DEPRESCRIBING – Is there an epidemic of prescription medicine overtreatment? Start CHOOSING WISELY

It is up to you to ask your physician if you, or a family member, are on too many medications.

“If a patient were to hear something to the effect of ‘let’s get some lab tests,’ I would ask the clinician: How many and why?” …. “Once you order six or seven individual lab tests, the odds of one of them being a false positive already is about 20 percent. Just statistically. So if there are a lot of vials of blood being drawn [ask] ‘Why are we doing this? Why are each of these lab tests needed to help in my care?'” (A)

Too many meds may be caused by defensive medicine, different physicians prescribing without considering what the patient is already taking, and patient failure to remember all prescriptions.

Here’s what you can do.
(1) Start by carrying a list of your prescription with you and show it to every physician every time, as well as others who prescribe like dentists and podiatrists. Include on the list over-the-counter supplements such as allergy medicine, probiotics, and pain relievers.
(2) Next, there are many drug on line interaction checkers to use e.g. WebMD http://www.webmd.com/interaction-checker/default.htm RxList http://www.rxlist.com/drug-interaction-checker.htm Medscape http://reference.medscape.com/drug-interactionchecker
(3) Then go to CHOOSING WISELY http://www.choosingwisely.org which seek to reduce overtreatment, and incorporate these recommendations into practice guidelines, local best practices, and decision support systems.
And, most importantly, tell your primary care practitioner every time you get a new prescription from another doctor or start a new over-the counter product.

NOW read the rest of this post to understand why this is so important!

“The point of prescription drugs is to help us get or feel well. Yet so many Americans take multiple medications that doctors are being encouraged to pause before prescribing and think about “deprescribing” as well.
The idea of dropping unnecessary medications started cropping up in the medical literature a decade ago. In recent years, evidence has mounted about the dangers of taking multiple, perhaps unnecessary, medications.” (B)

Here are some examples:
“When it comes to treating seniors with diabetes, new research suggests that doctors often don’t cut back on medications, even when treatment goals are surpassed.
The study found that when people had potentially dangerous low blood sugar levels, just 27 percent had their medicines decreased. And when blood pressure treatments lowered blood pressure levels too much, just 19 percent saw a reduction in their medications.” (C)

“….efforts to curb excessive antibiotic use toward outpatient and long term care settings. As many as 70% of nursing home residents receive at least one course of antibiotics each year, but up to 75% of those prescriptions are unnecessary, or the wrong drug, dose or duration of treatment is given, according to the CDC. UTIs are a commonly over-diagnosed in seniors, relying on vague symptoms of confusion or bacteria in the urine, leading to antibiotic overuse. “(D)

“The study…, found that in older adults aged 70 or older, taking blood pressure medication was linked to a higher risk of serious falls. (Serious falls as in, falls that caused an ER visit for a fracture, a dislocated joint, or a brain bleed. Serious stuff indeed!)” (E)

WHAT YOU SHOULD DO:
“Avoiding overdiagnosis and overtreatment also means letting go of some longstanding notions, such as the doctor always knows best; more treatment is better; and that improved technology and early screening will definitely lead to better outcomes..”
“How can we decrease overtreatment? Reducing the use of screening or diagnostic testing that relays more information than requested, increasing the use of surveillance or watchful waiting when small or lower-risk abnormalities are detected, and performing studies to determine the extent of benefit (if any) of treating abnormalities…(F)

(A) Signs of Overtreatment: How to Avoid Unnecessary Care .What to know before saying “yes” to more tests, procedures or prescriptions, by Michael O. Schroeder, http://health.usnews.com/health-news/patient-advice/articles/2015/08/18/signs-of-overtreatment-how-to-avoid-unnecessary-care
(B) How Many Pills Are Too Many? by Austin Frakt, New York Times https://www.nytimes.com/2017/04/10/upshot/how-many-pills-are-too-many.html?smprod=nytcore-ipad&smid=nytcore-ipad-share
(C) Too Many Seniors With Diabetes Are Overtreated by Serena Gordon, http://www.webmd.com/diabetes/news/20151029/too-many-seniors-with-diabetes-are-overtreated-study-suggests#1
(D) CDC warns of overdiagnosis and overtreatment of UTIs in seniors, https://www.univadis.com/viewarticle/cdc-warns-of-overdiagnosis-and-overtreatment-of-utis-in-seniors-316988?s1=news
(E) Blood pressure medications linked to serious falls: What you can do, by Leslie Kernisan, http://betterhealthwhileaging.net/falls-blood-pressure-medications-elderly/
(F) Improving Quality by Doing Less: Overtreatment, by Jessica Herzstein and Mark Ebell, http://www.aafp.org/afp/2015/0301/p289.html

Note: This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.

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LET’S MAKE AMERICA ALTRUISTIC AGAIN! National Volunteer Week – April 21-29.

As our economy takes off, there are still many left behind or in need of a helping hand – including veterans with disabilities, those with behavioral health and addiction challenges, the undocumented without access to health services, refugees seeking a new start, and many, many more.

Not-for-profit health and social service agencies are often the only source of case management services for these people are major contributors to our communities. They always need our support but perhaps more so now than ever with the “soft” program cuts proposed in the Trump administration budget to pay for increased military spending.

“If you are not part of the solution, you are part of the problem.” And part of the solution is to volunteer.

We celebrate the selfless individuals around our country who channel their civic virtues through volunteerism… devoted to a cause bigger than themselves….. ~Barack Obama

“Volunteering offers vital help to people in need, worthwhile causes, and the community, but the benefits can be even greater for you, the volunteer. Volunteering and helping others can help you reduce stress, combat depression, keep you mentally stimulated, and provide a sense of purpose. (A)

The smallest act of kindness is worth more than the grandest intention. ~Oscar Wilde

Don’t expect someone to come knocking on your door asking you to volunteer. You have to do it yourself.

Where to begin? “We live in a world where technology can connect us with new opportunities in almost every area of life, from who to date to what to have delivered for lunch. And while these choices can enhance and enrich our lives, people with time, skills and a desire to do good are also looking to technology to help them make a difference in the lives of others.” (B)

Here are some links to get started: web sites that match organizations looking for volunteers with folks look for nearby volunteer opportunities.
Catchafire https://www.catchafire.org/
VolunteerMatch https://www.volunteermatch.org/
boardnetUSA™ http://boardnetusa.org/public/home.asp
Create the Good http://createthegood.org/
Idealist https://www.idealist.org/en/?type=VOLOP
AllForGood http://www.allforgood.org/
Do Something https://www.dosomething.org/us/about/who-we-are

Even if it’s a little thing, do something for those who have need of a man’s help, something for which you get no pay but the privilege of doing it. For, remember, you don’t live in a world all your own. Your brothers are here too. ~Albert Schweitzer

(A) https://www.helpguide.org/articles/work-career/volunteering-and-its-surprising-benefits.htm
(B) http://www.huffingtonpost.com/2014/01/13/volunteering-websites_n_4551665.html

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Let’s prohibit Congressmen from insurance reimbursement for Prostate Screening and Treatment

Living in the rarified world of VIP access to health care maybe it’s time for a non-randomized clinical trial, with Congressman being in a study group where they have to pay out-of-pocket fee-for-service with no reimbursement, for prostate screening and treatment.

So they can experience what life was like for 20 million Americans before Obamacare.

Some specifics of the trial. They must get care in their districts. No “professional courtesy” from local physicians. No free PSA. Go to the ER if further tests are needed and become “self pay”, or apply for “charity care” and/ or work out a payment plan for the hospital charges, radiologist, urologist +++

THEN in a year come back to Washington and revise the Obamacare algorithms to assure its sustainability.

For which they might start be reading How to Build on Obamacare by Paul Krugman of the New York Times.
“Actually, though, health care isn’t all that complicated. Basically, you need to induce people who don’t currently need medical treatment to pay the bills for those who do, with the promise that the favor will be returned if necessary.
Unfortunately, Republicans have spent eight years angrily denying that simple proposition. And that refusal to think seriously about how health care works is the fundamental reason Mr. Trump and his allies in Congress now look like such losers.
But put politics aside for a minute, and ask, what could be done to make health care work better going forward?”

To see some solutions read the rest of the article by clicking on https://www.nytimes.com/2017/03/27/opinion/how-to-build-on-obamacare.html?smprod=nytcore-ipad&smid=nytcore-ipad-share&_r=0
To understand why “Repeal and Replace” was a flop click on LESSONS LEARNED: TrumpRyanCare Obits at http://doctordidyouwashyourhands.com/2017/03/lessons-learned-trumpryancare-obits/

And, worth reading:
Is Obamacare a Lifesaver? By Ross Douthat, New York Times https://www.nytimes.com/2017/03/29/opinion/is-obamacare-a-lifesaver.html?smprod=nytcore-ipad&smid=nytcore-ipad-share

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LESSONS LEARNED: TrumpRyanCare Obits

“Repeal and Replace” was a political play!
After eight years of whining, “there was no there there”, no Republican plan!
Following is a sequence of obituary snippets explaining what happened and why.

Ryan: ObamaCare will be law for ‘foreseeable future’
“GOP leadership and the White House had spent weeks attempting to bring skeptical Republicans on board. Conservatives argued the bill didn’t go far enough to repeal ObamaCare, while moderate lawmakers worried about backlash in their districts from those who came to rely on ObamaCare.”
http://thehill.com/policy/healthcare/325700-ryan-we-came-close-but-came-up-short-on-healthcare-bill
THE HILL. Ben Kamisar

Why Trumpcare Failed
“After making repeal of that law their top legislative priority for the past seven years, Republicans now join the much longer list of failures because, during all that time, they never reached a consensus. Rather than come up with a plan the party could unite behind, and with the ACA filling the space where bipartisan consensus could be had, they splintered and entrenched. You can’t bridge that divide. (For their own political sakes, they’re lucky they didn’t.)”
“Freedom Caucus members have a cold vision of health care reform, but a coherent one. They believe that the government being involved in health care, either through regulation or subsidies, is the factor driving up prices, and undoing all of that architecture is what’s necessary to allow market forces to drive down prices. Being coherent in this way on health care policy means accepting the trade-offs that your vision entails, and Freedom Caucus members accept that this approach would leave a lot of vulnerable people in the lurch, left to the care of charities and communities. They have an odd belief that a vast majority of the American public shares this vision despite representing only a small percentage of the House of Representatives.”
Slate. Jim Newell http://www.slate.com/articles/news_and_politics/politics/2017/03/all_of_the_reasons_why_trumpcare_failed.html

In Major Defeat for Trump, Push to Repeal Health Law Fails
“The Republican bill would have repealed tax penalties for people without health insurance, rolled back federal insurance standards, reduced subsidies for the purchase of private insurance and set new limits on spending for Medicaid, the federal-state program that covers more than 70 million low-income people. The bill would have repealed hundreds of billions of dollars in taxes imposed by the Affordable Care Act and would also have cut off federal funds to Planned Parenthood for one year.
Mr. Ryan had said the bill included “huge conservative wins.” But it never won over conservatives who wanted a more thorough eradication of the Affordable Care Act. Nor did it have the backing of more moderate Republicans who were anxiously aware of the Congressional Budget Office’s assessment that the bill would leave 24 million more Americans without insurance in 2024, compared with the number who would be uninsured under the current law.
The budget office also warned that in the short run, the Republicans’ legislation would drive insurance premiums higher. For older Americans approaching retirement, the cost of insurance could have risen sharply.”
New York Times. ROBERT PEAR, THOMAS KAPLAN and MAGGIE HABERMAN

Why Republicans failed to repeal Obamacare
“Let me briefly try to answer this question: How did Republicans fail to repeal and replace the Affordable Care Act? In no order, and off the top of my addled mind at the end of a crushing week:
— They hated Obamacare but they never understood the Affordable Care Act. This is the uber-explanation for much of what follows. Hating Obamacare became just what you did on the right. It didn’t mean you understood it, beyond maybe getting that it was a government program and thus paid for by taxes. It certainly (and this turned out to be very important) didn’t mean you had any ideas about what it did, how it worked or how many people were benefiting from it … or how to replace it.”
The Washington Post. Jared Bernstein
https://www.washingtonpost.com/posteverything/wp/2017/03/24/what-just-happened-explaining-the-republicans-big-health-care-fail/?utm_term=.15fbea5ab191

The Trumpcare Con Implodes
“Passing the bill would have also made a joke of Republican promises that, given the chance, they would replace Obamacare with something that would result in cheaper, better insurance for more people. Trump himself went much further, guaranteeing “insurance for everybody” at government expense. The American Health Care Act was diametrically opposed to those supposed goals.
And that’s what really matters, after all: The practical effects of huge changes to the health care system for those who actually need to use it, alongside the faith Americans can have that their elected officials are making promises they will at least attempt to keep.
Instead, the GOP, from Trump on down, spent years claiming they had a magic plan to make everyone’s health care better, and then tried to bang through a bill in just a few weeks that would have covered fewer people, who would have had to pay much more for whatever care they got, without even reducing the deficit conservatives pretend to care about by all that much. They didn’t even bother waiting for the Congressional Budget Office to assess the final product, so little did they care for the real-world effects it might have.”
U.S.News. Pat Garofalo
https://www.usnews.com/opinion/thomas-jefferson-street/articles/2017-03-24/trumpcare-con-ends-in-deserved-gop-failure

Three Real Reasons “TrumpCare” Failed
“Why was the bill so unpopular? First and foremost it’s because most people hate the underlying Republican philosophy pertaining to health care. And they hate it for good reason: it doesn’t work.
We tried the GOP philosophy of allowing the “competitive” market to provide the “most wonderful health care plan in the world” and it produced a system that resulted in per person health care costs twice as high as the rest of the industrial world and outcomes that were worse. That was the world of pre-ACA health care.
The “unfettered market” allowed insurance companies to discriminate against people with pre-existing conditions – and to define one of those “pre-existing conditions” as simply being a woman. It allowed them to enforce lifetime caps on coverage – so if you got really sick you were simply out of luck.”
The Huffington Post. Robert Creamer
http://www.huffingtonpost.com/entry/three-real-reasons-trumpcare-failed-gop-divisions_us_58d78074e4b0c0980ac0e701

The cruel double standard that may have saved Obamacare
“But others cite another factor: The face of Obamacare is now white.
More Americans now realize Obamacare helps millions of working class whites and that it’s not — as once portrayed by conservatives — a form of welfare pushed by the first black president to help people of color, historians and scholars say. The media landscape is filled with images of the furrowed brows of anxious white residents at congressional town halls who fear they will suffer if they lose Obamacare, says Judy Lubin, a sociologist and adjunct professor at Howard University in Washington.
“When you see white working-class Americans saying that I’m benefiting and my family is getting help from the Affordable Care Act, you start to hear ‘repair’ not ‘repeal,'” Lubin says. “Whites standing up in support of a policy changes the dynamics of the conversation.”
CNN. John Blake
http://www.cnn.com/2017/03/24/politics/obamacare-double-standard/

Trump’s Trainwreck
“For seven years — seven years — Republicans thundered about the evils of Obamacare, yearned for the day when they could bury it and vowed to do precisely that once the ball was in their hands.
Last week proved that this had all been an emotional and theatrical exercise, not a substantive one. The ball was in their hands, and they had no coherent playbook. No real play. They scurried around the Capitol with their chests deflated and their tails between their legs.
For the entirety of his campaign, Donald Trump crowed about his peerless ability to make deals, one of which, he assured us, was going to be a replacement for Obamacare that would cut costs without leaving any Americans in the lurch.
Last week proved that there was no such swap, that he hadn’t done an iota of work to devise one and that he was spectacularly unprepared to shepherd such legislation through Congress. As his promise lay in tatters at his feet, he gave a delusional interview to Time magazine about what an infallible soothsayer he is, then tried to shift the blame to Democrats, who, he said, would soon be the ones hankering for an Obamacare replacement.”
New York Times. Frank Bruni

Trump: I never said repeal and replace would come in 64 days
“Yet asked if he would talk to Democrats now that Republicans are moving on, Trump said no.
“I think we have to let Obamacare go its way for a little while, and we’ll see how things go. I’d love to see it do well, but it can’t. I mean, it can’t,” Trump said. “It’s not a question of, ‘Gee, I hope it does well.’ I would love it to do well. I want great health care for the people of this nation, but it can’t do well. It’s imploding and soon will explode, and it’s not gonna be pretty. So the Democrats don’t wanna see that so they’re gonna reach out when they’re ready. And whenever they’re ready, we’re ready.” “
POLITICO. Nolan D. McCaskill
http://www.politico.com/story/2017/03/trump-obamacare-statement-repeal-replace-236482

With GOP Plan Dead, Trump Weighs Other Ways to Reshape Health Care
Republicans have ability to make changes to Affordable Care Act but do so at their own risk
“With the collapse of Republicans’ health plan in the House on Friday, the Trump administration is set to ramp up its efforts to alter the Affordable Care Act in one of the few ways it has left—by making changes to the law through waivers and rule changes.”
Wall Street Journal. Stephanie Armour
https://www.wsj.com/articles/with-gop-plan-dead-trump-eyes-other-ways-to-reshape-health-care-1490434201

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The Mayo Clinic is discriminating against Medicare Patients. Unbelievable! Outrageous!

As a former hospital CEO, with many colleagues at nearby hospitals, I had quick access to the best medical care.

Now, as a Medicare enrollee, I am finding it more and more difficult and time-consuming to find doctors who will take Medicare. And, of course, I don’t want to sacrifice quality for price.

When a physician opts out of Medicare, ”The physician must sign and file an affidavit agreeing to forgo receiving any payment from Medicare for items or services provided to any Medicare beneficiary for the following 2-year period…”

Most significantly, if getting care from an opted-out physician the beneficiary (me or any other Medicare enrollee): “gives up all Medicare payment for services furnished by the “opt out” physician; agrees not to bill Medicare or ask the physician to bill Medicare; is liable for all of the physician’s charges, without any Medicare balance billing limits; acknowledges that Medigap or any other supplemental insurance will not pay toward the services; and acknowledges that he or she has the right to receive services from physicians for whom Medicare coverage and payment would be available. http://www.aafp.org/practice-management/regulatory/medicare.html

I have paid into Medicare for 45 years and, like many of you, now or later, don’t want to pay full out-of-pocket charges where doctors have opted out of Medicare. Why pay life-time premiums for Medicare than get care from non-Medicare providers.

One can inadvertently wind up with a big bill even when vigilant. For example:
– Go to an Emergency Room where the hospital takes Medicare but the ER group does not. http://www.cbs5az.com/story/23063821/emergency-room-doctors-may-not-take-insurance-even-if-hospital-does
– Your primary care physician takes Medicare but refers you to specialists who don’t.
– When you are admitted to the hospital for surgery and the surgeons takes Medicare and the anesthesiologist which you had no say in selecting (and perhaps radiologist and pathologist) does not.
– And when the surgeon is assisted by another surgeon, which you were not told about, who does not take Medicare.
– https://www.verywell.com/out-of-insurance-network-claims-and-bills-2615282
– You assume your MediGap insurance will cover an expense because like I was, you aren’t aware that MediGap insurance only clicks in for Medicare approved care.

Now blaming it on Obamacare and perhaps in anticipation of Trump/ Ryan Care, the Minneapolis Star Tribune, in an article by Jeremy Olson reported that:
“Mayo Clinic’s chief executive made a startling announcement in a recent speech to employees: The Rochester-based health system will give preference to patients with private insurance over those with lower-paying Medicaid or Medicare coverage, if they seek care at the same time and have comparable conditions.
“Mayo will always take patients, regardless of payer source, when it has medical expertise that they can’t find elsewhere, said Dr. John Noseworthy, Mayo’s CEO. But when two patients are referred with equivalent conditions, he said the health system should “prioritize” those with private insurance.”
http://www.beckershospitalreview.com/finance/mayo-clinic-to-give-preference-to-privately-insured-over-medicaid-medicare-patients.html

Incomprehensible! Unethical?
Let’s make sure that access to Medicare is not further compromised by health care providers.
________________
POSTSCRIPT
“DHS questions whether Mayo policy violates law”
Recent reports say that Mayo Clinic will give preference to privately insured patients under a new policy, which is under scrutiny by the DHS.
The Minnesota Department of Human Services is probing the Mayo Clinic for possible violations of civil- and human-rights laws by putting a higher priority on patients with commercial insurance.
https://www.mprnews.org/story/2017/03/16/mayo-under-scrutiny-for-possible-civil-human-rights-law-violations

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Doctor is going on sabbatical to think about the pending nullification of Obamacare…here’s why

Doctor, Did You Wash Your Hands?™  was created to explore healthcare transformation with the advent of the ACA.

Now that it will be likely be nullified we need to figure out what that might mean and what will happen.

Foundations of the ACA for providers included: Population Health management and Investment in ambulatory care centers; preparation for Pay for Value replacing fee-for-service reimbursement; Medicaid expansion; and a steep and fast trajectory in employing physicians particularly primary care physicians and hospitalists. And much more!

This triggered consolidation of hospitals into becoming regional hospital systems quickly transitioning into integrated health care delivery systems, then to mega systems focusing on geographic reach, then to super-size systems which have started or taken over medical schools, now functioning  like insurance companies and investment banks.

Billions of dollars were invested nationally to build and support this newly created infrastructure, often paid for by issuing bonds, using lines of credit and perhaps even dipping into endowment funds.

Months ago I suggested “stress tests” for super-sized hospital systems. Now we will find out if there are contingency plans or a “bubble.” Will we have an orderly unwinding or “toxic derivatives”? What will be the impact if 20 million people lose insurance and providers lose the payments associated with them?

So I am starting over by studying Nullification 101 and may be back if I have any insights.

DOCTOR appreciates our valued readers. It’s a challenge being an “orphan” blog so we will take a break and look for a host organization or web site. Please send any comments or suggestions to jonathanmetsch@gmail.com

Thanx! for being my treasured readers.

Jonathan

 

Jonathan M. Metsch, Dr.P.H.

Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai

Adjunct Professor, Management, Zicklin School of Business, Baruch College, C.U.N.Y.

Adjunct Professor, Rutgers School of Public Affairs and Administration & Rutgers School of Public Health

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There’s a growing movement in the United States to install video cameras in operating rooms…

Video surveillance has become increasingly pervasive. It is being used to prevent shoplifting, for homeland security at public events, police officers wearing cameras, in airplane cockpits and train locomotives, and for “instant replay” in college and professional sports.

Which led to me research a bit about the use of video surveillance cameras in hospitals.

There was an article this year about “Operating room staff are heard on the recording making rude comments about Ms. Easter while she is sedated. A surgeon calls Ms. Easter “a handful” and is heard laughing about how upset Ms. Easter was when she was told how long she would have to wait to schedule her surgery. The surgeon also comments that he feels sorry for Ms. Easter’s husband. OR staff also made derogatory comments about Ms. Easter’s body. Laughter is recorded in the OR after a female voice, which Ms. Easter claims is that of an OR nurse, is heard saying, “Did you see her belly button?” (A)

And I remember the 2002 episode where” “Massachusetts… indefinitely suspended a surgeon’s medical license because he left a patient anesthetized on an operating table with an open incision in his back while he went to a bank several blocks away.” (B)

A classic situation is Munchausen syndrome by proxy. “…a mental illness and a form of child abuse. The caretaker of a child, most often a mother, either makes up fake symptoms or causes real symptoms to make it look like the child is sick.” (C) “Beatrice Crofts Yorker, RN, JD,… writes that she has personally observed a videotape (of a hospitalized child) that showed a mother rinsing a thermometer under running water and then calling in the nurse to read an elevated temperature (covert video surveillance). Indeed, some hospitals have employed covert videotaping to observe the alleged perpetrator’s (mother’s) behavior with the child.” (D)

Some of the articulated benefits that video surveillance provides include: “Keeps patients’ records and identities safe; Ensures staff are meeting health and safety standards; Allows for remote monitoring from a smartphone or tablet; Prevents intruders from gaining access to restricted areas; Deters vandalism and other criminal acts; Increases safety for patients and staff.” (E)

And much has been written about using video surveillance to monitor hand washing and improve compliance. “For example, Summerville Medical Center, a 94-bed acute-care hospital in South Carolina, is having employees wear sensor tags to determine who is washing their hands before and after coming into contact with patients. The technology was first rolled out in the medical center’s intensive care unit in the spring of 2012 and then expanded to its surgery units and the emergency room. Each hospital caregiver wears a badge-like sensor tag that counts room entries and exits as well as the use of soap or sanitizer dispensers. The data collected from the system is used to model and characterize clinician-patient interactions, providing detailed data to help monitor and modify behavior. (F)

“At North Shore University Hospital on Long Island, motion sensors, like those used for burglar alarms, go off every time someone enters an intensive care room. The sensor triggers a video camera, which transmits its images halfway around the world to India, where workers are checking to see if doctors and nurses are performing a critical procedure: washing their hands.” (G)

But there are skeptics. “Another potential issue with the video observation is a false accusation of failure to wash. Patient rooms and patients themselves are not being watched. Let’s say a nurse went into a patient’s room to tell him something and didn’t touch anything. A person in India watching a video from a camera focused on a door or sink would not be able to tell that. If the nurse doesn’t wash her hands when she leaves the room, is she going to be cross-examined? (H)

“Operating rooms have long been equipped with cameras for security and training purposes. But video technology has rarely been used to improve patient care. ……… staff check in with the videos once every two minutes, and follow a checklist to look out for errors that could creep into surgery when staff skip steps in safety protocols. The data they collect on the performance of each team is then streamed real-time to the frontlines of the operating room; the medical teams and staff in charge can view the information on their smartphones.” (I)

“An eICU support center can provide care to patients in multiple hospitals. The goal of an eICU initiative is to optimize clinical expertise and facilitate 24-hour-a-day care by ICU caregivers, whether the caregivers are down the hall from the patient that’s being monitored or in another city. Two-way cameras, video monitors, microphones and smart alarms connected by high speed data lines provide eICU caregivers, who are called intensivists, with real-time patient data around the clock. Intensivists can also communicate with on-site caregivers through dedicated telephone lines. “ (J)

Some examples are useful “Chris Nowakowski’s wife died in Wisconsin during what should have been a routine procedure on her pacemaker. Danny Long’s wife in North Carolina suffered catastrophic neurological injury during a surgery to relieve numbness in her extremities. A doctor perforated the colon and esophagus of Deirdre Gilbert’s daughter in Texas, then operated on her after she was dead. In each case, the families still don’t know the full story of what happened to their loved ones because of a lack of documentation and an inability to pursue a costly lawsuit. They are relatives of an estimated 400,000 a year people who die in the United States of preventable medical errors, the third-leading cause of death after heart disease and cancer. But the families say they could have known much more if cameras had been installed in the operating rooms, recording the actions and movements of the doctors and staffers involved.” (K)

“There’s a growing movement in the United States to install video cameras in operating rooms (ORs)….. The idea is to document possible adverse events and thereby prevent similar ones from occurring in the future, but critics worry that recording devices in the OR would not only compromise patient and doctor privacy but lead to a wave of new malpractice lawsuits.

The camera-in-the-OR movement has taken off because of a number of high-profile medical mistakes. A woman named Julie Ayer Rubenzer died after breast-enhancement surgery done in Florida, after she was given excessive amounts of propofol, the same anesthetic that led to the 2009 death of pop star Michael Jackson.” (L)

“However the benefits of having video evidence in the operating rooms could be enormous. Think of the abusive surgeon who terrorizes the entire OR staff. Finally there will be evidence for disciplinary action, instead of just another he said/she said in front of some hospital committee. Wrong site surgery can be analyzed so that others can see what went wrong instead of reading through vague medical records which pretty much parrot the hospital’s time out protocol and doesn’t give any insight into how the mistake was made. Lap sponges left in the patient? The unblinking eye of the camera can show why the sponge was not counted properly at the end of the case. Were the nurses distracted by a shift change? Was the music too loud causing people not to be able to hear each other clearly? Was the count wrong at the beginning of the case and nobody noticed? All these could be answered by a simple video.” (M)

But not everyone agrees. “What scares me is the intent of such a policy. What exactly would a videotaped be used for? So the patient can watch it? Surely the patient will have no clue what he or she is watching. If the videotape is going to be used for malpractice, then I think patients will be the ones who suffer. Everybody in medicine knows that although surgical technique is standard, it varies widely. You will always find someone who is willing to say that your technique is not the standard of care. How they operate in Boston is not necessarily how they operate in San Francisco. Thus I don’t really think their (sic) is much utility because the nature of medicine and surgery is constant criticism to improve practice. This however is different from critique in the form of malpractice.” (N)

Which raises a number of medical ethics challenges, e.g. “Should a patient be able to refuse video surveillance? If so, shouldn’t the hospital be allowed to refuse medical care to patients that do not consent? Kind of like walking into an airport and refusing to be video recorded. If you don’t want to be videotaped, find another means of travel. For now, smile … if you enter a hospital, you’re going to be on camera. Ethics committee approval notwithstanding.” (O)

“Healthcare can benefit from the power of cameras to improve accountability,” Makary, Pawlik and Xu conclude. “In an era where 86% of nurses report having recently witnessed disruptive behavior at work, hand washing compliance remains highly variable, and many physicians do not use evidence based medicine, recorded video can be an invaluable quality improvement tool. If concerns about consent, privacy, and data security are dealt with carefully, video data can tell a story that simply cannot be matched by written documentation.” (P))

The use of technology in medical care is a reality “to improve clinical care and slash error rates, and to reduce patient stress, encouraging healing.” (Q)

Advanced patient safety technology should be embraced!

 

(A) http://www.beckershospitalreview.com/news-analysis/texas-hospital-or-staff-recorded-mocking-sedated-patient.html

(B) http://www.nytimes.com/2002/08/09/us/surgeon-who-left-an-operation-to-run-an-errand-is-suspended.html?_r=0

(C) https://medlineplus.gov/ency/article/001555.htm

(D) http://www.camorrison.com/articles/fourth_amendment.htm

(E) https://www.videosurveillance.com/healthcare.asp

(F) http://www.computerworld.com/article/2497225/healthcare-it/hospitals-use-cameras–sensor-tags-to-track-hand-washing.html

(G) http://www.nytimes.com/2013/05/29/nyregion/hospitals-struggle-to-get-workers-to-wash-their-hands.html?_r=0

(H) http://www.physiciansweekly.com/hand-washing-hospital-monitoring/

(I) http://www.newsweek.com/video-auditing-hospital-surgery-safety-medical-errors-479107

(J) http://searchhealthit.techtarget.com/definition/Electronic-Intensive-Care-Unit-eICU

(K) https://www.washingtonpost.com/local/could-cameras-in-operating-rooms-reduce-preventable-medical-deaths/2015/08/25/fc2696c4-3ae2-11e5-b3ac-8a79bc44e5e2_story.html

(L) http://www.medscape.com/viewarticle/851426

(M) http://www.blog.greatzs.com/2014/04/cameras-in-operating-room-is-it-time.html

(N) http://brainblogger.com/2007/05/09/do-you-want-your-surgery-to-be-videotaped/

(O) http://drwhitecoat.com/hospital-video-surveillance/

(P) https://www.minnpost.com/second-opinion/2015/10/its-time-start-videotaping-surgical-procedures-doctors-argue

(Q) http://health.usnews.com/health-news/best-hospitals/articles/2009/07/15/the-high-tech-hospital-of-the-future

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