Doctors control emotions with patients

From UPI, via GruntDoc:

A U.S. study suggests physicians shut off the portion of their brain that helps them appreciate the pain their patients are experiencing.

Instead, the University of Chicago research indicates physicians activate a portion of the brain connected with controlling emotions during such patient encounters.

Because doctors sometimes have to inflict pain on patients as part of the healing process, they also must develop the ability not to be distracted by the suffering, said Jean Decety, a professor of psychology and psychiatry and co-author of the study.

“They have learned through their training and practice to keep a detached perspective; without such a mechanism, performing their practice could be overwhelming or distressing, and as a consequence impair their ability to be of assistance for their patients” said Decety.

Obesity Threatens Emergency Services: Report

ABC News’ take on the effect of obese (and “super-obese”) patients in EMS and the ED.

Extra wide beds, stronger toilets and special patient lifting devices are becoming more and more common in emergency rooms. The reason for such new equipment? Hospitals across the United States are struggling to handle increasing numbers of extra-large patients.

And as the country’s rates of obesity and “superobesity” continue to climb, many worry that such accommodations will put an increasingly heavy toll on an already strained emergency services system.

Hospitalists Shorten Patient Stays

From the Washington Post:

Being cared for by hospital-based general physicians — also known as “hospitalists” — can shorten patients’ hospital stays, a U.S. study finds.

The study looked at more than 9,000 patients discharged from an academic medical center between July 2002 and June 2004.

The 2,913 patients cared for by hospitalists had an average hospital stay of just over 5 days, compared to nearly 6 days for the 6,124 patients cared for by non-hospitalists, reported researchers at Montefiore Medical Center in New York City.

“Hospitalist care had the strongest association with length of stay in patients with specific diagnoses, including cerebrovascular accidents (strokes), congestive heart failure, pneumonia, sepsis, urinary tract infections and asthma/chronic obstructive pulmonary disease,” the researchers wrote. “The close monitoring and continuous presence offered by hospitalists may allow for earlier discharge, because hospitalists are more likely to detect clinical improvement in real time and to make appropriate adjustments in treatment regimens.”

Tamper-Proof Prescriptions

From the Wall Street Journal Health Blog:

It looks like doctors and pharmacies will get a reprieve from a new rule requiring tamper-proof prescriptions for Medicaid patients.

Congress created the rule earlier this year, and it’s set to go into effect on October 1. But the Senate last night passed a bill that would push that back another six months, and a similar bill is moving through the House this week.

The shift is supposed to make it harder for patients to forge prescriptions. But doctors and pharmacies have said the quick implementation wouldn’t give them enough time to get ready and could result in patients not being able to get the medicine they need.

Obese and Super Obese Patients Challenge Emergency Medical Care Providers

From ACEP:

Obese patients are presenting new challenges in emergency care, from burdening patient transport systems to complicating diagnosis and treatment. As rates of obesity and super obesity accelerate, emergency departments struggle to cope (“Emergency Departments Shoulder Challenges of Providing Care, Preserving Dignity for the ‘Super Obese’”).

“Higher levels of obesity will lead to more people getting sick with heart disease, hypertension or diabetes and coming to the emergency department,” said Dr. Theodore Delbridge, chief of emergency medicine at Pitt County Memorial Hospital in Greenville, North Carolina. “Clearly the obesity epidemic is having an effect on emergency department care. The steady increase in obese and super obese patients creates pressures across the entire spectrum of patient care, from ambulance capacity to proper drug dosing.”

A survey cited in the article finds that the emergency department has been the most affected area in hospitals by the growing population of obese patients.

Super obese patients present the greatest difficulties to emergency medical care providers, from pre-hospital care through hospital admission. Patients who weigh more than 400 pounds may require bariatric ambulances, which are rare due to their high cost. In addition, EMS workers typically only lift 100 pounds, meaning a larger patient will require extra personnel. Nearly half of surveyed EMS workers reported back injuries related to lifting extremely heavy patients. Global sales in bariatric stretchers and lift systems are expected to soar in the next five years.

In addition, super obesity may create complications in diagnosis and treatment because of difficulties with blood draws, lumbar punctures or imaging machines such as CT scanners. Drug dosing poses additional dilemmas since, for most drugs, there are few clinical studies on proper dosing for very large patients.

Between 1986 and 2000, the prevalence of super obese patients has increased by a factor of five, from one in 2,000 to one in 400. Seventy-eight percent of hospitals reported an increase in the admission of severely obese patients in the last year, a trend that seems likely to continue.

“The bottom line is that this trend is not going away and emergency care providers will have to find ways to optimize care,” said Dr. Delbridge. “Emergency physicians adapt to all kinds of changes in our patient population and this is no different.”

WSJ: "Chatty Neatnik Docs Ace Malpractice Insurance Tests"

Love that title. From the Wall Street Journal Health Blog.

Paying premiums isn’t enough to get malpractice insurance for some docs these days. Some insurers now require an online personality test, reports American Medical News.

The test gauges a doctor’s “interpersonal communication skills,” “attention to detail” and “propensity for risk-taking behavior,” according to the Web site of United Medical Liability. The online test takes 15 to 20 minutes, according to the company. Insurers may send doctors who are sloppy, thrill-seeking clods to training to reduce their risk of being sued.

U of I med school eyes expansion in DM

From the Des Moines Register:

The University of Iowa Hospitals and the Des Moines Area Medical Consortium is looking at a new downtown location in order to double the number of medical students receiving training in the city.

“It will improve the medical education of our students and hopefully entice more of these students to stay in Des Moines and surrounding areas,” said Jean Robillard, vice president for medical affairs at the U of I.

Twenty-five to 35 U of I medical students now spend rotations each year at Iowa Methodist Medical Center, Iowa Lutheran Hospital, Blank Children’s Hospital, Veterans Affairs Medical Center and Broadlawns Medical Center, said Dr. Steven Craig, the consortium’s executive director.

Education space in the consortium’s offices at 1415 Woodland St. is already tight and would not be adequate if the consortium agrees to increase the number of U of I medical students to 50 to 55 each year, Craig said.

“We recognize that taking in more students means we need more classrooms, conference rooms and patient simulation rooms,” Craig said. “We’ve been exploring what type of facility we would need.”

The consortium would likely develop a new facility close to its offices just south of Methodist, Craig said. Consortium leaders are now trying to figure out how much it would cost, how they would raise the money and where the building would be located, he said.

“No timeline has been set,” he said. “We’re now in the exploratory stage.”

Hypothermia Treatment

From Medgadget:

Life Recovery Systems, HD, LLC, of Alexandria, LA was just issued the CE Mark of approval by the EU to market their ThermoSuit system, indicated for emergency cooling of patients to “preserve cardiac and brain function in victims of cardiac arrest, stroke, heart attack, traumatic brain injury and hyperthermic patients.”

The ThermoSuit System uses innovative technology to rapidly cool a patient’s core temperature. It consists of a disposable body suit and a means to pump coolant within the suit over the skin of the patient. It is the first device for patient temperature management that conveniently provides a thin layer of rapidly flowing liquid coolant in direct contact with the skin. This approach gives the ThermoSuit System outstanding capabilities to rapidly and non-invasively change patient temperature. It has been designed for ease of use for clinicians who treat patients indicated for cooling therapy, and has the potential to quickly cool these patients conveniently and rapidly.

Mayo Clinic Calls for Universal Coverage

From the (excellent) Wall Street Journal Health Blog

Make everybody in America buy health insurance, and give subsidies to help the poor afford it. Force insurance companies to offer some coverage to everyone, regardless of health status. And have everybody buy their insurance directly, rather than getting it through their employer.

Those are the broad outlines of a plan (described here) created by the Mayo Clinic’s Health Policy Center after consulting with hundreds of academics, patient activists and health-care providers in the last year and a half. The group also got input from executives at companies such as Wal-Mart and Verizon that are not part of the health-care industry.

Newsweek article about eICU’s

From Newsweek:

Here’s the sub-heading: Small hospitals use technology to run remote ICUs.

Swedish Medical is one of a growing number of hospitals opting for a radical form of outsourcing by using technology and doctors stationed off-site to monitor the well-being of critically ill patients. Instead of listening through a stethoscope, a single doctor can track multiple patients at all three hospitals from a remote facility by watching monitors and Webcams, working from a post that looks a lot like an air-traffic controller’s station.