Archive for the ‘doctors’ Category

Government Health Care Often Means Waiting Lines, Rationed “Care”

March 11, 2009

In Canada, Britain and Europe, government health care often means long waiting lines and rationed treatment and care.

Here’s today’s example:

by Rebecca Smith, Medical Editor
Telegraph (UK)

Patients face a significant increase in waiting times for operations as ‘insane’ European rules mean doctors’ hours are cut so much medics will not be able to cope, surgeons have warned.
The key pledge of Labour’s NHS reform has been to reduce waiting lists and now the majority of patients are treated within the target of 18 weeks from seeing their GP.

However this will be reversed as junior doctors will be limited to working a 48-hour week, from their current 56 hours, it is claimed.
The extension of the European Working Time Directive will effectively result in the loss of thousands of doctor shifts, John Black, President of the Royal College of Surgeons said.

And the Government fears there will be a lack of locum doctors available to step in and help fill the gaps, following changes in doctors’ recruitment.

It means patients will have to wait months for routine operations as surgeons prioritise emergencies rather than scheduled cases.

The Royal College of Surgeons wants trainee surgeons on a 65-hour working week in order to produce safe, properly trained doctors and cover the workload required by hospitals.

Mr Black said: “If the 48 hour limit is enforced, surgeons will have to make a hard choice between caring for emergency cases and dealing with elective cases as there will not be the time available to do both. Surgeons will put patient safety first and focus on looking after emergency patients.

“All the progress on reducing waiting lists will go out of the window. Forty eight hours for surgeons is currently insane if we want maintain surgery in the NHS.”

Doctors have calculated an average hospital trust outside London will lose the equivalent of three trainee surgeons and other specialities such as paediatrics, trauma, and intensive care are likely to be similarly affected.

Smaller surgical units may have to shut or be merged in order to comply with the Directive, Shadow Health Secretary Andrew Lansley warned.

It is understood the Department of Health is considering increasing the length of time it takes to qualify as a consultant surgeon from seven years to eight or nine so doctors can gain enough experience and also comply with the limited working week.

Vanessa Bourne of the Patients Association said: “How can this be happening in a supposedly patient-centred service? Access to high quality safe care is the paramount requisite for patient and clinician alike and this muddle needs sorting out before patients are put at risk.”

The new regulations come into force on August 1 at the same time hospital trusts are trying to cope with organising the new intake of junior doctors.

The shake-up of doctors’ training, which caused a fiasco in 2007, means more trainees are in longer-term posts so there are now fewer candidates looking for locum posts and temporary jobs.

Read the rest:
http://www.telegraph.co.uk/news/newstopics/pol
itics/4975055/Hospital-waiting-lists-will-soar-du
e-to-European-laws-surgeons-warn.html

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In the U.S., Some 50,000 applicants to nursing schools were turned away last year because there weren’t enough spots, even as a nursing shortage leaves hundreds of thousands of jobs vacant and threatens the quality of care in hospitals and nursing homes, Reuters reports. The federal stimulus package contains some $500 million to address health staffing shortages, of which about $100 million will go to address the nursing shortfall.

Health Care: Computerized Records Just Won’t Lead to Better “Care” or Cost Savings

March 5, 2009

If the cheerleaders – including the one in the Oval Office – are right, computerized medical records will save us all: save jobs, save money, reduce errors, and transform health care as we know it. In a January speech, President Obama evoked the promise of new technology: This will cut waste, eliminate red tape and reduce the need to repeat expensive medical tests,” he said, and he has proposed investing $50 billion over the next five years to help make it happen.

By Scot Haig
Time Magazine

 

Any doctor will tell you the advantages of having lots of patient data on computers: it helps us avoid redundant tests, gather huge amounts of data for research, screen automatically for drug interactions, all with no problems with our famously illegible handwriting. I would be happy if every patient could hand me a digital file of everything about him; it could really save time on first visits. But against our government’s push to get all patients’ records computerized we must keep in mind there will be a cost to this – far beyond the billions to be spent setting it up. Many of us in medicine are concerned that the greatest cost will be in the quality of medicine that we practice. (Read “The Year in Medicine 2008: From A to Z”)

 

American doctors have not been enemies of the digital revolution. Looking up lab results and x-rays on our computer screens beat out carbon copies and sheet film in an instant. We like e-mail; we shop, take tests and read our journals on line. But the romance, for most of us, began to sour with Computerized Physician Order Entry [CPOE]: entering patients’ hospital orders on the computer. This is when we first confronted the downside to uploading our every medical judgment.

 

The majority of us are forced to use computerized orders or risk losing our hospital privileges. But most of us have found that CPOE is a lot harder than writing out orders on paper, takes far more time and in too many ways is just not as good. We’re never quite sure that what we’ve typed is going to be seen by a real, live, analog nurse, that it isn’t just going to disappear. (It does.) We can’t order certain things with those buttons and pull-down menus that we could in writing – things like “patient may wear her own flannel nightgown and underwear” or “please, please get the x-ray I ordered for yesterday”, or “prop up patient’s legs with pillows like this” followed by a little stick-figure drawing. (See pictures from an X-Ray studio.)

Read the rest:
http://news.yahoo.com/s/time/200903
05/hl_time/08599188300200

Stimulus Makes Sure Feds Watch Your Doctor’s Medical Solutions For You

February 10, 2009

Republican Senators are questioning whether President Barack Obama’s stimulus bill contains the right mix of tax breaks and cash infusions to jump-start the economy.

Commentary by Betsy McCaughey
Bloomberg

Tragically, no one from either party is objecting to the health provisions slipped in without discussion. These provisions reflect the handiwork of Tom Daschle, until recently the nominee to head the Health and Human Services Department.

Senators should read these provisions and vote against them because they are dangerous to your health. (Page numbers refer to H.R. 1 EH, pdf version).

The bill’s health rules will affect “every individual in the United States” (445, 454, 479). Your medical treatments will be tracked electronically by a federal system. Having electronic medical records at your fingertips, easily transferred to a hospital, is beneficial. It will help avoid duplicate tests and errors.

But the bill goes further. One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (442, 446). These provisions in the stimulus bill are virtually….

Read the rest:
http://www.bloomberg.com/apps/news?pid=2060
1039&refer=columnist_mccaughey&sid=aLzfDxfbwhzs

Change: Obama Promised More Health Care Funding; But We Need Less

January 12, 2009

Will Obama be so bold? In the campaign, he proposed more, not less, health spending. It’s easier to embrace the rhetoric of change than change itself.

By Robert J.  Samuelson
The Washington Post

Barack Obama talked somberly last week about getting the federal budget under control once the present economic crisis has passed. To do that, he’ll have to confront the rapid growth of health spending, which in 2007 was already a quarter of total federal spending of $2.7 trillion. If Obama is serious, he should read a fascinating study from the McKinsey Global Institute, the research arm of the famed consulting company.

Read the rest:
http://www.washingtonpost.com/wp-dyn/conten
t/article/2009/01/11/AR2009011101895.htm
l?hpid=opinionsbox1

Dear President-elect Obama: America’s Healthcare Nightmare — 90% Failure Rate Sector

December 18, 2008

American healthcare has a secret few want to face; conditions “worse than Federal prison” in some cases.

American nursing homes and healthcare for the elderly dehumanizes, degrades, demeans and even harms the people that paid for middle-class and middle-aged Americans and their many luxuries.

After visiting a friend in a nursing home yesterday, my companion said, “That place is worse than Federal prison.” 

My friends are “retired convicts,” as one said.  He told me he’d rather be on death row than in the nursing home facility we visited yesterday.

Our friend in the nursing home wasn’t sure he was getting the proper medications, hadn’t had a bath or shower in weeks and a human waste bucket that had been next to his bed for days stood close to his cold breakfast.

And he’s one of the lucky ones.

More than 90 percent of  nursing homes were cited for violations of federal health and safety standards last year, and for-profit homes were more likely to have problems than other types of nursing homes, federal investigators say in a report issued last September.

The report last September by Daniel R. Levinson, the inspector general of the Department of Health and Human Services said 17 percent of nursing homes had deficiencies that caused “actual harm or immediate jeopardy” to patients.

The veterans of  World War II, for example, the people Tom Brokaw called the  “Greatest Generation,” sometimes live out their last days of their lives in their own filth — and in facilities paid for mainly by your tax dollars and your insurance companies.


Tom Brokaw by David Shankbone

The poorer you are in America the more likely you are to become  neglected, unwashed and uncared-for as an older prerson put away in a nursing home.

You can bet Tom Brokaw won’t end up living in aged squalor.

We’ve visited hundreds of nursing homes over the past year.  Some good.  Some bad.  Some deplorable.

But our overarching impression is this: while you are making money and lots of it, America loves you.  After your energy and money runs out you’ll be treated like an African refugee from Darfur.

There is now a move to rate nursing homes nation-wide.  We support this effert.

The nursing home “industry” is opposed to ratings and angry.

The system “is poorly planned, prematurely implemented and hamhandedly rolled out,” said Larry Minnix, president and chief executive officer of the American Association of Homes and Services for the Aging, an industry trade group.

If you’ve been in a below average nursing home lately, you’ll likely support the new rating system — any new rating system.

Related:
Nursing home industry worries about new ratings

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90% Of Nursing Homes Cited For Poor Care, Violations; 17% Do Harm

By Robert Pear
The New York Times

More than 90 percent of nursing homes were cited for violations of federal health and safety standards last year, and for-profit homes were more likely to have problems than other types of nursing homes, federal investigators say in a report issued on Monday.
.
About 17 percent of nursing homes had deficiencies that caused “actual harm or immediate jeopardy” to patients, said the report, by Daniel R. Levinson, the inspector general of the Department of Health and Human Services.

Problems included infected bedsores, medication mix-ups, poor nutrition, and abuse and neglect of patients.

Inspectors received 37,150 complaints about conditions in nursing homes last year, and they substantiated 39 percent of them, the report said. About one-fifth of the complaints verified by federal and state authorities involved the abuse or neglect of patients.

About two-thirds of nursing homes are owned by for-profit companies, while 27 percent are owned by nonprofit organizations and 6 percent by government entities, the report said.

The inspector general said 94 percent of for-profit nursing homes were cited for deficiencies last year, compared with 88 percent of nonprofit homes and 91 percent of government homes.

Read the rest:
http://www.nytimes.com/2008/09/30/us/30nursing.html?_r=1&a
dxnnl=1&referer=sphere_related_content&partner=rss&emc=r
ss&adxnnlx=1229594626-bUq4AQL/mqsIcfbvqCGZwQ

Nursing home industry worries about new ratings

December 18, 2008

Rating systems help people decide which restaurants to go to or hotels to stay at. So why not something similar from the federal government for the nation’s 16,000 nursing homes?

Such a simple rating for so complex a task as caring for the elderly is leading to much anxiety in the nursing home industry. Home operators worry about the ramifications for their business if they get one or two stars — when five is the best.

The Centers for Medicare and Medicaid Services was to let everyone know Thursday just how many stars each home is getting. Already the industry is questioning the validity of the rankings. To operators, the five-star system a great idea whose time has not yet come.

The system “is poorly planned, prematurely implemented and hamhandedly rolled out,” said Larry Minnix, president and chief executive officer of the American Association of Homes and Services for the Aging, an industry trade group.

Federal officials say the rankings will put nursing homes “on the path to improvement” because they know family members will think twice before putting someone in a one-star home.

The ratings are based on state inspections, staffing levels and quality measures, such as the percentage of residents with pressure sores. The nursing homes will receive stars for each of those categories as well as for their overall quality.

By KEVIN FREKING, Associated Press Writer

Gareth O'Connor holds his friend's dog 'Spanky' ...
In many places, pet care is better than a nursing home.  Gareth O’Connor holds his friend’s dog ‘Spanky’ as he sits in his pet ambulance in Sydney. Australian duo Niccole George and Gareth O’Connor have established a 24-hour ambulance service just for pets, to help desperate animal owners unable to transport their sick animals to medical help.(AFP/File/Greg Wood)

Consumer groups like the concept, but they agreed there are some potential problems with the data. For example, the staffing data is self-reported just before state surveys and is widely recognized as unreliable.

“From a consumer viewpoint, it’s not stringent enough,” said Alice H. Hedt, executive director of the National Citizens’ Coalition for Nursing Home Reform. “It’s basically taking information already available on Medicare’s Nursing Home Compare Web site and pulling it into an easier system for consumers to use, and that is a good thing.”

Hedt said consumers should consider the star ratings, but not solely rely on them when comparing facilities. Her organization also issued a press release warning that nursing homes may appear in the ratings to give better care than they actually do.

“Our initial reaction is that consumers should probably avoid any facility with a one- or two-star rating and even a three-star rating unless people they trust convince them that the rating is inaccurate or unfair,” she said.

But, in Indiana, eight nonprofit nursing homes have reported they got one star for staffing even though they have some of the highest staffing levels in the states, said Jim Leich, president and chief executive officer of the Indiana Association of Homes for the Aging. He believes the one-star rating is the result of a records glitch particular to any nursing home that is part of a campus that includes housing for residents with less intensive care needs.

Read the rest:
http://news.yahoo.com/s/ap/20081218/ap_
on_go_ot/rating_nursing_homes

Health clinics overwhelmed by cholera cases in Zimbabwe

December 10, 2008

In Zimbabwe, a cholera epidemic is claiming hundreds of lives.  The medical system has totally broken down.  Western aid agencies have arrived in force after the Mugabe regime reluctantly appealed for international help last week. They are flying in medics, medicines and equipment.

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The room suddenly fell silent. The local health official momentarily stopped his briefing of aid workers visiting the cholera treatment centre in Chitungwiza, a township 20 miles from Harare.

Right outside the open window four labourers in latex gloves were loading a rigid corpse, trussed up in black plastic sheeting, on to a pick-up truck that had come to take it away for burial.

It was a sight that reinforced the message of the official dramatically. Here in Chitungwiza, as in many other communities across Zimbabwe, the cholera epidemic is overwhelming the skeletal remains of social services.

The corpses of two other victims lay wrapped in blankets in the makeshift mortuary of the centre, which is in the former maternity unit of the clinic. Their deaths raised the total in this wretched, densely populated township to more than 80.

By Martin Fletcher
The Times (UK)

A baby drinks water from her mother's hand in Harare, Zimbabwe ... 
A baby drinks water from her mother’s hand in Harare, Zimbabwe Monday, Dec. 8, 2008. European Union nations moved to tighten sanctions against Zimbabwe’s government on Monday and stood united in calling for the country’s authoritarian leader Robert Mugabe to ‘step down.’ The move was to protest the deteriorating humanitarian situation in Zimbabwe, where a cholera outbreak is claiming thousands of live due to poor state of health care there. .(AP Photo/Tsvangirayi Mukwazhi)

Read the rest:
http://www.timesonline.co.uk/tol/news/w
orld/africa/article5315386.ece