“Analyzing the nature of misdiagnoses also provides significant opportunities for solutions: The errors are many, but they are quite concentrated. According to the study, 15 diseases account for about half the misdiagnoses, and five diseases alone — stroke, sepsis, pneumonia, venous thromboembolism, and lung cancer — caused 300,000 serious harms, or almost 40% of the total, because clinicians failed to identify them in patients. “That’s a lot that you could accomplish if you cut those harms by 50% for just those five diseases — that would be 150,000 prevented serious permanent disabilities or death,” said [lead author of the BMJ … Read More
“Over the years, medical schools have made some progress in diversifying their student bodies, with numbers ticking up. But just like undergraduate admissions, wealth and connections continue to play a determining role in who is accepted. More than half of medical students come from families in the top 20 percent of income, while only 4 percent come from those in the bottom 20 percent, according to data from the Association of American Medical Colleges. There is also a family dynamic. Children of doctors are 24 times more likely to become doctors than their peers, according to the American Medical Association. … Read More
Excerpt – “Crisis,” “collapse,” “catastrophe” — these are common descriptors from recent headlines about the National Health Service (NHS) in the United Kingdom. In 2022, the NHS was supposed to begin its recovery from being perceived as a Covid-and-emergencies-only service during parts of 2020 and 2021. [..] In the background of this acute [COVID] crisis, waiting lists for specialist consultation have been growing and now exceed 7 million patients (in a country of 66 million people), up from 4.4 million before the pandemic. There is substantial consensus about the causes of these crises, though different experts weight the contributory factors … Read More
“Since the early 2000s, hospitals have been developing metrics to define high-quality care. In addition to readmission rates and the incidence of various iatrogenic infections, reducing hospital length of stay has been a popular target. Most people prefer nonhospital days to hospitalized days, and insofar as effective treatments hasten the return to health, it seems plausible to assume that shorter stays correlate with effective stays. As an ancillary benefit, shorter stays may cost less and increase “throughput,” resulting in more revenue for hospitals. Because tallying the length of stay is easier than quantifying high-quality care for heterogeneous “hospital problems,” patients … Read More
“The Medicare Physician Fee Schedule (MPFS) directly determines nearly $200 billion in Medicare spending and indirectly affects an additional $600 billion or more in payments to physicians by other payers. Yet the fee schedule has widely recognized flaws: paying whether the service rendered is medically necessary, is performed efficiently, or meets acceptable quality standards. At its core, clinician fee schedules attempt to pay for clinicians’ time and effort, not whether the care maintains or improves patients’ health. Many hoped that value-based payment models would make MPFS flaws moot. Paradoxically, virtually all the alternative payment models that the Centers for Medicare … Read More
“In 2012, Scott Zeller, who was then the head of psychiatric emergency services at the Alameda Health System, in Oakland, California, was growing frustrated with the status quo. Many observers blamed long wait times for psychiatric patients on a sharp decline in the number of psychiatric beds in public hospitals. Zeller thought they were missing a more fundamental point. “Why is mental illness the only emergency where the treatment plan is, Let’s find them a bed somewhere?” Zeller asked. “If someone comes in with an asthma attack, we don’t say, ‘We’ve got a gurney here in the back for you. … Read More
“Mr. Ellsberg, who died on Friday at 92, copied the military’s secret 7,000-page history of the Vietnam War and gave it to The New York Times and The Washington Post in 1971. The government sued to stop publication, but the Supreme Court defended the First Amendment right of a free press against prior restraint. [..] [New York Times] The number of people with the security clearances to view classified material has expanded, perhaps exponentially, since the leak of the Pentagon Papers, and I wonder, aside from a few people like Edward Snowden and Chelsea Manning, why haven’t there been more … Read More
“Discussions of [health care system] reform here in the United States seem to focus on two options: Either we maintain the status quo of what we consider a “private” system, or we move toward a single-payer system like Canada’s. That’s always been an odd choice to me because true single-payer systems like that one are relatively rare in the world, and Canada performs almost as poorly as we do in many international rankings. [..] Universal coverage matters, not how we get there. [..] We have spent the last several decades fighting about health insurance coverage. [..] The only thing we … Read More
“Minimal manning—and with it, the replacement of specialized workers with problem-solving generalists—isn’t a particularly nautical concept. Indeed, it will sound familiar to anyone in an organization who’s been asked to “do more with less”—which, these days, seems to be just about everyone. Ten years from now, the Deloitte consultant Erica Volini projects, 70 to 90 percent of workers will be in so-called hybrid jobs or superjobs—that is, positions combining tasks once performed by people in two or more traditional roles. Visit SkyWest Airlines’ careers site, and you’ll see that the company is looking for “cross utilized agents” capable of ticketing, … Read More
“Already, we are being told that A.I. is making coders and customer service representatives and writers more productive. At least one chief executive plans to add ChatGPT use in employee performance evaluations. But I’m skeptical of this early hype. It is measuring A.I.’s potential benefits without considering its likely costs — the same mistake we made with the internet. I worry we’re headed in the wrong direction in at least three ways. One is that these systems will do more to distract and entertain than to focus. Right now, the large language models tend to hallucinate information: Ask them to … Read More