Learning by Surfing: Issue 4

Health care stuff to read.

The World Health Care Blog looks ahead to the coming privacy issues as health care (finally) goes internet:

So how do we manage ‘consent’ when it comes to private health information in this social media environment? This is one hell of a key question that needs to be addressed, and one that many are afraid to ask less it result in some draconian measures applied to all social media.

Do we have to accept a diminished private space to gain the benefits of social media? Will confidential health information become the entertainment for the ‘monitorial citizen’, part of the banal collective din of spectators who are fast becoming the new surveillance force in contemporary society? The values that are “animating our concern for privacy” are changing according to Zittrain, noting the age gap between those who use social media and those who shun it.

The health care debate we have most often concerns the issues we have in this country. I think it is important to remember that health is an international priority. Health in other countries increasingly has an effect on health in this country. And health care in this country apparently has an effect on health care in other countries. Health Populi reports:

Across the OECD countries, only 3% of health costs go to prevention. Yet we are well aware that once a person develops a chronic condition, it is much more expensive and difficult to reverse. It appears that the developed world is exporting sick-care medical systems to the developing world. This is a prescription for global health financing implosion — in addition to the extraordinarily negative impacts on business on a global basis.

The Health Blog writes a post that makes me really start to wonder how prevalent (and realistic) such doctor thoughts are:

Certainly, any doc (or anyone else, for that matter) who is not getting paid by the hour is likely to do some uncompensated work. But the issue does seem pretty compelling in the case of primary care docs, who work in a payment system that tends to favor procedure-oriented specialties.

“Just in the last three weeks, I have actually noticed three medication errors from specialists who prescribed medications for my patients because they did not have the full history,” (Ryan) Mire said. “I received those consultation notes, saw what the specialist prescribed, and said, ‘Absolutely not, do not take that medicine.’”

Yul Ejnes, a Rhode Island internist also on the panel added a couple other typical primary care tasks that aren’t reimbursable: “talking with family members,” and “just sitting down and thinking” about a case.

“Sometimes I wonder whether I want to keep doing this,” Ejnes said.

The culture of a hospital can be strikingly different during the evening hours. But the Health Blog explains that more than just the culture can be different:

After sundown the doctors get scarcer, the nurses fewer and the waits for just about everything get longer. There aren’t many bosses or seasoned pros around when things get sticky.

The result is a “stark discrepancy in quality between daytime and nighttime inpatient services,” David Shulkin, president and CEO of Beth Israel Medical Center in New York, writes in the current issue of the New England Journal of Medicine.

The lighter staffing in off-hours contributes to higher mortality rates, more complications from surgery and more frequent errors compared with the day side. Shulkin says we shouldn’t accept that. For starters, he writes, we need to scrap the notion that hospitals should run differently at night compared with the daytime. “We should be establishing equal standards for staffing and service and striving for acceptable outcomes for every hour of the week,” he argues.

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