Outpatient physician practices can play a key part in ensuring that patients have safe transitions in care and avoid preventable hospital readmissions, according to an American Medical Association report released in February.

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Achieving superior clinical outcomes often depends less on physicians making the right diagnosis and recommending the correct treatment and more on their patients’ willingness to take the necessary steps to maintain or improve their health.

Heart disease, cancer, stroke and diabetes together kill more than 1 million Americans each year, according to the Centers for Disease Control and Prevention. And it is patient choices — to give up smoking, shed pounds, exercise and faithfully take prescribed medications — that are essential to making a meaningful dent in that deadly toll.

But despite their best attempts to educate, inform, cajole or bargain with patients, physicians often find themselves tossing up their hands in despair at patients’ failure to change their harmful health habits. “It’s a source of great frustration,” says Yul Ejnes, MD, a general internist in private practice in Cranston, R.I.

Doctors have long hoped that developing a rapport with patients would help their messages finally sink in and prompt change. Now a growing body of evidence suggests that alternative ways of communicating with patients — ones that involve fewer instructions and more questions — can help physicians motivate at-risk patients to make smarter choices regarding their health.

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The gift restrictions adopted in medical schools and residency programs are linked to less prescribing of brand-name drugs, said two recently published studies that appear to be the first attempts to gauge the clinical practice impact of efforts within medicine to rein in pharma’s influence.

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Patients understand that sometimes physicians need help in making a diagnosis, but more evidence suggests that they are less comfortable when that advice comes from a computer.

Previous research has found that the use of clinical decision support seems to turn off patients, who grade doctors seeking such computer assistance about 10% lower than physicians who make a diagnosis without electronic aid. Findings published in January demonstrate that it is not merely doctors’ asking for outside help that it is troublesome, but something about the computer interaction that is turning them off. The results are especially surprising, because the research was conducted among college-age students who grew up with technology.

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During the winter holidays, a patient at Yale-New Haven Hospital in Connecticut had a large pressure ulcer with an abscess. A surgical intern made a note in the patient’s electronic health record that said, “Patient needs drainage, may need OR.”

The problem? The same note appeared for several consecutive days, even after a surgical team successfully drained the abscess. The intern had copied and pasted the previous day’s note, but failed to appropriately update it to reflect the fact that the drainage was done. The note confused the consulting infectious disease team and nearly led to an unneeded change in the patient’s antibiotic regimen.

General internist Leora Horwitz, MD, was serving as attending physician and clarified the electronic record.

“I knew [the note] was rubbish,” she said.

The practice of carelessly copying and pasting previous information, often dubbed “sloppy and paste,” is on the decline at Yale-New Haven Hospital but is widespread across medicine and can lead to mix-ups that sometimes harm patients, research shows.

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More evidence is emerging to show that tamper-resistant formulations of extended-release analgesic opioids are improving public health by discouraging abuse.

The results should provide some reassurance to physicians concerned about the potential misuse of opioids by their patients, say doctors who specialize in pain treatment and addiction medicine.

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The American Medical Association will award $10 million in grants over five years to a group of medical schools to engage in a broad range of teaching innovations.

They would include new ways of teaching and assessing core competencies, individualized learning plans, and a greater focus on patient safety, quality improvement and health care financing.

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Two studies published in January highlight the challenges blacks face in accessing equitable, quality health care.

In one study, primary care physicians found to have unconscious bias against blacks received lower marks from their African-American patients on measures of trust and communication skills. Another study found that racial segregation exacerbates disparities in lung cancer mortality.

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Patients who give their physicians low grades are likelier to have lapses in drug adherence, said a study of nearly 10,000 Northern California patients with diabetes.

Thirty-nine percent of patients who said they never or only sometimes have confidence in their primary care physicians skipped their cardiometabolic medicines at least 20% of the time, the study said. That is a nonadherence rate 11 percentage points higher than for patients who said they usually or always trust their doctors.

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About 80 times each week, U.S. patients undergoing surgery experience mistakes that safety advocates say never should happen.

The types of errors being made: Surgical instruments such as sponges are unintentionally left behind in the patient; a wrong procedure is performed; a wrong surgical site is operated upon; and surgery is done on the wrong patient altogether.

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Hospitals are reporting more patient safety problems related to electronic health records, yet it appears that only a fraction of the mix-ups are leading to patient harm, according to a recent study of more than 3,000 incidents in Pennsylvania.

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At a Rush University Medical Center continuing education course in Chicago last fall, a room of more than 80 physicians and other health professionals did something they rarely do during days packed with rushed patient encounters and consultations with colleagues — they sat together in silence for a solid 35 minutes.

In neat rows of chairs, the doctors, nurses, social workers, psychologists and other health professionals sat straight-backed with their hands on their knees and their eyes open, gazing into the middle distance. Throats were cleared, coughs pierced the stillness, and an elevated train rumbled just outside the conference room’s picture windows.

“The effort in this practice is remembering to come back — back to your posture, back to your breathing, over and over again,” said Mitchell M. Levy, MD. He led the exercise, known as mindfulness meditation, with a quiet yet commanding tone of voice.

“Whatever thought or feeling arises, just bring it here,” he said. “Let it be here in this space.”

This sort of meditative exercise is only one element of what Dr. Levy and the course participants covered during two days in October 2012, and the well-attended course is just one sign of the rising interest among physicians, medical schools and hospitals in using mindfulness practices to help alleviate doctors’ stress and reconnect them with their patients and their calling in medicine.

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When the employer-backed Leapfrog Group handed out grades of A, B or C on patient safety to individual hospitals in June, 5% of hospitals scored low enough to receive D’s or F’s but were marked as “grade pending.” The hospitals had better shape up by the end of the year, Leapfrog said, or they will get a D or F.

Now the group has kept its promise, handing out the low marks to 146 U.S. hospitals, including highly regarded facilities such as Cleveland Clinic and the Ronald Reagan UCLA Medical Center in Los Angeles.

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