A new study by a team from the University of Michigan Institute for Healthcare Policy and Innovation shows that adults over age 50 place more importance on convenience-related factors, rather than reputation, when choosing a doctor.
The study, based on data from IHPI’s National Poll on Healthy Aging supported by AARP and Michigan Medicine, still shows that online ratings and reviews of physicians play an important role, and should receive attention from providers and policymakers.
Dr. Jeffrey Kullgren, a U-M primary care physician and lead author of the study, describes the findings.
It has taken time — some say far too long — but medicine stands on the brink of an AI revolution. In a recent article in the New England Journal of Medicine, Isaac Kohane, head of Harvard Medical School’s Department of Biomedical Informatics, and his co-authors say that AI will indeed make it possible to bring all medical knowledge to bear in service of any case.
Properly designed AI also has the potential to make our health care system more efficient and less expensive, ease the paperwork burden that has more and more doctors considering new careers, fill the gaping holes in access to quality care in the world’s poorest places, and, among many other things, serve as an unblinking watchdog on the lookout for the medical errors that kill an estimated 200,000 people and cost $1.9 billion annually.
“I’m convinced that the implementation of AI in medicine will be one of the things that change the way care is delivered going forward,” said David Bates, chief of internal medicine at Harvard-affiliated Brigham and Women’s Hospital, professor of medicine at Harvard Medical School and of health policy and management at the Harvard T.H. Chan School of Public Health. “It’s clear that clinicians don’t make as good decisions as they could. If they had support to make better decisions, they could do a better job.”
Diagnostics World (June 30, 2020): The shift from face-to-face patient visits to remote medical appointments is a worldwide phenomenon, but most especially in the U.S., finds a recent global survey conducted by the doctors-only social networking platform Sermo. Unsurprisingly, Zoom tops the list of most-mentioned technologies. About one-fifth of surveyed doctors say they expect to be using telehealth tools “significantly” more post-pandemic than before COVID-19 upended business as usual.
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.
The proportion of patients who have two or more medical conditions simultaneously is, however, rising steadily. This is currently termed multimorbidity, although patient groups prefer the more intuitive “multiple health conditions.” In high income countries, multimorbidity is mainly driven by age, and the proportion of the population living with two or more diseases is steadily increasing because of demographic change. This trend will continue.
The cluster around diabetes is a good example, with the common serious disease affecting the heart, nervous system, skin, peripheral vasculature, and eyes. Diabetologists already provide care for the cluster of multiorgan diseases around diabetes, and some specialties, such as geriatrics or general practice, have multimorbidity at their heart. For most, however, training and service organisation are not optimised to face a multimorbidity dominated future.
The shift includes moving from thinking about multimorbidity as a random assortment of individual conditions to recognising it as a series of largely predictable clusters of disease in the same person. Some of these clusters will occur by chance alone because individuals are affected by a variety of commonly occurring diseases. Many, however, will be non-random because of common genetic, behavioural, or environmental pathways to disease. Identifying these clusters is a priority and will help us to be more systematic in our approach to multimorbidity.
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.
If one geriatrician can care for 700 patients with complicated medical needs, as a federal model estimates, then the nation will need 33,200 such doctors in 2025. It has about 7,000, only half of them practicing full time. (They’re sometimes confused with gerontologists, who study aging, and may work with older adults, but are not health care providers.)
Geriatrics became a board-certified medical specialty only in 1988. An analysis published in 2018 showed that over 16 years, through academic year 2017-18, the number of graduate fellowship programs that train geriatricians, underwritten by Medicare, increased to 210 from 182. That represents virtually no growth when adjusted for the rising United States population.
“It’s basically stagnation,” said Aldis Petriceks, the study’s lead author, now a medical student at Harvard.
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.