Physicians Participating in OH Shortage Program Studied

From the Coshocton Tribune

CLEVELAND (AP) – Ohio’s program for foreign-born medical school graduates is not easing the state’s shortage of primary care doctors, the Cleveland Plain Dealer reported Monday.

 

Foreign-born doctors across the United States can apply for a visa waiver if they agree to practice in an underserved community for three years. Thousands of doctors sign up each year and the programs have become a major source of medical service for rural and poor communities.

 

More than half of the doctors who joined Ohio’s program in the past two years are working as specialists at major hospitals and are not primary care doctors, the paper found.

 

“We have such a hard time finding doctors. Why are multimillion-dollar hospital organizations using this?” said Joe Liszak, chief executive of Fremont-based Community Health Services, a federally qualified health center in Sandusky County. “That’s just not right. This program was designed for the underserved.”

Cardiac Arrest in Hospital is Deadlier at Night

From the Wall Street Journal Health Blog:

If you’re planning on going into cardiac arrest during your next hospital stay, try to do it on the day shift. You’ll have a better chance of surviving.

Researchers pored over data from nearly 87,000 cardiac arrests that occurred between 2000 and 2007, and found that 14.7% of patients whose hearts stopped beating between 11 p.m. and 6:59 a.m. left the hospital alive, compared with 19.8% of patients who went into cardiac arrest during the day and evening. Patients whose hearts stopped beating during weekend days and evenings survived 17.4% of the time. The study is published in this week’s JAMA.

Primary Care: Fewer US MDs, More Imported Docs

From the Wall Street Journal Health Blog:

In the past decade, the number of U.S.-trained MDs working to become primary care docs has fallen. Sounds terrible, but the shortfall has been more than made up for by a growing number of osteopathic docs and foreign-trained MDs, a government report says.

 

After med school, doctors go through several years of residency to become certified in a specialty. Primary care specialties — such as internal medicine, family medicine and pediatrics — have been losing their luster for domestically trained MDs, who have gravitated to more lucrative specialties, some of which also offer more predictable work hours.

This Season’s Flu Strains Are Not a Good Match for Vaccine

Frpm the Washington Post:

Seasonal influenza is spreading widely throughout the United States, with nearly half the cases caused by strains of the virus that are not directly covered by this year’s flu vaccine.

Whether the winter will end up being worse than usual remains to be seen. Flu mortality in adults has been higher than in the past two years, but deaths in children — an important marker of severity — have been rare.

Nevertheless, this winter is likely to be one of the few times that public health experts lose the bet they make each year when they devise the formula for the flu vaccine — eight months before the virus starts circulating in the fall. Experts must decide on the formulation then because of the time it takes to produce mass quantities of the vaccine.

21st Century CPR

From the Philadelphia Inquirer, posted on JEMS:

PHILADELPHIA — Every few seconds, the sonorous male voice issues a command:

Compress a little deeper. Increase duration of each compression. Release pressure between compressions.

Ernest Kwiatkowski obediently adjusts the force of his hands on the breastbone of Resuscitation Anne, a vinyl dummy long used to teach cardiopulmonary resuscitation.

As an emergency department nurse at the Hospital of the University of Pennsylvania, Kwiatkowski already knows CPR. But this is the first time he can tell exactly how well he is doing it, because Anne is connected to a new CPR monitoring device.

Within a minute, the voice falls silent, satisfied with Kwiatkowski’s technique.

“That is the best teacher you could ever have,” he enthuses.

That “teacher,” introduced to him last week, is part of a wave of technology and research aimed at breathing new life into CPR, the emergency treatment for cardiac arrest.

Ambulance Delayed While Patient Hit Up for $5 Co-Pay

From JEMS:

NEW YORK — As she lay on an ambulance gurney, ready to be taken to the hospital after suffering a heart attack, 76-year-old Barbara Antonelli saw a receptionist from her Sunnyside doctor’s office running toward her.

Mrs. Antonelli figured she had left something behind or that the employee simply wanted to wish her well.

Instead, the stricken woman was asked for her $5 co-pay, and the ambulance was held up while she scoured her purse for the money.

“Stupid me, I gave her the five dollars,” said Mrs. Antonelli, while resting yesterday at her Dongan Hills home. “This was an emergency … and they asked for a lousy $5. They could have billed me. I never thought they would have the audacity to ask.”

Mrs. Antonelli visited the Staten Island Physician Practice (SIPP) on Jan. 14 to make sure she was OK after having chest pains the day before. After an electrocardiogram showed that she had suffered a heart attack, Dr. Jonathan Okum ordered an ambulance from Richmond University Medical Center so that Mrs. Antonelli could undergo further testing at the hospital

Lost Opportunities: How Physicians Communicate About Medical Errors

“Lost Opportunities: How Physicians Communicate About Medical Errors”
Health Affairs (Quarter 1, 2008) Vol. 27, No. 1, P. 246; Garbutt, Jane; Waterman, Amy D.; Kapp, Julie M.

Medical error reporting is at the forefront of recent healthcare reform movements, and physicians are often categorized as a group of “reluctant partners” despite attempts to create a blame-free culture of error reporting. Because errors are underreported, healthcare facilities and providers find it difficult to create patient safety initiatives that will accurately eliminate future errors. A survey of 1,082 U.S. physicians conducted between July 2003 and March 2004 helped researchers determine that physicians are reluctant to report errors because of medical malpractice fears and because they do not believe hospitals and others are using the error reports to improve care. Though error reporting was not mandatory at the time of the survey, a majority of physicians indicate error reporting can help improve patient care and safety. However, the survey also indicates physicians prefer informal means of error communication on rounds, at medical meetings and during conferences to formal hospital procedures because they do not believe these processes lead to improvement. Physicians who participated in the survey recommended formal error reporting systems that ensure reports are confidential and foster patient care improvements. Other recommendations were that the error reporting process should take two minutes or less and be local to their department or unit; most physicians also want error information to reflect how errors can best be prevented. Hospitals and patient safety organizations must report back to physicians about error reports, develop processes to collect accurate near-miss and error data quickly and connect patient mortality and morbidity to quality initiatives.

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