Frustrated by mounting regulation, declining pay, loss of autonomy and uncertainty about the effect of health system reform, doctors are cutting back the number of hours they work and how many patients they see.

Between 2008 and 2012, the average number of hours physicians worked fell by 5.9%, from 57 hours a week to 53, and doctors saw 16.6% fewer patients, according to a survey of nearly 14,000 doctors released in September. If the trend continues through 2016, it would equate to the loss of 44,250 full-time physicians, said the report, conducted by the doctor-recruiting firm Merritt Hawkins & Associates for the Physicians Foundation.

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The vast majority of patients have never asked a physician or other health professional if they washed their hands before a physical exam or medical procedure, said a survey released in September.

Only 21% of patients have asked about hand hygiene in the hospital, and just 17% have inquired about hand-washing at their doctor’s office, said the nationwide online survey of 1,020 U.S. adults. Fewer than 10% of patients said they ask “frequently” or “all the time.”

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Despite repeated warnings from the Centers for Disease Control and Prevention and others, unsafe injection practices continue to lead to disease outbreaks. Though rare in the U.S., safety experts say these mishaps should never happen.

Health industry companies say they have a solution: injection systems they say are designed to make it easier for physicians, nurses and other health professionals to deliver shots safely.

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More than a half-million preventable drug-related injuries occur among Medicare outpatients each year. And a quarter of medication errors are attributed to poor drug packaging and labeling.

To combat this, the Institute of Medicine recommends generally applicable safety strategies such as reducing polypharmacy and spreading adoption of electronic prescribing, medication reconciliation and clinical decision support. Yet new research suggests that interventions are needed to target the specific medicines that most commonly harm patients.

Adverse drug events send at least 265,000 seniors to U.S. emergency departments every year and hospitalize nearly 100,000 patients 65 and older, according to a Nov. 24, 2011, study in The New England Journal of Medicine. What is striking, experts say, is the study’s finding that four kinds of medications — warfarin, insulins, oral antiplatelet agents and oral hypoglycemic agents — together account for seven in 10 emergency hospitalizations among seniors.

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Additional evidence emerged in September to document the nation’s patient safety breakthrough in reducing the toll of central line-associated bloodstream infections in hospital intensive care units.

More than 1,100 hospitals in 44 states participated in a federally funded initiative using an evidence-based tool kit that incorporates standardized checklists. They slashed central-line infections by 40% over four years. The overall infection rate among hospitals in the project fell from 1.903 infections for every 1,000 days patients have a central line inserted to a rate of 1.137 per 1,000 days.

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Medicare’s 2008 policy of denying extra payment for catheter-associated urinary tract infections is having virtually no impact on hospital finances, suggests a study published Sept. 4 in Annals of Internal Medicine.

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State laws allowing taxpayers who serve as living organ donors to write off some of the costs involved have had no impact on donation rates, said a study in the August issue of American Journal of Transplantation.

Since 2004, 16 states have enacted legislation giving living organ donors tax breaks. Fifteen of those states let living donors deduct up to $10,000 from their taxable income. The other state, Idaho, gives living organ donors a dollar-for-dollar tax credit for donation-related expenses up to $5,000.

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An evidence-based video that reviews the pros and cons of back surgery to treat a herniated disk can help patients learn more about their condition and make medical decisions in line with their goals and preferences, said a study published Aug. 16 in Spine.

The 38-minute DVD was part of a tool known as a patient decision aid. These are videos, booklets and other materials designed to supplement face-to-face physician counseling on complex medical choices. The tools encourage patients to interpret the best available evidence in light of their care goals and often include stories from other patients to provide meaningful context about likely outcomes.

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Nearly three-quarters of patients say they are concerned about the potential for medical errors, according to a poll that sheds light on public perceptions of patient safety.

Three in 10 patients said they had experience with a medical error, either personally or through a close friend or family member. Twenty-one percent reported having been misdiagnosed by a physician, said the Wolters Kluwer Health survey of 1,000 American adults released Aug. 15. Wolters Kluwer is a Philadelphia-based publisher of medical journals and maker of point-of-care clinical software.

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Hospitals and other imaging facilities across the nation are employing new scanning technology and protocols to reduce and track the radiation doses delivered to patients during imaging studies. The developing trend joins ongoing efforts to help physicians and patients rethink when to opt for advanced imaging tests.

More than two dozen U.S. hospitals have adopted a lower-dose method of reconstructing the images obtained through computed tomography. The technology, marketed as Veo and launched by General Electric Co. subsidiary GE Healthcare in December 2011, can help capture a chest CT scan that delivers virtually the same radiation dose as a two-view chest x-ray. Older CT scanning technology sometimes delivers as much as 50 times the radiation dose of an x-ray.

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Despite the federal law that bars emergency departments from refusing to treat patients with acute medical conditions, lax enforcement and monitoring allow patient dumping to continue, argue the authors of a case study in the August Health Affairs.

In a separate article in the journal, a group of emergency care experts argues that many hospitals have been slow to take action to address patient boarding. The practice occurs when an emergency physician has admitted a patient to the hospital but the patient remains in the ED because there is no inpatient bed available.

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Nearly 800 physician practices around the country are participating in a program that gives soon-to-expire pharmaceutical sample medications to low-income, uninsured patients at safety-net clinics.

The Nashville, Tenn.-based service, Dispensary of Hope, has brought in more than $9 million worth of samples in the last year from practices in 30 states. In turn, the drugs have been dispensed to 80 community health centers and charitable pharmacies in 15 states.

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A group of 37 physicians in July petitioned the Food and Drug Administration to no longer approve the use of opioid analgesics in patients with moderate noncancer pain. The FDA has until the end of the year to respond to the petition, which is the latest entry in the fierce debate about the proper boundaries of opioid prescribing for patients with chronic pain.

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