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12 noviembre, 2019

Effective Strategies for Hospitals Responding to the Opioid Crisis

Botticelli M, Gottlieb M, Laderman M. Effective Strategies for Hospitals Responding to the Opioid Crisis. Boston: Institute for Healthcare Improvement and The Grayken Center for Addiction at Boston Medical Center; 2019. (Available at www.ihi.org)
With the growing volume of inpatient admissions and outpatient visits for individuals with a substance use disorder, hospitals have the opportunity to make a major impact in reducing morbidity and mortality related to opioid use, from prevention to screening, to treatment, to engaging with communities to reduce harms.
This document provides hospital and health system administrators and leaders with:
  • Specific improvement ideas for five system-level strategies that address the challenges of preventing, identifying, and treating opioid use disorder
  • Brief case examples describing other hospitals’ approaches
  • Source literature and additional resources, including cost savings data, where applicable

09 noviembre, 2019

Medical Error Statistics 2019

  •  Medical billing errors cost Americans $210,000,000,000 annually.
  • Roughly 12,000,000 Americans are misdiagnosed each year.
  • Medical errors cause an estimated 250,000 deaths in the United States annually.
  •  As many as 80 percent of medical bills contain at least one error.
  • A little more than 4,000 surgical errors occur each year.
  • It’s estimated that 7,000 to 9,000 patients die every year from medication errors.
As you can see from our top stats, medical errors are abundant in the American health care system.  What qualifies as a medical error, and how can you know if you or a loved one has been the victim of one?

What Is a “Medical Error”?

According to the book Medical Error, it is defined as a “preventable adverse effect of medical care, whether or not it is evident or harmful to the patient.” (Emphasis added.)
As a patient, you may not even know a medical error has taken place, and even if you do know about it, the medical error may not negatively affect you in any way.  However, many medical errors are quite serious, and can even result in death.
According to data provided by the U.S. Department of Health and Human Services, one in seven patients on Medicare in a hospital setting is the victim of a medical error.
A Johns Hopkins study released in 2016 estimated that roughly 250,000 people die annually because of medical errors.  That would make medical errors the third leading cause of death in the United States, behind only heart disease and cancer.

Top Ten Causes of Death in the United States (2016)

Top 10 Causes of Death in US
*It should be noted that the annual death rate from medical errors is an extrapolation based on a smaller pool of data.
As you can see from the chart above, heart disease and cancer each kill roughly 600,000 Americans per year.  They are followed by medical errors, then accidents at 161,000 deaths per year. 
Some studies indicate that death from medical errors could be even higher due to the way medical errors are reported on death certificates—with as many as 440,000 people dying every year from medical errors. The number of deaths caused by medical errors is far too high. 

High-Risk Medical Errors

Sometimes, a medical error poses little physical risk to a patient, such as getting billed for a procedure that didn’t take place.  
Other times, the consequences are life or death—and those types of high-risk medical errors typically occur in fast-paced, high-pressure environments, such as hospital emergency rooms, hospital intensive care units, and operating rooms in hospitals.
But that doesn’t mean medical errors can’t happen at your care provider’s office or other outpatient settings.

Types of Medical Errors

Now that we’ve defined what counts as a medical error, what are the most common types of medical errors in the United States?
  • Misdiagnosis
  • Billing errors
  • Incorrect medication/incorrect dosage
  • Incorrectly identifying a patient
  • Surgical errors
We explore each type of error in more detail below.

Misdiagnosis

Misdiagnosis occurs when a patient with one illness or disease is told they have a different illness or disease.  According to a 2014 study, roughly 12,000,000 Americans are misdiagnosed at outpatient facilities every year.  
The study’s authors concluded that this issue creates a “substantial patient safety risk” and should be addressed. Reducing the chance of patient harm should be a main priority. 
Of the 12,000,000 total Americans receiving a misdiagnosis, roughly 50 percent could be seriously harmed by getting the wrong diagnosis, as shown in the chart below.

That total number breaks down to about 5 percent of the adult U.S. population.
According to a study that analyzed more than 300 medical claims between 2007 and 2013, the following health issues were the most commonly misdiagnosed.
  • Stroke
  • Heart attack
  • Spinal epidural abscess
  • Pulmonary embolism
  • Necrotizing fasciitis
  • Meningitis
  • Testicular torsion
  • Subarachnoid hemorrhage
  • Septicemia
  • Lung cancer
  • Fractures
  • Appendicitis
Some of these may not sound very familiar dressed up in their medical terminology, so they are described here in everyday terms.
A spinal epidural abscess is infected fluid and germs on the spinal cord, and it can be deadly.  It is harder to diagnose because two of the main symptoms (fever and back pain) are vague and could be caused by many non-fatal diseases or illnesses.
Pulmonary embolisms are more commonly referred to as a blood clot in one or both lungs.  These can be deadly if not diagnosed and treated in time.  In fact, roughly one-third of all people who have this condition and have not been diagnosed or treated will die.
This condition is also tough to diagnose if someone already has heart or lung disease.
Necrotizing fasciitis is a fast-spreading bacterial infection.  According to the Centers for Disease Control and Prevention, time is of the essence when diagnosing and treating this disease to minimize loss of tissue and prevent death. 
However, as many as one-third of people who contract this disease will still die, even with treatment.
Meningitis is a bacterial infection that affects the brain and spinal cord.  It can be easily misdiagnosed since the symptoms match up nearly identically with the flu.  This, too, can be a deadly disease if not treated quickly.
Testicular torsion occurs when blood flow is cut off to the testicle because a blood vessel becomes twisted.  If caught within six hours, there’s a high likelihood the testicle can be saved.  Otherwise, the testicle will need to be removed. Take a look at the time-sensitive nature of testicular torsion: 
Time-Sensitivity of Testicular Torsion
As you can see from the chart above, if testicular torsion is treated within six hours, there’s a 90 percent chance the testicle can be saved.  After 24 hours, that rate drops to only 10 percent.
Subarachnoid hemorrhages are also known as bleeding on the brain, and have several causes, including concussions and traumatic brain injuries.  This condition can also be deadly if not caught in time.
Septicemia, also known as blood poisoning, occurs when bacteria enters the bloodstream.
If you think you’re suffering from any of these health issues, but you can’t find a health care provider to take you seriously, keep pushing until someone does the necessary testing to rule out or confirm any potential issues.  It just may be your life on the line.

Billing Errors

Billing errors happen when patients are charged for procedures they did not receive, or are charged for staying longer at an in-patient facility than they actually did, or correct procedures/stays have been coded incorrectly due to data entry errors.  
In fact, medical billing errors cost Americans around $210 billion annually.
Most medical bills, around 80 percent of them, contain some type of error, and the errors are rarely in favor of the patient.  According to one report, there are around 70,000 diagnosis codes that could be used, and around 71,000 procedure codes available.  That makes errors nearly inevitable.

Medication Errors

Another major medical error that affects public health in the United States is incorrect medications or dosages of those medications.  It costs over $40 billion per year to care for and treat patients who were victims of medication errors.
In the United States, between 7,000 and 9,000 patients die from medication errors every year.
The types of errors that fall under this category include:
  • Prescribing the wrong medication.
  •  Failing to include a necessary part of the prescription.
  • Telling the patient to take the prescription at the wrong time of day.
  • Giving the improper dose of medication.
  • Failing to check whether the patient is allergic to that medication.
  • Failing to check whether there are other medications the patient takes that could interact with the prescribed drug.
  • Transcribing the prescription incorrectly.
In hospitals or outpatient facilities performing surgical procedures, this can also include anesthesia errors—either using too much or too little, or using an anesthetic the patient is allergic to.

Patient Misidentification

Believe it or not, incorrect identification of patients occurs frequently enough to make this list.  You may think it wouldn’t be possible to confuse which patient is having which procedure performed, or even which patient the doctor is there to see, but it happens.
In the chart below, we examine a few instances related to frequency of misidentification.
Patient Misidentification Instances
Between 2003 and 2005, hospitals in the United Kingdom reported 236 incidents or near-incidents in which patients were misidentified.  
Florida practitioners indicated that between 1990 and 2003, the wrong patient had gotten surgical procedures in 67 cases. 
And in New York City, over a three-year span, the wrong patient had gotten an invasive medical procedure in 27 cases.
In one incident from Boston, a patient with healthy kidneys was mistaken for a patient with a kidney tumor.  The healthy patient’s kidney was removed—and the error was only discovered after the surgery had been performed.
The following graphic provides summary numbers from several misidentification incidents across the United States.
Misidentification Errors Statistics
It’s difficult to know exactly how many cases of misidentification occur nationwide, but most researchers believe actual instances are much higher than reported numbers, and the impact on the affected individuals is enormous.

Surgical Errors

Finally, we take a look at surgical errors.  According to data from 2012, surgical errors resulted in $1.3 billion in medical malpractice payouts annually.  The annual number of surgical errors rose above 4,000, and were nearly all preventable. 
In fact the authors of the study this data is based on called the surgical errors “never events,” which means the errors never should have happened in the first place.  These include things like leaving a surgical tool inside the patient, or operating on the wrong limb.
The graphic below goes into more detail on common surgical errors and their frequency.
Surgical Errors
Are these surgical errors harmful, though?  According to the data below—yes!
Injuries From Surgical Errors
While the majority of surgical errors only resulted in temporary injuries (59 percent), nearly 40 percent of these errors resulted in permanent injuries or death.  Less than two percent of surgical errors resulted in no injury. 
And most of the surgeons who committed surgical errors (two-thirds) had been involved in at least two prior medical malpractice actions.

What Causes Medical Errors?

What are the factors that go into creating a medical error, and are they fixable?  Can we reduce the number of medical errors, and more importantly, the adverse effects of these errors on patients? 
We review a few of the most typical components that, in combination or alone, cause the vast majority of medical errors in the United States.
  • Lack of training
  • Assigning tasks to inappropriate staff
  • Rare or copy-cat illnesses
  • Lack of adequate testing  
  • Time-sensitivity—the treatment or procedure must be done immediately
  •  Complexity of the illness or health issue being treated
  • Age of the patient
  • New procedures
Let’s look a little more closely at each of the factors listed above.

Training

In some cases, errors are caused by new staff, who are still learning or haven’t encountered a specific situation before, and therefore haven’t had the necessary training to know how to handle the issue presented. 

Inappropriate Assignments

Other times, errors are due to assigning tasks to the wrong staff.  For example, one study found that pharmacy technicians were making medical formulations instead of the pharmacists, who were specially trained and educated for that purpose.

Rare Illness

Sometimes, a patient may have a rare illness.  Because these illnesses are rare, they’re often misdiagnosed as something else, especially if their symptoms mimic another, much better known disease or illness.  For example, meningitis and the flu have nearly identical symptoms.

Testing

Unfortunately, a patient’s pre-existing health condition may limit the amount of diagnostic testing that’s done to determine the cause of reported symptoms. 
In some cases, heart attacks in female patients may be dismissed as simply an extreme panic attack, because the heart attack symptoms women experience are almost identical to those of panic attacks, and further testing may not be done.
Lack of adequate testing also affects obese patients, as it was found that not all necessary diagnostic testing was done for these patients, leading to diagnostic errors or failure to diagnose any illness or disease at all.  
Patients with pre-existing mental health disorders were especially vulnerable to this.  For example, if a patient with depression reports a sudden lack of energy, they may be prescribed a higher dose of their antidepressant, instead of being tested for thyroid function or other possible culprits. 

Time Pressure

And any time there is pressure to get a diagnosis completed right away, or a procedure done immediately, there is a greater risk of missing the actual cause of the symptoms or performing the procedure incorrectly.  (Or performing the incorrect procedure.)

Complexity

The more complex an illness or disease is, or the more complex the treatment protocol required to help the patient, the higher the risk that something will get missed along the way.  

Age

Patients at both the high and low ends of the age spectrum are often victims of medical errors, as well.  The youngest members of the population can’t articulate their symptoms or what has been helpful in alleviating those symptoms, and that is often the same for the oldest members of the population.

New Procedures

Finally, if a new procedure is developed for the treatment of a disease or illness, there is always a learning curve related to putting that new procedure successfully into practice.  Sometimes a health care provider picks up the new procedure quickly; but if they don’t, medical errors may occur.

How Can You Protect Yourself?

At this point, you may be wondering how you can protect yourself and your loved ones from these types of errors.  There are several things you can do, so take heart. All of these factors will contribute to your well-being. 
  • Ask questions at every stage.  When seeking a diagnosis, ask your doctor about specific tests you’d like to have done, or about specific health concerns you have.  If you’re scheduled for surgery, ask questions about the specific procedure, or about any medications you may be prescribed.
  • Get a second opinion.  While it may feel awkward or like you’re betraying your doctor’s trust in some way, it’s in your best interests to get a second opinion when it comes to difficult diagnoses or major treatment options.
  • Do your homework.  Research your condition and the appropriate treatment options as much as possible before any surgery or medications have been prescribed.  The better informed you are, the easier it will be to determine if your treatment plan is correct and the best option for your situation.
  • Request an itemized bill.  This way you can check dates of service, services provided, and the doctors involved in your treatment and/or diagnosis.  Any medical mistakes will be much easier to identify than if you receive a summarized statement.
  • Bring someone with you. Two heads are better than one!  It’s nerve-wracking to be in a doctor’s office or hospital and having someone you trust at your side can make it easier to ask questions and share pertinent information.   

National Academy of Medicine

The National Academy of Medicine, formerly known as the Institute of Medicine, is a non-profit organization that was originally created to provide leadership in the field of healthcare. 
Two of their publications, Crossing the Quality Chasm (2001) and To Err is Human: Building a Safer Health System (1999) shone a light on medical errors at the beginning of the 21st Century and garnered national attention. 
Today, they continue to issue publications related to the state of America’s health care system, as well as examining health care issues world-wide.

Where Can I Learn More?

To get more information on specific health conditions, the Mayo Clinic’s website has a “condition finder” where you can type in any condition and see what information they have on it.  You can also look through an A-Z directory of conditions.
The Centers for Disease Control and Prevention also lists multiple conditions, research being done, and the latest treatments for certain diseases.
Condition-specific organizations, such as the American Heart Association, are great options for getting more information on a specific condition you may be concerned about.
The Agency for Health Care Research and Quality’s website has resources to help patients advocate for themselves and includes things patients can do to help prevent medical errors, such as asking hospital staff if they’ve washed their hands before they touch anything that will touch you (needles, catheters, food trays, your skin).
You can always report a doctor or surgeon to your state’s medical board if you have concerns about how they have handled your condition.

In Summary…

Getting proper medical care is necessary for your health and safety.  While none of us want to believe that medical errors will happen to us, based on the frequency of these issues, it’s highly probable that you will experience at least one of the errors outlined here during your lifetime.
Educate yourself and your loved ones as well as you can on your specific health issues or health concerns, and don’t be afraid to push back if something doesn’t seem right.  That persistence might just save your life.

Sources

  1. CNBC, “The Third-Leading Cause of Death in U.S. Most Doctors Don’t Want You to Know About.”
  2. The National Center for Biotechnology Information, “Medical Error.”  
  3. Johns Hopkins Medicine, “Study Suggests Medical Errors Now Third Leading Cause of Death in the U.S.”
  4. Agency for Healthcare Research and Quality, “20 Tips to Help Prevent Medical Errors Patient Fact Sheet.”
  5. Centers for Disease Control and Prevention, “FastStats: Leading Causes of Death.”
  6. MedicalNewsToday, “1 in 20 American Adults ‘Misdiagnosed in Outpatient Clinics Each Year’.”
  7. MedicineNet, “Definition of Cerebrovascular Accident.”
  8. Wikipedia, “Myocardial Infarction.”
  9. Medline Plus, “Epidural Abscess.”
  10. The National Center for Biotechnology Information, “Spinal Epidural Abscess: Common Symptoms of an Emergency Condition.”
  11. Mayo Clinic, “Pulmonary Embolism.”
  12. The Centers for Disease Control and Prevention, “Necrotizing Fasciitis: All You Need to Know.”
  13. Mayo Clinic, “Meningitis.”
  14. TeensHealth from Nemours, “Testicular Torsion.”
  15. Mayfield Brain & Spine, “Subarachnoid Hemorrhage and Vasospasm.”
  16. Healthline, “Septicemia.”
  17. Anxiety and Depression Association of America, “Am I Having a Panic Attack or a Heart Attack?”
  18. Healthline, “Up to 80% of Hospital Bills Have Errors.  Are You Being Overcharged?”
  19. Becker Hospital Review, “Medical Billing Errors Growing, Says Medical Billing Advocates of America.”
  20. The National Center for Biotechnology Information, “Medication Errors.”
  21. Agency for Healthcare Research and Quality, “Mistaken Identity.”
  22. ECRI Institute, “Patient Identification Errors.”
  23. JAMA Network, “Wrong-Site and Wrong-Patient Procedures in the Universal Protocol Era.”
  24. Boston Globe, “14 Instances of Right Procedure, Wrong Patient in Mass.”
  25. WebMD, “Thousands of Mistakes Made in Surgery Every Year.”
  26. National Academy of Medicine, “To Err is Human:  Building a Safer Health System.”
  27. National Academy of Medicine, “Crossing the Quality Chasm:  A New Health System for the 21st Century.”

Note: also checkout our statistics on rare diseases.

03 octubre, 2019

Metablog Salud

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SEP 29

Artificial intelligence in medicine raises legal and ethical concerns

The use of artificial intelligence in medicine is generating great excitement and hope for treatment advances. AI generally refers to computers’ ability to mimic human intelligence and to learn. For example, by using machine learning, scientists are working to develop algorithms that will help them make decisions about cancer treatment. They hope that computers will […] Find jobs at Careers by Ke
A patient confesses that he cuts himself

I walked into the room and said: “Hi, Jason.” “Do you think it’s deep enough to need stitches? I am really scared of needles,” was his reply to me. I said, “Why don’t you let me take a look, and we can both come up with a plan of how to make it look better?” […] Find jobs at Careers by KevinMD.com . Search thousands of physician, PA, NP, and CRNA jobs now. Learn more .
Medicine must stop eating its own

Despair has been trying to find me again. That fickle nightmare is breathing down my neck once more. I know her all too well — she has nipped at my heels most of my career and has kept me running for the past 20 years. Running from friendships, running from family, running from loss, running […] Find jobs at Careers by KevinMD.com . Search thousands of physician, PA, NP, and CRNA jobs now. Learn
This doctor defines himself as a Christian, not a physician

What is life? It’s the cumulation of the daily processes all wrapped up into one, filling the void of each day. These processes coalesce hour by hour, filled with demands, expectations, current crisis, and bills to pay. Life is a full-contact sport, each hour brimming with all-encompassing activities, expectations, and trivial pursuits. We live every […] Find jobs at Careers by KevinMD.com . Sear

SEP 28

To reduce suicides, follow the data

On Kimberly Repp’s office wall is a sign in Latin: Hic locus est ubi mors gaudet succurrere vitae. This is a place where the dead delight in helping the living. For medical examiners, it’s a mission. Their job is to investigate deaths and learn from them, for the benefit of us all. Repp, however, isn’t a […] Find jobs at Careers by KevinMD.com . Search thousands of physician, PA, NP, and CRNA job
Don’t underestimate the appeal of a Trump “health plan”

As the Democratic candidates for president continue to beat up each other on how best to achieve universal coverage (Medicare for all, a public option, closing the ACA’s coverage gaps), health care journalists keep wondering when President Trump will release his long-promised “phenomenal” plan to position the GOP as “the party of health care” for the 2020 election. Skepticism […] Find jobs at Car
It’s time for presidential candidates to debate the safety of pharmaceutical products

I watched all three presidential debates this summer with health care being a time-consuming topic for all. Universal health care and Medicare for all, with or without an option for private insurance, were debated and discussed at length. At the same time, NBC Nightly News presented a story documenting that all our antibiotics come from […] Find jobs at Careers by KevinMD.com . Search thousands o
MKSAP: 40-year-old man with a flesh-colored lesion

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 40-year-old man is evaluated for a firm, flesh-colored lesion that has been growing on the back for several months. Foul-smelling material can be expressed from the lesion. The patient is bothered by the periodic drainage. He is otherwise healthy and […] Find jobs at Careers by KevinMD

SEP 27

4 reasons why physicians should hire a financial advisor

I’m a big proponent of do-it-yourself investing. In the age of index funds, many investors can manage their own investments at very low cost. And fees you pay to a financial advisor could be used to invest and grow your nest egg. But that’s not to say that I believe that no one should have a financial […] Find jobs at Careers by KevinMD.com . Search thousands of physician, PA, NP, and CRNA jobs n
Cine y Pediatría (507). “Juegos prohibidos” de guerra e infancia

“Por elevar a una singular pureza lírica y a una excepcional fuerza de expresión la inocencia de la infancia por encima de la tragedia y desolación de la guerra”. Esta era la mención especial para esta película clásica en blanco y negro del año 1952, cuando obtuvo el León de Oro del Festival de Venecia, amén de obtener también la Palma de Oro del Festival de Cannes y de ganar el Oscar Honorífico
El autentico “No hacer” en actividades burocráticas

Pues eso, que al contrario que otros que se publicaron con anterioridad, este documento es claro y cristalino. Puedes cambiar el logo del SAS y poner el de tu servicio sanitario ,aunque te recomendamos que se lo envíes y lo asuman primero. Puedes conseguir el documento completo, aquí
The mystery illness of Kim Kardashian West

Reality star and meta-celebrity Kim Kardashian West made the rounds on the network news and talk shows last week to promote her new line of shapewear. But she also talked about the recent health scare that was revealed on the latest episode of “Keeping Up with the Kardashians.” Talking to Savannah Guthrie and Hoda Kotb […] Find jobs at Careers by KevinMD.com . Search thousands of physician, PA, N
Don’t let patient care interfere with documentation

I’m being sarcastic, of course, but that’s often how it seems some days. Those are days when I’ve been busy at patients’ bedsides all day and then struggle to get my documentation done later, typically many hours later. I jot notes to myself as I go along, but it can be hard to recall at […] Find jobs at Careers by KevinMD.com . Search thousands of physician, PA, NP, and CRNA jobs now. Learn more
The answer to physician burnout isn’t resilience training

The answer to physician burnout is purported to be resilience training. That’s like glorifying the natural ability of frogs to tolerate gradually heating and boiling water. Unfortunately, health care today has some toxic ingredients, and physician burnout is directly related to them. Some forms of resilience training I have been exposed to are no more […] Find jobs at Careers by KevinMD.com . Sea

SEP 26

What has emergency medicine wrought? Helplessness.

It seems that all day, every day, I care for patients who simply won’t take care of themselves. And I sometimes think that we in emergency medicine have caused more harm than we expected. Now let me first say, I also take care of those who can’t care for themselves. There are those who, through […] Find jobs at Careers by KevinMD.com . Search thousands of physician, PA, NP, and CRNA jobs now. Lea
Cinema Paradiso: Diario de un joven doctor

. Basada en la prolífica obra de novelas cortas del autor Mikjaíl Bulgákov, Young Doctor's Notebook narra la historia de un doctor durante dos épocas de su vida: cuando es un joven intrépido con muchas ganas de desempeñar su profesión, y cuando es un adulto al que el paso del tiempo ha desviado de su camino. Tras el final de la primera Guerra Mundial, el doctor Vladimir Bomgard (Jon Hamm,
What’s the best way to treat doctors and nurses with drug addiction?

Dr. Wesley Boyd, an associate professor of psychiatry at Harvard, has spent years working with state programs that help doctors, nurses and other health care workers who have become addicted to opioids get back on their feet professionally. He supports these non-disciplinary programs, in which doctors and nurses enroll for a number of years and […] Find jobs at Careers by KevinMD.com . Search tho
The keyboard is the sworn enemy of physicians

During one long ago very hot Washington, DC summer, at the suggestion of my parents, I enrolled in a typing course that was given at our elementary school. This was the summer between sixth and seventh grades, and there were lots of things I would’ve preferred to have been doing, but my dad, who started […] Find jobs at Careers by KevinMD.com . Search thousands of physician, PA, NP, and CRNA jobs
A physician is on the scene in the Bahamas after hurricane Dorian

The water continued to rise as the rain pounded Marsh Harbor, a town on Abaco, one of the 700 islands of the Bahamas archipelago. Hurricane Dorian plodded along, nearly slowing to a stop directly over their meager homes. The rain and wind continued to lash their wood and aluminum dwellings, but the real threat came […] Find jobs at Careers by KevinMD.com . Search thousands of physician, PA, NP, a
Doctors, do you really understand?

There is a haze lurking overhead clouding rational thinking. Thoughts wander back to times when my body was unencumbered, and I felt nothing was out of my grasp. Maybe that was an unrealistic thought, but it is how youth and inexperience protect one from the somewhat harsh realities of growing older. Coming to terms with […] Find jobs at Careers by KevinMD.com . Search thousands of physician, PA,
Here’s why health care innovations stay secret

Having been an improvement advisor with many quality improvement initiatives and collaboratives, I have observed that stories about successful initiatives too often leave out major relational barriers that got in the way as well as the critical interventions necessary to overcome them. That important details about relational challenges so often remain hidden is not a […] Find jobs at Careers by K
Amazon care: ¿la revolución?

Amazon ha lanzado un sistema de atención sanitaria dirigido a sus empleados y familiares en la zona de Seattle. El sistema se llama Amazon.care y tiene una web en la que se explican sus servicios y otras características. Por ahora se ofrecen 4 servicios sanitarios: - Un chat a través de la app que permite conversar con una enfermera para recibir consejos de salud y resolver dudas sobre cualquier

SEP 25

Who actually owns your medical records?

I was in a discussion with a group of patients about how difficult it is for patients to get access to their own medical records. It was initiated after one of my patients was refused copies of her recent hospitalization. There is much confusion out there about who actually owns the record and how it […] Find jobs at Careers by KevinMD.com . Search thousands of physician, PA, NP, and CRNA jobs no
Mergers emergentes...

En lo que va de 2019, el sector farmacéutico está batiendo su récord de movimientos corporativos. Hasta junio, se han registrado 62 operaciones de fusiones y adquisiciones, por un valor de 155.100 millones de euros. La cifra en tan solo seis meses ya es mayor que muchos de los ejercicios completos precedentes en la última década, según datos de la consultora Evaluate Pharma. Ver: Todo
Black market pharmaceuticals target immigrants

The bootleg medications were smuggled across the border and sold to mostly Latino immigrants in public spaces throughout Los Angeles — at swap meets, parks, beauty salons and makeshift stands outside mom-and-pop grocery stores. The drugs were cheap, and the customers — mostly from Mexico and Central America — did not need prescriptions to buy […] Find jobs at Careers by KevinMD.com . Search thous
In medicine, find the beauty in what is common

“The value of experience is not in seeing much, but in seeing wisely.” – Osler, “Aequanimitas” Recently, my family and I were leaving a restaurant, and in so doing, we crossed a large parking lot filled with a seemingly endless number of pebbles. My youngest daughter, whose hand I was holding, suddenly pulled away from […] Find jobs at Careers by KevinMD.com . Search thousands of physician, PA, N
An important health care safety net is at risk

EMTALA is born The machine beeps alarmingly as it breathes for your child. The various numbers on the monitor are foreign to you, but you know something isn’t right because the nurse briskly walks away from the stretcher to grab the doctor, who then orders more medication and makes adjustments to the machine. The beeping […] Find jobs at Careers by KevinMD.com . Search thousands of physician, PA,
Your bone fracture, my cash flow: the consequences of private equity in health care

A recent article in Modern Healthcare describes how private equity firms are starting to snatch up specialist physician groups that promise rich revenues, such as orthopedists, dermatologists, and ophthalmologists. Naturally, this is about adding value, not adding to bank accounts. Because whether it’s physicians or hospitals, health insurers or drug companies, no one in health […] Find jobs at C
How emotional intelligence makes you a better physician

In the early evenings after work, I thoroughly enjoy taking brisk walks. Walks are a great opportunity to exercise, of course, but I also cherish making time for myself to process the many thoughts that can occupy the mind of a busy physician. My walks are typically the only time of the day when I […] Find jobs at Careers by KevinMD.com . Search thousands of physician, PA, NP, and CRNA jobs now.
Mercaderes y brahmanes

Cuenta Fito Paez en el Gatopardo que en su adolescencia se sacó todas las muelas con tal de librarse del servicio militar. Puede sonar excesivo, pero no hay que olvidar que en aquellos años dicho servicio se realizaba en una de las dictaduras más atroces que conoció el siglo. A uno le dan las ganas de “sacarse todas las muelas” (electoralmente hablando) y no votar el próximo 10 de noviembre, porq
Sarampión. Vacunación de adultos nacidos entre 1970 y 1980

La vacuna del sarampión no existe, existe la vacuna triple vírica, sarampión, parotiditis y rubeola. Hay que comentárselo a los pacientes, pues lo que precisarían sería sólo la vacuna para el sarampión. Ojo con la rubeola en mujeres fértiles, no pueden estar embarazadas ni embarazarse. La recomendación es para los nacidos entre 1970 y 1980 (y no hay que hacer anticuerpos) ya que en 1981 se introd
“Roma” y el parto de Cleo

En la película “Roma” hay un parto de película, el de Cleo. La película está rodada en blanco y negro y su protagonista es Cleo, empleada doméstica de una familia de clase media en la que el padre es médico. Cleo es indígena, oaxaqueña, y habla tanto el español como su lengua materna, el mixteco. Su personaje se basa en el personaje real que atendió a la familia del director de la película, Alfon
Jornada de prevención de agresiones en el entorno sanitario

Hace ahora justo medio año que compartimos un post justo y necesario bajo el título de "Agresiones a profesionales sanitarios: una lacra social" . El contenido se puede revisar en el enlace adjunto, pero estos eran los mensajes clave : - Las agresiones verbales y físicas al personal médico y de enfermería, se están incrementando. - Las agresiones en el entorno sanitario son más frecuentes a mujer

SEP 24

When patients die, physicians mourn as well

I was driving to work one morning, and as part of my new routine, I listen to The Moth podcast. If you do not know it, it’s a wonderful community of storytellers — compelling stories, told by people from every walk of life. I often find myself drawn into the program (like a moth to a flame, […] Find jobs at Careers by KevinMD.com . Search thousands of physician, PA, NP, and CRNA jobs now. Learn m
Vacuna (?) migraña...la deseada

Los nuevos tratamientos se basan en tres principios activos: “galcanezumab”, “fremanezumab” y “erenumab”. Valentín Mateos puntualiza que, pese a su éxito en el lenguaje coloquial, aplicarles la expresión “vacuna de la migraña” no es del todo correcta. Eso sí, “representan una aproximación más específica a la migraña”, al contrario de lo que sucede con los fármacos preventivos actualmente
How pneumatic tubes symbolizes our health system

About once or twice a day, everyone on our hospital’s computer network gets an emergency message that scrolls across the bottom of our screens, highlighted in the colors of danger and warning. They include things like a notification that a particular data system is down and that a backup on paper will have to be […] Find jobs at Careers by KevinMD.com . Search thousands of physician, PA, NP, and
Let’s end surprise billing without a Trojan Horse

With August recess at a close, Congress has yet to find a solution to end balance (or “surprise”) billing, where patients are charged the remainder of their medical bill for out-of-network (OON) expenses not reimbursed by their health plan. About the only compromise for-profit health insurers, hospitals, and physician groups can agree on is that […] Find jobs at Careers by KevinMD.com . Search th
It’s time for AI-enabled solutions in health care to live up to their buzz

Artificial intelligence is incredibly buzzy in health care right now, and for a good reason. Other industries are already experiencing AI-enabled radical transformations, like real-time fraud monitoring and detection in banking and finance and instantaneous image recognition across the web and social media. Health care now stands similarly positioned to capitalize on the transformative power […]
To extinguish burnout, bring back physician autonomy

In his article, “Medical education needs to stop burning out students — now,” Augustine Choi suggests the culture of medical education is responsible for increasing numbers of depression and burnout among medical students, and suggests that more programs are needed to address self-care and wellness in order to build resilience. While I agree that mental […] Find jobs at Careers by KevinMD.com . S
Made mistakes? How to spin them for your medical school applications.

Despite more than a dozen years in medical school admissions consulting, I still clearly recall a bright advisee who had improved her grades considerably throughout her college career. But I, unfortunately, had a less than stellar freshman transcript. After calculating her AMCAS GPA with me, she lamented, “I feel like my grades are a criminal […] Find jobs at Careers by KevinMD.com . Search thous

SEP 23

The unexpected people who’s listening to your conference speech

Do you ever wonder what the staff in hotel conference rooms think about what we talk about in presentations and lectures? I talk about sensitive stuff — sexuality, fertility, etc. — and I use words that many people have not said out loud in front of hundreds or thousands of people. I’m used to the […] Find jobs at Careers by KevinMD.com . Search thousands of physician, PA, NP, and CRNA jobs now.
Creatividad: GSK / Las mujeres se hacen fuertes

. La mayor farmacéutica británica, liderada por Emma Walmsley, quiere tener un 37% de directivas en 2022. En septiembre de 2016, GSK, la mayor farmacéutica británica, sorprendió al mercado al anunciar el nombramiento de Emma Walmsley como nueva consejera delegada. La directiva, con una larga experiencia en el grupo y licenciada en Lenguas Modernas por la Universidad de Oxford, se convertía en
Seniority is the worst metric for health care leadership

Health care delivery in the United States is being led by practitioners who have ascended to leadership roles primarily through years of loyalty to their organizations. But as burnout worsens and affects the youngest clinicians to the detriment of the system, is this the appropriate cadre to shepherd us towards necessary system transformation? We share […] Find jobs at Careers by KevinMD.com . Se
Fact-checking faces steep challenges in health care

Fact-checking has become one of the buzziest buzzwords in journalism. There are more than 100 fact-checking projects around the world. It’s been trotted out to counter alleged “fake” news. And to monitor the accuracy of political leaders who stretch the boundaries of believability. April 2 has been proclaimed International Fact-Checking Day. Indeed, genuine fact-checking may play an important rol
Modern health care and the Burger King mentality: Sometimes you can’t “have it your way”

It’s difficult to put into words the honor I feel as an emergency physician. Strangers invite you into their lives, trusting in your training, knowledge, and compassion as they battle crisis. We are involved in intimate details of triumphs and loss on a daily basis, sharing in tears of joy and sorrow as we fight […] Find jobs at Careers by KevinMD.com . Search thousands of physician, PA, NP, and
Wonder about each patient outside the exam room

I pass by one of our local parochial schools on the way to clinic two mornings a week. With the school year in full swing, each Friday I see the children lining up outside to go to weekly Mass. With the girls in their grey tartan skirts and blue vests and the boys in their […] Find jobs at Careers by KevinMD.com . Search thousands of physician, PA, NP, and CRNA jobs now. Learn more .
Hair is undoubtedly the politician’s crowning glory

It all started with John F. Kennedy’s campaign for the presidency. After eight years with President Eisenhower’s baldness and Vice President Nixon’s receding hairline, the American public was ready for a change. Kennedy had great hair, which he flaunted by appearing bareheaded at his inauguration. A new political maxim was established that day; to win […] Find jobs at Careers by KevinMD.com . Sea
Mental Health of Children in Conflict

This week issue of the Lancet brings to our attention the problem of the Mental health of children living in areas with open social and war conflicts. (ref. DOI: https://doi.org/10.1016/S0140-6736(19)32143-9 The text: The mental health imperative of children in conflict On Sept 10, ahead of the UN General Assembly and a mental health in emergencies summit in the Netherlands (Oct 7–8), Save the Ch
Vapeo, el peligro emergente

Hace justo un año publicamos en este blog el post titulado "La epidemia (y las consecuencias) de los cigarrillos electrónicos entre los jóvenes" , en donde, ante el alarmane crecimiento del uso (y abuso) del cigarrillo electrónico se respondían a estas preguntas: - ¿Qué contiene el cigarrillo electrónico? - 

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