Friday, October 21, 2016

On Call by Casey Ross

Good morning! I must end this week with an apology. So many readers have emailed me that I haven't had a chance to respond to everyone. Rest assured, I deeply appreciate your tips and feedback and will be in touch soon. Now, on to today’s hospital news.

On the front line: Listening to patients' fears

In five words, the index card summarized the patient’s biggest fear: “Being killed in these streets!”

Dr. Maia Dorsett, an emergency medicine resident at Barnes Jewish Hospital in St. Louis, had handed out the cards to patients in her ED, asking them to share their biggest worries. She expected to hear about medication or mobility. Instead, her patients opened up about their lives outside the hospital.

They wrote about violence around their homes, family problems, and their deepest insecurities. One woman’s worry was simply this: “That I may not be a good single mother, with God on my side.”

Dorsett, 36, has distributed the cards for the past two years as part of Lown Institute’s Right Care Action Week, which encourages clinicians to spend more time listening. The exercise isn’t just about letting patients vent. It is a way for their caregivers to figure out how to help them.

Dorsett remembered one patient who arrived in the ED hysterical and complaining about shortness of breath. No one could figure out what was wrong with her medically — until Dorsett stopped and asked the woman her biggest worry.

“She said, ‘I’m really worried that my son is going to die of a heroin overdose, and I feel like I let him down,’” Dorsett said. “I could have ordered a million tests to try to help her. But I sat down and talked with her, and her symptoms went away.”

New research: Giving doctors financial incentives can improve cancer care

Maybe it is about the money.

A new study from Taiwan shows that linking doctor pay to quality measures resulted in more effective, less costly care for breast cancer patients.

The study, just published in JAMA Oncology, found that patients in an incentive-based system had a 4 percent higher survival rate at five years compared to those whose care was funded the old fashioned way — piece by piece, unconnected to performance.

Oncologists in the incentive system also had lower costs over time and better adherence to quality measures.

The study followed 17,940 women with newly diagnosed breast cancer for five years. It's a hopeful sign for a similar oncology payment program rolled out recently by the Centers for Medicare and Medicaid Services.

One key difference between the US and Taiwan: The latter implemented single-payer health care in 1995, while lawmakers in the US were busy torpedoing it.

Can you believe we used to....

it's hard to believe this once seemed like a good idea. (Clyde Putnam Jr. photo/Thomas Robinson)

We used to sell cigarettes to patients at their hospital beds. Which of today's practices will look just as ridiculously outdated in 30 years?

Piling so much paperwork on doctors that they barely have time to see patients? Hiring observers to monitor clinician hand washing? Giving patients pill bottles that don't clearly state what the medication is for? 

Reporter Melissa Bailey has compiled a list of practices we may come to regret. Read it here.

Which practices do you think will soon be obsolete? Email them to

Zag of the day: How one insurer cut opioid abuse

Sometimes, red tape saves lives.

We often criticize insurers for creating tangles of regulation. But the CDC just released a report showing how Blue Cross Blue Shield of Massachusetts used several policy restrictions to cut opioid use.

CDC’s shout out, published in its weekly morbidity and mortality report, noted that BCBS’s opioid utilization program cut average monthly prescriptions by 15 percent over three years. That’s huge in a state where the opioid-related death rate is 2.5 times higher than in the US overall. It means the program likely saved lives, not to mention incalculable personal pain and huge sums of money.

So, how did it work?

Well, doctors need prior approval from BCBS before they prescribe opioids. To get it, they must assess the patient's risk of abuse and show they considered alternate treatment options. Both doctor and patient must sign a formal agreement, and strict limits are placed on the amount of opioids prescribed at one time.

Not only did the number prescriptions fall in the years after implementation, but few complaints emerged that patients were denied needed medications.

The CDC’s conclusion: “Public and private insurers in the United States could benefit from their own best practices for opioid utilization.”

And so could their customers.



  • Shame proves ineffective in getting hospitals to lower prices (Washington Post)
  • Obama says the end of his presidency might fix the Affordable Care Act (Reuters)
  • A mother’s devastating diagnosis (NY Times)
  • Is the common cold beatable? Some scientists think so. (STAT)

Have a news tip or comment you want to send me?

Send me an email

Stay well, and enjoy the weekend. I'll be back Monday.


Enjoy this email? Tell your friends and coworkers to sign up here.