My lede:

Choosing treatments for patients who cannot do so for themselves puts surrogate decision-makers in an unenviable position. The situation requires that physicians navigate a careful path in offering recommendations while respecting surrogates’ and patients’ wishes, according to two recent medical journal articles.

“Data have shown that the stress of being a surrogate decision-maker is equivalent to the kind of scores people get on psychological instruments when their house just burned down,” said Daniel P. Sulmasy, MD, PhD, co-author of a Nov. 3 commentary on surrogate decision-making in The Journal of the American Medical Association.

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My lede:

Pharmaceutical promotion through drug rep visits, medical journal advertisements and company-sponsored meetings rarely results in higher-quality prescribing, according to a systematic review published in the October PLoS Medicine.

“The big news here is that many physicians deny that they are influenced by information from pharmaceutical companies, and yet we found many studies where there was an association between promotion and the physician’s prescribing,” said Dr. Geoffrey Spurling, senior lecturer at the University of Queensland School of Medicine in Brisbane, Australia. “Physicians need to realize that they are not invulnerable to persuasion techniques.”

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My lede:

The New York City burial site of the nation’s first black medical degree-holder received a new headstone — one provided by his white descendants in a recent public ceremony.

Dr. James McCune Smith received his medical degree at the University of Glasgow in Scotland in 1837, forced to go overseas for his education due to U.S. colleges’ racist admissions policies. Historians say the training provided at European medical schools at that time was, ironically, superior to that offered in the U.S.

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Five hospitals following best practices have cut their number of fumbled transfers by more than half.

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My lede:

Performing surgery on the wrong body part — or, worse yet, the wrong patient — is the kind of mistake physicians agree should never happen.

A series of reports from hospitals documenting how these devastating errors slip through the cracks prompted the Joint Commission in 2004 to mandate a three-step protocol. It required physicians and other health professionals to perform a pre-procedure verification process, mark the correct site for the procedure and conduct a “timeout” discussion as a final check before the procedure begins.

Yet new evidence shows the commission’s “universal protocol” has not stopped wrong procedures.

In fact, the number of wrong-patient and wrong-site procedure reports rose, according to a study of more than 27,370 adverse events self-reported by Colorado physicians and published in the October Archives of Surgery. The study found that 132 wrong-patient and wrong-site procedures were voluntarily reported to the Colorado Physician Insurance Co. from 2002 to 2008, with peak annual numbers of reports for both categories occurring after the commission’s protocol was required.

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My lede:

Implementing a comprehensive set of infection control measures can cut the incidence of Clostridium difficile significantly, according to a study presented at the American College of Gastroenterology’s annual meeting.

Integris Baptist Medical Center in Oklahoma City was able to cut its C. diff rate by 40%, from 11.3 per 10,000 admissions to 6.9, in three months after forming a multidisciplinary “war on C. diff” committee to devise and implement infection prevention measures.

The infection occurs nearly 500,000 times annually in hospitals and nursing homes. The national C. diff rate is 13 per 10,000 admissions, and about 30,000 people die each year of the disease in health care facilities, according to the Centers for Disease Control and Prevention.

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My lede:

A group that represents patients living with pain has launched an initiative aimed at educating physicians and patients on how to prescribe and use opioids and other pain treatments safely.

The $1 million-a-year project is called Pain Safety & Access for Everyone, or PainSAFE. It comes in response to a striking rise in deaths and overdoses related to opioid abuse and controversy over how the drugs are marketed.

Fatal opioid overdoses tripled to nearly 14,000 deaths from 1999 to 2006, according to Centers for Disease Control and Prevention data reported in September 2009. In June, the CDC estimated that 305,885 emergency department visits in 2008 were related to opioids, more than double the 2004 estimate of 144,644.

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Physicians who serve as team doctors must resist pressure from athletes, coaches and parents. Now they face added scrutiny over sports-related concussions.

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My lede:

Four decades ago, a majority of Americans told pollsters that the idea of creating a baby in a test tube went “against God’s will.” In early October, the Nobel Prize in Physiology or Medicine was awarded to one of the men who helped make in vitro fertilization a reality.

Physicians specializing in fertility medicine said the prize — awarded to 85-year-old British biologist Robert G. Edwards — was long overdue and reflects how far the field has come. IVF initially sparked suspicion and condemnation from religious authorities, scientists, medical ethicists and the public.

In the 32 years since, more than 4 million children worldwide have been born with the help of IVF. Doctors have seen the attitudes shift in their patients, who in decades past felt stigmatized when seeking out IVF but today often regard the technique as a first option when natural methods fail.

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My lede:

Every three minutes, Scottsdale Healthcare in Arizona tells patients how long they can expect to wait to see a doctor or other health professional at one of its four emergency departments. The times are automatically posted on electronic billboard ads and the hospital system’s website.

Posting ED wait times on billboards, websites, Twitter accounts and mobile apps may seem like a way to better serve patients. Yet it could backfire, some physicians say.

Hospital systems from Oregon to Arizona to Virginia see it as an opportunity to boost revenue and smooth patient demand over the course of the day and week, as well as among different EDs they operate. The argument is also made that greater transparency about wait times could encourage hospital administrators to devote more resources to reducing patient boarding and diversion.

But the growing trend could lead to misuse. Patients could self-triage in a dangerous way. There could be inappropriate use of the emergency department. There also might be a misplaced emphasis on door-to-doctor times versus more meaningful measures, such as how long it takes for an ED patient to be admitted or discharged once their care is completed.

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A $3 million federal grant will test whether the University of Illinois Medical Center’s “seven pillars” model can work at other hospitals.

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My lede:

First it was aviation, then the Toyota assembly line. Now physicians are looking to auto-racing pit crews for ways to improve health care quality and patient safety.

Hospitals in at least a dozen countries, including the U.S., are learning how to translate the split-second timing and near-perfect synchronization of Formula One pit crews to the high-risk handoffs of patients from surgery to recovery and intensive care. The racing crews can refuel a car and change all four tires in seven seconds, and no F1 driver has died at the wheel in a Grand Prix race since 1994.

The key lessons physicians, nurses and other health professionals can get from these well-honed teams is how to use briefings and checklists to prevent errors, apply technology to transfer key information and learn afterward by mining data, according to a recent study published in the British medical journal Quality and Safety in Health Care. The findings were based on structured interviews with the technical managers of nine F1 racing teams.

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