction, though.  Data collection and dissemination continues to get easier and less expensive.  If we can start a website that lets all patients rate their satisfaction with all doctors, we should be able to create reliable safety reporting system.

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