EM Physician Named as White Hourse Fellow

From AmedNews:

4 doctors named White House fellows

Pat Basu, MD, on June 23 became the first radiologist to be named a White House fellow and special assistant to the president, according to the American College of Radiology. Dr. Basu, a resident at Stanford University and the Palo Alto VA Hospital in California, is joined as a fellow by three other physicians:
Dr. Harley Feldbaum, MPH, director of the Global Health and Foreign Policy Initiative at the Johns Hopkins Nitze School of Advanced International Studies in Washington, D.C.
Thomas Fisher Jr., MD, an emergency physician and assistant professor of medicine at the University of Chicago Medical School.
Sunny Ramchandani, MD, MPH, integrated chief of general internal medicine at the Walter Reed Medical Center in Washington, D.C. He is also a lieutenant commander in the U.S. Navy.

Fellows typically spend a year as full-time, paid assistants to senior White House staff, the vice president, cabinet secretaries and other top-ranking government officials, according to the White House. President Lyndon Johnson created the fellows program in October 1964. The 2010-11 program has 13 fellows.

Solving the Med Student Debt Problem: Collect a Percentage of Income

From the Wall Street Journal Health Blog:

Educational debt is a serious burden for young (and middle-aged) doctors — the median amount owed for both premedical and medical school was $145,000 for those graduating from public med schools in 2008 and a whopping $180,000 for private school grads.

And that has consequences, affecting the type of person who can afford to go into medicine (60% of med students come from families in the top 20% of households by income) and the specialties they choose. There have been a bunch of different proposals to deal with this problem, including some by the AMA, but a recently published opinion piece has a different approach to the problem.

The piece, published earlier this month in the American Journal of Obstetrics & Gynecology, proposes that med schools cut out tuition and fees during medical education, then collect a fixed percentage of income for 10 years after a physician has finished training.

Advocates Say ‘Good Samaritan’ Laws Could Save Overdose Victims

From Newsweek:

Chicago has the highest number of heroin-related emergency-room visits in major metropolitan areas, followed by New York City, Boston, and Detroit, according to a study out this week. The Roosevelt University researchers who conducted the research say medical care for heroin overdoses could be improved by “good Samaritan” laws, which currently exist in only two states.

As it now stands in most states, people who dial 911, drop a friend off at a hospital, or otherwise try to get care for someone in the midst of a drug overdose are subject to prosecution for use, possession, or distribution. No national figures exist for how often callers are arrested, but users are attuned to the stories that show up in the media with some regularity, says Meghan Ralston of the Drug Policy Alliance, pointing to a recent case in which an overdosing woman and a man who called an ambulance for her were both arrested. “That sends a chilling, disturbing message to all people who will one day witness an overdose,” Ralston says. “It says, ‘Don’t call 911 because you and the victim will be arrested.’ ”

Interpretation and intent: A study of the (mis)understanding of DNAR orders in a teaching hospital

From Resuscitation:

Do not attempt resuscitation (DNAR) orders have been shown to be subject to misinterpretation in the 1980s and 1990s. We investigated whether this was still the case, and examined what perceptions doctors and nurses had of what care patients with DNAR orders receive.

Methods: Using an anonymous written questionnaire, we directly approached 50 doctors and 40 nurses from a range of medical specialities and grades in our teaching hospital.

Results: All 50 physicians and 35/40 nurses took part. Using McNemar’s test, there were highly significant differences (p<0.0001) in what doctors believed ‘should’ take place and what they perceived ‘in practice’ occurred on patients with DNAR orders in all areas questioned (e.g., frequency of nursing observations and contacting medical staff in the event of a patient’s deterioration). Using Fisher’s exact test, there were significant differences between what nursing staff thought occurred and what doctors thought should occur, for example, frequency of nursing observations (p<0.001), contacting the medical team (p=0.01) and giving fluids (p<0.005).

Conclusions: Despite widespread use of DNAR orders, they are still misunderstood. This article highlights the frequency with which DNAR orders are interpreted to mean that other care should be withheld. In addition, it shows that although some doctors know that this should not be the case, they believe that DNAR orders affect the care that their patients receive. We propose that options for more detailed care plans should be embedded within the resuscitation decision and documentation to improve communication and understanding.