Plea to nation from doctors fighting COVID-19: #GetMePPE

After completing another shift as an emergency physician treating many patients with influenza-like illnesses amid the COVID-19 global pandemic that has reached every state in the nation, Megan L. Ranney, MD, MPH, changes her clothes before heading home to her husband and their two children, 11 and 8 years old.

She leaves her shoes outside, along with a plastic bag filled with her clothes, then immediately gets in the shower to wash away the pandemic gunk before touching another soul. She wipes down her smartphone, her keys and the steering wheel of her car.

But what remains safely stored inside her car’s trunk, tucked inside of a paper bag, are two increasingly precious items in a world wracked by a global shortage of personal protective equipment (PPE): a procedural mask and a medical grade N95 respirator.

The items, designed to be used once and then disposed of, will be reused “for as long as possible,” Dr. Ranney said in an interview.

That’s the lede to a notable story of mine recently published on the AMA website. Read the whole shebang.

Also check out these other recent stories I’ve written that address various elements of the COVID-19 global pandemic:

How Kaiser Permanente manages at burning edge of climate change

Nothing pierces through the noise like your child’s scream.

That was the sound that echoed through the smoky airwaves aglow with the flames of the Tubbs Wildfire in California, a state where millions live through the summer and fall months at the burning edge of climate change.

That dreadful cry stretched from one end of a telephone conversation to the other—to a phone held by Joshua Weil, MD, on duty that fateful 2017 night as the assistant physician-in-chief at Kaiser Permanente Medical Center in Santa Rosa.

My latest for the AMA. The whole shebang.

AMA-brokered deal poised to cover residents affected by Hahnemann closure

A settlement reached with the owners of now-closed Hahnemann University Hospital would—if approved by a federal bankruptcy judge—pay for the long-tail medical liability insurance coverage for more than 1,400 residents, fellows and alumni of the hospital’s training programs. The AMA is underwriting legal representation of the orphaned residents and fellows in the case.

The settlement, filed in Chapter 11 proceedings in the U.S. Bankruptcy Court for the District of Delaware, would also provide the legally required coverage for the 100 attending physicians who lost their jobs when Hahnemann closed in the summer of 2019. Legal representation on behalf of displaced residents and fellows in the case is being conducted by Jeremy Ryan and the firm of Potter Anderson & Corroon, whose work is being underwritten by the AMA. Premiums for this long-tail coverage can run into the tens of thousands of dollars per physician.

My lede. The whole shebang.

New JAMA Network site offers daily insights on hot health care issues

With voting for the 2020 presidential race officially underway, health care will again take center stage in the political and policy discussion. To meet the need for “high-quality content to inform the debate about the future of health care in the United States and globally,” JAMA Network™ has launched JAMA Health Forum™, a new way “to assemble and highlight health policy content from the JAMA Network with interpretive commentary and analysis.”

My latest for the AMA. The whole shebang.

Why physicians’ use of digital health is on the rise

Physician use of technology to provide televisits or virtual visits has doubled since 2016, with nearly 30% of doctors adopting the digital health technology, according to an AMA survey of 1,300 physicians.

The survey found that rising shares of physicians are using many digital health tools to enable:

  • Consumer access to clinical data—58%.
  • Point of care or workflow enhancements—47%.
  • Clinical decision support—37%.
  • Patient engagement—33%.
  • Remote monitoring and management for improved care—22%.
  • Remote monitoring for efficiency—16%.

Nearly 90% of doctors see at least some advantage in digital health tools, and more doctors are likely to see a definite plus to using them. That’s more likely to be the case among primary care physicians, 40% of whom see the sure upside in these digital health tools, compared with 33% of specialists—a change from the 2016 results.

My latest for the AMA. The whole shebang.

Tracking the Wuhan coronavirus: 5 things doctors must know

A man hospitalized in Everett, Washington, has been diagnosed with the 2019 novel coronavirus (2019-nCoV) after returning to the U.S. from travels to Wuhan, China, the city of 11 million people. At this article’s deadline, the infectious respiratory disease had already killed 18 people and spread to nine countries since first being identified last month.

Because there’s so little known so far about 2019-nCoV, there’s no vaccine or specific treatment available and the care is primarily supportive rather than curative. The World Health Organization is declining, for now, to declare a public health emergency of international concern but will meet again in early February and has offered recommendations to China and other countries.

My latest for the AMA. The whole shebang.

New Jersey rejects bill to weaken doctors’ role as care team leaders

Lawmakers in New Jersey this week opted against moving forward with legislation that would have allowed advanced practice registered nurses (APRNS) to prescribe without any physician oversight. The legislation (Senate bill 1961 and the identical Assembly bill 854) would have also given APRNs full signatory authority, meaning they could have signed off on any document requiring a physician signature by law.

The New Jersey Senate’s health committee moved the bill to the floor in June 2019, but the state’s physicians were able to persuade lawmakers against taking up the bill to weaken the physician-led health care team during the 2018–2019 legislative session that closed Monday. Most states do not allow APRNs to prescribe independently.

My latest at the AMA. The whole shebang.

Distracted driving: Most states aren’t cracking down on deadly practice

Eight Americans are killed every day in a car crash involving a distracted driver, and more than 1,000 are injured daily in such accidents, says the National Highway Traffic Safety Administration. Six percent of drivers in fatal crashes were distracted at the time, the NHTSA says, yet most states are coming up short when it comes to cracking down on a major cause of distracted driving.

While 48 states bar texting and driving, only 20 states ban drivers from using hand-held cellphones entirely while operating a motor vehicle, according to the Insurance Institute for Highway Safety.

My latest for the AMA. The whole shebang.

Vaping: Move to ban some flavors only 1st step in addiction fight

Amid pressure from the AMA and other physician and public health organizations, the Trump administration is moving to ban the sale of flavored e-cigarette cartridges used in closed system e-cigarettes such as those made by Juul, a subsidiary of Marlboro owner Altria Group Inc.

However, the new Department of Health and Human Services (HHS) announcement leaves untouched—for now—the sale of tobacco- or menthol- flavored cartridge-based products, as well as open systems in which users refill their e-cigarette devices with exotic flavors of nicotine juices widely sold at vaping shops.

The “new policy to address the youth e-cigarette epidemic by limiting flavors in some vaping products is a step in the right direction, but does not go far enough,” said AMA President Patrice A. Harris, MD, MA. “The AMA is disappointed that menthol flavors—one of the most popular—will still be allowed, and that flavored e-liquids will remain on the market, leaving young people with easy access to alternative flavored e-cigarette products.”

My latest for the AMA. The whole shebang.

Latest ACA ruling: What it means now for doctors, patients

The 5th U.S. Circuit Court of Appeals has ruled in the case of Texas v. United States that the Affordable Care Act’s individual mandate provision is unconstitutional. While that ruling affirmed a portion of the decision by the U.S. District Court for the Northern District of Texas, the appeals court did not go along with district court ruling vacating the entirety of the ACA, which has expanded health insurance coverage for tens of millions of Americans.

Instead, the appeals court has remanded the case to the district court to further analyze which of the ACA’s many vital provisions remain constitutionally valid.

The “decision leaves important health insurance protections shrouded in uncertainty despite overwhelming public support for these policies,” said AMA President Patrice A. Harris, MD, MA. “The decision underscores that the district court’s initial ruling striking down the entire ACA was made without appropriate analysis, ignoring the extensive reach of the law and its many provisions that have no relationship to the individual mandate.”

Read the whole shebang at the AMA.

Physicians have duty to monitor their own competence

Physicians’ ethical responsibility to provide competent care is fluid and context-dependent at different phases of their careers, according to an AMA Council on Ethical and Judicial Affairs report adopted at the 2019 AMA Interim Meeting.

“The ethical responsibility of competence requires that physicians at all stages of their professional lives be able to recognize when they are and when they are not able to provide appropriate care for the patient in front of them or the patients in their practice as a whole,” says the report.

My latest for the AMA. The whole shebang.