About once a year, a patient or family member will “jump up and just walk out of the room when I mention hospice,” says David Casarett, MD, chief medical officer of the University of Pennsylvania Health System’s hospice program.

“They will say: ‘We came to Penn for the best possible treatment. You were supposed to save Dad’s life, and now you’re giving up on him. How dare you do that to my father!’ ”

Even though such harsh reactions may be the exception, Dr. Casarett says, they are enough to make many doctors uneasy about bringing up hospice — a program that offers at-home nursing care, pain and symptom relief, spiritual counseling and other services but typically requires patients to forgo disease-directed treatments that aim to extend survival time.

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The experience of working in American health care is being drained of joy and meaning amid a rising rate of occupational injuries, episodes of verbal abuse and physical assaults from colleagues, and a seemingly relentless drive to provide more care in less time.

This toxic blend is setting back the effort to improve the quality of care and prevent patient harm, according to a recently published report produced by some of the most distinguished names in the field of patient safety.

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Graduating medical students rate their level of education debt as the least influential factor in their choice of specialty, according to an Assn. of American Medical Colleges survey of nearly of 14,000 students. But others said money is a driver among many of the reasons students named for picking their career path.

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Innovative research on diagnostic mistakes suggests that most misdiagnoses that occur in primary care practice are related to basic elements of the office visit. A new study illustrates how time constraints make it harder for physicians to solve the medical mysteries that confront them.

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When patients make demands about who should care for them based on race or ethnicity, the correct response is to refuse those requests, say experts on health law and medical ethics. With such demands rarely voiced, physician practices ought to make sure all members of the team know how to address them properly.

The issue is in the news after a recent case in Flint, Mich. An African-American nurse, Tonya L. Battle, accused her employer, Hurley Medical Center, of acceding to the demand of a white man that no black health professionals attend to the needs of his infant being cared for in the neonatal intensive care unit.

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There are now 135 tests, procedures and other medical interventions that specialty societies are urging physicians to think twice about before ordering, as part of the American Board of Internal Medicine Foundation’s Choosing Wisely initiative. The items were chosen based on evidence showing they are ineffective or unnecessary.

The campaign, launched with a list of 45 items in April 2012, also is stepping up its efforts to communicate a key message to patients, families and the public — in medicine, sometimes less is more. The widespread view that a physician who denies a test or treatment is offering substandard care puts pressure on doctors to order interventions against their better judgment, say the initiative’s leaders.

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Integrating fall-prevention protocols into scheduled rounds, grouping cognitively impaired patients into so-called safety zones and doing post-fall assessments are some new strategies to reduce the number of falls for hospital patients. The ideas are part of a recently released Agency for Healthcare Research and Quality toolkit aimed at cutting the estimated 700,000 patient falls that happen in hospitals each year.

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In spring 2012, a surgeon tried to electronically access a patient’s radiology study in the operating room but the computer would show only a blue screen. The patient’s time under anesthesia was extended while OR staff struggled to get the display to function properly.

That is just one example of 171 health information technology-related problems reported during a nine-week period to the ECRI Institute PSO, a patient safety organization in Plymouth Meeting, Pa., that works with health systems and hospital associations in Kentucky, Michigan, Ohio, Tennessee and elsewhere to analyze and prevent adverse events.

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The country is deep in winter, but attention again is returning to that summertime phenomenon dubbed “the July effect.” That’s the name given to a supposed spike in medical mistakes and poor patient outcomes at teaching hospitals during the seventh month of the year, when newly minted MDs start providing care.

Numerous studies have reached conflicting conclusions about the extent of the July effect and whether it even exists. A massive study of spinal surgery outcomes published Jan. 29 online further complicates the picture, finding that patients going under the knife at teaching hospitals in July largely fare just as well as their counterparts during the rest of the year but do slightly worse on a couple of metrics.

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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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