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The CMG Voice

Are Teaching Hospitals Better?

Posted Friday, June 16, 2017 by Gene Moen

There are many assumptions about both teaching hospitals and community hospitals. The latter are thought to have lesser quality physicians and medical staff, while the former have better educated and well-published experts. However, with teaching hospitals patients worry about medical interns or residents doing the actual medical work, while the attending physicians are in their ivory towers writing peer-reviewed articles to advance their academic careers. There are also the horror stories about the July 1 shift for new residents each year. Do you want your emergency intubation being done by a resident who just started his residency?

A recent study, published in the Journal of the American Medical Association, tries to measure the difference between the two kinds of hospital by looking at objective data. The study found that there are significant differences in outcome, and this generally reflects better care in teaching hospitals. The authors looked at 21 million hospitalization records from Medicare data. They were looking for risk-adjusted 30-day mortality. The study focused on 15 diagnosis groups and 6 common surgical procedures.

Except for stroke and sepsis, teaching hospital patients did better by every measure. For more complex procedures, like abdominal aortic aneurysm repairs, teaching hospitals had a mortality rate that was 5% lower than their community hospital counterparts. There was also a substantial gap — favoring teaching hospitals — for respiratory disease treatment. Since teaching hospitals often get referrals of patients who have more complex problems, the gap in favor of teaching hospitals may be even larger.

One of the reasons for this gap is probably that “practice makes perfect” – or at least better. As noted, major teaching hospitals are often the hospitals to which complex cases are referred, so the average doctor there may do similar procedures many more times than would a community hospital physician. There have been other studies that show that the more of a particular procedure, like aortic valve replacements, performed by an individual doctor, the fewer complications or bad outcomes.

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Reduce your chances of post-surgical infection by going under the knife in winter

Posted Monday, June 12, 2017 by Tyler Goldberg-Hoss

We routinely receive calls from potential clients injured due to postoperative infections. Often times it is difficult to make a claim that a health care provider – be it the surgeon or other person involved in the surgery – was negligent and caused the infection to occur. More often claims can be made in a failure by the health care provider to reasonably and carefully diagnose and treat the infection when it does occur.

Often times in such situations there are possible arguments to be made that something the patient did or failed to do caused or contributed to the infection, or in the delay in treating it.

A new study put out in Infection Control & Hospital Epidemiology gives patients an additional tool in preventing such infections from occurring – schedule your surgery for when the weather is colder.

The new study looked at every adult hospitalization with a surgical site infection from 1998 to 2011, and found that “for every five-degree Fahrenheit increase in average monthly temperature, the risk of hospital admission for a surgical site infection increased by 2.1 percent.”

You can read an article on the findings of this study here:

Warmer Weather Brings More Infections After Surgery

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Virginia Mason latest hospital to tell its patients that their surgeons may be overlapping surgeries

Posted Thursday, June 8, 2017 by Tyler Goldberg-Hoss

After the recent discovery at Swedish Medical Center of surgeons performing multiple surgeries at the same time, Virginia Mason joins the University of Washington in confirming that the practice exists outside of Swedish, and that they are revising their informed consent forms to address it.

Prior to this, most informed consent forms for surgery talked vaguely the patient’s “care team” being involved in the surgery. Knowing that alone, one might be led to think that the care provided is going to be even better than with just a lone surgeon. However, those words in fact often meant that providers other than the surgeon were involved in many parts of the surgery. And it certainly wasn’t conveyed to a patient that their surgeon would in fact be in other operating rooms during surgery.

The new Virginia informational sheet (you can read it here) describes how the surgeon will always be in the operating room for the “critical portions” of your surgery, but may not be in the room for noncritical parts. Further, your surgeon will not perform any “critical portions” of another person’s surgery while your surgery is occurring.

The term “critical portions” is undefined in the information sheet. However, it appears that the hospital is attempting to allay fears in their patients that their surgeon will be unavailable to them if something goes wrong. Still, who gets to decide what are the “critical portions” of a surgery is unknown. Further, complications from surgeries necessitating competent surgeons occur both in “critical” and “noncritical” portions of surgery. While this updated policy may reduce the risk of your surgeon being unavailable while working on another patient, it does not appear to eliminate it.

To fully eliminate this problem, institutions like Virginia Mason, UW, and Swedish could just eliminate the practice of overlapping surgeries. We are left to wonder why they don’t.

You can read another excellent Seattle Times article on this here:

Virginia Mason to inform patients about overlapping surgeries

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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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