“One for the Money,” the latest Katherine Heigl vehicle to park itself in the multiplexes, is also the title of a best-selling novel by Janet Evanovich. It is worth stating this fact at the outset to avoid the mistaken but entirely plausible assumption that the phrase somehow made its way onto the lobby posters from the subject line of an e-mail from Ms. Heigl’s agent.

– A.O. Scott, The New York Times

A team-based approach to primary care can help patients with depression and other chronic conditions better achieve their clinical goals, said a study in Annals of Family Medicine’s January/February issue.

More than 200 patients with depression and at least one other chronic condition such as diabetes, hypertension or high cholesterol were studied in a randomized controlled trial. The study was conducted at 14 primary care clinics that are part of the Group Health Cooperative integrated system based in Seattle.

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Physicians, nurses and other health professionals who work in hospitals soon may be getting a one-size-fits-all list of what adverse events they should report to improve patient safety.

That is the principal recommendation of a report released in January by the Dept. of Health and Human Services’ Office of Inspector General. The Agency for Healthcare Research and Quality and the Centers for Medicare & Medicaid Services already have pledged to deliver such a must-report adverse events list.

The OIG’s study found that 86% of harmful inpatient adverse events are not captured by hospitals’ incident-reporting systems, with physicians and other health professionals often choosing not to report the patient harm cases because they did not believe they were supposed to. Health professionals reported only two of the 18 most serious events identified — those that involved permanent disability or death, the study said.

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The goal is to deliver “parsimonious care,” says the American College of Physicians’ updated ethics manual. The college also offers guidance for online behavior.

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The Laser Spine Institute, a Tampa, Fla.-based endoscopic spine ambulatory surgery center with locations in seven cities, has a sophisticated approach to getting out the word about its treatments for back and neck pain. The institute’s website features videos of its physicians talking about the minimally invasive procedures and includes links to their frequent appearances in news media and the institute’s active social media accounts.

Now the institute, like many other health care organizations, is expanding its marketing beyond the public and aiming at physicians in the community who might send them new patients. To help in the effort, the 25-doctor group is looking to hire four new representatives — called physician liaisons or physician relations associates — who have at least five years’ experience as drug or device-company detailers. The new hires will visit doctors in their offices and discuss how the institute’s services could benefit their patients.

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The Joint Commission has issued a sentinel-event alert saying drowsy health professionals are likelier to be involved in adverse events than their well-rested counterparts. The commission advised the more than 6,500 hospitals and other health care organizations it accredits to take steps to mitigate the risks of such fatigue.

The December 2011 action comes amid more pushback against the Accreditation Council for Graduate Medical Education’s resident work-hour restrictions, with research published in December 2011 linking the limitations with more complications among neurosurgery patients.

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The past decade saw high-profile private and publicly funded initiatives targeted at the patient safety hazards affecting inpatients, including hospital-associated infections and wrong-site surgeries. Now experts are calling for a similar effort focused on the dangers that afflict outpatients.

In 2000, the Agency for Healthcare Research and Quality set an ambulatory care research agenda to help fill the gap. But the subsequent 10 years amounted to a “lost decade” as outpatient safety research and initiatives took a back seat to problems in hospitals, say the patient safety experts who produced a December 2011 report reviewing about 100 outpatient safety studies from 2000 to 2010.

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… Their largest achievement is today’s redistributionist government. But such government is inherently regressive: It tends to distribute power and money to the strong, including itself.

Government becomes big by having big ambitions for supplanting markets as society’s primary allocator of wealth and opportunity. Therefore it becomes a magnet for factions muscular enough, in money or numbers or both, to bend government to their advantage.

– George F. Will, “Government: The redistributionist behemoth“

Most hospitals say the Centers for Medicare & Medicaid Services’ no-pay policy for hospital-acquired conditions has pushed them to make greater efforts to prevent health care-associated infections. But a study says preventing one item on the no-pay policy has gotten less of a push: catheter-associated urinary tract infections.

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Back in 2007, when Barack Obama was running for president, a mildly surprising bit of news emerged: He and Dick Cheney were eighth cousins. Today, though, it appears that report was wrong. Judging from Obama’s record in office, the two are practically brothers.

– Steve Chapman, “Czar Barack.”

Kansas City, Mo. – Thirty years after the disaster, Joseph F. Waeckerle, MD, still prays that he made the right calls.

The 1981 collapse of the interior skywalk system in the Hyatt Regency in Kansas City killed 114 people and injured 216 under the crushing weight of concrete and steel. Dr. Waeckerle directed the rescue effort and decided with just a few moments’ review who could be rescued and who could be offered only a morphine drip and advised to make peace with God.

Dr. Waeckerle and others at the scene had to determine how to save the most lives and limbs with little assurance that their judgments would be well-regarded in the aftermath.

A medical disaster is when the need for care outstrips the available resources — medicines, equipment, personnel. Such a chasm between demand and supply stretches far beyond a hectic day in the emergency department and requires a shift in ethical thinking because not every patient can get the care he or she would be entitled to under normal circumstances.

Which patients get the highest priority? What obligation do physicians have to respond to patient need in disasters? What should physicians do to prepare?

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Physicians are accustomed to dealing with interruptions of all kinds — nurses with questions, phone calls from the pharmacy, incoming test results. With recent surveys showing that more than 80% of doctors carry smartphones and about a third use iPads or other tablet computers, some doctors are raising concerns about the capacity of these always-with-you devices to cause new distractions that could hurt patients.

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Even as physicians face increasing pressure to perform well on measures of patient satisfaction, they may take some comfort in knowing that most patients rate their own doctors very highly.

The average physician rating is 9.3 out of 10, according to a study based on nearly 15,000 patient online ratings between 2004 to 2010. The analysis is based on data from DrScore.com, an online rating site started by a physician. Sites such as Yelp.com may highlight venomous comments from some unhappy patients and paint a misleading portrait of overall patient satisfaction, said Rajesh Balkrishnan, PhD, lead author of the study.

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