Despite pleas from the White House, some Democratic activists are gearing up for a renewed onslaught against ... Democrats. Democracy for America, the liberal grassroots political action committee founded by Howard Dean, the former chairman of the Democratic National Committee and governor of Vermont, is appealing for money to continue its campaign against what it calls "Insurance Industry Democrats." They include Senators Blanche Lincoln of Arkansas and Ben Nelson of Nebraska. The two joined a party-line vote Saturday to allow the Senate to begin debating healthcare legislation. But they have vowed to oppose one of its key elements—the creation of a government-run insurance plan, known as a public option, to compete with private insurers.
If the Senate were going to write a new rule for Medicare payments meant to slow the growth of medical costs, you might think that the rule would apply to hospitals and doctors. A fair amount of medical care is, after all, provided by hospitals and doctors. But the Senate's health reform bill exempts hospitals from just such a rule until 2019. Doctors, meanwhile, are likely to be effectively exempt, the Congressional Budget Office says. And come 2019, a separate part of the rule will change, making the entire thing mostly moot. This odd situation is just one of the opportunities that awaits those senators who don't yet seem to have a firm position on health reform.
In the campaign to broaden support for the overhaul of American healthcare, few arguments have packed as much rhetorical punch as the there-but-for-the-grace-of-God notion that average families, through no fault of their own, are going bankrupt because of medical debt. The health reform legislation moving through Congress would attack the problem in numerous ways.
Canadian doctors have been advised not to use a batch of 170,000 doses of swine flu vaccine while authorities investigate reports of allergic reactions among recipients, drug maker GlaxoSmithKline PLC said Tuesday. Authorities routinely monitor vaccines for any signals of problems, such as the allergic reactions that do occur, rarely, every year. Company spokeswoman Gwenan White said that GlaxoSmithKline advised medical staff in Canada last week to refrain from using one batch of the vaccine while they look into reports that that it might have caused more allergic reactions than normal. GlaxoSmithKline, the world's second largest drug maker by revenue, is only investigating the one batch of its swine flu vaccine in Canada. White said no other doses of its swine flu vaccine around the world are affected.
Nearly 9% of nearly 8,000 surveyed members of the American College of Surgeons said they'd made a major medical error in the last three months, and one-third attributed the mistake to a "lapse in judgment," rather than a system failure.
Reporting those errors was strongly associated with burnout and depression manifested by emotional exhaustion, depersonalization, and decline in a sense of personal accomplishment.
Those are the results from the latest in a series of reports on the mental health of America's surgeons from Charles M. Balch, MD, colleagues at Johns Hopkins University, and others at the Mayo Clinic and the Winchester Surgical Clinic. It was published yesterday in the online version of the Annals of Surgery.
"People have talked about fatigue and long working hours, but our results indicate that the dominant contributors to self-reported medical errors are burnout and depression," said Balch, a professor of surgery. "All of us need to take this into account to a greater degree than in the past. Frankly burnout and depression hadn't been on everybody's radar screen."
The study found that 40% of the surgeons who responded to the survey said they were burned out.
The authors said the findings are important because, while surgeons don't make more errors than physicians in other disciplines, "errors made by surgeons may have more severe consequences for patients due to the interventional nature of surgical practice."
"For example, reporting a major medical error in the last three months was associated with a 7-point increase ... in emotional exhaustion on the MBI (Maslach Burnout Inventory questionnaire) and roughly a doubling in the risk of screening positive for depression," the authors wrote.
The mean age of those reporting medical errors was three years younger than those who did not report errors (49 versus 52). Surgeons who worked an average of 4.6 more hours a week were more likely to report a recent medical error (63.5 hours versus 58.9) and spent an additional hour per week in the operating room. They also had slightly more nights on call per week.
General surgeons were more likely to report errors than obstetrician gynecologists, plastic surgeons, and otolaryngologists.
The report said the rate of reporting perceived mistakes seemed linked to career satisfaction. "Surgeons reporting recent errors were less likely to report they would become a physician or a surgeon again and were also less likely to recommend their children pursue a career as a physician or surgeon."
Surgeons reporting a medical error were also associated with higher levels of burnout. "Each 1-point increase in depersonalization was associated with an 11% increase in the likelihood of reporting an error while each 1-point increase in emotional exhaustion was associated with a 5% increase," according to the report.
"The most important thing for those of us who work with other surgeons who do not appear well is to address it with them so that they can get the help they need," said Julie A. Freischlag, MD, chair of the Department of Surgery at Johns Hopkins and one of the study's authors.
In August, the same group of researchers led by Balch reported in Annals of Surgery that burnout is common among American surgeons and is the single greatest predictor of surgeons' satisfaction with career and specialty choice.
With Los Angeles County supervisors expected to sign off next week on plans to partner with the University of California to reopen the Martin Luther King Jr. medical facility, the hard work—creating a new hospital from the ashes of the old by 2013—begins. In many respects, the partnership with UC would wipe the slate clean, creating a nonprofit company overseen by a seven-member board of directors who would decide how to run the facility and whom to hire—a key issue to critics who cite the county's poor history of dealing with problematic employees at the Willowbrook hospital. County supervisors closed King to all but outpatient care after the facility failed a make-or-break inspection that meant the loss of $200 million in federal funds. The final failure came after repeated findings that inadequate care had led to patient injuries and deaths.