EPM presents a weekly rundown of critical reads from around the web, along with commentary by EPM senior editors. This week, we look at stories from the New York Times Well blog, Kaiser Health News, and the CBC about the learning curve for doctors, wide variations in hospital charges for blood tests, and the ALS Ice Bucket Challenge.
PRACTICE MAKES PERFECT?
Original article: NYT Well: Practicing on Patients
Nick Genes, MD, PhD: I thought this piece was excellent. Not only did it realistically portray the challenges of training new doctors, but it also addressed the broader issue about certifying small facilities for advanced procedures when the bigger institutions will probably always do it better (and aren't all that far away).
The comments, however, gave me pause. The white lie that the supervising physician told the patient, about the junior doc having done the procedure "many times," was regarded as a profound ethical violation by the readers. Almost nothing else in the piece mattered to them.
William Sullivan, MD: This concept becomes a slippery slope. How much training is or should be necessary before one is considered proficient in performing a procedure? I recall in my internship when laparoscopic surgery started to become popular. One of the senior residents went to a course for three days and then came back and began teaching the attending physicians how to perform some of the procedures. By creating "regional" centers, we may improve the outcomes at those centers, but what happens as more and more specialists leave rural and even suburban areas to practice at the regional centers? I can see such regionalization for complex and rarely performed procedures, but where should we draw the line at which procedures to regionalize? We're starting to see adverse outcomes due to lack of access of nearby trauma centers and emergency departments. Is lack of nearby specialty procedures going to be the next crisis? One other point is that in one of the rural hospitals where I work, many patients do not want to be transferred to the regional referral center that is 90 minutes away. They'd prefer to be in the local hospital closer to their families.
Original article: KHN: Wide Variation in Hospital Charges for Blood Tests Called 'Irrational'
William Sullivan, MD: I've been beating this drum for years. Pricing for all medical testing should be publicly disclosed as a matter of law. People research prices for a pound of ground beef and drive across town to save 20 cents per pound. Public disclosure of grocery prices forces competition between different grocery stores. The same free market principles would apply to hospitals. How many patients would go to a hospital that charged $10,169 for a cholesterol test when you could get the same test for $10 down the street? Want to change disclosure practices quickly? Create a law stating that if the price for common testing or procedures isn't disclosed to patients in advance in plain English, the patient doesn't have to pay for it. Problem solved.
Nick Genes, MD, PhD: So glad this is getting press. Everyone needs to hear just how 'irrational' and frankly, made-up, these hospital charges are. Last year's piece in Time by Brill about the secretive Chargemaster employed by hospitals really opened my eyes, and we'll need a steady drumbeat of stories like this before we can hope for any sort of change.
I remember from my history class that the federal government once required railroads implement reasonable pricing - short trips had to cost less than long trips, for instance. With all the regulation already in place in US hospitals, I'm surprised there's nothing against charging thousands of dollars for a test that's offered for $10 down the street. Maybe if some commonsense rules like that had been enforced, years ago, we wouldn't need so much more, today.
FREEZING FOR FUNDRAISING
Original article: CBC: Winnipeggers get chilled with ALS ice bucket challenge
Nick Genes, MD, PhD: I think we'll look back at the ice bucket challenge as a ... watershed ... moment in fundraising. Sure, social media had a hand in earlier fundraising efforts but this ALS fundraiser wouldn't have been possible without smartphones and the web. Folks like that Vice reporter who are saying this is "narcissism masked as altruism" need to dunk their heads in water (anyone else remember when Vice was fun?) More people are talking about ALS than ever, and millions have been raised. Just wondering what the next combo will be - a celebrity kickstarter for a cream pie in the face?
William Sullivan, MD: The person who came up with this idea is a genius. All of my kids have asked me about ALS, what it means, and what it does. What a great way to raise awareness of this terrible disease.