Humanizing anatomy: a medical student’s first patient

My lede:

Most people do not choose their names, but they can choose to love them, loathe them or change them. About a decade ago, one woman was known as Mercedes — like the German luxury car. It was not the name her parents gave her. It was not how she was listed on her death certificate.

Mercedes was the name she was given by a medical student dissecting her cadaver as part of the gross anatomy course at Indiana University School of Medicine Northwest in Gary.

“Why do you call her Mercedes?” asked anatomy instructor Ernest F. Talarico Jr., PhD.

“Because,” the student said, “she’s going to enable me to purchase a bunch of Mercedes.”

For Talarico, the student’s comment was the wake-up call that things needed to change. “That wasn’t what we were trying to communicate or trying to teach,” he said.

The experience of dissecting a cadaver in a lab always has separated the medical profession from the rest of society, but ideas about what — beyond basic anatomy — that rite of passage should teach have evolved.

In the late 19th and early 20th centuries, dissection was seen as a transformative event, and medical students used black humor to defuse tensions surrounding what was then seen as a quasi-legal and ethically questionable activity. In the mid-20th century, anatomy became an opportunity for physicians in training to develop a skill that medical sociologists called “detached concern.”

Today, most medical schools opt for a more humanistic approach that uses ritual ceremonies to thank cadaver donors, encourages students to reflect on their experiences and, in some cases, allows students to meet and correspond with donors’ loved ones.

Read the whole shebang. And see the accompanying slide show.

1 in 3 patients harmed during hospital stay

My lede:

One-third of hospital patients experience adverse events and about 7% are harmed permanently or die as a result, according to a study that detected patient safety problems at a far higher rate than other methods.

The study, in April’s Health Affairs, echoes two reports issued in November 2010 that showed rates of adverse events hovering near 25% among hospitalized Medicare patients nationwide and at 10 North Carolina hospitals.

The findings draw attention to the safety troubles that have lingered in U.S. hospitals in the 12 years since the Institute of Medicine’s headline-grabbing report “To Err is Human.” The study cited research estimating that up to 98,000 patients die each year due to preventable medical errors.

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Walmart’s anti-hunger program

Chicagoans’ irrational hatred of Walmart appears to continue unabated, as evidenced by a zoning hearing held Monday regarding a proposed grocery store in the well-to-do Lakeview neighborhood. Among the many misguided or myopic reasons to oppose the mere opening of a Walmart store, perhaps this one reported by the Chicago Tribune’s Dawn Rhodes counts as the dumbest:

“I don’t want them in this neighborhood, and I wish they would hear us saying no,” said Erin Edwards, 27, who works for North Side Anti-Hunger Network. “I’m all for job creation. But it would be wonderful for the people in this neighborhood to have the small stores that can provide fresh produce and to be able to pay their employees well so they wouldn’t have to need our services.”

Guess what, Ms. Edwards? Walmart is an anti-hunger program. The new Walmart grocery store could save shoppers anywhere from 20% to 33%. Walmart, all by itself, accounted for a 10% drop in U.S. food prices from 1985 to 2004, saving individuals nearly $900 a year and households more than $2,300 a year. And Walmart is slashing prices even further to compete with Target, whose prices are slightly lower in Chicago.

So, those people in low-wage jobs who might occasionally take advantage of whatever food pantry services the North Side Anti-Hunger Network provides will benefit far more from vigorous, open competition for grocery shoppers — including Walmart. How many Chicago families could pass on help from a food pantry with a weekly grocery bill that’s 33% cheaper, or an annual savings of $2,300?

Those savings would dwarf the slightly lower wages (perhaps 2%) offered to the few hundred people who will staff the Walmart. That cost-benefit comparison assumes, by the way, that there are hundreds of higher-wage, entry-level jobs that would somehow magically appear if only Walmart could be prevented from opening its store. Are those small stores that supposedly pay so well hiring hundreds of new workers in our still slumbering economy?

Hate Walmart, if you must. Picket. Try to organize their workers, if you want to press your luck. But rest assured that you’re not doing poor folks any favors by denying them a valuable shopping choice.

Financial ties to industry widespread on clinical guideline panels

My lede:

More than half of the people serving on cardiovascular guideline-writing committees between 2004 and 2008 had financial conflicts, according to a March 28 Archives of Internal Medicine study that sheds new light on the pervasiveness of financial ties to industry among the experts who make the clinical recommendations that shape medical care.

The new data arrived only days after an Institute of Medicine panel proposed wide-reaching standards on how clinical guideline panels should manage and limit conflicts of interest.

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Medical oaths less of a moral compass for physicians

My lede:

Most physicians take part in a medical school oath ceremony, but few believe that the rite of passage has strongly shaped their sense of professionalism, according to an article published March 14 in Archives of Internal Medicine.

Nearly 80% of 1,032 practicing physicians surveyed in 2009 said they took part in a medical school oath ceremony using the original or modified version of the Hippocratic Oath, the Osteopathic Oath, the Prayer of Maimonides or the Declaration of Geneva. However, only 26% said the oath they took significantly influenced their practice of medicine or provided moral guidance in their medical careers.

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51 died under Washington’s assisted-suicide law in 2010

My lede:

Fifty-one patients in Washington died after taking lethal medication prescribed by physicians under the first full year of the state’s aid-in-dying law, according to a state health department report released in March.

Sixty-eight physicians wrote life-ending prescriptions for 87 patients, 51 of whom took the medication and died. As of Feb. 9, 15 died of their illnesses before taking the lethal medication, and another 15 patients were still alive. For the remaining six deaths, it is unclear whether the patients ingested the medication prescribed under the law, the report said.

The physician-assisted suicide total represents a 42% rise from the 36 doctor-aided deaths in 2009, though the law didn’t take effect until March of that year. In Oregon, the only other state with a law authorizing physician-assisted suicide, 65 patients died last year after taking life-ending medication prescribed by their doctors, according to a state report released in January. Oregon has allowed physician-assisted suicide since 1998.

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Universal coverage may not eliminate health disparities

My lede:

The 32 million Americans expected to obtain insurance coverage by 2019 under the Patient Protection and Affordable Care Act are likely to have better access to health care. But if Canada’s experience is any guide, disparities in health outcomes will continue.

Researchers followed 14,800 Canadian patients over 10 years and studied their use of health care services and health outcomes. Although all the patients were insured under Canada’s single-payer health system, health outcomes varied by patients’ income and educational levels, said a study in the February issue of Health Affairs.

“There is evidence out there that giving people who are uninsured some health insurance coverage will reduce disparities,” said David A. Alter, MD, PhD, the study’s lead author. “The word of caution is that will not eliminate disparities.”

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Opioid prescribing requires close monitoring

My lede:

Opioid analgesics help alleviate the symptoms of patients with chronic pain, but they also are vulnerable to abuse. About 14,000 people die annually from opioid overdoses, and the medicines are implicated in more than 300,000 emergency department visits each year, according to estimates from the Centers for Disease Control and Prevention.

To reduce the overdose risk, pain specialists advise that doctors prescribing opioids to patients with chronic pain monitor them closely to ensure that they do not misuse the drugs, especially if the patients have a history of substance abuse. But a study shows that some primary care doctors are not aggressive in pursuing monitoring strategies that could help prevent misuse and diversion.

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1 in 3 surrogate decision-makers carries lasting emotional burden

My lede:

A third of surrogate decision-makers experience stress, guilt and other upsetting emotions related to their role in determining a loved one’s care, according to a March 1 Annals of Internal Medicine systematic review of 40 studies.

The emotional burden on surrogate decision-makers often lasts for months — and sometimes years — after the treatment choice, researchers found. One study cited in the review found that stress levels of surrogates were comparable to those of people who experienced construction disasters or lost their homes to fire.

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ICU central-line infections drop dramatically nationwide

My lede:

American hospital intensive care units cut central line-associated bloodstream infections by about 60% over nearly a decade, saving an estimated 27,000 lives and avoiding up to $1.8 billion in medical costs, said a new report from the Centers for Disease Control and Prevention.

“This is the first national success we have for patient safety in this country,” said Peter J. Pronovost, MD, PhD. He is principal investigator of a bundle of central-line infection prevention techniques that in 2006 demonstrated success statewide in Michigan and has spread to nearly 1,000 hospitals in 43 states.

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Comedic skills for a serious role

My lede:

The game is attacker-defender. Each player spontaneously selects another person in the room to “kill” with a tag. The targeted player selects another person as a “defender,” trying at all times to use that person as a shield against the attacker. When they are killed, players die a loud, dramatic death.

The game — a warm-up exercise for six students learning improvisational skills — quickly elicits a cacophony of shouts and squeals reminiscent of playground days. But all noise and movement stops with an unexpected knock at the door, the way children go mum during a sleepover when Mom checks in to see how things are going.

“Umm, could you kind of keep the noise down a little bit?” says the young woman who knocked. “We’re taking an exam next door.”

Oops.

The place — a medical school — is what makes this improv class unusual. Chicago, birthplace of the famed Second City improv comedy troupe that has served as the training ground for John Belushi, Bill Murray and many others, also is home to what appears be to the country’s only recurring improv class that also is part of a medical school curriculum.

Read the whole shebang. And here is a slide show of the class in action.