Physicians at an open forum voice concerns about confidentiality and the potential for abuse when remote care happens without an initial in-person consultation.

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Chicago Physicians have an obligation to recommend the less expensive option when the available medical alternatives offer a “similar likelihood” of patient benefit, according to ethics policy adopted at the AMA Annual Meeting.

Doctors ought to be “prudent stewards of the shared societal resources with which they are entrusted,” says the ethical opinion. The Council on Ethical and Judicial Affairs report overcame objections that it could wrongly limit physicians’ ability to advocate for the interests of individual patients when those conflict with the need to constrain health care costs. Medical spending consumes nearly 18% of the U.S. gross domestic product.

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The U.S. health system is underperforming in delivering care that could prevent heart attacks, stroke, cancer and the spread of HIV, says the Centers for Disease Control and Prevention.

For example, only 47% of Americans diagnosed with ischemic cardiovascular disease were prescribed aspirin or another antiplatelet, according to federal survey data from 2005 to 2008 analyzed in a CDC report published as a special supplement to the June 15 Morbidity and Mortality and Weekly Report.

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If the challenges facing individual practices moving toward the patient-centered medical home concept were not already daunting enough, a study published in June presents a new wrinkle: Patients may not like the new approach to care.

Researchers asked 393 physician practices whether they implemented medical-home elements such as team-based care, electronic health records, disease registries, clinical decision support, quality measurement, patient reminders, email access and group visits. Then they surveyed 1,304 patients who received care at those clinics about their experience during the last six months. The study, published online June 7 in the journal Health Services Research, found no association between a clinic’s use of patient-centered medical home processes and patients’ satisfaction with care.

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Rosemont, Ill. Researchers from Harvard Medical School soon will begin testing a checklist-style approach to helping cancer patients get the kind of end-of-life care they want. The plans, detailed in June at a meeting of the International Society of Advance Care Planning and End of Life Care, are aimed at helping oncologists discuss end-of-life care issues with patients at an earlier stage in the disease process.

The trial of the serious illness communication checklist will involve 60 practicing oncologists and begin enrolling 450 patients in June. Data on patient and family satisfaction and treatment choices will be collected over three years, researchers said.

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Hospitals are getting another grade.

Dozens of quality and safety report cards already scrutinize hospital performance. Now patients and physicians will see a letter grade to sum up how well a hospital does on 26 patient-safety metrics based on publicly collected data.

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The growth rate in physician ordering of computed tomography scans began to slow between 2005 and 2008 and has flattened since then, according to data from six large HMOs that corroborates trends seen in emergency departments and among Medicare patients.

The trend suggests that research demonstrating a link between radiation exposure from medical testing and cancer is having an impact on how often doctors order CTs as well as how much radiation is used when conducting imaging studies, doctors said. High-profile physician organization educational efforts and cuts in Medicare payment for imaging also have contributed, they said.

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Surveys of physicians in recent years have found that doctors frequently recommend placebo treatments to mollify patients and describe them in deceptive ways, despite ethical guidelines urging them to steer clear of those practices.

Now questions are being raised about whether it may be OK for physicians deceptively to use placebos in certain situations and what should count as a placebo.

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The physicians, nurses and clerical support staffers in medical offices say the frenetic work pace and high patient volume are making it harder to provide top-notch care.

More than 70% feel rushed when taking care of patients, and 52% say there are too many patients for the number of doctors and other health professionals in the office. Forty-one percent believe their office “has too many patients to be able to handle everything effectively,” said an Agency for Healthcare Research and Quality survey of 23,679 people working in 934 U.S. medical offices that was released in June.

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Two states that require pharmaceutical companies to report how much they spend on marketing their products saw little shift away from brand-name drugs in doctors’ prescribing habits, said a study in the May 28 Archives of Internal Medicine.

The findings come as the Centers for Medicare & Medicaid Services works to address more than 300 responses from physician organizations, drugmakers and others to its proposed rule to implement the Physician Payments Sunshine Act that was included in the 2010 health-system reform law. In May, CMS announced that federal requirements for medical industry firms to collect data on payments to doctors would not begin until 2013. They had been set to start this year.

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Physicians are accustomed to fielding many challenging questions from patients, but there is one query that they may find especially flummoxing, considering the delicate terrain it requires them to traverse.

The question: “Doctor, will you pray with me?”

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One in seven drug packages stored in physicians’ pharmaceutical sample closets is expired, and an estimated $2.2 billion worth of drug samples go to waste each year, a study says.

Researchers took inventories of the drug sample closets at 10 primary care clinics in the Phoenix metropolitan area. Of the 12,581 sample boxes or packages examined, 14% were expired, said the study, published in the May-June issue of the Journal of the American Board of Family Medicine.

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A Food and Drug Administration advisory panel is recommending approval of an over-the-counter, rapid at-home HIV test that would let patients take control of determining their HIV status and could expand the rate of testing.

But some physicians and public health experts say the product, the OraQuick In-Home HIV Test, would allow patients to skip pre- and post-test counseling. It also could hinder efforts to educate patients about practicing safe sex and starting treatment, they said.

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