One of the hopes embedded in the health law was to expand the role of nurse practitioners and physician assistants in addressing the nation's shortage of primary care providers. But a new study questions whether that's actually happening in doctors' offices. Of the more than 4 million procedures office-based nurse practitioners and physician assistants independently billed more than 5,000 times in a year to Medicare – a list including radiological exams, setting casts and injecting anesthetic agents – more than half were for dermatological surgeries. That's not surprising, according to Ken Miller, president of the American Association of Nurse Practitioners, because when patients are older, skin problems such as "boils, skin tags and warts" are pretty typical.
Most of us who have been hospitalized have never seen physical restraints, as they are rarely used outside the ICU. Examples include wrist and ankle belts, vests, mitts, and full-length side rails attached to the bed. According to Medicare guidelines, restraints should only be used to ensure the safety of patients and staff and should be removed as early as possible. There are only a handful of situations where Medicare and other physician groups recommend using restraints, including patient violence towards himself or others and a threat of a patient disrupting his or her life-saving therapy, such as a breathing tube.
Health care is full of buzzwords. The latest is "engagement." The theory behind it is that all will be well if we can just get people—especially those with chronic diseases—more involved with their illnesses. But what if the opposite is true? Let's do a simple experiment. Imagine you have a chronic disease. Someone approaches you, asking whether you'd like to be more engaged with your diabetes or lupus or Crohn's disease. Whether you actually have one of these conditions or not, you can easily imagine that your answer would be a categorical "no."
The Food and Drug Administration is warning consumers about fake drugs, vaccines and supplements being sold online as treatments to cure or prevent Ebola. The regulatory agency issued an alert Thursday reminding consumers that only the FDA has authority to approve a drug or vaccine, and has not yet approved any products as a treatment for the disease. The warning comes amid a massive outbreak of the Ebola virus, which has killed over a thousand people in West Africa. "Since the outbreak of the Ebola virus in West Africa, the FDA has seen and received consumer complaints about a variety of products claiming to either prevent the Ebola virus or treat the infection," said the agency.
In recent years, standardized patients have played a larger role in the training of health professionals, expanding into fields such as dentistry, pharmacy and physical therapy. "At a minimum, it gives students more confidence" after working with standardized patients, said Karen Lewis, president of the Association of Standardized Patient Educators. "When they walk into an exam room for the first time with a (real) patient, they're not nervous or worried about what to say. They already know that." But the ability of doctors to communicate with patients and be able to elicit the information they need for a proper diagnosis can save lives. "All mistakes, when you really drill down to what caused them, it's a communications problem," Lewis said.
How to protect patients while doctors learn is a conundrum faced in all areas of medicine. For example, studies have shown that surgeons' outcomes improve up to four years after their first hospital appointment. Some have argued that neophyte surgeons during this period should take on only the most straightforward cases. Yet every doctor eventually has to perform a procedure for the first time. It isn't only doctors who face this quandary. Hospitals too have their own learning curves. Medical teams work better together with practice. The first few cases of a new procedure frequently have subpar results.