Honolulu The autonomy of the rising number of employed physicians ought to be respected, and patient care should come before the financial interests of employers, according to principles on physician employment adopted in November at the American Medical Association Interim Meeting.

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Family physician and addiction medicine specialist Aleksandra Zgierska, MD, PhD, often treats patients referred to her by primary care colleagues concerned about their patients’ growing reliance on opioid analgesics.

Caring for these patients raises clinical questions that even the most skilled physicians have trouble answering. But recently, Dr. Zgierska has considered another question as she wonders how to proceed with treatment: Will using her best medical judgment harm her patient-satisfaction rating?

“If I feel the patient is not an appropriate candidate for opioids, I should say no,” she says. “But in the back of my mind, the question can arise, ‘What will the patient do with that?’ Especially since the No. 1 question on our patient-satisfaction survey is, ‘Are you happy with the way the physician treated your pain?’ ”

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Clinical guideline developers are not adhering to standards on minimizing financial conflicts, increasing transparency and explaining the evidence used to make their recommendations, according to an Archives of Internal Medicine study.

Fewer than half of the 114 guidelines randomly sampled from the National Guideline Clearinghouse met most of the “standards for developing trustworthy clinical practice guidelines” set forth by an Institute of Medicine committee in March 2011. The typical guideline met 44% of the IOM standards, said the study, published Oct. 22. For example, the IOM said panel chairs and co-chairs should not have financial conflicts. More than 70% of guideline panel chairs listed a financial conflict, and more than 90% of co-chairs had a conflict.

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More than one-third of U.S. adults are obese. If current trends continue, no state will have an obesity rate lower than 44% by 2030, according to September estimates by the Robert Wood Johnson Foundation and Trust for America’s Health.

As clinically challenging as it is for primary doctors to treat obese patients — defined as those with a body mass index of 30 or higher — the problem is compounded when caring for patients with morbid obesity. These are patients with a BMI greater than 40, and their numbers are growing rapidly.

In 2000, 3.9% of U.S. adults had a BMI of 40 or greater. By 2010, the figure grew to 6.55%, said a study published Sept. 18 in the International Journal of Obesity.

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The leaders of U.S. hospitals need to spearhead changes to encourage physicians and other health professionals to report the quality and safety problems they witness, said a report released in October.

The “call to action” was issued by the National Assn. for Healthcare Quality, which represents more than 10,000 professionals worldwide who are charged with administering hospital quality measurement and adverse-event reporting programs.

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The majority of hospitals are eschewing aggressive, time-consuming and costly interventions that might help prevent the spread of multidrug-resistant organisms such as methicillin-resistant Staphylococcus aureus.

Forty percent of infection-control directors said their intensive care units screen all newly admitted patients for multidrug-resistant organisms, according to a study in the October American Journal of Infection Control. About 30% of ICUs do such screening periodically, said the study, based on a nationwide survey of infection-control directors at 250 hospitals operating 413 ICUs.

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This isn’t the first time compounders have been linked to safety problems. Physicians can seek out the rare accredited pharmacies or carefully question nonaccredited suppliers.

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The comparative effectiveness research program that is getting $3.5 billion in federal funding through 2019 under the Affordable Care Act aims to deliver actionable information to help physicians and patients decide among competing treatment options.

That money is meant to fix what many experts see as a market failure. To get Food and Drug Administration approval, pharmaceutical companies need not demonstrate that their drug is superior to others already approved. Once drugs and other treatments are available on the market, there is little financial incentive for companies to fund expensive studies that may show their option is inferior.

Yet an analysis of high-profile comparison trials during the past decade suggests that a lack of funding for comparative research has not been the only obstacle to using top-flight evidence to shape patient care. Even when they contradict prevailing practice, comparative effectiveness studies often fail to translate into substantial changes in patient care, said a study in the October issue of Health Affairs.

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The rate of article retractions in the biomedical and life-sciences literature has risen tenfold in the last 35 years. Most retractions are due to fraud, plagiarism and other misconduct, said a study published online Oct. 1 in the journal Proceedings of the National Academy of Sciences.

The proliferation of journals and the intense competition for research grants and academic tenure may be contributing to the growing problem, experts said. Along with continuing concerns about researchers’ financial relationships with industry, the rise of scientific misconduct adds yet another reason for practicing physicians to scrutinize carefully what they read in medical journals, they added.

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Physicians are deeply suspicious of industry-funded randomized clinical trials, even when they are of high methodological rigor, according to recently published findings.

The study, which appeared in the Sept. 20 issue of The New England Journal of Medicine, comes amid efforts by leading pharmaceutical companies to close what they see as a “credibility gap” faced by industry-sponsored research. The study’s authors and other experts argue that high-profile controversies such as misleading and selectively reported trial data related to Merck’s Vioxx (rofecoxib) and GlaxoSmithKline’s Avandia (rosiglitazone) have made physicians more doubtful of pharma-sponsored studies.

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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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