Psychiatry--an emerging malpractice issue and what to do about it

Frequent malpractice situations arise in the overlap between medical and psychiatry diagnosis in the E.R. Examples of positive risk management and risk prevention measures are described which will lead to improved patient care for psychiatric patients. Now is the time to take a preventive approach through a review of hospital policies and procedures in Psychiatry. This will lead to risk prevention and improved patient care.     

Evidence-based medicine: what it can and cannot do

Evidence-based medicine (EBM) is not a old hat, a "cookbook" medicine perpetrated by arrogant to serve cost cutters to suppress clinical freedom, a mandatory, deterministic, totalitarian practice of medicine, a way to control cost and to ignore patient preferences, a limit to personal/ humanistic/individual medicine. EBM is a reference of excellence to guide clinical decisions, the integration of own expertise with others' expertise and patient preferences, a way to improve medical practice and limit the variability and errors created when there is not evidence to identify the gold standard and differentiate among alternatives available. But evidences need to be integrated with a new thinking based on Complexity Science. Health care systems operates as complex adaptative systems rather than rigid, linear or mechanical organizations and innovation is a critical outcome of Complexity Science. How does EBM impact drug innovation? New drug approvals are not keeping pace with rising Research and Development spending, clinical approval success rate for new chemical entities (NCEs) is progressively dropping and maybe, through these indicators, we are seeing the worst face of EBM: its limiting, blocking, and controlling side. If that is the case, EBM is the main ally to keep the economy of health systems under control and the great excuse to block the access of the innovation to patients. Certainly not the best way to maximize the benefits of EBM.     

The rise in health care spending and what to do about it

Reforms for slowing the growth in health care spending and increasing the value of care have largely focused on insurance-based solutions. Consumer-driven health care represents the most recent example of this approach. However, much of the growth in health care spending over the past twenty years is linked to modifiable population risk factors such as obesity and stress. Rising disease prevalence and new medical treatments account for nearly two-thirds of the rise in spending. To be effective, reforms should focus on health promotion, public health interventions, and the cost-effective use of medical care.     

Losing the war against cancer: who's to blame and what to do about it

In 1971, the U.S. Congress launched a War on Cancer. Eighteen years and billions of dollars later, the United States is still in the grips of a cancer epidemic--and the number of victims grows every year. Much of the money has been squandered on a fruitless search for cancer "cures." Little has been done to prevent exposure to carcinogenic chemicals in the environment, despite ample evidence that chemical pollution of our air, water, food, and the workplace is the major cause of cancer. On the contrary, government, industry, and a small coterie of scientists have combined to stymie efforts to introduce preventive measures, such as strict pollution control standards. But cancer remains a preventable disease. It is up to citizens to push for action.     

The social cost of adverse medical events, and what we can do about it

Adverse medical events-medical interventions that cause harm or injury to a patient separate from the underlying medical condition-are unfortunately an all-too-frequent occurrence in US hospitals. They may cause as many as 187,000 deaths in hospitals each year, and 6.1 million injuries, both in and out of hospitals. We estimate the annual social cost of these adverse medical events based on what people are willing to pay to avoid such risks in non-health care settings. That social cost ranges from $393 billion to $958 billion, amounts equivalent to 18 percent and 45 percent of total US health care spending in 2006. A possible solution: Patients offered voluntary, no-fault insurance prior to treatment or surgery would be compensated if they suffered an adverse event-regardless of the cause of their misfortune-and providers would have economic incentives to reduce the number of such events.     

Side effects. While politicians and lobbyists duke it out in Washington, providers worry about what to do next

While the House of Representatives' vote to repeal the Patient Protection and Affordable Care Act captured the nation's attention last week, providers knew the biggest threat lies elsewhere--with Republicans' plans to undermine the law. "We view the current effort of repeal as background noise," says Dr. William Walker, left, of Contra Costa Health Services.     

How to do it in surgery: laparoscopic rectopexy

Laparoscopically performed rectopexy is now possible, with all the advantages of a minimally invasive technique. It may involve implantation of mesh (Cuesta et al, 1993), suturing (Graf et al, 1995) of the reduced rectum or resection of redundant colon (Baker et al, 1995). Essentially the laparoscopic operation mimics the open procedure.