To Survive, Rural Hospitals Need To Grow—But The Demographics Don’t Add Up

From St. Louis Public Radio:

For the nearly 700 rural hospitals in the United States on the brink of financial collapse, relatively small amounts of money can be the difference between life and death. There are variables that can strengthen their chances of survival: Did their state expand Medicaid? Does their patient mix include some higher-paying private insurance? Are they able to recruit doctors?

But health policy researchers say the problem for rural hospitals is deeper than all these issues. Rural America’s dwindling populations make it nearly impossible to keep these community institutions afloat.

“I saved an old man’s life. He didn’t want it.”

From the Post:

What do you do when you disagree medically with a patient on matters of life and death? When there is no ability to have a thoughtful, patient, nuanced conversation over life support? For Herb, was it a “hard no” to any intubation? Were two days okay if there was a high likelihood of recovery? Or was even one day too much?

When doctors disagree with patients and families, it is usually the family choosing aggressive care in the face of overwhelming illness even though the benefits of life support are negligible or nonexistent. It gives a reprieve of sorts, allowing for further discussion. But what if it’s the reverse? What if the patient’s decision for no intervention leads to a potentially premature or unnecessary death from a treatable illness? What if a patient’s limits were stated without ever considering the current context? And what if this is your own family member writhing in pain, struggling to breathe?

We often talk about decisions of life and death, of aggressive care or comfort, of full “code” — do everything possible — vs. do not resuscitate/do not insert a breathing tube. One or the other. Binary options. But in real life, applying these decisions can get messy. There is nuance and context and uncertainty.

More doctors, patients turning to telemedicine for emergency care

From WRAL:

FirstHealth physicians may also respond to emergency department patient consultations while they are at home late at night. Through the use of a special mobile app on their smart phone, doctors can speak to other physicians or patients through the robot-transported monitor.

Police Give Naloxone to Dog That Got Into Owner’s Oxycodone

From US News:

Police in Maine say a dog that got into its owner’s oxycodone perked right up after police administered the opioid-overdose antidote naloxone.

York County Sheriff William King says the dog’s owner flagged down a passing officer in Lyman on Thursday. The owner said she was unable to get help from a veterinarian and asked Sgt. David Chauvette to help the 3-year-old yellow Labrador named Addie. King says the dog was drowsy and the owner feared an overdose.

King says Chauvette administered naloxone and the dog “seemed to perk up.”

Doctors frustrated that electronic records steal time from patients

From Reuters:

EHRs were developed in response to federal government financial incentives aimed at facilitating the exchange of health information, reducing medical errors and improving care. But they can strain clinical encounters, Gardner and colleagues write in a new study in the Journal of Innovation in Health Informatics.

Researchers asked doctors licensed to practice in Rhode Island the question: “How does using an EHR affect your interaction with patients?”

They got an earful.

Controversy: “The antibiotic course has had its day”

From the BMJ:

With little evidence that failing to complete a prescribed antibiotic course contributes to antibiotic resistance, it’s time for policy makers, educators, and doctors to drop this message, argue Martin Llewelyn and colleagues

Rural wait times for EMS more than twice that for urban, suburban areas

From Healthcare Dive:

  • Patients in rural America can wait up to 30 minutes for emergency medical services (EMS) after dialing 911 — far longer than the average interval of 7 minutes, according to a new study in JAMA Surgery.
  • The researchers analyzed 1.7 million EMS runs in the U.S. and found average wait times of 6 minutes in urban and suburban zip codes, compared with 13 minutes in rural ones. But one in 10 calls to 911 in rural areas resulted in waits just shy of 30 minutes.
  • The findings point to the need for trained bystanders who can intervene in cases that are time-sensitive like severe allergic reactions, heart attack or severe bleeding, the researchers say.

Doctors view technology as largely problematic

From Reuters:

Technology offers doctors a view inside patients’ hearts, brains and bowels. And technology may speed the diagnosis of diabetic retinopathy, the leading cause of blindness, said panelist Dr. Jessica Mega, who leads the healthcare team at Verily, formerly Google Life.

Nonetheless, 69 percent of the 100 doctors in the audience said increased reliance on technology and electronic health records only served to separate them from their patients.

As evidence of the problem, the panelists cited apps that claim to do things they don’t really do, like accurately measure blood pressure.

But the biggest problem stemming from technology for the doctors, and the bane of many doctors’ existence, is the electronic health record, also known as an EHR.

The overwhelmed emergency physician

From Kevin MD:

I see it time and time again. Overwhelming numbers of patients with increasingly complex medical and social problems, versus inadequate physician coverage at all hours of the day, and especially the night. We’ve all done it. Already fatigued, we have five chest pains yet to see, as well as a trauma on the way into the department. Two more patients have fever but don’t speak English, and we’re waiting to make the translation line work. And there’s a large facial laceration yet to be repaired. And that’s just the first nine patients. It’s not even three hours into the shift. (And the EMR backup is in process.)

Why Low-Acuity Patients Often Complain

From Emergency Medicine News (hat tip: Dr. Menadue):

Patients, just like everyone else, experience cognitive dissonance. Sometimes they feel it in the ED when two ideas conflict. The decision to seek care is not an easy one. When they realize they’ve misjudged their emergency, they experience cognitive dissonance about their acuity, or more specifically, acuity dissonance.

Low-acuity patients still have nonmedical needs, even though their medical needs are easy to meet. But these nonmedical needs are legitimate. Rushing them through their encounter is a disservice to everyone. Inexperienced doctors make the mistake of ignoring acuity dissonance at their peril.