Facing shortages of critical equipment, medical workers must make life-or-death decisions about who receives care. WSJ’s Joe Palazzolo reports from an emergency room that’s running short on ventilators, and Chris Weaver explains the plans hospitals are putting in place to decide who gets them.
Arthur Caplan, a bioethicist at NYU’s School of Medicine, talks about how hospitals think about these difficult choices.
From a National Poll on Aging (Univ. of Michigan) online release:
Among older adults age 50–80, 43% had ever reviewed doctor ratings; 14% had reviewed ratings more than once in the past year, 19% had done so once in the past year, and 10% had reviewed ratings more than one year ago.
Among older adults who had looked up doctor ratings within the past year, 65% read reviews of a doctor they were considering, 34% read reviews to find a new doctor, and 31% read reviews for a doctor they had already seen.
Ratings and reviews for nearly everything can be found online these days, including doctors. How are older adults using these ratings in their decisions about choosing doctors? In May 2019, the University of Michigan National Poll on Healthy Aging asked a
national sample of adults age 50–80 about their use and perceptions of online doctor ratings.
From a British Medical Journal (BMJ) online article:
…primary care providers (general practice, paediatrics, and internal medicine) performed the best, giving a considerably lower percentage of antibiotic prescriptions without a documented indication (12%) than other specialists such as gynaecologists and urologists, who commonly prescribed antibiotics (24%), as well as those in all other specialties (29%).
As many as two in five antibiotic prescriptions (43%) provided in outpatient settings in the US could be inappropriate, a study published by The BMJ has found.1
Researchers from Oregon, USA, looked at prescriptions in ambulatory settings such as primary care and found that a quarter (25%) were deemed to be inappropriate, while a further 18% did not have an indication.
This systematic review and meta-analysis of 11 studies involving 21 517 physicians demonstrated an association between physician depressive symptoms and an increased risk for perceived medical errors (RR, 1.95; 95% CI, 1.63-2.33). We also found that the magnitude of the associations of physician depressive symptoms and perceived medical errors were relatively consistent across studies that assessed training and practicing physicians, providing additional evidence that physician depression has implications for the quality of care delivered by physicians at different career stages.
Medical errors are a major source of patient harm. Studies estimate that, in the United States, as many as 98 000 to 251 000 hospitalized patients die each year as result of a preventable adverse event.1–4 In addition, medical errors are a major source of morbidity5 and account for billions of dollars in financial losses to health care systems every year.6–9
Depressive symptoms are highly prevalent among physicians,10,11 and several studies have investigated the associations between physician depressive symptoms and medical errors.12–16 Although most studies on physician depressive symptoms and medical errors have identified a substantial association, their results are not unanimous, and questions regarding the direction of these associations remain open in recent literature.17
As a consultant, I had profoundly failed to appreciate the experience of fatigue and apathy among patients. More than excessive tiredness, the fatigue was overwhelming, turning simple activities into insurmountable, exhausting challenges. It was frustrating and I fell into the trap of overexertion when I did have energy, thus exhausting myself and sabotaging the day’s recovery plan. Had staff not been so adept at encouraging me when I lacked energy and holding me back when I tried to overdo things, I would have squandered much valuable rehabilitation time.
I was a consultant in neurological rehabilitation for acquired brain injury when, at the age of 62 years, I had a stroke. Running for a train, I experienced pain in the right side of my head and mild weakness and sensory loss in my left limbs. I thought I’d had a stroke, but I was remarkably calm. It was late and my instinct was to get home, where I went to the study. In the morning, I found myself on the floor, half-blind, half-paralysed, and terrified.
Scans showed a large intracerebral haemorrhage in the area of the right basal ganglia. My symptoms could be explained by the damage to my brain—my medical world was in order, something to hold on to. I discussed my diagnosis and treatment with my colleagues during brief waking periods, grateful that they still saw the person I was before my stroke. Meanwhile, my wife was in the good hands of staff who treated her with sensitivity, giving her plain facts and support.
It was all horribly familiar — a rerun of an episode 15 months earlier, when she was with her family in River Vale, N.J. Back then, the burning pressure sent her to the emergency department, and she was told the same thing: She was having a heart attack. Immediately the cardiologist looked for blockages in the coronary arteries, which feed blood and oxygen to the hardworking muscles of her heart. That was the cause of most heart attacks. But they found no blockage.
Since childhood, she had frequent terrible canker sores that lasted for weeks. Sometimes it was hard to eat or even talk. Her mother, a nurse, told her everybody got them and thought she was being dramatic when she complained. So she had never brought them up with her doctors. Now the woman saw that her answer somehow made sense to the rheumatologist.
Indeed, that was the clue that led the rheumatologist to a likely diagnosis: Behcet’s disease. It’s an unusual inflammatory disorder characterized by joint pains, muscle pains and recurrent ulcers in mucus membranes throughout the body. Almost any part of the body can be involved — the eyes, the nose and lungs, the brain, the blood vessels, even the heart. Behcet’s was named after a Turkish dermatologist who in 1937 described a triad of clinical findings including canker sores (medically known as aphthous ulcers), genital ulcers and an inflammatory condition of the eye.