kboreilly.com :: [Kevin B. O'Reilly]

My lede:

Doctors in Maryland hospitals soon may find themselves the targets of covert surveillance.

That stranger in the corridor reading Newsweek or texting on his iPhone actually may be taking notes on whether physicians and other health care workers wash their hands after leaving patients’ rooms.

In early November, the state launched a safety initiative using $100,000 in American Recovery and Reinvestment Act — popularly known as the federal stimulus package — funds to help hospitals train “secret shoppers” to monitor health workers’ hand hygiene. Forty-five of the state’s 47 acute care hospitals have joined the voluntary initiative.

The Maryland effort is believed to be the first time that government funds are going to train secret observers to keep an eye on doctors. At the same time, Rhode Island health officials have ordered video monitoring of surgeries at one hospital after a rash of wrong-site surgical errors.

The whole shebang.

My lede:

The American Medical Association came out in favor of ending the “don’t ask, don’t tell” law that requires gays in the military to hide their sexual orientation from their physicians and others. Delegates to the AMA Interim Meeting said the policy threatens the physician-patient relationship and compromises the medical care of gay patients in the military.

The military reserves the power to inspect service members’ medical records for combat readiness purposes. So any mention of their sexual orientation could result in discharge under the federal law governing the military’s policy on gays, known as “don’t ask, don’t tell.”

The whole shebang.

And here is a round-up of my other stories from the AMA’s Interim Meeting in Houston.

The Association called for a review of marijuana’s schedule I status; said drivers should keep their hands on wheel; rejected ordering medical residents to sleep; took a pass on requiring doctors to get flu shots; and debated physicians’ role in controlling health care costs.

My lede:

Hospitals that disproportionately care for poor patients are less likely than other hospitals to have adopted health information technology, says a new study. The research finds the digital divide is associated with differences in how well hospitals address racial and ethnic disparities in care and highlights the importance of helping hospitals go electronic.

Researchers surveyed 2,368 hospitals about their use of electronic systems for 24 functions such as physician notes, discharge summaries, test results viewing, order entries and decision support. The hospitals that served the most Medicaid, black and Hispanic patients, according to a Medicare measure known as the disproportionate-share hospital index, had lower rates of adoption than hospitals that served the fewest such patients, said the Health Affairs study published online Oct. 26.

The whole shebang.

My lede:

Concerned about the diversion of controlled substances in nursing homes, hospice care organizations and long-term-care facilities, the U.S. Drug Enforcement Administration no longer is allowing pharmacies to dispense schedule II drugs based on chart orders.

The DEA has taken actions against long-term-care pharmacies in Ohio, Virginia and Wisconsin for violating the Controlled Substances Act. The agency says the federal law requires that, except in emergencies, doctors provide written orders directly to pharmacists. Following an emergency, a written order authorizing the prescription is required within seven days. Pharmacists who fill schedule II orders without a written prescription could face fines or criminal prosecution from the DEA.

The whole shebang.

My lede:

America’s hospital chaplains just got a big nod of approval from the nation’s physicians.

Nine in 10 doctors said they were satisfied or very satisfied with their experiences with chaplains, according to a survey of 1,144 U.S. physicians published in the Oct. 26 Archives of Internal Medicine.

Because of physicians’ leadership roles, their views of chaplains are critical, said George Fitchett, PhD, the study’s lead author and a chaplain at Rush University Medical Center in Chicago.

The whole shebang.

My lede:

After heated controversy last winter over the birth of octuplets conceived through in vitro fertilization, the American Society for Reproductive Medicine in October announced tightened practice guidelines and a willingness to work with policymakers to put teeth into its recommendations.

ASRM did not change its guidance on the number of embryos to transfer based on different patient prognoses. But it asked that doctors who exceed the recommendation transfer only one additional embryo, note the decision in the medical record and caution patients about the risks of multifetal pregnancies. The society said it is rare that patient circumstances will warrant exceeding its guidelines.

The whole shebang.

My lede:

An influential group of medical journal editors in October announced a new, more probing conflict-of-interest disclosure form that it hopes will become the industry standard. The effort comes in response to criticism that medical journals have failed to properly inform their readers about authors’ financial relationships with industry.

The uniform disclosure form, adopted by the International Committee of Medical Journal Editors, asks authors submitting for publication to disclose any payment for the research that generated the article as well as other kinds of industry relationships such as consultancies, honoraria or stock options from the last three years.

The whole shebang.

My lede:

The American Academy of Family Physicians announced in October that it was partnering with Coca-Cola Co., the world’s No.1 soft-drink maker, “to develop consumer education content on beverages and sweeteners.”

The one-year deal is the first in the academy’s new “consumer alliance program” and is in the “strong six figures,” according to AAFP Executive Vice President Douglas E. Henley, MD. Coca-Cola is listed as a partner at the academy’s familydoctor.org Web site. The AAFP said it plans to use the funding from Coke and other consumer-goods companies to beef up the site’s educational offerings.

In the fight against childhood obesity, many medical experts have tabbed sugar-sweetened sodas as a principal culprit, and for that reason some have criticized the AAFP deal.

The whole shebang.

My lede:

The Centers for Medicare & Medicaid Services has estimated that rules that took effect in October 2008 and denied payment for “reasonably preventable” hospital-associated conditions would save the government $21 million and encourage patient safety improvement.

But the savings probably will be much lower, according to a study in the September/October Health Affairs.

The nonpayment rules are likely to cost hospitals about $2.7 million — $368 per facility — raising the question of whether the no-pay policy will achieve Medicare’s cost and safety objectives. Hospitals and physician organizations, including the American Medical Association, have objected to some of the conditions included in the no-pay list, saying prevention is not always possible.

The whole shebang.

My lede:

All adults should be screened for depression, and primary care physicians should do the screening, according to a position statement issued in October by the American College of Preventive Medicine.

With 6.7% of American adults — about 15 million people — experiencing depression in any given year, the prevalence of the disabling and potentially deadly condition makes it imperative that primary care doctors regularly screen their patients, the college’s statement said. The college consists of 2,000 physicians who specialize in preventive medicine practice or research.

Primary care physicians are the principal health care contacts for most patients with mental illnesses, according to the paper, published in the October Journal of Family Practice. More than a third of primary care patients experience some form of depression, and 10% of patients have major depression. But, the college’s position statement said, most depressed patients seeing primary care doctors go undiagnosed.

The whole shebang.

My lede:

Two New England physicians are taking on a state law they argue interferes with their ability to prescribe life-ending doses of medication to terminally ill patients who request it.

Gary Blick, MD, an HIV/AIDS specialist in Norwalk, Conn., and Ronald M. Levine, MD, an internist in Greenwich, Conn., in October filed a legal challenge to the state’s assisted-suicide statute, saying the threat of punishment prevents them from prescribing lethal doses of medication.

Dr. Blick said that since he started practicing in 1987, he has received numerous requests for lethal prescriptions from terminally ill patients with “agonizing pain” and poor quality of life. “I always tell them I can’t do that — I could be tried for manslaughter.”

The whole shebang.

My lede:

GlaxoSmithKline plc, the world’s No. 2 selling drugmaker, said in September it will stop taking continuing medical education grant applications from medical education and communication companies.

The world’s top-selling drugmaker, Pfizer Inc., in July 2008, became the first company to steer its money away from these for-profit CME companies, often called MECCs. Critics argue that commercial CME providers are more likely than nonprofit providers to let bias slip into their offerings.

“A MECC can’t say to a drug company grant, ‘I can take this or leave this,’ whereas a medical center can say that, because they derive income from so many other sources,” said Daniel J. Carlat, MD, a prominent critic of industry support for CME and assistant clinical professor of psychiatry at the Tufts University School of Medicine in Massachusetts. “The incentives to create obviously promotional CME are much greater with MECCs than with other organizations.”

The whole shebang.

My lede:

Sporting a pair of stylish aviator sunglasses as a hip-hop beat swells on the soundtrack, John D. Clarke, MD, seems at home in the rap video for which he won a national contest to find the best flu-prevention public service announcement.

But the first giveaway that the lyrics to this rap will stray far from typical Jay-Z fare is a close-up of Dr. Clarke’s name in script over the pocket on his white coat. Then he dishes out the rhyme: “Hand sanitizer, I advise you get it — why? It makes germs die when you rub and let it dry.”

The minute-long music video also advises patients to seek medical care if they believe they are infected with influenza A(H1N1), stay home when sick, use tissues when sneezing, wash their hands for 20 seconds, and avoid touching the nose, eyes and mouth.

The whole shebang.

The video: