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The CMG Voice

Is The Internet Eroding Trust In Physicians?

Posted Monday, June 5, 2017 by Tyler Goldberg-Hoss

We all know how much information — good and bad — one can find on an online search. This includes searching for possible diagnoses for our own symptoms (or those of our family and friends).

There are even websites inviting the viewer to log in their signs and symptoms and try to make their own diagnosis. A recent study presented at the 2017 Pediatric Academic Societies showed that exposure to internet information about a child’s symptoms influenced the willingness of the parents to accept their child’s doctor’s diagnosis.

In the study, 1,300 parents were told that a child “had a rash and worsening fever for three days.” They were then divided into three groups, with the first two being shown information on computer screen shots: one with clinical information on scarlet fever and the other with clinical information on Kawasaki Disease. The third group viewed no Internet screenshots.

Afterward, all three groups were told that a physician had diagnosed the child with scarlet fever. When asked about the likelihood of seeking a second opinion, members of the second group (exposed to information about Kawasaki Disease) were significantly more likely to seek a second opinion about the physician’s diagnosis.

The conclusion of the study’s authors was that exposure to clinical information online “primed” the parents to a particular point of view and tendency to take action. Much of this is fairly basic social-psychology: those who are exposed to certain information can have that point of view reflected in subsequent opinions. Malcolm Gladwell recently popularized this concept in the book Blink.

As a medical malpractice attorney, I occasionally receive phone calls from distraught parents who are convinced that their hospitalized child’s medical care is causing harm to the child and they want me, as an attorney, to intervene in the care. I advise them that, as an attorney who brings cases on behalf of those who have been injured, I am not able to involve myself in ongoing medical care. But what is striking is how often the parents have read about some condition on the Internet and are convinced their child’s doctor is not practicing good medicine. The level of paranoia in that situation can be severe.

The conclusion of the pediatric study noted above was the overall trust in a physician’s decisions regarding diagnosis and treatment has been eroded by the parents’ access to Google or other search engines.

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Local subscription-based health care model Qliance closes

Posted Friday, June 2, 2017 by Tyler Goldberg-Hoss

Typically most of us have health insurance, and we use it to get the health care we need. This often comes through our employers, and with the advent of the Affordable Care Act, more and more of us are getting it outside the employment context.

For the past decade, Qliance in Washington has offered something different: subscription based health care that costs a monthly fee and doesn’t accept health insurance. Pay a monthly fee, and you have unlimited access to primary care 24/7. The business model is in some ways like a membership to 24 Hour Fitness or Netflix.

From the perspective of Qliance, one benefit of the model was that it saved patients money by keeping administrative costs down, mostly because it was not dealing with insurance billing. And patients and doctors both appreciated that they were able to spend more time together during visits. Thousands of patients have subscribed to this Qliance model over the last decade

Recently, however, Qliance was forced to close for financial reasons.

You can read a Seattle Times article on the closure here:

Qliance closes after 10-year effort at new approach to basic medical care

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Recent study finds patients fare slightly worse with older doctors

Posted Wednesday, May 31, 2017 by Tyler Goldberg-Hoss

Researchers at Harvard Medical School recently went through Medicare data for hundreds of thousands of hospital admissions and correlated the age of the doctors treating them with the mortality rate.

What the researchers found was “the older the doctor, the higher the patient mortality rate.” The difference in mortality rate was not staggering: for doctors under 40 treating patients, it was 10.8%. The rate for doctors in their 40s was 11%. For doctors in their 50s the rate was 11.3%. And for physicians over 60, the rate was above 12%.

The research did find one wrinkle: for doctors of all ages who saw a large number of patients there was no difference in mortality rates. This suggests that doctors who continue to see a high volume of patients don’t lose any skill as they age.

One physician questioned about the study suggested that it wasn’t that clinical skills deteriorate, but that older doctors “are just not as familiar with the new methods. That’s what gives younger doctors the edge. It’s access to newer technology, and knowing the newer drugs.”

You can read an article on the results of this research here:

Patients fare worse with older doctors, study finds

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Does Sepsis Lead To Seizures After Hospital Discharge?

Posted Thursday, May 25, 2017 by Gene Moen

A recent study showed that those who survive sepsis, especially younger patients, had a substantially increased risk of seizures long after discharge from the hospital. Dr. Michael Reznik of the Columbia University Medical Center did the study. The analysis of 850,000 discharges in three large states, with up to eight years of follow-up, found that there was a five-fold increase in risk of seizures in those who had sepsis.

This increase in risk was noted in the analysis of Medicare records for patients older than 65, but the increase was also found to be more marked in those younger than age 65. The study used data from detailed administrative claims for hospital discharges in California, New York, and Florida. The findings, along with previous medical studies, point to sepsis as a major potential to cause brain damage. According to Dr. Reznik, the results of the study may led to “future research to study the specific pathways and risk factors that lead to seizures following sepsis, and whether protective interventions or strategies could be developed.”

As in many such medical studies, there are limitations to the analysis. It relies on administrative codes, which may be completed differently in different institutions. In addition, there may be possible presence of other neuropathologies not noted in charts. Finally, recent sepsis patients may be monitored more closely than others, and therefore seizures would be more likely to be noted.

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Recent article examines the possibility of bias affecting both doctors and patients in health care.

Posted Monday, May 22, 2017 by Tyler Goldberg-Hoss

We all have some bias, and bias can be helpful and harmful. It can be helpful because it helps us function on a daily basis and helps protect us from harm. It can also be harmful, when it becomes a prejudice against someone who is different than us: the “other.”

In 1998 the implicit association test (IAT) was developed to measure unconscious bias. You can try one of the available tests for yourself here:

Project Implicit

Tests include those on sexuality, gender, religion, various ethnic groups, disability, and weight, to name a few. All of them (aside from those devoted to our current President) are biases that can be found in medical encounters all over the country.

Bias can and does exist in the health care, and it can unfortunately cause different patients to get different treatment. There has been one study using the IAT to determine whether doctors are implicitly biased based on race. The study looked at treatment recommendations for patients with acute coronary syndromes presenting to the emergency department.

The study found that there was implicit preference for the white patients and implicit stereotypes of the black patients as being less cooperative.

In our practice, bias shows up in many formers. Often we are called by potential clients who believe they were treated unfairly because of their race, sexual orientation, or something else. In focus groups we run, we routinely analyze potential juror attitudes towards these issues.

I can recall specifically presenting a case involving my young female client. I described the facts of what happened to her, and one focus group participant volunteered that my client was black, because of the way she was treated.

Another time I wanted input as to whether a potential client’s weight would be an issue for jurors (he weighed over 400 lbs when he presented to the emergency room). On one hand, many of the jurors thought that his weight may have been an issue in the way in which he was treated. However, they also felt like his medical problems were his fault, much more so than anything the health care provider did.

Bias exists in all facets of our society. Although we will likely never be “bias-free”, having an awareness of our biases is a good first step in hopefully working towards those biases not affecting how we treat people, particularly in the medical field.

You can read the full article here:

How Does Bias Affect Physicians, Patients?

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