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The CMG Voice

Researchers hope to use precision medicine to treat depression.

Posted Monday, June 18, 2018 by Tyler Goldberg-Hoss

If you or a close friend or family member suffers from depression, you may understand the difficulty in finding a medication and/or treatment plan that works. Oftentimes, a health care provider may prescribe one medication, only to find out after weeks (or months) that it doesn’t work, or it’s not the right dose.

And people change, making the right medication and/or dose challenging to determine dynamically.

In an effort to find a more effective approach, researchers are attempting to apply the concepts of precision medicine to this mental health disorder.

Precision medicine refers to better tailored treatments for each patient. Researchers have begun by gathering data – brain scans, blood work, patients’ subjective symptoms – and attempting to find subtypes of depression. From there, the goal is to find the best treatment for each subtype.

The same approach has worked in recent years in cancer treatment. It is the hope of these researchers – and everyone affected by depression – that we will find similar success.

You can read more about this here:

Can precision medicine do for depression what it’s done for cancer? It won’t be easy

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Walmart’s answer to better healthcare: find the bad doctors and get rid of them.

Posted Friday, June 15, 2018 by Tyler Goldberg-Hoss

As readers of this blog know, there are many amazing things happening in healthcare in the United States (particularly technological advancements), and there are still real problems.

Recently, large corporations like Amazon and Walmart have entered the fray. Walmart itself has been gathering data from its own healthcare program, attempting to find ways to improve the care provided to its patients, and improve profits from delivering that health care.

What it found was that the behavior of some doctors was a “root cause” of giving wrong care, not enough care, and not offering sufficient value for the cost of the care.

And instead of working with those providers to understand better why those problems are occurring, it appears Walmart is going the other way: “We will build networks that realize some providers just won’t cut it and won’t get any value from the network.”

These doctors have been identified as not practicing evidence-based medicine, and the implication is, at least within the Walmart system, that unless they do, they will be out of the Walmart system.

You can read more about this here:

Walmart’s next healthcare move: Using data to identify bad doctors

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Changes to risk calculator may change your blood pressure medication

Posted Tuesday, June 12, 2018 by Tyler Goldberg-Hoss

Millions of Americans take medication to prevent heart attacks and other cardiovascular disease. These medications include aspirin, statins, and other types of drugs.

Often times, doctors prescribing these medications for their patients use a risk calculator, which estimates the 10 year risk of cardiovascular disease. This calculator (you can find a version here) was based on research done decades ago.

Recently, Stanford researchers have updated the data, and as a result have created a new calculator that purports to be more accurate in their risk estimates.

As a result, an estimated 11 million Americans may benefit from a reassessment of their 10 year risk. Some may find that their risk has been overestimated, and thus should be taking a lower dose of medication. Conversely, some may find that their risk has been underestimated, and should take more or a different medication.

African Americans in particular may benefit from these revised risk assessments, since their population was not well represented in data supporting the previous calculator.

You can read more about this here:

New risk calculator could change the aspirin, statins, and blood pressure medications some people take

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That doctor you saw in the ER? She may not be employed by the hospital. Sometimes that matters.

Posted Tuesday, June 5, 2018 by Tyler Goldberg-Hoss

Most folks I talk with about medical care think that when they go to a hospital, the health care providers treating them are employees of the hospital. And when things go wrong giving rise to a claim of medical negligence, folks think the hospital is on the hook for the bad actions of the doctors, nurses or other providers who were negligent.

Except, that’s not always how it works these.

Typically, nurses, CNAs, techs, therapists, scribes, and administrative personnel are employed by the hospital. The hospital would typically be responsible for their actions because they are employees.

However, many physicians (and mid-level providers like ARNPs and PAs) who practice in a hospital – any many of them only practice in a hospital, and often only in that hospital – are actually not employees.

Rather, often they are either independent contractors, or employed with a group that contracts with the hospital to provide particular physician services to that hospital.

Here are some examples:

When you go to the ER, often these days the physicians and mid-level providers who treat you there are not employees. If that doctor orders imaging to be taken, those images are likely read by another doctor who is similarly not employed by the hospital. If you require inpatient hospitalization, often times the hospitalists – those doctors whose practice is just providing medicine in a hospital – are part of a group of hospitalists that contracts with the hospital to provide such services.

Need surgery? That surgeon may not be an employee of the hospital, and the anesthesiologist likely isn’t as well. Does that surgeon want to send a specimen to have a pathologist look at it? That pathologist may just be an independent contractor as well.

So why does this matter?

For one thing, bringing a claim against one defendant (i.e. the hospital) is typically easier than bringing it against two or three or four. For another, depending on the nature of the injuries, it may be the case that the doctor herself has limited insurance proceeds that are insufficient given the magnitude of the harm.

Fortunately, in Washington there is law that, in certain situations, the hospital may be liable for the actions of non-employee physicians. This is known as ostensible or apparent agency. Although the law itself is a bit confusing, the essence is that if you go to a hospital, and you reasonably believe that the doctor treating you is an employee of the hospital, a jury may find that the hospital is liable for the actions of the doctor. Even though he or she is not an employee.

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Intricate design, unsafe cleaning practices to blame for high rate of infected medical scopes

Posted Monday, April 30, 2018 by Tyler Goldberg-Hoss

In a recent paper published in the American Journal of Infection Control, 71% of reusable medical scopes tested at three major hospitals carried bacteria.

Scopes are medical devices used to look deep into areas of the body, including the colon, lung, and esophagus. Because such a high percentage of these scopes carry bacteria, considerable numbers of patients are harmed: 35 deaths since 2013.

These bacteria, including superbugs such as CRE and MRSA, are responsible for even more harm: around 2 millions Americans are made sick by such bugs, and overall 23,000 die.

Part of the problem is the design, and also the cleaning procedures of hospital staff often lacked. This includes using the same gloves when disinfecting the scopes multiple times, scopes stored in unsanitary conditions, and generally skipping steps in the cleaning process due to the need to rush between procedures.

Higher standards have been proposed to increase patient safety. This includes sterilizing all scopes using gas or chemicals, and concurrently redesigning scopes to withstand the stress of repeated sterilizations (or creating single use scopes).

Scopes – in all their forms – are terrific inventions that have saved countless lives and solved countless medical problems. It appears that, with a little tweaking, they can continue to be promoters of patient safety.

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