Some medical items from the past few weeks:
1) Dr. Charles Vega has published the article, “The Satisfied Patient: Overprescribed and Costly” in the on-line journal Medscape Family Medicine. A study found that patients who go to doctors requesting specific remedies or tests are much more likely to get them, whether beneficial or not.
One quoted study showed that patients who requested specific brands of pills were 17 times more likely to get them, even though the doctors reported they would not prescribe the drugs to other similar patients. Another study used “sham” patients visiting doctors’ offices with a combination of depression or dysphoria and mild physical complaints. Requests for drugs not only led to significantly more prescriptions, but over half were prescribed for inappropriate reasons.
On the plus side, the study showed that what patients desire most is more information about their condition, and are most satisfied when their situation is approached with an appreciation of their perspective, regardless of whether they leave with a new pill or diagnostic test.
2) A study from the April issue of Journal of the American Geriatrics Society looked at daily medication use among people with advanced dementia living in 22 Boston-area nursing homes. On average, this group received 6 different daily medications and 37.5% received at least one medication deemed “never appropriate” for use in this condition. Also, 28% were on daily antipsychotic drugs. (This is no slap on Boston – I am sure that remarkably similar stats can be found in Anytown, USA.)
3) Finally, another Medscape article reports that more medical groups and a few insurers are starting to move toward binding arbitration as a way to manage malpractice claims. This is favored as being more cost-effective and fairer with regard to verdicts and awards than jury trials. Some group practices have moved to this type of program, though there are ethical and legal challenges involved with asking their patients to agree to be part of this process.
One argument leveled against binding arbitration is that the relative ease of the process (compared with court trials) may actually encourage litigation. I don’t buy this. I think that a process that makes malpractice litigation fair and cost-effective can only improve the situation in the long run.