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The American Psychiatric Assn. has appointed a work group to identify the industry money it receives, what the funds pay for and whether to go without them. The Ad Hoc Workgroup on Adapting to Changes in Pharmaceutical Revenue was appointed last spring and is set to report to the APA’s board of trustees in October.

The move comes on the heels of intense news media and congressional scrutiny of potential conflicts of interest posed by drug- and device-makers’ support of clinical researchers, medical education programs and practicing physicians.

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One physician had the social skills of a 2-year-old, said a nurse in an anonymous survey on disruptive behavior published last year. A cardiologist was upset by phone calls and told a nurse it was not her job to think, just follow orders — a squabble that delayed treatment for a patient with a heart attack. On the other hand, a doctor complained about an increasing lack of respect from nurses who frequently challenged or flatly disobeyed clinician orders.

The Joint Commission is calling on hospitals to crack down on “disruptive” health care professionals, over concerns that such behavior impacts patient care. A new commission standard taking effect in January 2009 will require hospital administrators to adopt codes defining disruptive behavior and develop procedures to discipline medical staff and other health professionals who behave badly.

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In March, a patient at Park Nicollet Methodist Hospital in the Minneapolis suburb of St. Louis Park underwent surgery to remove a cancerous kidney. But the next day, a hospital pathologist reported no evidence of cancer in the kidney that was removed.

The surgical site had been marked, and the surgeon and operating room team did the
recommended “time out” briefing to confirm the plan before surgery. The problem: Weeks before the surgery, the side of the patient’s body with the diseased kidney was wrongly identified in the patient’s medical chart.

Officials at Park Nicollet told the patient and family about the error and apologized for it. Days later, the Minneapolis Star Tribune ran a story headlined, “Wrong kidney removed from Methodist Hospital cancer patient.” But the scoop was not planted by an aggressive trial lawyer or dug up by a resourceful investigative reporter. Rather, officials at Park Nicollet decided to go public with the mistake.

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Chicago — It’s a relatively simple case, Dr. Murphy told the ethics consultants he met with in June. A Spanish-speaking, 65-year-old woman of Mexican descent presented with a large growth in the soft tissue of her lower torso. He suspected it might be cancer and wanted to order a biopsy, but was worried the woman’s daughter — who handled interpreting duties — would try to shelter her mother from the bad news.

“It’s crazy,” Dr. Murphy said. The patient “needs to be involved in her own health care decisions at some level.”

When the daughter, Ines, stepped in to meet with the same ethics consultants, Michael Bliss and Jeffrey Loebl, tension filled the room.

“I know how she is,” Ines said of her mother. “When my dad was really ill — he had cancer — she used to say to me all the time, ‘You shouldn’t tell someone they have cancer.’ She’s right. Knowing that information doesn’t help you get better.”

The case represented a clash of cultures. On one side was Dr. Murphy’s medical culture of patient autonomy; on the other was the patient’s cultural preference to be left in the dark. Slapped on top was a healthy dose of strained relations that left the ethics consultants flummoxed on how to satisfy everyone.

Perhaps it’s a good thing the scenario was just pretend.

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Chicago — A panel appointed by President Bush that met here in June appears set to endorse some form of societal obligation to provide health care access to all.

The meeting was part of the President’s Council on Bioethics initiative examining the ethical underpinnings of approaches to reforming the nation’s health system and covering the estimated 47 million uninsured Americans. A report is likely to be issued after the November election.

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The idea of paying physicians more for providing guideline-based care has taken the American health system by storm in the last decade. Today, more than 150 pay-for-performance programs are centered on the notion that rewarding evidence-based care is key to improving health care quality.

But research shows there is a fundamental problem with the P4P programs: They have had little to no impact on quality. That is the conclusion of many studies, including a new analysis of quality incentives, published in the July/August Health Affairs. It compared 81 Massachusetts physician groups eligible for quality incentives with 73 that were not.

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The American Medical Association officially apologized in July for its history of excluding black physicians from membership, for listing black doctors as “colored” in its national physician directory for decades, and for failing to speak against federal funding of segregated hospitals and in favor of civil rights legislation.

“The AMA failed, across the span of a century, to live up to the high standards that define the noble profession of medicine,” said AMA Immediate Past President Ron Davis, MD, in a commentary published in the July 16 Journal of the American Medical Association.

The apology came in response to an AMA-appointed expert panel’s report on the historical racial divide in organized medicine, “African American Physicians and Organized Medicine, 1846-1968: Origins of a Racial Divide,” also published in JAMA.

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Starting in January, drug detailers will have a lighter load to carry when they visit physician offices. That is when new industry guidelines take effect that bar them from leaving behind drugmaker-branded pens, notepads, coffee mugs and other reminder items.

The ban, announced July 10, is the biggest change the Pharmaceutical Research and Manufacturers of America laid out in a revised code on interactions with physicians and other health professionals. The PhRMA code says reminder items “may foster misperceptions that company interactions with health care professionals are not based on informing them about medical and scientific issues.”

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A group of 16 hospitals last month announced a collaboration on a 21-month patient safety initiative to eliminate preventable birth injuries in their facilities, building on the success of an effort spearheaded by the Institute for Healthcare Improvement.

Three in 1,000 deliveries involve serious perinatal injuries that can result in cerebral palsy, birth asphyxia or permanent neurological disability, said officials involved in the initiative. Many of these can be prevented if physicians follow evidence-based guidelines and do a better job recognizing when infants are in distress, initiating timely cesarean births, properly resuscitating depressed babies and appropriately using labor-inducing drugs and vacuum or forceps, they added.

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Under intense criticism for its slow response to drug and device safety problems, the Food and Drug Administration last month announced a new initiative to detect adverse event patterns and warn physicians earlier.

The effort, known as the Sentinel Initiative, marks a significant shift from relying on physicians and patients to report adverse events toward a program of high-tech, active postmarket surveillance.

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Seven in 10 doctors agree that chronic noncancer pain is undertreated in the U.S.

Nearly half of 150 practicing primary care physicians surveyed said they used nonclinical considerations to determine whether to prescribe opioids to treat such pain. In a recent study by the American Pain Foundation, the doctors ranked regulatory and law enforcement scrutiny as the biggest barriers.

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