Longer Looks: A 'Biopsy Chaperone;' Medical Errors At Assisted Living Homes

Every week reporter Ankita Rao selects interesting reading from around the Web.

UT San Diego: Medical Errors Plague Care Homes
At least 80 times in recent years, employees at San Diego County assisted living homes overlooked serious medical issues, gave the wrong medication or otherwise failed to properly care for vulnerable seniors. The problems arose as a result of the unique position held by the care homes, viewed by many families as health-care facilities even though they lack the required levels of training, supervision and oversight. The new cases were examined by U-T Watchdog as part of an ongoing partnership with the CHCF Center for Health Reporting at the University of Southern California (Jeff McDonald, 12/14).

The New Yorker: Controlling Health-Care Costs
[T]he political furor over [Obamacare] has obscured a quieter but arguably more consequential development: health-care costs in this country may finally be coming under control. ... there’s good reason to think that the moderation of health-care spending will persist, because, according to Jason Yeung, an investor at Morgan Stanley’s Growth Team, we’re beginning to see deeper structural changes in the health-care system. Historically, costs have been hard to contain because most of the players in the system have had no incentive to do so. ... “What we’re moving toward instead is a world in which everybody in the system is sharing financial risk,” Yeung told me. “And therefore everybody has an incentive to control costs” (James Surowiecki, 12/9).

Health Affairs: A Resident Helps Redesign How One Institution Provides Emergency Care
Ms. Fuentes, thirty-two years old and healthy, came to the ED many hours ago for consultation on a localized finger infection. ... I cannot stop in Ms. Fuentes’s room, provide a quick and focused exam, and make a simple recommendation for the ED doctor. Although this may be valuable to the patient, it doesn’t generate revenue for the medical center or protect me against liability. Instead, I must provide a full consultation and make the incision myself. The patient’s infection could have been diagnosed and treated in a supervising hand surgeon’s clinic in minutes. Instead, ... she has had to wait well over six hours to see the least-experienced member on the orthopedic team. ... My portion of her lengthy stay took less than twenty minutes. I never saw her again. There was no tracking of her satisfaction, no knowledge as to whether her infection was eradicated, and no measure of cost at the end of her care cycle (Dr. Kamran S. Hamid, December 2013).

Billy Rubin's Blog: The E-Mail I Want To Send, But Probably Won't
Thank you for your note. I will let my patient know as soon as possible that you aren't interested in seeing him in your clinic so that he won't trouble you with his medical issues. It is true that we did have him admitted to expedite a biopsy while you were the attending on service for the [Q] team. However, as he had not yet seen a specialist in [Q] and that Dr. [Y] had provided help to me in phone consultation, we both thought that you would have been the most logical choice to see him in follow-up. The misunderstanding is all mine, as I thought you were this person called a "doctor" and that doctors do this thing called "taking care of patients". You appear to be a "biopsy chaperone". Please forgive my confusion on this point (Billy Rubin, 12/14). 

The Atlantic: Experts Decisive Against Multivitamins: 'Stop Wasting Money'
"We believe that the case is closed— supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful. These vitamins should not be used for chronic disease prevention. Enough is enough." So reads an authoritative editorial today in one of the widest-read U.S. medical journals, Annals of Internal Medicine (James Hamblin, 12/17).

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