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Monday, November 7, 2016

On Call by Casey Ross

Good morning and welcome to election week! Here is today's news on hospitals and health care. For more coverage, follow us @statnews on Twitter and like us on Facebook.

Fresh debate: Should first-year residents go back to 28-hour shifts?

Enough with the kid-glove treatment.

In a nutshell, that’s the rationale behind a revised rule that would end the 16-hour cap on work shifts for first-year residents. The Accreditation Council for Graduate Medical Education says shifts should go back to 28 hours, the same as the limit for other residents.

But the proposal, announced on Friday, has kicked up a ton of debate. 

The watchdog group Public Citizen has called it a “dangerous step backward,” while some physician groups have argued in favor of the move.

Dr. Thomas Nasca, the accreditation council’s chief executive, said the council decided a longer shift is necessary to promote “team-based care” and prevent disruptions in the delivery of medical services.

“Training to become a practicing physician can be compared to training for a marathon,” he said. “You must learn how to pace yourself, take care of yourself, and recognize your limits."

The debate will carry out for the next 45 days in a public comment period.

What do you think? We may publish your comments in a future On Call. Email casey.ross@statnews.com

Please don't talk politics on the treadmill

This polarizing presidential election has generated plenty of stress.

That's why nurses at Southhampton Hospital’s Cardio Rehabilitation Gym in New York have posted signs banning debate. They fear Trump-Clinton squabbles could undermine patients’ recoveries from heart attacks and cardiac surgeries.

“We like to keep our cardiac rehab a stress-free zone,” the gym’s manager, Jessica Swiatocha, told me, noting that some loud clashes have made patients uncomfortable. Swiatocha said she told patients they could continue to discuss politics in the gym, but no squaring off over the candidates.

Tomorrow’s election will finally put the debate to rest, and maybe even lower the nation’s collective blood pressure.

On second thought, who am I kidding?

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New poll: Needless tests and pointless visits

Please stop going to the doctor every time you get a runny nose. It’s about as necessary as a snow blower in southern California.

In a new poll, US health professionals told us that primary care visits for the common cold and unnecessary antibiotics are the most wasteful uses of health care. In the more than 340 responses collected by our partner, Figure 1, you also called out over-prescribed anti-depressants, annual Pap smears, and daily blood work on intensive care patients as a waste of resources.

“Is it necessary or are you playing a CYA (Cover Your A**) game?” one registered nurse asked about the routine blood tests. “Just because they are in the hospital does not mean they need daily blood work.”

Another family medicine doctor quipped: “Blood should be in you, not in the lab.”

Unnecessary care is estimated to cost the US health system between $750 billion and $1 trillion a year. Just last week, the University of Michigan flagged a pointless genetic test that cost Medicare up to $670 million in 2014 alone.

Front lines: Over three days, a woman finds out she is pregnant and has cancer

The two images put Gina Neri in a panic: One showed the beating heart of her baby, the other a large tumor in her colon.

It all happened over a three-day span in April 2015. Neri was 39, and suddenly was not only facing cancer, but fighting for the life of her third child.

“I felt alone and shocked,” Neri, of Ossining, N.Y.,  told me. “There’s really no way to describe that feeling.”

Her diagnosis started a medical odyssey. One doctor after another advised her to terminate the pregnancy, Neri said. They told her it made surgery too risky, potentially compromising her life as well as that of her child. She kept seeking out additional opinions, eventually undergoing robotic surgery to remove a foot of her colon at Northwell Health’s Northern Westchester Hospital.

She and the baby survived, but the cancer was still in her lymph nodes. She had to undergo months of chemotherapy, which presented yet another threat to her baby. Neri said she got ultrasounds every four days.

Finally, Nov. 6 arrived. Doctors had decided to induce her; a scheduled delivery meant they could ensure the chemo wouldn’t interfere with her platelet count and put her and the child in jeopardy.

CBS News had heard about her case and was preparing a story for that very evening. In fact, it was on air when her baby girl arrived — weighing in at over six pounds.

A nurse put the girl on her chest. “I remember looking at her and just crying,” Neri said. “I looked over at my husband and he was crying. My obstetrician was crying. It was such a beautiful moment.”

Referrals

  • A new wave of buyers clubs helps patients with hepatitis C, HIV (Reuters)
  • Medical schools tackle the primary care challenge (Modern Healthcare)
  • Why healthcare HR execs are in high demand (Fierce Healthcare)

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

Send me an email

Stay well, and come back tomorrow. Follow me on Twitter.

Casey

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