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Free teledermatology clinic helps underserved patients initiate AD care
A in other underserved areas in the United States.
Washington, D.C., has “staggering health disparities that are among the largest in the country,” and Ward 8 and surrounding areas in the southeastern part of the city are “dermatology deserts,” said Adam Friedman, MD, professor and chair of dermatology at George Washington University, Washington, who started the program in 2021 with a pilot project. Dr. Friedman spoke about the project, which has since been expanded to include alopecia areata, at the Revolutionizing Atopic Dermatitis conference in April and in an interview after the meeting.
Patients who attend the clinics – held at the Temple of Praise Church in a residential area of Ward 8, a predominantly Black community with a 30% poverty rate – are entered into the GW Medical Faculty Associates medical records system and educated on telemedicine best practices (such as not having light behind them during a session) and how to use telemedicine with their own device.
Those with AD who participate learn about the condition through an image-rich poster showing how it appears in various skin tones, handouts, National Eczema Association films, and discussion with medical students who staff the clinics under Dr. Friedman’s on-site supervision. Participants with alopecia areata similarly can view a poster and converse about the condition.
Patients then have a free 20-minute telehealth visit with a GWU dermatology resident in a private room, and a medical student volunteer nearby to assist with the technology if needed. They leave with a treatment plan, which often includes prescriptions, and a follow-up telemedicine appointment.
The program “is meant to be a stepping point for initiating care ... to set someone up for success for recurrent telehealth visits in the future” and for treatment before symptoms become too severe, Dr. Friedman said in an interview. “We want to demystify telemedicine and educate on the disease state and dispel myths ... so the patient understands why it’s happening” and how it can be treated.
The pilot project, funded with a grant from Pfizer, involved five 2-hour clinics held on Mondays from 4 p.m. to 6 p.m., that together served almost 50 adult and pediatric patients. Grants from Pfizer and Eli Lilly enabled additional clinics in the spring of 2023 and into the summer. And in June, GWU and Pfizer announced a $1 million national grant program focused on broad implementation of what they’ve coined the “Teledermatology Help Desk Clinic” model.
Practices or organizations that secure grants will utilize GWU’s experience and meet with an advisory council of experts in dermatology telemedicine and community advocacy. Having a “long-term plan” and commitment to sustainability is an important element of the model, said Dr. Friedman, who is chairing the grant program.
Patients deem clinic ‘extremely’ helpful
As one of the most prevalent skin disorders – and one with a documented history of elevated risk for specific populations – AD was a good starting point for the teledermatology clinic program. Patients who identify as Black have a higher incidence and prevalence of AD than those who identify as White and Hispanic, and they tend to have more severe disease. Yet they account for fewer visits to dermatologists for AD.
One cross-sectional study of about 3,500 adults in the United States with AD documented that racial/ethnic and socioeconomic disparities reduce outpatient utilization of AD care and increase urgent care and hospital utilization. And in a longitudinal cohort study of children in the United States with AD, Black children with poorly controlled AD were significantly less likely than White children to see a dermatologist.
Like other programs, the GWU department of dermatology had pivoted to telehealth in 2020, and a published survey of patients who attended telehealth appointments during the early part of the pandemic showed that it was generally well liked – and not only for social distancing, but for time efficiency and because transportation was not needed. Only 10% of the 168 patients who completed the survey (out of 894 asked) reported they were unlikely to undertake another telehealth visit. For 10%, eczema was the reason for the visit.
However, only 1% of the survey respondents were from Ward 8, which “begged the question, did those who really need access know this was an option?” Dr. Friedman said at the RAD meeting. He wondered whether there was not only a dermatology desert in Ward 8, but a “technology desert” as well.
Findings from a patient satisfaction survey taken at the end of the pilot program are encouraging, Dr. Friedman said. While data on follow-up visits has not been collected yet, “what I do now have a sense of” is that “the entry point [afforded by the clinics] changed the course in terms of patients’ understanding of the disease and how they feel about its management.”
About 94% of survey respondents indicated the clinic was “extremely” helpful and the remainder said it was “very” helpful; 90% said telehealth significantly changed how they will manage their condition; and 97% said it is “extremely” important to continue the clinics. The majority of patients – 70% – indicated they did not have a dermatologist.
Education about AD at the clinics covers moisturizers/emollients, bathing habits, soaps and detergents, trigger avoidance, and the role of stress and environmental factors in disease exacerbation. Trade samples of moisturizers, mild cleansers, and other products have increasingly been available.
For prescriptions of topical steroids and other commonly prescribed medications, Dr. Friedman and associates combed GoodRx for coupons and surveyed local pharmacies for self-pay pricing to identify least expensive options. Patients with AD who were deemed likely candidates for more advanced therapies in the future were educated about these possibilities.
Alopecia areata
The addition of alopecia areata drew patients with other forms of hair loss as well, but “we weren’t going to turn anyone away who did not have that specific autoimmune form of hair loss,” Dr. Friedman said. Depending on the diagnosis, prescriptions were written for minoxidil and 5-alpha reductase inhibitors.
Important for follow-up is GWU’s acceptance of Medicaid and the availability of both a sliding scale for self-pay and services that assist patients in registering for Medicaid and, if eligible, other insurance plans.
Building partnerships, earning trust
Establishment of the teledermatology clinic program took legwork and relationship building. “You can’t just show up. That’s not enough,” said Dr. Friedman, who also directs the dermatology residency program at GWU. “You have to show through action and through investment of time and energy that you are legitimate, that you’re really there for the long haul.”
Dr. Friedman had assistance from the Rodham Institute, which was established at GWU (and until recently was housed there) and has a history of engagement with local stakeholders such as community centers, church leadership, politicians, and others in the Washington area. He was put in touch with Bishop Deborah Webb at the Temple of Praise Church, a community pillar in Ward 8, and from there “it was a courtship,” he said, with trust to be built and logistics to be worked out. (Budgets for the clinics, he noted, have included compensation to the church and gift cards for church volunteers who are present at the clinics.)
In the meantime, medical student volunteers from GWU, Howard University, and Georgetown University were trained in telemedicine and attended a “boot camp” on AD “so they’d be able to talk with anyone about it,” Dr. Friedman said.
Advertising “was a learning experience,” he said, and was ultimately multipronged, involving church service announcements, flyers, and, most importantly, Facebook and Instagram advertisements. (People were asked to call a dedicated phone line to schedule an appointment and were invited to register in the GW Medical Faculty Associates records system, though walk-ins to the clinics were still welcomed.)
In a comment, Misty Eleryan, MD, MS, a Mohs micrographic surgeon and dermatologist in Santa Monica, Calif., said dermatology deserts are often found in rural areas and/or areas “with a higher population of marginalized communities, such as Black, Brown, or poorer individuals” – communities that tend to rely on care from urgent care or ED physicians who are unaware of how skin conditions present on darker skin tones.
Programs that educate patients about various presentations of skin conditions are helpful not only for the patients themselves, but could also enable them to help friends, family members, and colleagues, said Dr. Eleryan, who did her residency training at GWU.
“Access,” she noted, is more than just physical access to a person, place, or thing. Referring to a “five A’s” framework described several decades ago, Dr. Eleryan said access to care is characterized by affordability, availability (extent to which the physician has the requisite resources, such as personnel and technology, to meet the patient’s needs), accessibility (geographic), accommodation (extent to which the physician can meet the patient’s constraints and preferences – such as hours of operation, how communications are handled, ability to receive care without prior appointments), and acceptability (extent to which the patient is comfortable with the “more immutable characteristics” of the physician and vice versa).
The GWU program, she said, “is a great start.”
Dr. Friedman said he’s fully invested. There has long been a perception, “rightfully so, that underserved communities are overlooked especially by large institutions. One attendee told me she never expected in her lifetime to see something like this clinic and someone who looked like me caring about her community. ... It certainly says a great deal about the work we need to put in to repair longstanding injury.”
Dr. Friedman disclosed that, in addition to being a recipient of grants from Pfizer and Lilly, he is a speaker for Lilly. Dr. Eleryan said she has no relevant disclosures.
A in other underserved areas in the United States.
Washington, D.C., has “staggering health disparities that are among the largest in the country,” and Ward 8 and surrounding areas in the southeastern part of the city are “dermatology deserts,” said Adam Friedman, MD, professor and chair of dermatology at George Washington University, Washington, who started the program in 2021 with a pilot project. Dr. Friedman spoke about the project, which has since been expanded to include alopecia areata, at the Revolutionizing Atopic Dermatitis conference in April and in an interview after the meeting.
Patients who attend the clinics – held at the Temple of Praise Church in a residential area of Ward 8, a predominantly Black community with a 30% poverty rate – are entered into the GW Medical Faculty Associates medical records system and educated on telemedicine best practices (such as not having light behind them during a session) and how to use telemedicine with their own device.
Those with AD who participate learn about the condition through an image-rich poster showing how it appears in various skin tones, handouts, National Eczema Association films, and discussion with medical students who staff the clinics under Dr. Friedman’s on-site supervision. Participants with alopecia areata similarly can view a poster and converse about the condition.
Patients then have a free 20-minute telehealth visit with a GWU dermatology resident in a private room, and a medical student volunteer nearby to assist with the technology if needed. They leave with a treatment plan, which often includes prescriptions, and a follow-up telemedicine appointment.
The program “is meant to be a stepping point for initiating care ... to set someone up for success for recurrent telehealth visits in the future” and for treatment before symptoms become too severe, Dr. Friedman said in an interview. “We want to demystify telemedicine and educate on the disease state and dispel myths ... so the patient understands why it’s happening” and how it can be treated.
The pilot project, funded with a grant from Pfizer, involved five 2-hour clinics held on Mondays from 4 p.m. to 6 p.m., that together served almost 50 adult and pediatric patients. Grants from Pfizer and Eli Lilly enabled additional clinics in the spring of 2023 and into the summer. And in June, GWU and Pfizer announced a $1 million national grant program focused on broad implementation of what they’ve coined the “Teledermatology Help Desk Clinic” model.
Practices or organizations that secure grants will utilize GWU’s experience and meet with an advisory council of experts in dermatology telemedicine and community advocacy. Having a “long-term plan” and commitment to sustainability is an important element of the model, said Dr. Friedman, who is chairing the grant program.
Patients deem clinic ‘extremely’ helpful
As one of the most prevalent skin disorders – and one with a documented history of elevated risk for specific populations – AD was a good starting point for the teledermatology clinic program. Patients who identify as Black have a higher incidence and prevalence of AD than those who identify as White and Hispanic, and they tend to have more severe disease. Yet they account for fewer visits to dermatologists for AD.
One cross-sectional study of about 3,500 adults in the United States with AD documented that racial/ethnic and socioeconomic disparities reduce outpatient utilization of AD care and increase urgent care and hospital utilization. And in a longitudinal cohort study of children in the United States with AD, Black children with poorly controlled AD were significantly less likely than White children to see a dermatologist.
Like other programs, the GWU department of dermatology had pivoted to telehealth in 2020, and a published survey of patients who attended telehealth appointments during the early part of the pandemic showed that it was generally well liked – and not only for social distancing, but for time efficiency and because transportation was not needed. Only 10% of the 168 patients who completed the survey (out of 894 asked) reported they were unlikely to undertake another telehealth visit. For 10%, eczema was the reason for the visit.
However, only 1% of the survey respondents were from Ward 8, which “begged the question, did those who really need access know this was an option?” Dr. Friedman said at the RAD meeting. He wondered whether there was not only a dermatology desert in Ward 8, but a “technology desert” as well.
Findings from a patient satisfaction survey taken at the end of the pilot program are encouraging, Dr. Friedman said. While data on follow-up visits has not been collected yet, “what I do now have a sense of” is that “the entry point [afforded by the clinics] changed the course in terms of patients’ understanding of the disease and how they feel about its management.”
About 94% of survey respondents indicated the clinic was “extremely” helpful and the remainder said it was “very” helpful; 90% said telehealth significantly changed how they will manage their condition; and 97% said it is “extremely” important to continue the clinics. The majority of patients – 70% – indicated they did not have a dermatologist.
Education about AD at the clinics covers moisturizers/emollients, bathing habits, soaps and detergents, trigger avoidance, and the role of stress and environmental factors in disease exacerbation. Trade samples of moisturizers, mild cleansers, and other products have increasingly been available.
For prescriptions of topical steroids and other commonly prescribed medications, Dr. Friedman and associates combed GoodRx for coupons and surveyed local pharmacies for self-pay pricing to identify least expensive options. Patients with AD who were deemed likely candidates for more advanced therapies in the future were educated about these possibilities.
Alopecia areata
The addition of alopecia areata drew patients with other forms of hair loss as well, but “we weren’t going to turn anyone away who did not have that specific autoimmune form of hair loss,” Dr. Friedman said. Depending on the diagnosis, prescriptions were written for minoxidil and 5-alpha reductase inhibitors.
Important for follow-up is GWU’s acceptance of Medicaid and the availability of both a sliding scale for self-pay and services that assist patients in registering for Medicaid and, if eligible, other insurance plans.
Building partnerships, earning trust
Establishment of the teledermatology clinic program took legwork and relationship building. “You can’t just show up. That’s not enough,” said Dr. Friedman, who also directs the dermatology residency program at GWU. “You have to show through action and through investment of time and energy that you are legitimate, that you’re really there for the long haul.”
Dr. Friedman had assistance from the Rodham Institute, which was established at GWU (and until recently was housed there) and has a history of engagement with local stakeholders such as community centers, church leadership, politicians, and others in the Washington area. He was put in touch with Bishop Deborah Webb at the Temple of Praise Church, a community pillar in Ward 8, and from there “it was a courtship,” he said, with trust to be built and logistics to be worked out. (Budgets for the clinics, he noted, have included compensation to the church and gift cards for church volunteers who are present at the clinics.)
In the meantime, medical student volunteers from GWU, Howard University, and Georgetown University were trained in telemedicine and attended a “boot camp” on AD “so they’d be able to talk with anyone about it,” Dr. Friedman said.
Advertising “was a learning experience,” he said, and was ultimately multipronged, involving church service announcements, flyers, and, most importantly, Facebook and Instagram advertisements. (People were asked to call a dedicated phone line to schedule an appointment and were invited to register in the GW Medical Faculty Associates records system, though walk-ins to the clinics were still welcomed.)
In a comment, Misty Eleryan, MD, MS, a Mohs micrographic surgeon and dermatologist in Santa Monica, Calif., said dermatology deserts are often found in rural areas and/or areas “with a higher population of marginalized communities, such as Black, Brown, or poorer individuals” – communities that tend to rely on care from urgent care or ED physicians who are unaware of how skin conditions present on darker skin tones.
Programs that educate patients about various presentations of skin conditions are helpful not only for the patients themselves, but could also enable them to help friends, family members, and colleagues, said Dr. Eleryan, who did her residency training at GWU.
“Access,” she noted, is more than just physical access to a person, place, or thing. Referring to a “five A’s” framework described several decades ago, Dr. Eleryan said access to care is characterized by affordability, availability (extent to which the physician has the requisite resources, such as personnel and technology, to meet the patient’s needs), accessibility (geographic), accommodation (extent to which the physician can meet the patient’s constraints and preferences – such as hours of operation, how communications are handled, ability to receive care without prior appointments), and acceptability (extent to which the patient is comfortable with the “more immutable characteristics” of the physician and vice versa).
The GWU program, she said, “is a great start.”
Dr. Friedman said he’s fully invested. There has long been a perception, “rightfully so, that underserved communities are overlooked especially by large institutions. One attendee told me she never expected in her lifetime to see something like this clinic and someone who looked like me caring about her community. ... It certainly says a great deal about the work we need to put in to repair longstanding injury.”
Dr. Friedman disclosed that, in addition to being a recipient of grants from Pfizer and Lilly, he is a speaker for Lilly. Dr. Eleryan said she has no relevant disclosures.
A in other underserved areas in the United States.
Washington, D.C., has “staggering health disparities that are among the largest in the country,” and Ward 8 and surrounding areas in the southeastern part of the city are “dermatology deserts,” said Adam Friedman, MD, professor and chair of dermatology at George Washington University, Washington, who started the program in 2021 with a pilot project. Dr. Friedman spoke about the project, which has since been expanded to include alopecia areata, at the Revolutionizing Atopic Dermatitis conference in April and in an interview after the meeting.
Patients who attend the clinics – held at the Temple of Praise Church in a residential area of Ward 8, a predominantly Black community with a 30% poverty rate – are entered into the GW Medical Faculty Associates medical records system and educated on telemedicine best practices (such as not having light behind them during a session) and how to use telemedicine with their own device.
Those with AD who participate learn about the condition through an image-rich poster showing how it appears in various skin tones, handouts, National Eczema Association films, and discussion with medical students who staff the clinics under Dr. Friedman’s on-site supervision. Participants with alopecia areata similarly can view a poster and converse about the condition.
Patients then have a free 20-minute telehealth visit with a GWU dermatology resident in a private room, and a medical student volunteer nearby to assist with the technology if needed. They leave with a treatment plan, which often includes prescriptions, and a follow-up telemedicine appointment.
The program “is meant to be a stepping point for initiating care ... to set someone up for success for recurrent telehealth visits in the future” and for treatment before symptoms become too severe, Dr. Friedman said in an interview. “We want to demystify telemedicine and educate on the disease state and dispel myths ... so the patient understands why it’s happening” and how it can be treated.
The pilot project, funded with a grant from Pfizer, involved five 2-hour clinics held on Mondays from 4 p.m. to 6 p.m., that together served almost 50 adult and pediatric patients. Grants from Pfizer and Eli Lilly enabled additional clinics in the spring of 2023 and into the summer. And in June, GWU and Pfizer announced a $1 million national grant program focused on broad implementation of what they’ve coined the “Teledermatology Help Desk Clinic” model.
Practices or organizations that secure grants will utilize GWU’s experience and meet with an advisory council of experts in dermatology telemedicine and community advocacy. Having a “long-term plan” and commitment to sustainability is an important element of the model, said Dr. Friedman, who is chairing the grant program.
Patients deem clinic ‘extremely’ helpful
As one of the most prevalent skin disorders – and one with a documented history of elevated risk for specific populations – AD was a good starting point for the teledermatology clinic program. Patients who identify as Black have a higher incidence and prevalence of AD than those who identify as White and Hispanic, and they tend to have more severe disease. Yet they account for fewer visits to dermatologists for AD.
One cross-sectional study of about 3,500 adults in the United States with AD documented that racial/ethnic and socioeconomic disparities reduce outpatient utilization of AD care and increase urgent care and hospital utilization. And in a longitudinal cohort study of children in the United States with AD, Black children with poorly controlled AD were significantly less likely than White children to see a dermatologist.
Like other programs, the GWU department of dermatology had pivoted to telehealth in 2020, and a published survey of patients who attended telehealth appointments during the early part of the pandemic showed that it was generally well liked – and not only for social distancing, but for time efficiency and because transportation was not needed. Only 10% of the 168 patients who completed the survey (out of 894 asked) reported they were unlikely to undertake another telehealth visit. For 10%, eczema was the reason for the visit.
However, only 1% of the survey respondents were from Ward 8, which “begged the question, did those who really need access know this was an option?” Dr. Friedman said at the RAD meeting. He wondered whether there was not only a dermatology desert in Ward 8, but a “technology desert” as well.
Findings from a patient satisfaction survey taken at the end of the pilot program are encouraging, Dr. Friedman said. While data on follow-up visits has not been collected yet, “what I do now have a sense of” is that “the entry point [afforded by the clinics] changed the course in terms of patients’ understanding of the disease and how they feel about its management.”
About 94% of survey respondents indicated the clinic was “extremely” helpful and the remainder said it was “very” helpful; 90% said telehealth significantly changed how they will manage their condition; and 97% said it is “extremely” important to continue the clinics. The majority of patients – 70% – indicated they did not have a dermatologist.
Education about AD at the clinics covers moisturizers/emollients, bathing habits, soaps and detergents, trigger avoidance, and the role of stress and environmental factors in disease exacerbation. Trade samples of moisturizers, mild cleansers, and other products have increasingly been available.
For prescriptions of topical steroids and other commonly prescribed medications, Dr. Friedman and associates combed GoodRx for coupons and surveyed local pharmacies for self-pay pricing to identify least expensive options. Patients with AD who were deemed likely candidates for more advanced therapies in the future were educated about these possibilities.
Alopecia areata
The addition of alopecia areata drew patients with other forms of hair loss as well, but “we weren’t going to turn anyone away who did not have that specific autoimmune form of hair loss,” Dr. Friedman said. Depending on the diagnosis, prescriptions were written for minoxidil and 5-alpha reductase inhibitors.
Important for follow-up is GWU’s acceptance of Medicaid and the availability of both a sliding scale for self-pay and services that assist patients in registering for Medicaid and, if eligible, other insurance plans.
Building partnerships, earning trust
Establishment of the teledermatology clinic program took legwork and relationship building. “You can’t just show up. That’s not enough,” said Dr. Friedman, who also directs the dermatology residency program at GWU. “You have to show through action and through investment of time and energy that you are legitimate, that you’re really there for the long haul.”
Dr. Friedman had assistance from the Rodham Institute, which was established at GWU (and until recently was housed there) and has a history of engagement with local stakeholders such as community centers, church leadership, politicians, and others in the Washington area. He was put in touch with Bishop Deborah Webb at the Temple of Praise Church, a community pillar in Ward 8, and from there “it was a courtship,” he said, with trust to be built and logistics to be worked out. (Budgets for the clinics, he noted, have included compensation to the church and gift cards for church volunteers who are present at the clinics.)
In the meantime, medical student volunteers from GWU, Howard University, and Georgetown University were trained in telemedicine and attended a “boot camp” on AD “so they’d be able to talk with anyone about it,” Dr. Friedman said.
Advertising “was a learning experience,” he said, and was ultimately multipronged, involving church service announcements, flyers, and, most importantly, Facebook and Instagram advertisements. (People were asked to call a dedicated phone line to schedule an appointment and were invited to register in the GW Medical Faculty Associates records system, though walk-ins to the clinics were still welcomed.)
In a comment, Misty Eleryan, MD, MS, a Mohs micrographic surgeon and dermatologist in Santa Monica, Calif., said dermatology deserts are often found in rural areas and/or areas “with a higher population of marginalized communities, such as Black, Brown, or poorer individuals” – communities that tend to rely on care from urgent care or ED physicians who are unaware of how skin conditions present on darker skin tones.
Programs that educate patients about various presentations of skin conditions are helpful not only for the patients themselves, but could also enable them to help friends, family members, and colleagues, said Dr. Eleryan, who did her residency training at GWU.
“Access,” she noted, is more than just physical access to a person, place, or thing. Referring to a “five A’s” framework described several decades ago, Dr. Eleryan said access to care is characterized by affordability, availability (extent to which the physician has the requisite resources, such as personnel and technology, to meet the patient’s needs), accessibility (geographic), accommodation (extent to which the physician can meet the patient’s constraints and preferences – such as hours of operation, how communications are handled, ability to receive care without prior appointments), and acceptability (extent to which the patient is comfortable with the “more immutable characteristics” of the physician and vice versa).
The GWU program, she said, “is a great start.”
Dr. Friedman said he’s fully invested. There has long been a perception, “rightfully so, that underserved communities are overlooked especially by large institutions. One attendee told me she never expected in her lifetime to see something like this clinic and someone who looked like me caring about her community. ... It certainly says a great deal about the work we need to put in to repair longstanding injury.”
Dr. Friedman disclosed that, in addition to being a recipient of grants from Pfizer and Lilly, he is a speaker for Lilly. Dr. Eleryan said she has no relevant disclosures.
Hospital guards snoop through patient records, cost hospital $240K
Yakima Valley Memorial Hospital agreed to the voluntary settlement after an investigation into the actions of 23 emergency department security guards who allegedly used their login credentials to access the patient medical records of 419 patients.
The information accessed included names, dates of birth, medical record numbers, addresses, certain notes related to treatment, and insurance information, according to a release by the U.S .Department of Health & Human Services’ Office for Civil Rights (OCR). A breach notification report alerted OCR to the snooping.
As part of the agreement, OCR will monitor Yakima Valley Memorial Hospital for 2 years and the hospital must conduct a thorough risk analysis as well as develop a risk management plan to address and mitigate identified security risks and vulnerabilities. The settlement is not considered an admission of guilt by the hospital.
Is such snooping common?
The incident highlights the frequent practice of employees snooping through medical records and the steep consequences that can result for providers, said Paul Redding, vice president of partner engagement and cybersecurity at Compliancy Group, a company that offers guided HIPAA compliance software for healthcare providers and vendors.
“I think the problem is absolutely growing,” he said. “What’s crazy about this case is it’s actually a really small HIPAA violation. Less than 500 people were affected, and the hospital still must pay a quarter-of-a-million-dollar settlement. If you take the average HIPAA violation, which is in the thousands and thousands of [patients], this amount would be magnified many times over.”
In general, employees snoop through records out of curiosity or to find out information about people they know – or want to learn about, said J. David Sims, a cybersecurity expert and CEO of Security First IT, a company that provides cybersecurity solutions and IT support to health care businesses.
Mr. Sims says he has heard of cases where health professionals snooped through records to find information about the new love interests of ex-partners or to learn about people on dating websites whom they’re interested in dating.
“Most of the time, it’s people being nosy,” he said. “In a lot of cases, it’s curiosity about famous people. You see it a lot in areas where you have football players who come in with injuries or you have an actor or actress who come in for something.”
“Data breaches caused by current and former workforce members impermissibly accessing patient records are a recurring issue across the health care industry. Health care organizations must ensure that workforce members can only access the patient information needed to do their jobs,” OCR director Melanie Fontes Rainer said in a June statement. “HIPAA-covered entities must have robust policies and procedures in place to ensure patient health information is protected from identify theft and fraud.”
Yakima Valley Memorial Hospital did not return a message seeking comment.
According to OCR’s latest report to Congress, complaints about HIPAA violations increased by 39% between 2017 and 2021. Breaches affecting fewer than 500 individuals rose by 5% during the same time period, and breaches impacting 500 or more individuals increased by 58%.
Common reasons employees snoop
The OCR announcement does not specify why the 23 security guards were accessing the medical records, but the incident raises questions about why the security guards had access to protected health information (PHI) in the first place, Mr. Redding said.
“I have yet to have anyone explain to me why the security guards would have access to PHI at all, at any level,” he said. “Was it by design or was it by error?”
In 2019 for instance, dozens of employees at Northwestern Memorial Hospital in Chicago were fired for accessing the health records of former Empire actor Jussie Smollett. In another high-profile case, nearly a dozen emergency medical service employees were caught snooping through 911 records connected to the treatment and, later, death of Joan Rivers.
“Sadly, there is a lack of education around what compliance really means inside the medical industry as a whole,” Mr. Redding said. “There is a lack of employee training and a lack of emphasis on accountability for employees.”
Privacy breaches fuel lawsuits
Health professionals caught snooping through records are frequently terminated and employers can face a range of ramifications, including civil and criminal penalties.
A growing trend is class action lawsuits associated with privacy violations, Mr. Redding adds.
Because patients are unable to sue in civil court for HIPAA breaches, they frequently sue for “breach of an implied contract,” he explained. In such cases, patients allege that the privacy documents they signed with health care providers established an implied contract, and their records being exposed constituted a contract breach.
“Class action lawsuits are starting to become extremely common,” Mr. Redding said. “It’s happening in many cases, even sometimes before Health & Human Services issue a fine, that [providers] are being wrapped into a class action lawsuit.”
Mayo Clinic, for example, was recently slapped with a class action suit after a former employee inappropriately accessed the records of 1,600 patients. Mayo settled the suit in January 2023, the terms of which were not publicly disclosed.
Multiple patients also filed a class action suit against San Diego–based Scripps Health after its data were hit with a cyberattack and subsequent breach that impacted close to 2 million people. Scripps reached a $3.5 million settlement with the plaintiffs in 2023.
Some practices and employers may also face state penalties for data privacy breaches, depending on their jurisdiction. In July, Connecticut became the fifth state to enact a comprehensive data privacy law. The measure, which creates a robust framework for protecting health-related records and other data, includes civil penalties of up to $5,000 for violations. Other states, including California, Virginia, Utah, and Colorado, also have state data privacy laws on the books.
How can practices stop snooping?
A first step to preventing snooping is conducting a thorough risk assessment, said David Harlow, a health care attorney and chief compliance and privacy officer for Insulet Corporation, a medical device company. The analysis should address who has access to what data and whether they really need such access, he said.
“Then it’s putting in place the proper controls to ensure access is limited and use is limited to the appropriate individuals and circumstances,” Mr. Harlow said.
Regulators don’t expect a giant academic medical center and a small private physician practice to take an identical HIPAA compliance approach, he stressed. The ideal approach will vary by entity. Providers just need to address the standards in a way that makes sense for their operation, he said.
Training is also a critical component, adds Mr. Sims.
“Having training is key,” he said. “Oftentimes, an employee might think, ‘Well, if I can click on this data and it comes up, obviously, I can look at it.’ They need to understand what information they are and are not allowed to access.”
Keep in mind that settings or controls might change when larger transitions take place, such as moving to a new electronic health record system, Mr. Sims said. It’s essential to reevaluate controls when changes in the practice take place to ensure that everything is functioning correctly.
Mr. Sims also suggests that practices create a type of “If you see something, say something,” policy that encourages fellow physicians and employees to report anything that looks suspicious within electronic logs. If an employee, for instance, is suddenly looking at many more records than usual or at odd times of the day or night, this should raise red flags.
“It’s great to stop it early so that it doesn’t become a bigger issue for the practice to deal with, but also, from a legal standpoint, you want to have a defensible argument that you were doing all you could to stop this as quickly as possible,” he said. “It puts you in a better position to defend yourself.”
The snooping security guards case holds an important lesson for all health providers, Mr. Harlow said.
“This is a message to all of us, that you need to have done the assessment up front,” he said. You need to have the right controls in place up front. This is not a situation where somebody managed to hack into a system for some devious means. This is someone who was given keys. Why were they given the keys?”
A version of this article first appeared on Medscape.com.
Yakima Valley Memorial Hospital agreed to the voluntary settlement after an investigation into the actions of 23 emergency department security guards who allegedly used their login credentials to access the patient medical records of 419 patients.
The information accessed included names, dates of birth, medical record numbers, addresses, certain notes related to treatment, and insurance information, according to a release by the U.S .Department of Health & Human Services’ Office for Civil Rights (OCR). A breach notification report alerted OCR to the snooping.
As part of the agreement, OCR will monitor Yakima Valley Memorial Hospital for 2 years and the hospital must conduct a thorough risk analysis as well as develop a risk management plan to address and mitigate identified security risks and vulnerabilities. The settlement is not considered an admission of guilt by the hospital.
Is such snooping common?
The incident highlights the frequent practice of employees snooping through medical records and the steep consequences that can result for providers, said Paul Redding, vice president of partner engagement and cybersecurity at Compliancy Group, a company that offers guided HIPAA compliance software for healthcare providers and vendors.
“I think the problem is absolutely growing,” he said. “What’s crazy about this case is it’s actually a really small HIPAA violation. Less than 500 people were affected, and the hospital still must pay a quarter-of-a-million-dollar settlement. If you take the average HIPAA violation, which is in the thousands and thousands of [patients], this amount would be magnified many times over.”
In general, employees snoop through records out of curiosity or to find out information about people they know – or want to learn about, said J. David Sims, a cybersecurity expert and CEO of Security First IT, a company that provides cybersecurity solutions and IT support to health care businesses.
Mr. Sims says he has heard of cases where health professionals snooped through records to find information about the new love interests of ex-partners or to learn about people on dating websites whom they’re interested in dating.
“Most of the time, it’s people being nosy,” he said. “In a lot of cases, it’s curiosity about famous people. You see it a lot in areas where you have football players who come in with injuries or you have an actor or actress who come in for something.”
“Data breaches caused by current and former workforce members impermissibly accessing patient records are a recurring issue across the health care industry. Health care organizations must ensure that workforce members can only access the patient information needed to do their jobs,” OCR director Melanie Fontes Rainer said in a June statement. “HIPAA-covered entities must have robust policies and procedures in place to ensure patient health information is protected from identify theft and fraud.”
Yakima Valley Memorial Hospital did not return a message seeking comment.
According to OCR’s latest report to Congress, complaints about HIPAA violations increased by 39% between 2017 and 2021. Breaches affecting fewer than 500 individuals rose by 5% during the same time period, and breaches impacting 500 or more individuals increased by 58%.
Common reasons employees snoop
The OCR announcement does not specify why the 23 security guards were accessing the medical records, but the incident raises questions about why the security guards had access to protected health information (PHI) in the first place, Mr. Redding said.
“I have yet to have anyone explain to me why the security guards would have access to PHI at all, at any level,” he said. “Was it by design or was it by error?”
In 2019 for instance, dozens of employees at Northwestern Memorial Hospital in Chicago were fired for accessing the health records of former Empire actor Jussie Smollett. In another high-profile case, nearly a dozen emergency medical service employees were caught snooping through 911 records connected to the treatment and, later, death of Joan Rivers.
“Sadly, there is a lack of education around what compliance really means inside the medical industry as a whole,” Mr. Redding said. “There is a lack of employee training and a lack of emphasis on accountability for employees.”
Privacy breaches fuel lawsuits
Health professionals caught snooping through records are frequently terminated and employers can face a range of ramifications, including civil and criminal penalties.
A growing trend is class action lawsuits associated with privacy violations, Mr. Redding adds.
Because patients are unable to sue in civil court for HIPAA breaches, they frequently sue for “breach of an implied contract,” he explained. In such cases, patients allege that the privacy documents they signed with health care providers established an implied contract, and their records being exposed constituted a contract breach.
“Class action lawsuits are starting to become extremely common,” Mr. Redding said. “It’s happening in many cases, even sometimes before Health & Human Services issue a fine, that [providers] are being wrapped into a class action lawsuit.”
Mayo Clinic, for example, was recently slapped with a class action suit after a former employee inappropriately accessed the records of 1,600 patients. Mayo settled the suit in January 2023, the terms of which were not publicly disclosed.
Multiple patients also filed a class action suit against San Diego–based Scripps Health after its data were hit with a cyberattack and subsequent breach that impacted close to 2 million people. Scripps reached a $3.5 million settlement with the plaintiffs in 2023.
Some practices and employers may also face state penalties for data privacy breaches, depending on their jurisdiction. In July, Connecticut became the fifth state to enact a comprehensive data privacy law. The measure, which creates a robust framework for protecting health-related records and other data, includes civil penalties of up to $5,000 for violations. Other states, including California, Virginia, Utah, and Colorado, also have state data privacy laws on the books.
How can practices stop snooping?
A first step to preventing snooping is conducting a thorough risk assessment, said David Harlow, a health care attorney and chief compliance and privacy officer for Insulet Corporation, a medical device company. The analysis should address who has access to what data and whether they really need such access, he said.
“Then it’s putting in place the proper controls to ensure access is limited and use is limited to the appropriate individuals and circumstances,” Mr. Harlow said.
Regulators don’t expect a giant academic medical center and a small private physician practice to take an identical HIPAA compliance approach, he stressed. The ideal approach will vary by entity. Providers just need to address the standards in a way that makes sense for their operation, he said.
Training is also a critical component, adds Mr. Sims.
“Having training is key,” he said. “Oftentimes, an employee might think, ‘Well, if I can click on this data and it comes up, obviously, I can look at it.’ They need to understand what information they are and are not allowed to access.”
Keep in mind that settings or controls might change when larger transitions take place, such as moving to a new electronic health record system, Mr. Sims said. It’s essential to reevaluate controls when changes in the practice take place to ensure that everything is functioning correctly.
Mr. Sims also suggests that practices create a type of “If you see something, say something,” policy that encourages fellow physicians and employees to report anything that looks suspicious within electronic logs. If an employee, for instance, is suddenly looking at many more records than usual or at odd times of the day or night, this should raise red flags.
“It’s great to stop it early so that it doesn’t become a bigger issue for the practice to deal with, but also, from a legal standpoint, you want to have a defensible argument that you were doing all you could to stop this as quickly as possible,” he said. “It puts you in a better position to defend yourself.”
The snooping security guards case holds an important lesson for all health providers, Mr. Harlow said.
“This is a message to all of us, that you need to have done the assessment up front,” he said. You need to have the right controls in place up front. This is not a situation where somebody managed to hack into a system for some devious means. This is someone who was given keys. Why were they given the keys?”
A version of this article first appeared on Medscape.com.
Yakima Valley Memorial Hospital agreed to the voluntary settlement after an investigation into the actions of 23 emergency department security guards who allegedly used their login credentials to access the patient medical records of 419 patients.
The information accessed included names, dates of birth, medical record numbers, addresses, certain notes related to treatment, and insurance information, according to a release by the U.S .Department of Health & Human Services’ Office for Civil Rights (OCR). A breach notification report alerted OCR to the snooping.
As part of the agreement, OCR will monitor Yakima Valley Memorial Hospital for 2 years and the hospital must conduct a thorough risk analysis as well as develop a risk management plan to address and mitigate identified security risks and vulnerabilities. The settlement is not considered an admission of guilt by the hospital.
Is such snooping common?
The incident highlights the frequent practice of employees snooping through medical records and the steep consequences that can result for providers, said Paul Redding, vice president of partner engagement and cybersecurity at Compliancy Group, a company that offers guided HIPAA compliance software for healthcare providers and vendors.
“I think the problem is absolutely growing,” he said. “What’s crazy about this case is it’s actually a really small HIPAA violation. Less than 500 people were affected, and the hospital still must pay a quarter-of-a-million-dollar settlement. If you take the average HIPAA violation, which is in the thousands and thousands of [patients], this amount would be magnified many times over.”
In general, employees snoop through records out of curiosity or to find out information about people they know – or want to learn about, said J. David Sims, a cybersecurity expert and CEO of Security First IT, a company that provides cybersecurity solutions and IT support to health care businesses.
Mr. Sims says he has heard of cases where health professionals snooped through records to find information about the new love interests of ex-partners or to learn about people on dating websites whom they’re interested in dating.
“Most of the time, it’s people being nosy,” he said. “In a lot of cases, it’s curiosity about famous people. You see it a lot in areas where you have football players who come in with injuries or you have an actor or actress who come in for something.”
“Data breaches caused by current and former workforce members impermissibly accessing patient records are a recurring issue across the health care industry. Health care organizations must ensure that workforce members can only access the patient information needed to do their jobs,” OCR director Melanie Fontes Rainer said in a June statement. “HIPAA-covered entities must have robust policies and procedures in place to ensure patient health information is protected from identify theft and fraud.”
Yakima Valley Memorial Hospital did not return a message seeking comment.
According to OCR’s latest report to Congress, complaints about HIPAA violations increased by 39% between 2017 and 2021. Breaches affecting fewer than 500 individuals rose by 5% during the same time period, and breaches impacting 500 or more individuals increased by 58%.
Common reasons employees snoop
The OCR announcement does not specify why the 23 security guards were accessing the medical records, but the incident raises questions about why the security guards had access to protected health information (PHI) in the first place, Mr. Redding said.
“I have yet to have anyone explain to me why the security guards would have access to PHI at all, at any level,” he said. “Was it by design or was it by error?”
In 2019 for instance, dozens of employees at Northwestern Memorial Hospital in Chicago were fired for accessing the health records of former Empire actor Jussie Smollett. In another high-profile case, nearly a dozen emergency medical service employees were caught snooping through 911 records connected to the treatment and, later, death of Joan Rivers.
“Sadly, there is a lack of education around what compliance really means inside the medical industry as a whole,” Mr. Redding said. “There is a lack of employee training and a lack of emphasis on accountability for employees.”
Privacy breaches fuel lawsuits
Health professionals caught snooping through records are frequently terminated and employers can face a range of ramifications, including civil and criminal penalties.
A growing trend is class action lawsuits associated with privacy violations, Mr. Redding adds.
Because patients are unable to sue in civil court for HIPAA breaches, they frequently sue for “breach of an implied contract,” he explained. In such cases, patients allege that the privacy documents they signed with health care providers established an implied contract, and their records being exposed constituted a contract breach.
“Class action lawsuits are starting to become extremely common,” Mr. Redding said. “It’s happening in many cases, even sometimes before Health & Human Services issue a fine, that [providers] are being wrapped into a class action lawsuit.”
Mayo Clinic, for example, was recently slapped with a class action suit after a former employee inappropriately accessed the records of 1,600 patients. Mayo settled the suit in January 2023, the terms of which were not publicly disclosed.
Multiple patients also filed a class action suit against San Diego–based Scripps Health after its data were hit with a cyberattack and subsequent breach that impacted close to 2 million people. Scripps reached a $3.5 million settlement with the plaintiffs in 2023.
Some practices and employers may also face state penalties for data privacy breaches, depending on their jurisdiction. In July, Connecticut became the fifth state to enact a comprehensive data privacy law. The measure, which creates a robust framework for protecting health-related records and other data, includes civil penalties of up to $5,000 for violations. Other states, including California, Virginia, Utah, and Colorado, also have state data privacy laws on the books.
How can practices stop snooping?
A first step to preventing snooping is conducting a thorough risk assessment, said David Harlow, a health care attorney and chief compliance and privacy officer for Insulet Corporation, a medical device company. The analysis should address who has access to what data and whether they really need such access, he said.
“Then it’s putting in place the proper controls to ensure access is limited and use is limited to the appropriate individuals and circumstances,” Mr. Harlow said.
Regulators don’t expect a giant academic medical center and a small private physician practice to take an identical HIPAA compliance approach, he stressed. The ideal approach will vary by entity. Providers just need to address the standards in a way that makes sense for their operation, he said.
Training is also a critical component, adds Mr. Sims.
“Having training is key,” he said. “Oftentimes, an employee might think, ‘Well, if I can click on this data and it comes up, obviously, I can look at it.’ They need to understand what information they are and are not allowed to access.”
Keep in mind that settings or controls might change when larger transitions take place, such as moving to a new electronic health record system, Mr. Sims said. It’s essential to reevaluate controls when changes in the practice take place to ensure that everything is functioning correctly.
Mr. Sims also suggests that practices create a type of “If you see something, say something,” policy that encourages fellow physicians and employees to report anything that looks suspicious within electronic logs. If an employee, for instance, is suddenly looking at many more records than usual or at odd times of the day or night, this should raise red flags.
“It’s great to stop it early so that it doesn’t become a bigger issue for the practice to deal with, but also, from a legal standpoint, you want to have a defensible argument that you were doing all you could to stop this as quickly as possible,” he said. “It puts you in a better position to defend yourself.”
The snooping security guards case holds an important lesson for all health providers, Mr. Harlow said.
“This is a message to all of us, that you need to have done the assessment up front,” he said. You need to have the right controls in place up front. This is not a situation where somebody managed to hack into a system for some devious means. This is someone who was given keys. Why were they given the keys?”
A version of this article first appeared on Medscape.com.
Sick humor
This past June, during the search for the Titan submersible, and since then, we’ve had a not-entirely-unexpected development: Sick humor.
There was a lot of it. The Subway owner who got reprimanded for putting “Our subs don’t implode” on his sign was minor league compared with other things circulating on the Internet. One example that was sent to me showed the late Stockton Rush, OceanGate’s co-owner, as the new spokesman for Cap’n Crunch.
Of course, this is nothing new. People have made jokes about awful situations since to the dawn of civilization.
Why do we do this?
Humor is a remarkably human trait. There’s evidence other mammals have it, but not to the extent we do. We’ve created a multitude of forms that vary between cultures. But there isn’t a civilization or culture on Earth that doesn’t have humor.
Why we developed it I’ll leave to others, though I assume a key part is that it strengthens bonds between people, helping them stick together in the groups that keep society moving forward.
Sick humor is part of this, though having grown up watching Monty Python and reading National Lampoon magazine I’m certainly guilty of enjoying it. To this day I think “Eating Raoul” is one of the greatest comedies ever.
It’s also pretty common in medicine. I’ve been involved in plenty of hospital situations that were quite unfunny, yet there are always jokes about it flying as we work.
I assume it’s a defense mechanism. Helping us cope with a bad situation as we do our best to deal with it. Using humor to put a block between the obvious realization that someday this could happen to us. To help psychologically shield us from something tragic.
Years ago I was trying to describe the plot of “Eating Raoul” and said “if you read about this sort of crime spree in a newspaper you’d be horrified. But the way it’s handled in the movie it’s hysterical.” Perhaps that’s as close to understanding sick humor as I’ll ever get. It makes the unfunny funny.
Perhaps the better phrase is the more generic “it’s human nature.”
Whether or not it’s funny depends on the person. There were plenty of people horrified by the Subway sign, enough that the owner had to change it. But there were also those who admitted they found it tasteless, but still got a laugh out of it. I’m sure the families of those lost on the Titan were justifiably upset, but the closer you get to a personal tragedy the more serious it is.
There’s a fine line, as National Lampoon put it, between funny and sick. But it’s also part of who we are.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
This past June, during the search for the Titan submersible, and since then, we’ve had a not-entirely-unexpected development: Sick humor.
There was a lot of it. The Subway owner who got reprimanded for putting “Our subs don’t implode” on his sign was minor league compared with other things circulating on the Internet. One example that was sent to me showed the late Stockton Rush, OceanGate’s co-owner, as the new spokesman for Cap’n Crunch.
Of course, this is nothing new. People have made jokes about awful situations since to the dawn of civilization.
Why do we do this?
Humor is a remarkably human trait. There’s evidence other mammals have it, but not to the extent we do. We’ve created a multitude of forms that vary between cultures. But there isn’t a civilization or culture on Earth that doesn’t have humor.
Why we developed it I’ll leave to others, though I assume a key part is that it strengthens bonds between people, helping them stick together in the groups that keep society moving forward.
Sick humor is part of this, though having grown up watching Monty Python and reading National Lampoon magazine I’m certainly guilty of enjoying it. To this day I think “Eating Raoul” is one of the greatest comedies ever.
It’s also pretty common in medicine. I’ve been involved in plenty of hospital situations that were quite unfunny, yet there are always jokes about it flying as we work.
I assume it’s a defense mechanism. Helping us cope with a bad situation as we do our best to deal with it. Using humor to put a block between the obvious realization that someday this could happen to us. To help psychologically shield us from something tragic.
Years ago I was trying to describe the plot of “Eating Raoul” and said “if you read about this sort of crime spree in a newspaper you’d be horrified. But the way it’s handled in the movie it’s hysterical.” Perhaps that’s as close to understanding sick humor as I’ll ever get. It makes the unfunny funny.
Perhaps the better phrase is the more generic “it’s human nature.”
Whether or not it’s funny depends on the person. There were plenty of people horrified by the Subway sign, enough that the owner had to change it. But there were also those who admitted they found it tasteless, but still got a laugh out of it. I’m sure the families of those lost on the Titan were justifiably upset, but the closer you get to a personal tragedy the more serious it is.
There’s a fine line, as National Lampoon put it, between funny and sick. But it’s also part of who we are.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
This past June, during the search for the Titan submersible, and since then, we’ve had a not-entirely-unexpected development: Sick humor.
There was a lot of it. The Subway owner who got reprimanded for putting “Our subs don’t implode” on his sign was minor league compared with other things circulating on the Internet. One example that was sent to me showed the late Stockton Rush, OceanGate’s co-owner, as the new spokesman for Cap’n Crunch.
Of course, this is nothing new. People have made jokes about awful situations since to the dawn of civilization.
Why do we do this?
Humor is a remarkably human trait. There’s evidence other mammals have it, but not to the extent we do. We’ve created a multitude of forms that vary between cultures. But there isn’t a civilization or culture on Earth that doesn’t have humor.
Why we developed it I’ll leave to others, though I assume a key part is that it strengthens bonds between people, helping them stick together in the groups that keep society moving forward.
Sick humor is part of this, though having grown up watching Monty Python and reading National Lampoon magazine I’m certainly guilty of enjoying it. To this day I think “Eating Raoul” is one of the greatest comedies ever.
It’s also pretty common in medicine. I’ve been involved in plenty of hospital situations that were quite unfunny, yet there are always jokes about it flying as we work.
I assume it’s a defense mechanism. Helping us cope with a bad situation as we do our best to deal with it. Using humor to put a block between the obvious realization that someday this could happen to us. To help psychologically shield us from something tragic.
Years ago I was trying to describe the plot of “Eating Raoul” and said “if you read about this sort of crime spree in a newspaper you’d be horrified. But the way it’s handled in the movie it’s hysterical.” Perhaps that’s as close to understanding sick humor as I’ll ever get. It makes the unfunny funny.
Perhaps the better phrase is the more generic “it’s human nature.”
Whether or not it’s funny depends on the person. There were plenty of people horrified by the Subway sign, enough that the owner had to change it. But there were also those who admitted they found it tasteless, but still got a laugh out of it. I’m sure the families of those lost on the Titan were justifiably upset, but the closer you get to a personal tragedy the more serious it is.
There’s a fine line, as National Lampoon put it, between funny and sick. But it’s also part of who we are.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Pain mismanagement by the numbers
Despite my best efforts to cultivate acquaintances across a broader age group, my social circle still has the somewhat musty odor of septuagenarians. We try to talk about things beyond the weather and grandchildren but pain scenarios surface with unfortunate frequency. Arthritic joints ache, body parts wear out or become diseased and have to be removed or replaced. That stuff can hurt.
There are two pain-related themes that seem to crop up more frequently than you might expect. The first is the unfortunate side effects of opioid medication – most often gastric distress and vomiting, then of course there’s constipation. They seem so common that a good many of my acquaintances just plain refuse to take opioids when they have been prescribed postoperatively because of their vivid memories of the consequences or horror stories friends have told.
The second theme is the general annoyance with the damn “Please rate your pain from one to ten” request issued by every well-intentioned nurse. Do you mean the pain I am having right now, this second, or last night, or the average over the last day and a half? Or should I be comparing it with when I gave birth 70 years ago, or when I stubbed my toe getting out of the shower last week? And then what are you going to do with my guesstimated number?
It may surprise some of you that 40 years ago there wasn’t a pain scale fetish. But a few observant health care professionals realized that many of our patients were suffering because we weren’t adequately managing their pain. In postoperative situations this was slowing recovery and effecting outcomes. Like good pseudoscientists, they realized that we should first quantify the pain and the notion that no pain should go unrated came into being. Nor should pain go untreated, which is too frequently interpreted as meaning unmedicated.
For example a systematic review of 61 studies of juvenile idiopathic arthritis (JIA) published in the journal Pediatric Rheumatology found that there was positive relationship between pain and a child’s belief that pain causes harm, disability, and lack of control. Not surprisingly, stress was also associated with pain intensity.
It is a long paper and touches on numerous other associations of varying degrees of strength between parental, social, and other external factors. But, in general, they were not as consistent as those related to a child’s beliefs.
Before, or at least at the same time, we treat a patient’s pain, we should learn more about that patient – his or her concerns, beliefs, and stressors. You and I may have exactly the same hernia operation, but if you have a better understanding of why you are going to feel uncomfortable after the surgery, and understand that not every pain is the result of a complication, I suspect you are more likely to complain of less pain.
The recent JIA study doesn’t claim to suggest therapeutic methods. However, one wonders what the result would be if we could somehow alter a patient’s belief system so that he or she no longer sees pain as always harmful, nor does the patient see himself or herself as powerless to do anything about the pain. To do this experiment we must follow up our robotic request to “rate your pain” with a dialogue in which we learn more about the patient. Which means probing believes, fears, and stressors.
You can tell me this exercise would be unrealistic and time consuming. But I bet in the long run it will save time. Even if it doesn’t it is the better way to manage pain.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at [email protected].
Despite my best efforts to cultivate acquaintances across a broader age group, my social circle still has the somewhat musty odor of septuagenarians. We try to talk about things beyond the weather and grandchildren but pain scenarios surface with unfortunate frequency. Arthritic joints ache, body parts wear out or become diseased and have to be removed or replaced. That stuff can hurt.
There are two pain-related themes that seem to crop up more frequently than you might expect. The first is the unfortunate side effects of opioid medication – most often gastric distress and vomiting, then of course there’s constipation. They seem so common that a good many of my acquaintances just plain refuse to take opioids when they have been prescribed postoperatively because of their vivid memories of the consequences or horror stories friends have told.
The second theme is the general annoyance with the damn “Please rate your pain from one to ten” request issued by every well-intentioned nurse. Do you mean the pain I am having right now, this second, or last night, or the average over the last day and a half? Or should I be comparing it with when I gave birth 70 years ago, or when I stubbed my toe getting out of the shower last week? And then what are you going to do with my guesstimated number?
It may surprise some of you that 40 years ago there wasn’t a pain scale fetish. But a few observant health care professionals realized that many of our patients were suffering because we weren’t adequately managing their pain. In postoperative situations this was slowing recovery and effecting outcomes. Like good pseudoscientists, they realized that we should first quantify the pain and the notion that no pain should go unrated came into being. Nor should pain go untreated, which is too frequently interpreted as meaning unmedicated.
For example a systematic review of 61 studies of juvenile idiopathic arthritis (JIA) published in the journal Pediatric Rheumatology found that there was positive relationship between pain and a child’s belief that pain causes harm, disability, and lack of control. Not surprisingly, stress was also associated with pain intensity.
It is a long paper and touches on numerous other associations of varying degrees of strength between parental, social, and other external factors. But, in general, they were not as consistent as those related to a child’s beliefs.
Before, or at least at the same time, we treat a patient’s pain, we should learn more about that patient – his or her concerns, beliefs, and stressors. You and I may have exactly the same hernia operation, but if you have a better understanding of why you are going to feel uncomfortable after the surgery, and understand that not every pain is the result of a complication, I suspect you are more likely to complain of less pain.
The recent JIA study doesn’t claim to suggest therapeutic methods. However, one wonders what the result would be if we could somehow alter a patient’s belief system so that he or she no longer sees pain as always harmful, nor does the patient see himself or herself as powerless to do anything about the pain. To do this experiment we must follow up our robotic request to “rate your pain” with a dialogue in which we learn more about the patient. Which means probing believes, fears, and stressors.
You can tell me this exercise would be unrealistic and time consuming. But I bet in the long run it will save time. Even if it doesn’t it is the better way to manage pain.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at [email protected].
Despite my best efforts to cultivate acquaintances across a broader age group, my social circle still has the somewhat musty odor of septuagenarians. We try to talk about things beyond the weather and grandchildren but pain scenarios surface with unfortunate frequency. Arthritic joints ache, body parts wear out or become diseased and have to be removed or replaced. That stuff can hurt.
There are two pain-related themes that seem to crop up more frequently than you might expect. The first is the unfortunate side effects of opioid medication – most often gastric distress and vomiting, then of course there’s constipation. They seem so common that a good many of my acquaintances just plain refuse to take opioids when they have been prescribed postoperatively because of their vivid memories of the consequences or horror stories friends have told.
The second theme is the general annoyance with the damn “Please rate your pain from one to ten” request issued by every well-intentioned nurse. Do you mean the pain I am having right now, this second, or last night, or the average over the last day and a half? Or should I be comparing it with when I gave birth 70 years ago, or when I stubbed my toe getting out of the shower last week? And then what are you going to do with my guesstimated number?
It may surprise some of you that 40 years ago there wasn’t a pain scale fetish. But a few observant health care professionals realized that many of our patients were suffering because we weren’t adequately managing their pain. In postoperative situations this was slowing recovery and effecting outcomes. Like good pseudoscientists, they realized that we should first quantify the pain and the notion that no pain should go unrated came into being. Nor should pain go untreated, which is too frequently interpreted as meaning unmedicated.
For example a systematic review of 61 studies of juvenile idiopathic arthritis (JIA) published in the journal Pediatric Rheumatology found that there was positive relationship between pain and a child’s belief that pain causes harm, disability, and lack of control. Not surprisingly, stress was also associated with pain intensity.
It is a long paper and touches on numerous other associations of varying degrees of strength between parental, social, and other external factors. But, in general, they were not as consistent as those related to a child’s beliefs.
Before, or at least at the same time, we treat a patient’s pain, we should learn more about that patient – his or her concerns, beliefs, and stressors. You and I may have exactly the same hernia operation, but if you have a better understanding of why you are going to feel uncomfortable after the surgery, and understand that not every pain is the result of a complication, I suspect you are more likely to complain of less pain.
The recent JIA study doesn’t claim to suggest therapeutic methods. However, one wonders what the result would be if we could somehow alter a patient’s belief system so that he or she no longer sees pain as always harmful, nor does the patient see himself or herself as powerless to do anything about the pain. To do this experiment we must follow up our robotic request to “rate your pain” with a dialogue in which we learn more about the patient. Which means probing believes, fears, and stressors.
You can tell me this exercise would be unrealistic and time consuming. But I bet in the long run it will save time. Even if it doesn’t it is the better way to manage pain.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at [email protected].
Nursing diploma mill leader sentenced to nearly 2 years
U.S. District Judge Rodney Smith of the Southern District of Florida in Fort Lauderdale recently sentenced Johanah Napoleon, former president of the Palm Beach School of Nursing, to 21 months in prison, according to the Miami Herald . The judge also ordered Ms. Napoleon to pay about $3.5 million. She already paid $2.6 million of it, the Herald reports.
The sentence is “indicative of the seriousness of this crime,” shared Willa Fuller, BSN, RN, executive director of the Florida Nurses Association. “Hopefully, this decision will deter potential perpetrators in the future,” Ms. Fuller said in an email.
Ms. Napoleon was charged in 2021 along with two owners of nursing schools in Maryland and Virginia who worked with her. All pled guilty to selling fake degrees for $6,000-$18,000. The Florida Board of Nursing had previously shut down the Palm Beach school in 2017 as a result of its students’ low passing rate on the national licensing exam.
A tip related to the Maryland case led to federal charges in January against 25 owners, operators, and employees of the Palm Beach School of Nursing and two other Florida nursing schools for selling thousands of fake nursing degrees. Those who were charged operated in Delaware, New York, New Jersey, Texas, and Florida.
Five of those 25 defendants will be sentenced on July 27 in a federal district court in Fort Lauderdale after pleading guilty in May to wire fraud conspiracy, according to the U.S. Attorney for the Southern District of Florida. They each face up to 20 years in federal prison.
Purchasers of the fake associate or bachelor’s degrees received transcripts showing that they completed coursework. Some 2,800 of the buyers passed the national nursing licensing exam to become registered nurses and licensed practice nurses/vocational nurses in hospitals, nursing homes, and Veterans Affairs medical centers around the country, according to The New York Times.
Ms. Napoleon’s attorney, Joel DeFabio, said in an interview that he requested a lower sentence than the 4 years recommended in sentencing guidelines because Ms. Napoleon pled guilty quickly and cooperated with the federal investigation.
Mr. DeFabio said that Ms. Napoleon will appear as the government’s witness in a trial in November against Gail Russ, who is one defendant, along with 13 others in the case involving the Palm Beach School of Nursing.
Meanwhile, state nursing boards have been trying to locate nurses who received the fake degrees. In March, the New York nursing board told 903 nurses to either surrender their licenses or prove they had the appropriate education. The board estimated that another 2,300 licensees from the Florida schools had pending applications.
Some nurses who received fake diplomas are pushing back. Attorneys for nurses in Georgia and Pennsylvania claim that their clients were either victims or in some cases, have legitimate credentials.
“The quality of nursing education as well as protection of applicants from these harmful schemes is essential to maintaining the strict standards of the nursing profession,” Ms. Fuller said.
A version of this article appeared on Medscape.com.
U.S. District Judge Rodney Smith of the Southern District of Florida in Fort Lauderdale recently sentenced Johanah Napoleon, former president of the Palm Beach School of Nursing, to 21 months in prison, according to the Miami Herald . The judge also ordered Ms. Napoleon to pay about $3.5 million. She already paid $2.6 million of it, the Herald reports.
The sentence is “indicative of the seriousness of this crime,” shared Willa Fuller, BSN, RN, executive director of the Florida Nurses Association. “Hopefully, this decision will deter potential perpetrators in the future,” Ms. Fuller said in an email.
Ms. Napoleon was charged in 2021 along with two owners of nursing schools in Maryland and Virginia who worked with her. All pled guilty to selling fake degrees for $6,000-$18,000. The Florida Board of Nursing had previously shut down the Palm Beach school in 2017 as a result of its students’ low passing rate on the national licensing exam.
A tip related to the Maryland case led to federal charges in January against 25 owners, operators, and employees of the Palm Beach School of Nursing and two other Florida nursing schools for selling thousands of fake nursing degrees. Those who were charged operated in Delaware, New York, New Jersey, Texas, and Florida.
Five of those 25 defendants will be sentenced on July 27 in a federal district court in Fort Lauderdale after pleading guilty in May to wire fraud conspiracy, according to the U.S. Attorney for the Southern District of Florida. They each face up to 20 years in federal prison.
Purchasers of the fake associate or bachelor’s degrees received transcripts showing that they completed coursework. Some 2,800 of the buyers passed the national nursing licensing exam to become registered nurses and licensed practice nurses/vocational nurses in hospitals, nursing homes, and Veterans Affairs medical centers around the country, according to The New York Times.
Ms. Napoleon’s attorney, Joel DeFabio, said in an interview that he requested a lower sentence than the 4 years recommended in sentencing guidelines because Ms. Napoleon pled guilty quickly and cooperated with the federal investigation.
Mr. DeFabio said that Ms. Napoleon will appear as the government’s witness in a trial in November against Gail Russ, who is one defendant, along with 13 others in the case involving the Palm Beach School of Nursing.
Meanwhile, state nursing boards have been trying to locate nurses who received the fake degrees. In March, the New York nursing board told 903 nurses to either surrender their licenses or prove they had the appropriate education. The board estimated that another 2,300 licensees from the Florida schools had pending applications.
Some nurses who received fake diplomas are pushing back. Attorneys for nurses in Georgia and Pennsylvania claim that their clients were either victims or in some cases, have legitimate credentials.
“The quality of nursing education as well as protection of applicants from these harmful schemes is essential to maintaining the strict standards of the nursing profession,” Ms. Fuller said.
A version of this article appeared on Medscape.com.
U.S. District Judge Rodney Smith of the Southern District of Florida in Fort Lauderdale recently sentenced Johanah Napoleon, former president of the Palm Beach School of Nursing, to 21 months in prison, according to the Miami Herald . The judge also ordered Ms. Napoleon to pay about $3.5 million. She already paid $2.6 million of it, the Herald reports.
The sentence is “indicative of the seriousness of this crime,” shared Willa Fuller, BSN, RN, executive director of the Florida Nurses Association. “Hopefully, this decision will deter potential perpetrators in the future,” Ms. Fuller said in an email.
Ms. Napoleon was charged in 2021 along with two owners of nursing schools in Maryland and Virginia who worked with her. All pled guilty to selling fake degrees for $6,000-$18,000. The Florida Board of Nursing had previously shut down the Palm Beach school in 2017 as a result of its students’ low passing rate on the national licensing exam.
A tip related to the Maryland case led to federal charges in January against 25 owners, operators, and employees of the Palm Beach School of Nursing and two other Florida nursing schools for selling thousands of fake nursing degrees. Those who were charged operated in Delaware, New York, New Jersey, Texas, and Florida.
Five of those 25 defendants will be sentenced on July 27 in a federal district court in Fort Lauderdale after pleading guilty in May to wire fraud conspiracy, according to the U.S. Attorney for the Southern District of Florida. They each face up to 20 years in federal prison.
Purchasers of the fake associate or bachelor’s degrees received transcripts showing that they completed coursework. Some 2,800 of the buyers passed the national nursing licensing exam to become registered nurses and licensed practice nurses/vocational nurses in hospitals, nursing homes, and Veterans Affairs medical centers around the country, according to The New York Times.
Ms. Napoleon’s attorney, Joel DeFabio, said in an interview that he requested a lower sentence than the 4 years recommended in sentencing guidelines because Ms. Napoleon pled guilty quickly and cooperated with the federal investigation.
Mr. DeFabio said that Ms. Napoleon will appear as the government’s witness in a trial in November against Gail Russ, who is one defendant, along with 13 others in the case involving the Palm Beach School of Nursing.
Meanwhile, state nursing boards have been trying to locate nurses who received the fake degrees. In March, the New York nursing board told 903 nurses to either surrender their licenses or prove they had the appropriate education. The board estimated that another 2,300 licensees from the Florida schools had pending applications.
Some nurses who received fake diplomas are pushing back. Attorneys for nurses in Georgia and Pennsylvania claim that their clients were either victims or in some cases, have legitimate credentials.
“The quality of nursing education as well as protection of applicants from these harmful schemes is essential to maintaining the strict standards of the nursing profession,” Ms. Fuller said.
A version of this article appeared on Medscape.com.
Pending Legislation Puts VA Health Care at Risk
“What if VA health care goes away?” That was the headline of a July 6, 2023, Disabled American Veterans news article to its members. The question was not hypothetical. Legislation currently under consideration by the US Congress may make it a strong probability.
The US Senate Committee on Veterans’ Affairs recently held a hearing to discuss 2 bills that would drastically reshape the provision of private health care services through the Veterans Community Care Program. An unprecedented coalition of 10 organizations—made up of US Department of Veterans Affairs (VA) nurses, psychologists, physicians, dentists, social workers, optometrists, physician assistants, and nurse anesthetists, as well as the American Psychological Association, the Military and Veterans Committee of the Group for the Advancement of Psychiatry and the Veterans Healthcare Policy Institute—came together in a unified statement for the record highlighting how these proposed policies would open a Pandora’s box that could forever eliminate the Veterans Health Administration as we know it.
Over the past decade—and especially following the passage of the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act—there has been a surge of veterans gaining eligibility for private care if a VA medical facility is too far away, does not offer the needed care, or the wait time for an appointment is too long. 
Testifying before the House Committee on Veterans’ Affairs hearing last year, Miguel LaPuz, MD, MBA, then the acting Deputy Under Secretary for Health at the VA, warned that “VA is rapidly approaching a point where half of all care available in both settings is provided through community care.” He cautioned that leaders were bracing for “the potential of a spiral effect.”
Care that is rendered to veterans in the community must, of course, be paid for. When those community costs began to soar at the start of the Community Care program, Congress bailed out the VA by allocating extra funds. Today, escalating costs are drawn from local VA facility budgets. And to guarantee that private sector care is paid for out of VA facility funds, legislators are introducing language, such as in the Veterans Healthcare Freedom Act, which states: “No additional funds are authorized to be appropriated to carry out this section and the amendments made by this section, and this section and the amendments made by this section shall be carried out using amounts otherwise made available to the Veterans Health Administration.” The anticipated vicious cycle looms. More money pouring into the private sector will force reductions and closures of in-house VA staff, programs, clinics, and units. This will cause more veterans to obtain care in the community, which will further drain more money out of VA facilities, leading to more reductions, etc. Rural areas will likely be hit hardest.
The VA is nearing the tipping point of this ever-descending spiral. And that is even without expanding eligibility further. Three provisions in this pair of bills could, on their own, drastically open eligibility, eliminate remaining guardrails, and push VA over the edge:
(1) Veteran preference. Tucked into the HEALTH Act, introduced by the ranking Republican Member, Jerry Moran of Kansas, is language which would require VA to consider a “veteran’s preference” for obtaining their health care in the private sector.
This stipulation violates the intent of the VA MISSION Act. When MISSION passed, there was bipartisan agreement that the Community Care Program was meant, in numerous Senators’ words, to “supplement, not supplant” VA health care. A veteran would be offered the option of receiving health care outside of the VA under 6 narrowly defined criteria. Legislators understood that veterans would get the option to choose whether to receive care in the private sector or the VA if, and only if, they qualified under the 6 eligibility rules. As a well-researched document coauthored by Disabled American Veterans, Paralyzed Veterans of America, and the Veterans of Foreign Wars stated, “veteran convenience or preference” should never be used as a sole reason for referral.
Explicitly adding preference for the first time will create the expectation among veterans and lawmakers of a new allowance. Were this to pass, every veteran—100%—would become eligible for referral to the private sector, kicking off an unstoppable drainage of VA budget resources and threatening its viability. Hopefully, the Senate will follow the lead of the US House Committee on Veterans’ Affairs which, last week, amended its its own community care bill by deleting “veteran preference” as a possible new eligibility criterion.
(2) Self-referral. Also being deliberated is the Making Community Care Work for Veterans Act, a draft bill authored by the US Senate Committee on Veterans’ Affairs Democratic Chairman Senator Jon Tester of Montana. It calls for allowing self-initiated routine vaccinations and routine vision/hearing services in the community.
On the surface, Tester’s bill focuses on only a tiny sliver of care. But once self-referral is permitted for a few services, private sector interests will, in no time, push the door wide open and add more services to which veterans can self-refer. Testimony at the hearing confirmed that prediction, as the Veterans of Foreign Wars and America’s Warrior Partnership stated there is no reason to limit self-referral to only eye and ear examinations. They proposed that self-referral should extend to mental health, substance use, podiatry, prosthetics, laboratory services, dermatology, and diabetes. Like other perilous sections of these bills, seemingly innocuous language would quickly lead to crippling impacts.
(3) Pilot program for unfettered access. The HEALTH Act contains another provision in which veterans would be allowed to receive outpatient care without VA referral, authorization, or oversight. An enrolled veteran could simply make an appointment with any Veterans Community Care Program mental health or substance use disorder practitioner for care for any duration of time. VA’s only role would be to pay the invoice. Private sector interests have been pressing this sort of program for years, and when it was carefully studied by the Commission on Care, the costs were estimated to be 2 to 3 times the existing system. That would come from a combination of fee-for-service reimbursement structures that abet overuse and higher overall costs in the private sector. Were the pilot to pass, VA would convert from its primary role as a system providing health care to an insurance carrier.
In the name of offering more choices, health care options will diminish for veterans. When VA programs/clinics/facilities close, veterans—especially service-connected veterans who depend on VA for high-quality care tailored to their needs—will lose those choices. Moreover, a downsized VA will make it nearly impossible for the VA to continue to research veterans’ complex health conditions, educate future health care professionals (the majority of whom train at VA medical centers), or fulfill its Fourth Mission as a backup for national emergencies.
Senate Committee members indicated their intention to combine provisions of the Moran and Tester bills into a larger compromise bill in September. Legislators must slow down, contemplate the ramifications, and set aside the stipulations noted above. What is needed first is a projection of future veterans’ authorizations for community care (under current eligibility criteria and also with these new allowances), how much money would that pull out of VA facilities, and what is the tipping point of a doom cycle.
In the meantime, there are smart solutions to ensure veterans can access high-quality care, as Disabled American Veterans testified at the hearing: By “investing in VA's health care infrastructure and staffing… this is particularly true for veterans who live in rural and remote areas where VA is most likely to be a stable, long-term health care option for veterans.”
The VA administers the most successful health care system in the country. As a recent summary of research confirmed yet again, the quality of care delivered by the VA is as good as or better than the care veterans receive from VA-paid community care or the general public obtains through private care. There will always be a supplemental role for the community to play when VA cannot provide care in a timely or convenient manner. But community care must be fixed in ways that never starves VA facilities of essential funding. If there ever were a time to stand up for the sake of our veterans and the long-term viability of the VA, it is now.
“What if VA health care goes away?” That was the headline of a July 6, 2023, Disabled American Veterans news article to its members. The question was not hypothetical. Legislation currently under consideration by the US Congress may make it a strong probability.
The US Senate Committee on Veterans’ Affairs recently held a hearing to discuss 2 bills that would drastically reshape the provision of private health care services through the Veterans Community Care Program. An unprecedented coalition of 10 organizations—made up of US Department of Veterans Affairs (VA) nurses, psychologists, physicians, dentists, social workers, optometrists, physician assistants, and nurse anesthetists, as well as the American Psychological Association, the Military and Veterans Committee of the Group for the Advancement of Psychiatry and the Veterans Healthcare Policy Institute—came together in a unified statement for the record highlighting how these proposed policies would open a Pandora’s box that could forever eliminate the Veterans Health Administration as we know it.
Over the past decade—and especially following the passage of the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act—there has been a surge of veterans gaining eligibility for private care if a VA medical facility is too far away, does not offer the needed care, or the wait time for an appointment is too long.
Testifying before the House Committee on Veterans’ Affairs hearing last year, Miguel LaPuz, MD, MBA, then the acting Deputy Under Secretary for Health at the VA, warned that “VA is rapidly approaching a point where half of all care available in both settings is provided through community care.” He cautioned that leaders were bracing for “the potential of a spiral effect.”
Care that is rendered to veterans in the community must, of course, be paid for. When those community costs began to soar at the start of the Community Care program, Congress bailed out the VA by allocating extra funds. Today, escalating costs are drawn from local VA facility budgets. And to guarantee that private sector care is paid for out of VA facility funds, legislators are introducing language, such as in the Veterans Healthcare Freedom Act, which states: “No additional funds are authorized to be appropriated to carry out this section and the amendments made by this section, and this section and the amendments made by this section shall be carried out using amounts otherwise made available to the Veterans Health Administration.” The anticipated vicious cycle looms. More money pouring into the private sector will force reductions and closures of in-house VA staff, programs, clinics, and units. This will cause more veterans to obtain care in the community, which will further drain more money out of VA facilities, leading to more reductions, etc. Rural areas will likely be hit hardest.
The VA is nearing the tipping point of this ever-descending spiral. And that is even without expanding eligibility further. Three provisions in this pair of bills could, on their own, drastically open eligibility, eliminate remaining guardrails, and push VA over the edge:
(1) Veteran preference. Tucked into the HEALTH Act, introduced by the ranking Republican Member, Jerry Moran of Kansas, is language which would require VA to consider a “veteran’s preference” for obtaining their health care in the private sector.
This stipulation violates the intent of the VA MISSION Act. When MISSION passed, there was bipartisan agreement that the Community Care Program was meant, in numerous Senators’ words, to “supplement, not supplant” VA health care. A veteran would be offered the option of receiving health care outside of the VA under 6 narrowly defined criteria. Legislators understood that veterans would get the option to choose whether to receive care in the private sector or the VA if, and only if, they qualified under the 6 eligibility rules. As a well-researched document coauthored by Disabled American Veterans, Paralyzed Veterans of America, and the Veterans of Foreign Wars stated, “veteran convenience or preference” should never be used as a sole reason for referral.
Explicitly adding preference for the first time will create the expectation among veterans and lawmakers of a new allowance. Were this to pass, every veteran—100%—would become eligible for referral to the private sector, kicking off an unstoppable drainage of VA budget resources and threatening its viability. Hopefully, the Senate will follow the lead of the US House Committee on Veterans’ Affairs which, last week, amended its its own community care bill by deleting “veteran preference” as a possible new eligibility criterion.
(2) Self-referral. Also being deliberated is the Making Community Care Work for Veterans Act, a draft bill authored by the US Senate Committee on Veterans’ Affairs Democratic Chairman Senator Jon Tester of Montana. It calls for allowing self-initiated routine vaccinations and routine vision/hearing services in the community.
On the surface, Tester’s bill focuses on only a tiny sliver of care. But once self-referral is permitted for a few services, private sector interests will, in no time, push the door wide open and add more services to which veterans can self-refer. Testimony at the hearing confirmed that prediction, as the Veterans of Foreign Wars and America’s Warrior Partnership stated there is no reason to limit self-referral to only eye and ear examinations. They proposed that self-referral should extend to mental health, substance use, podiatry, prosthetics, laboratory services, dermatology, and diabetes. Like other perilous sections of these bills, seemingly innocuous language would quickly lead to crippling impacts.
(3) Pilot program for unfettered access. The HEALTH Act contains another provision in which veterans would be allowed to receive outpatient care without VA referral, authorization, or oversight. An enrolled veteran could simply make an appointment with any Veterans Community Care Program mental health or substance use disorder practitioner for care for any duration of time. VA’s only role would be to pay the invoice. Private sector interests have been pressing this sort of program for years, and when it was carefully studied by the Commission on Care, the costs were estimated to be 2 to 3 times the existing system. That would come from a combination of fee-for-service reimbursement structures that abet overuse and higher overall costs in the private sector. Were the pilot to pass, VA would convert from its primary role as a system providing health care to an insurance carrier.
In the name of offering more choices, health care options will diminish for veterans. When VA programs/clinics/facilities close, veterans—especially service-connected veterans who depend on VA for high-quality care tailored to their needs—will lose those choices. Moreover, a downsized VA will make it nearly impossible for the VA to continue to research veterans’ complex health conditions, educate future health care professionals (the majority of whom train at VA medical centers), or fulfill its Fourth Mission as a backup for national emergencies.
Senate Committee members indicated their intention to combine provisions of the Moran and Tester bills into a larger compromise bill in September. Legislators must slow down, contemplate the ramifications, and set aside the stipulations noted above. What is needed first is a projection of future veterans’ authorizations for community care (under current eligibility criteria and also with these new allowances), how much money would that pull out of VA facilities, and what is the tipping point of a doom cycle.
In the meantime, there are smart solutions to ensure veterans can access high-quality care, as Disabled American Veterans testified at the hearing: By “investing in VA's health care infrastructure and staffing… this is particularly true for veterans who live in rural and remote areas where VA is most likely to be a stable, long-term health care option for veterans.”
The VA administers the most successful health care system in the country. As a recent summary of research confirmed yet again, the quality of care delivered by the VA is as good as or better than the care veterans receive from VA-paid community care or the general public obtains through private care. There will always be a supplemental role for the community to play when VA cannot provide care in a timely or convenient manner. But community care must be fixed in ways that never starves VA facilities of essential funding. If there ever were a time to stand up for the sake of our veterans and the long-term viability of the VA, it is now.
“What if VA health care goes away?” That was the headline of a July 6, 2023, Disabled American Veterans news article to its members. The question was not hypothetical. Legislation currently under consideration by the US Congress may make it a strong probability.
The US Senate Committee on Veterans’ Affairs recently held a hearing to discuss 2 bills that would drastically reshape the provision of private health care services through the Veterans Community Care Program. An unprecedented coalition of 10 organizations—made up of US Department of Veterans Affairs (VA) nurses, psychologists, physicians, dentists, social workers, optometrists, physician assistants, and nurse anesthetists, as well as the American Psychological Association, the Military and Veterans Committee of the Group for the Advancement of Psychiatry and the Veterans Healthcare Policy Institute—came together in a unified statement for the record highlighting how these proposed policies would open a Pandora’s box that could forever eliminate the Veterans Health Administration as we know it.
Over the past decade—and especially following the passage of the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act—there has been a surge of veterans gaining eligibility for private care if a VA medical facility is too far away, does not offer the needed care, or the wait time for an appointment is too long.
Testifying before the House Committee on Veterans’ Affairs hearing last year, Miguel LaPuz, MD, MBA, then the acting Deputy Under Secretary for Health at the VA, warned that “VA is rapidly approaching a point where half of all care available in both settings is provided through community care.” He cautioned that leaders were bracing for “the potential of a spiral effect.”
Care that is rendered to veterans in the community must, of course, be paid for. When those community costs began to soar at the start of the Community Care program, Congress bailed out the VA by allocating extra funds. Today, escalating costs are drawn from local VA facility budgets. And to guarantee that private sector care is paid for out of VA facility funds, legislators are introducing language, such as in the Veterans Healthcare Freedom Act, which states: “No additional funds are authorized to be appropriated to carry out this section and the amendments made by this section, and this section and the amendments made by this section shall be carried out using amounts otherwise made available to the Veterans Health Administration.” The anticipated vicious cycle looms. More money pouring into the private sector will force reductions and closures of in-house VA staff, programs, clinics, and units. This will cause more veterans to obtain care in the community, which will further drain more money out of VA facilities, leading to more reductions, etc. Rural areas will likely be hit hardest.
The VA is nearing the tipping point of this ever-descending spiral. And that is even without expanding eligibility further. Three provisions in this pair of bills could, on their own, drastically open eligibility, eliminate remaining guardrails, and push VA over the edge:
(1) Veteran preference. Tucked into the HEALTH Act, introduced by the ranking Republican Member, Jerry Moran of Kansas, is language which would require VA to consider a “veteran’s preference” for obtaining their health care in the private sector.
This stipulation violates the intent of the VA MISSION Act. When MISSION passed, there was bipartisan agreement that the Community Care Program was meant, in numerous Senators’ words, to “supplement, not supplant” VA health care. A veteran would be offered the option of receiving health care outside of the VA under 6 narrowly defined criteria. Legislators understood that veterans would get the option to choose whether to receive care in the private sector or the VA if, and only if, they qualified under the 6 eligibility rules. As a well-researched document coauthored by Disabled American Veterans, Paralyzed Veterans of America, and the Veterans of Foreign Wars stated, “veteran convenience or preference” should never be used as a sole reason for referral.
Explicitly adding preference for the first time will create the expectation among veterans and lawmakers of a new allowance. Were this to pass, every veteran—100%—would become eligible for referral to the private sector, kicking off an unstoppable drainage of VA budget resources and threatening its viability. Hopefully, the Senate will follow the lead of the US House Committee on Veterans’ Affairs which, last week, amended its its own community care bill by deleting “veteran preference” as a possible new eligibility criterion.
(2) Self-referral. Also being deliberated is the Making Community Care Work for Veterans Act, a draft bill authored by the US Senate Committee on Veterans’ Affairs Democratic Chairman Senator Jon Tester of Montana. It calls for allowing self-initiated routine vaccinations and routine vision/hearing services in the community.
On the surface, Tester’s bill focuses on only a tiny sliver of care. But once self-referral is permitted for a few services, private sector interests will, in no time, push the door wide open and add more services to which veterans can self-refer. Testimony at the hearing confirmed that prediction, as the Veterans of Foreign Wars and America’s Warrior Partnership stated there is no reason to limit self-referral to only eye and ear examinations. They proposed that self-referral should extend to mental health, substance use, podiatry, prosthetics, laboratory services, dermatology, and diabetes. Like other perilous sections of these bills, seemingly innocuous language would quickly lead to crippling impacts.
(3) Pilot program for unfettered access. The HEALTH Act contains another provision in which veterans would be allowed to receive outpatient care without VA referral, authorization, or oversight. An enrolled veteran could simply make an appointment with any Veterans Community Care Program mental health or substance use disorder practitioner for care for any duration of time. VA’s only role would be to pay the invoice. Private sector interests have been pressing this sort of program for years, and when it was carefully studied by the Commission on Care, the costs were estimated to be 2 to 3 times the existing system. That would come from a combination of fee-for-service reimbursement structures that abet overuse and higher overall costs in the private sector. Were the pilot to pass, VA would convert from its primary role as a system providing health care to an insurance carrier.
In the name of offering more choices, health care options will diminish for veterans. When VA programs/clinics/facilities close, veterans—especially service-connected veterans who depend on VA for high-quality care tailored to their needs—will lose those choices. Moreover, a downsized VA will make it nearly impossible for the VA to continue to research veterans’ complex health conditions, educate future health care professionals (the majority of whom train at VA medical centers), or fulfill its Fourth Mission as a backup for national emergencies.
Senate Committee members indicated their intention to combine provisions of the Moran and Tester bills into a larger compromise bill in September. Legislators must slow down, contemplate the ramifications, and set aside the stipulations noted above. What is needed first is a projection of future veterans’ authorizations for community care (under current eligibility criteria and also with these new allowances), how much money would that pull out of VA facilities, and what is the tipping point of a doom cycle.
In the meantime, there are smart solutions to ensure veterans can access high-quality care, as Disabled American Veterans testified at the hearing: By “investing in VA's health care infrastructure and staffing… this is particularly true for veterans who live in rural and remote areas where VA is most likely to be a stable, long-term health care option for veterans.”
The VA administers the most successful health care system in the country. As a recent summary of research confirmed yet again, the quality of care delivered by the VA is as good as or better than the care veterans receive from VA-paid community care or the general public obtains through private care. There will always be a supplemental role for the community to play when VA cannot provide care in a timely or convenient manner. But community care must be fixed in ways that never starves VA facilities of essential funding. If there ever were a time to stand up for the sake of our veterans and the long-term viability of the VA, it is now.
Lawsuit against insurer claims retaliation against docs for out-of-network referrals
The case, which has bounced around courts in the Golden State since 2012, pits the nearly 50,000-member California Medical Association (CMA) against Aetna, one of the nation’s largest health insurers. The physician group alleges that Aetna illegally retaliated against physicians who sent patients to certain out-of-network clinics.
Out-of-network providers and clinics were involved in just 4.7% of professional medical claims in 2020, according to a federal report released July 6, 2023. Such claims are more likely than others to be denied, and they result in unexpected medical bills, which have led to the passage of state and federal laws that target “surprise billing.”
In a July 17 ruling, the California Supreme Court unanimously resurrected the CMA v. Aetna case after a judge and a state appeals court killed it on the grounds that the CMA - which is affiliated with the American Medical Association (AMA) - had no standing to sue Aetna. The high state court declared that the CMA could sue on its own behalf, but the justices noted that their ruling says nothing about the merits of the case.
The ruling appears to mean that CMA’s lawsuit will head back to Superior Court in Los Angeles County. The outcome of the case won’t have a direct national effect, since the case is in state court, not federal court. However, state rulings can influence the thinking of judges elsewhere.
The case, filed in 2012, alleges that Aetna harmed patient care by harassing and sacking contract physicians who referred patients to out-of-network ambulatory surgery centers.
According to the new ruling, Aetna responded by saying that “its policy, rather than interfering in medical judgments, was designed simply to encourage participating physicians, consistent with their judgment, to use in-network care providers, such as ambulatory surgery centers, and was adopted in part in response to physicians referring patients to facilities in which they had financial interests.”
In a 2012 letter to CMA, as reported by the Los Angeles Times, an Aetna attorney went further and claimed that “physicians and their business partners secure outsized and improper windfalls at the expense of Aetna’s plan members and employer plan sponsors.”
The CMA received support for its lawsuit via friend-of-the-court legal briefs from the California attorney general, city attorneys for several major California cities, the AMA, several major labor unions, the AIDS Healthcare Foundation, and the advocacy organization Consumer Watchdog. The U.S. Chamber of Commerce, the California Association of Health Plans, and the Association of California Life and Health Insurance Companies filed briefs supporting Aetna.
Aetna, now part of CVS Health, declined to comment about the new ruling.
The CMA released a statement from its president, internist/hospitalist Donaldo M. Hernandez, MD: “The practice of threatening physicians who refer patients to out-of-network providers is unlawful, and we are pleased that the court agrees that CMA has the right to challenge these practices in court.”
In an interview, research professor emeritus Jack Hoadley, PhD, of the Health Policy Institute at Georgetown University’s McCourt School of Public Policy, noted that many health plans don’t cover out-of-network care. Those that do – including PPOs and hybrid plans – often require that patients pay a larger share of the total cost or pay a separate or higher deductible, he said.
So why would an insurer punish doctors who refer patients to health care providers who are outside the insurer’s approved network? In some cases, patients may blame insurers when they’re forced to pay higher rates for out-of-network care, Dr. Hoadley said. Insurers may also be miffed when physicians send patients out of network, he said, because insurers contract with physicians to send a certain number of patients within the insurer’s network.
The federal No Surprises Act, passed by Congress in 2020, hasn’t decreased tension between providers and insurers over out-of-network fees, Dr. Hoadley said. As the effects of the law are hammered out in court, he said, there’s still an adversarial relationship.
In California, the out-of-network landscape changed 3 years before the No Surprises Act. In 2017, the state passed its own no-surprise-billing law, which “protects consumers from surprise medical bills when they get non-emergency services, go to an in-network health facility and receive care from an out-of-network provider without their consent.” In these cases, the law says patients need to pay only in accordance with in-network cost sharing.
In 2019, a USC-Brookings Schaeffer Initiative for Health Policy report found signs that out-of-network care was fading in California other than in the emergency setting, possibly as a result of the law.
A version of this article first appeared on Medscape.com.
The case, which has bounced around courts in the Golden State since 2012, pits the nearly 50,000-member California Medical Association (CMA) against Aetna, one of the nation’s largest health insurers. The physician group alleges that Aetna illegally retaliated against physicians who sent patients to certain out-of-network clinics.
Out-of-network providers and clinics were involved in just 4.7% of professional medical claims in 2020, according to a federal report released July 6, 2023. Such claims are more likely than others to be denied, and they result in unexpected medical bills, which have led to the passage of state and federal laws that target “surprise billing.”
In a July 17 ruling, the California Supreme Court unanimously resurrected the CMA v. Aetna case after a judge and a state appeals court killed it on the grounds that the CMA - which is affiliated with the American Medical Association (AMA) - had no standing to sue Aetna. The high state court declared that the CMA could sue on its own behalf, but the justices noted that their ruling says nothing about the merits of the case.
The ruling appears to mean that CMA’s lawsuit will head back to Superior Court in Los Angeles County. The outcome of the case won’t have a direct national effect, since the case is in state court, not federal court. However, state rulings can influence the thinking of judges elsewhere.
The case, filed in 2012, alleges that Aetna harmed patient care by harassing and sacking contract physicians who referred patients to out-of-network ambulatory surgery centers.
According to the new ruling, Aetna responded by saying that “its policy, rather than interfering in medical judgments, was designed simply to encourage participating physicians, consistent with their judgment, to use in-network care providers, such as ambulatory surgery centers, and was adopted in part in response to physicians referring patients to facilities in which they had financial interests.”
In a 2012 letter to CMA, as reported by the Los Angeles Times, an Aetna attorney went further and claimed that “physicians and their business partners secure outsized and improper windfalls at the expense of Aetna’s plan members and employer plan sponsors.”
The CMA received support for its lawsuit via friend-of-the-court legal briefs from the California attorney general, city attorneys for several major California cities, the AMA, several major labor unions, the AIDS Healthcare Foundation, and the advocacy organization Consumer Watchdog. The U.S. Chamber of Commerce, the California Association of Health Plans, and the Association of California Life and Health Insurance Companies filed briefs supporting Aetna.
Aetna, now part of CVS Health, declined to comment about the new ruling.
The CMA released a statement from its president, internist/hospitalist Donaldo M. Hernandez, MD: “The practice of threatening physicians who refer patients to out-of-network providers is unlawful, and we are pleased that the court agrees that CMA has the right to challenge these practices in court.”
In an interview, research professor emeritus Jack Hoadley, PhD, of the Health Policy Institute at Georgetown University’s McCourt School of Public Policy, noted that many health plans don’t cover out-of-network care. Those that do – including PPOs and hybrid plans – often require that patients pay a larger share of the total cost or pay a separate or higher deductible, he said.
So why would an insurer punish doctors who refer patients to health care providers who are outside the insurer’s approved network? In some cases, patients may blame insurers when they’re forced to pay higher rates for out-of-network care, Dr. Hoadley said. Insurers may also be miffed when physicians send patients out of network, he said, because insurers contract with physicians to send a certain number of patients within the insurer’s network.
The federal No Surprises Act, passed by Congress in 2020, hasn’t decreased tension between providers and insurers over out-of-network fees, Dr. Hoadley said. As the effects of the law are hammered out in court, he said, there’s still an adversarial relationship.
In California, the out-of-network landscape changed 3 years before the No Surprises Act. In 2017, the state passed its own no-surprise-billing law, which “protects consumers from surprise medical bills when they get non-emergency services, go to an in-network health facility and receive care from an out-of-network provider without their consent.” In these cases, the law says patients need to pay only in accordance with in-network cost sharing.
In 2019, a USC-Brookings Schaeffer Initiative for Health Policy report found signs that out-of-network care was fading in California other than in the emergency setting, possibly as a result of the law.
A version of this article first appeared on Medscape.com.
The case, which has bounced around courts in the Golden State since 2012, pits the nearly 50,000-member California Medical Association (CMA) against Aetna, one of the nation’s largest health insurers. The physician group alleges that Aetna illegally retaliated against physicians who sent patients to certain out-of-network clinics.
Out-of-network providers and clinics were involved in just 4.7% of professional medical claims in 2020, according to a federal report released July 6, 2023. Such claims are more likely than others to be denied, and they result in unexpected medical bills, which have led to the passage of state and federal laws that target “surprise billing.”
In a July 17 ruling, the California Supreme Court unanimously resurrected the CMA v. Aetna case after a judge and a state appeals court killed it on the grounds that the CMA - which is affiliated with the American Medical Association (AMA) - had no standing to sue Aetna. The high state court declared that the CMA could sue on its own behalf, but the justices noted that their ruling says nothing about the merits of the case.
The ruling appears to mean that CMA’s lawsuit will head back to Superior Court in Los Angeles County. The outcome of the case won’t have a direct national effect, since the case is in state court, not federal court. However, state rulings can influence the thinking of judges elsewhere.
The case, filed in 2012, alleges that Aetna harmed patient care by harassing and sacking contract physicians who referred patients to out-of-network ambulatory surgery centers.
According to the new ruling, Aetna responded by saying that “its policy, rather than interfering in medical judgments, was designed simply to encourage participating physicians, consistent with their judgment, to use in-network care providers, such as ambulatory surgery centers, and was adopted in part in response to physicians referring patients to facilities in which they had financial interests.”
In a 2012 letter to CMA, as reported by the Los Angeles Times, an Aetna attorney went further and claimed that “physicians and their business partners secure outsized and improper windfalls at the expense of Aetna’s plan members and employer plan sponsors.”
The CMA received support for its lawsuit via friend-of-the-court legal briefs from the California attorney general, city attorneys for several major California cities, the AMA, several major labor unions, the AIDS Healthcare Foundation, and the advocacy organization Consumer Watchdog. The U.S. Chamber of Commerce, the California Association of Health Plans, and the Association of California Life and Health Insurance Companies filed briefs supporting Aetna.
Aetna, now part of CVS Health, declined to comment about the new ruling.
The CMA released a statement from its president, internist/hospitalist Donaldo M. Hernandez, MD: “The practice of threatening physicians who refer patients to out-of-network providers is unlawful, and we are pleased that the court agrees that CMA has the right to challenge these practices in court.”
In an interview, research professor emeritus Jack Hoadley, PhD, of the Health Policy Institute at Georgetown University’s McCourt School of Public Policy, noted that many health plans don’t cover out-of-network care. Those that do – including PPOs and hybrid plans – often require that patients pay a larger share of the total cost or pay a separate or higher deductible, he said.
So why would an insurer punish doctors who refer patients to health care providers who are outside the insurer’s approved network? In some cases, patients may blame insurers when they’re forced to pay higher rates for out-of-network care, Dr. Hoadley said. Insurers may also be miffed when physicians send patients out of network, he said, because insurers contract with physicians to send a certain number of patients within the insurer’s network.
The federal No Surprises Act, passed by Congress in 2020, hasn’t decreased tension between providers and insurers over out-of-network fees, Dr. Hoadley said. As the effects of the law are hammered out in court, he said, there’s still an adversarial relationship.
In California, the out-of-network landscape changed 3 years before the No Surprises Act. In 2017, the state passed its own no-surprise-billing law, which “protects consumers from surprise medical bills when they get non-emergency services, go to an in-network health facility and receive care from an out-of-network provider without their consent.” In these cases, the law says patients need to pay only in accordance with in-network cost sharing.
In 2019, a USC-Brookings Schaeffer Initiative for Health Policy report found signs that out-of-network care was fading in California other than in the emergency setting, possibly as a result of the law.
A version of this article first appeared on Medscape.com.
Physician not held liable for child’s necrotizing pancreatitis, jury finds
, according to a report posted on the website of Courtroom View Network.
In 2018, the parents of the then 9-year-old child brought him to Wellstar Paulding Hospital in Hiram, Ga., because of his severe abdominal pain and distention, among other symptoms. Following their examination, medical personnel at the hospital suspected the child’s symptoms were the result of severe constipation.
That evening, he was transferred to Children’s Healthcare of Atlanta, where a pediatric gastroenterologist oversaw his care. (Neither the Atlanta hospital nor Wellstar Paulding were defendants in the subsequent lawsuit.)
Late the following day, the child went into hypovolemic shock, a condition that interrupted the blood supply to his body. Admitted to the pediatric ICU, he was diagnosed with a dangerous complication of acute pancreatitis, necrotizing pancreatitis.
Further complications of his original disease led to a 4-month hospital stay, multiple surgeries, and other interventions. To this point, his medical expenses totaled more than $2.5 million.
His parents then sued the pediatric gastroenterologist who had overseen their child’s care. At issue during the 4-day trial was whether the doctor had properly monitored and treated his patient before his hypovolemic shock set in.
Their attorney sketched the “timeline” of the child’s decline, including his rapid heart rate and repeated vomiting. Given these symptoms, he argued, the standard of care required that steps be taken – including the proper tests and other interventions – to prevent the child’s acute pancreatitis from progressing even further.
“We are not asking you to say, ‘Should [the doctor] have immediately diagnosed pancreatitis,’ “ the attorney told the jury. “But the totality here requires you to think, ‘This might be more than just a backed-up kid.’ ”
The defense pushed back strenuously, however. It argued that the pediatric gastroenterologist had acted appropriately given the prevailing consensus, namely that the child was suffering from extreme constipation. Doctors at Wellstar Paulding, the first hospital where he was seen, suspected this diagnosis – and so, based on his exam and the child’s “non-specific” symptoms, did their client, the pediatric gastroenterologist, who saw him subsequently. “The only clinicians who actually laid hands on [the child] all thought constipation,” the attorney said during his closing argument.
The jury agreed, finding that the pediatric gastroenterologist had acted appropriately, based on the available evidence. Following the jury verdict, the defense attorney noted: Absent the “classic” symptoms of pancreatitis, the jury saw that his client “was working with a reasonable diagnosis until [the child’s] clinical picture deteriorated.”
ED doctors can reduce system errors, study says
Emergency physicians are often blamed for system errors beyond their control, asserts a study in the June issue of Emergency Medicine News.
The study – conducted by Tom Belanger, MD, an emergency physician in Texas and chair-elect of the American College of Emergency Physicians Workforce Section – sought to understand to what extent doctors themselves were aware of systemic problems affecting their job. Dr. Belanger surveyed 99 doctors who were asked to comment on a series of ED–related adverse outcomes.
To mitigate response bias, he randomly manipulated the degree to which system error was a perceived factor in each of the adverse cases. In other words, in some cases, the system was represented as a major factor leading to error, while, in other cases, its role was diminished.
Dr. Belanger also divided his doctor/respondents into two groups: The first was asked about his or her personal experience with systemic issues before being presented with the adverse cases; the second group was queried about this experience after being presented with the cases.
The result confirmed Dr. Belanger’s suspicions: Physicians in the first group – that is, those asked about “system factors” before reading about the cases – “were 1.7 times more likely ... to attribute the adverse outcomes in the cases to system factors. (Other significant variables – including whether their shift was busy – also contributed to doctors’ perceptions of adverse outcomes.)
Concluded Dr. Belanger: Since doctors “can identify factors that increase their chances of making mistakes,” system designers should take heed and make efforts to reduce “the probability of error.” If they drag their heels or continue to point to individual doctor error, “they should be held medically and legally liable.”
A version of this article first appeared on Medscape.com.
, according to a report posted on the website of Courtroom View Network.
In 2018, the parents of the then 9-year-old child brought him to Wellstar Paulding Hospital in Hiram, Ga., because of his severe abdominal pain and distention, among other symptoms. Following their examination, medical personnel at the hospital suspected the child’s symptoms were the result of severe constipation.
That evening, he was transferred to Children’s Healthcare of Atlanta, where a pediatric gastroenterologist oversaw his care. (Neither the Atlanta hospital nor Wellstar Paulding were defendants in the subsequent lawsuit.)
Late the following day, the child went into hypovolemic shock, a condition that interrupted the blood supply to his body. Admitted to the pediatric ICU, he was diagnosed with a dangerous complication of acute pancreatitis, necrotizing pancreatitis.
Further complications of his original disease led to a 4-month hospital stay, multiple surgeries, and other interventions. To this point, his medical expenses totaled more than $2.5 million.
His parents then sued the pediatric gastroenterologist who had overseen their child’s care. At issue during the 4-day trial was whether the doctor had properly monitored and treated his patient before his hypovolemic shock set in.
Their attorney sketched the “timeline” of the child’s decline, including his rapid heart rate and repeated vomiting. Given these symptoms, he argued, the standard of care required that steps be taken – including the proper tests and other interventions – to prevent the child’s acute pancreatitis from progressing even further.
“We are not asking you to say, ‘Should [the doctor] have immediately diagnosed pancreatitis,’ “ the attorney told the jury. “But the totality here requires you to think, ‘This might be more than just a backed-up kid.’ ”
The defense pushed back strenuously, however. It argued that the pediatric gastroenterologist had acted appropriately given the prevailing consensus, namely that the child was suffering from extreme constipation. Doctors at Wellstar Paulding, the first hospital where he was seen, suspected this diagnosis – and so, based on his exam and the child’s “non-specific” symptoms, did their client, the pediatric gastroenterologist, who saw him subsequently. “The only clinicians who actually laid hands on [the child] all thought constipation,” the attorney said during his closing argument.
The jury agreed, finding that the pediatric gastroenterologist had acted appropriately, based on the available evidence. Following the jury verdict, the defense attorney noted: Absent the “classic” symptoms of pancreatitis, the jury saw that his client “was working with a reasonable diagnosis until [the child’s] clinical picture deteriorated.”
ED doctors can reduce system errors, study says
Emergency physicians are often blamed for system errors beyond their control, asserts a study in the June issue of Emergency Medicine News.
The study – conducted by Tom Belanger, MD, an emergency physician in Texas and chair-elect of the American College of Emergency Physicians Workforce Section – sought to understand to what extent doctors themselves were aware of systemic problems affecting their job. Dr. Belanger surveyed 99 doctors who were asked to comment on a series of ED–related adverse outcomes.
To mitigate response bias, he randomly manipulated the degree to which system error was a perceived factor in each of the adverse cases. In other words, in some cases, the system was represented as a major factor leading to error, while, in other cases, its role was diminished.
Dr. Belanger also divided his doctor/respondents into two groups: The first was asked about his or her personal experience with systemic issues before being presented with the adverse cases; the second group was queried about this experience after being presented with the cases.
The result confirmed Dr. Belanger’s suspicions: Physicians in the first group – that is, those asked about “system factors” before reading about the cases – “were 1.7 times more likely ... to attribute the adverse outcomes in the cases to system factors. (Other significant variables – including whether their shift was busy – also contributed to doctors’ perceptions of adverse outcomes.)
Concluded Dr. Belanger: Since doctors “can identify factors that increase their chances of making mistakes,” system designers should take heed and make efforts to reduce “the probability of error.” If they drag their heels or continue to point to individual doctor error, “they should be held medically and legally liable.”
A version of this article first appeared on Medscape.com.
, according to a report posted on the website of Courtroom View Network.
In 2018, the parents of the then 9-year-old child brought him to Wellstar Paulding Hospital in Hiram, Ga., because of his severe abdominal pain and distention, among other symptoms. Following their examination, medical personnel at the hospital suspected the child’s symptoms were the result of severe constipation.
That evening, he was transferred to Children’s Healthcare of Atlanta, where a pediatric gastroenterologist oversaw his care. (Neither the Atlanta hospital nor Wellstar Paulding were defendants in the subsequent lawsuit.)
Late the following day, the child went into hypovolemic shock, a condition that interrupted the blood supply to his body. Admitted to the pediatric ICU, he was diagnosed with a dangerous complication of acute pancreatitis, necrotizing pancreatitis.
Further complications of his original disease led to a 4-month hospital stay, multiple surgeries, and other interventions. To this point, his medical expenses totaled more than $2.5 million.
His parents then sued the pediatric gastroenterologist who had overseen their child’s care. At issue during the 4-day trial was whether the doctor had properly monitored and treated his patient before his hypovolemic shock set in.
Their attorney sketched the “timeline” of the child’s decline, including his rapid heart rate and repeated vomiting. Given these symptoms, he argued, the standard of care required that steps be taken – including the proper tests and other interventions – to prevent the child’s acute pancreatitis from progressing even further.
“We are not asking you to say, ‘Should [the doctor] have immediately diagnosed pancreatitis,’ “ the attorney told the jury. “But the totality here requires you to think, ‘This might be more than just a backed-up kid.’ ”
The defense pushed back strenuously, however. It argued that the pediatric gastroenterologist had acted appropriately given the prevailing consensus, namely that the child was suffering from extreme constipation. Doctors at Wellstar Paulding, the first hospital where he was seen, suspected this diagnosis – and so, based on his exam and the child’s “non-specific” symptoms, did their client, the pediatric gastroenterologist, who saw him subsequently. “The only clinicians who actually laid hands on [the child] all thought constipation,” the attorney said during his closing argument.
The jury agreed, finding that the pediatric gastroenterologist had acted appropriately, based on the available evidence. Following the jury verdict, the defense attorney noted: Absent the “classic” symptoms of pancreatitis, the jury saw that his client “was working with a reasonable diagnosis until [the child’s] clinical picture deteriorated.”
ED doctors can reduce system errors, study says
Emergency physicians are often blamed for system errors beyond their control, asserts a study in the June issue of Emergency Medicine News.
The study – conducted by Tom Belanger, MD, an emergency physician in Texas and chair-elect of the American College of Emergency Physicians Workforce Section – sought to understand to what extent doctors themselves were aware of systemic problems affecting their job. Dr. Belanger surveyed 99 doctors who were asked to comment on a series of ED–related adverse outcomes.
To mitigate response bias, he randomly manipulated the degree to which system error was a perceived factor in each of the adverse cases. In other words, in some cases, the system was represented as a major factor leading to error, while, in other cases, its role was diminished.
Dr. Belanger also divided his doctor/respondents into two groups: The first was asked about his or her personal experience with systemic issues before being presented with the adverse cases; the second group was queried about this experience after being presented with the cases.
The result confirmed Dr. Belanger’s suspicions: Physicians in the first group – that is, those asked about “system factors” before reading about the cases – “were 1.7 times more likely ... to attribute the adverse outcomes in the cases to system factors. (Other significant variables – including whether their shift was busy – also contributed to doctors’ perceptions of adverse outcomes.)
Concluded Dr. Belanger: Since doctors “can identify factors that increase their chances of making mistakes,” system designers should take heed and make efforts to reduce “the probability of error.” If they drag their heels or continue to point to individual doctor error, “they should be held medically and legally liable.”
A version of this article first appeared on Medscape.com.
Pediatric dermatologists encouraged to counter misinformation on TikTok, other social media sites
ASHEVILLE, N.C. – , warned an expert at the annual meeting of the Society for Pediatric Dermatology.
“If we don’t get involved, we are basically letting misinformation win. We need to be there,” said Angelo Landriscina, MD, director of dermatology at a Mount Sinai Doctors Clinic in New York.
Most of the content currently available on medical topics, including dermatology and pediatric dermatology, is not created by health care professionals, Dr. Landriscina noted. Not surprisingly, given that much of the content is based on personal opinion from individuals who have no expertise in medical care, he described the information as being of “low quality” when not fully erroneous.
Dr. Landriscina has been active on social media, including TikTok, for several years. Most of his posts involve responses to misinformation. When he sets the record straight on the basis of existing evidence, he often supports his counterargument with references.
He acknowledged that when he became involved in social media he faced criticism from colleagues about participating on an entertainment platform that many considered unworthy of providing objective information. If that was ever true, he argued, it is no longer the case.
“TikTok has adopted a new strategy. The goal is to unseat Google as a search tool, and it’s working,” he said. He explained that many people now use TikTok and other social media sites as their primary source of information on essentially every topic, from where to eat to whether to be screened for cancer.
The particular problem with TikTok – one of the most popular social media outlets – is that there is no mechanism for vetting the source of information. YouTube, by contrast, now requires some sort of validation for anyone who claims to have a medical degree or any other verifiable qualification, according to Dr. Landriscina. TikTok, like many other platforms, has no such requirement.
“Anyone can buy a pair of scrubs [implying expertise] and then post a video,” Dr. Landriscina said.
Even if information from one content provider is more valid than information from others, the TikTok algorithm is specifically designed to emphasize content that has the potential for going viral, which means it favors videos that are provocative over those that are not.
“The algorithm favors any content that is more controversial, more surprising, and keeps viewers engaged,” Dr. Landriscina pointed out.
This does not mean that objective and factual information is ignored, but the algorithm is indifferent to the validity of information, meaning that it allows videos to be posted without regard to whether the content is true, untrue, purposefully misleading, or utter nonsense. For that reason, it is often easier to attract attention by responding to a post that has already gone viral. Information that is clear and digestible can attract viewers and therefore is distributed more widely with the TikTok algorithm.
Parents are on Tiktok too
There is a misperception that the TikTok audience is younger, according to Dr. Landriscina. While peak use in the United States fell among people between the ages of 25 and 34 years in 2022, he said the number of users falls off relatively slowly with subsequent 10-year increments in age. In 2022, there were nearly 20 million users in the peak 10-year age range, but 7.5 million users were 55 years of age or older.
“Pediatric dermatologists should recognize that it is not just kids who are looking for information about their skin diseases, but also their parents,” Dr. Landriscina said.
The top three dermatology topics searched on TikTok in a recent period were acne, alopecia, and cysts. But top searches are very fluid and are extremely hard to quantify, because the basis of the algorithm, which is a proprietary secret, is not only unknown but produces different results for every user.
“The second you touch the app, it changes,” Dr. Landriscina said. He explained that an inquiry about any subject, including those that are medically related, yields content that is different, or at least ordered differently, “depending on how you behaved on the app in the past.”
The phenomenon that drives social media predates this technology. Dr. Landriscina cited a study in 1956 that described the “parasocial interaction theory.” The theory was based on the observation that those who consume media, such as television, which was relatively new in 1956, believed that they had a personal relationship with media figures.
“The users begin to trust influencers as a source, like a friend providing them advice,” Dr. Landriscina said. As an example, he suggested that a fan of the television show Friends who follows actor Jennifer Aniston on social media platforms may begin to think of her as a trusted source of information on any topic, including those for which she may not have expertise.
The reason that he urges medical professionals to become active on TikTok and other social media platforms is that they have a potentially critical role in responding to information that is not just wrong but harmful.
On TikTok and other social media platforms, “there is a lot of interest in content about dermatologic conditions in children. There is a real need for accurate information,” he said,
In the question-and-answer session following his presentation, Dr. Landriscina’s message was not uniformly embraced. One risk, according to an audience member, is that medical professionals will begin to express their own personal opinions rather than rely on evidence, with the result that they will “just add to the sea of misinformation.”
However, this opinion appeared to be the minority view. Most of those who commented took a “that-ship-has-sailed” stance, recognizing the irreversible ascendancy of social media.
“Whether you like it or not, social media is here to stay. We cannot fight it. Rather, we need to embrace it in a responsible way,” said Dakara R. Wright, MD, a dermatologist at the Mid-Atlantic Kaiser Permanente Group, Halethorpe, Md. She, like others, reported that she has come to recognize that social media is a major source of medical information for her patients.
“We need to be a presence on these platforms for the benefit of our patients and their parents,” she said. She acknowledged that she has not been active in posting on social media in the past but said that she has been speaking with administrators in her organization about how to become involved in a responsible way that can be useful to patients.
Candrice R. Heath, MD, assistant professor of dermatology at Temple University, Philadelphia, has been active on social media for several years, posting content on her own account, which is not related to her academic affiliation. She posts for many reasons, not least of which is drawing attention to her expertise.
Like Dr. Landriscina, she recognizes that users of these platforms are guided by the content to make decisions about health care. She also agreed that physicians should not ignore this phenomenon.
Tips on providing content
Given the fact that the algorithm is intended to produce posts that go viral, Dr. Landriscina urged clinicians to make their content easy to watch. He said it is not necessary to overthink content beyond providing accurate information, but he advised that videos be made with attention to adequate lighting and other simple factors to promote visual quality. He said that accurate information is not necessarily dull.
“Some facts can actually be surprising to patients,” he said. He noted that a calm, coherent video can be particularly effective in attracting an audience when it is in reaction to information that has gone viral but is misleading or patently incorrect.
Dr. Landriscina has been an influencer associated with multiple social media platforms, including TikTok. He has in the past been paid for consulting work for TikTok. Dr. Wright and Dr. Heath reported no potential conflicts of interest.
A version of this article first appeared on Medscape.com.
ASHEVILLE, N.C. – , warned an expert at the annual meeting of the Society for Pediatric Dermatology.
“If we don’t get involved, we are basically letting misinformation win. We need to be there,” said Angelo Landriscina, MD, director of dermatology at a Mount Sinai Doctors Clinic in New York.
Most of the content currently available on medical topics, including dermatology and pediatric dermatology, is not created by health care professionals, Dr. Landriscina noted. Not surprisingly, given that much of the content is based on personal opinion from individuals who have no expertise in medical care, he described the information as being of “low quality” when not fully erroneous.
Dr. Landriscina has been active on social media, including TikTok, for several years. Most of his posts involve responses to misinformation. When he sets the record straight on the basis of existing evidence, he often supports his counterargument with references.
He acknowledged that when he became involved in social media he faced criticism from colleagues about participating on an entertainment platform that many considered unworthy of providing objective information. If that was ever true, he argued, it is no longer the case.
“TikTok has adopted a new strategy. The goal is to unseat Google as a search tool, and it’s working,” he said. He explained that many people now use TikTok and other social media sites as their primary source of information on essentially every topic, from where to eat to whether to be screened for cancer.
The particular problem with TikTok – one of the most popular social media outlets – is that there is no mechanism for vetting the source of information. YouTube, by contrast, now requires some sort of validation for anyone who claims to have a medical degree or any other verifiable qualification, according to Dr. Landriscina. TikTok, like many other platforms, has no such requirement.
“Anyone can buy a pair of scrubs [implying expertise] and then post a video,” Dr. Landriscina said.
Even if information from one content provider is more valid than information from others, the TikTok algorithm is specifically designed to emphasize content that has the potential for going viral, which means it favors videos that are provocative over those that are not.
“The algorithm favors any content that is more controversial, more surprising, and keeps viewers engaged,” Dr. Landriscina pointed out.
This does not mean that objective and factual information is ignored, but the algorithm is indifferent to the validity of information, meaning that it allows videos to be posted without regard to whether the content is true, untrue, purposefully misleading, or utter nonsense. For that reason, it is often easier to attract attention by responding to a post that has already gone viral. Information that is clear and digestible can attract viewers and therefore is distributed more widely with the TikTok algorithm.
Parents are on Tiktok too
There is a misperception that the TikTok audience is younger, according to Dr. Landriscina. While peak use in the United States fell among people between the ages of 25 and 34 years in 2022, he said the number of users falls off relatively slowly with subsequent 10-year increments in age. In 2022, there were nearly 20 million users in the peak 10-year age range, but 7.5 million users were 55 years of age or older.
“Pediatric dermatologists should recognize that it is not just kids who are looking for information about their skin diseases, but also their parents,” Dr. Landriscina said.
The top three dermatology topics searched on TikTok in a recent period were acne, alopecia, and cysts. But top searches are very fluid and are extremely hard to quantify, because the basis of the algorithm, which is a proprietary secret, is not only unknown but produces different results for every user.
“The second you touch the app, it changes,” Dr. Landriscina said. He explained that an inquiry about any subject, including those that are medically related, yields content that is different, or at least ordered differently, “depending on how you behaved on the app in the past.”
The phenomenon that drives social media predates this technology. Dr. Landriscina cited a study in 1956 that described the “parasocial interaction theory.” The theory was based on the observation that those who consume media, such as television, which was relatively new in 1956, believed that they had a personal relationship with media figures.
“The users begin to trust influencers as a source, like a friend providing them advice,” Dr. Landriscina said. As an example, he suggested that a fan of the television show Friends who follows actor Jennifer Aniston on social media platforms may begin to think of her as a trusted source of information on any topic, including those for which she may not have expertise.
The reason that he urges medical professionals to become active on TikTok and other social media platforms is that they have a potentially critical role in responding to information that is not just wrong but harmful.
On TikTok and other social media platforms, “there is a lot of interest in content about dermatologic conditions in children. There is a real need for accurate information,” he said,
In the question-and-answer session following his presentation, Dr. Landriscina’s message was not uniformly embraced. One risk, according to an audience member, is that medical professionals will begin to express their own personal opinions rather than rely on evidence, with the result that they will “just add to the sea of misinformation.”
However, this opinion appeared to be the minority view. Most of those who commented took a “that-ship-has-sailed” stance, recognizing the irreversible ascendancy of social media.
“Whether you like it or not, social media is here to stay. We cannot fight it. Rather, we need to embrace it in a responsible way,” said Dakara R. Wright, MD, a dermatologist at the Mid-Atlantic Kaiser Permanente Group, Halethorpe, Md. She, like others, reported that she has come to recognize that social media is a major source of medical information for her patients.
“We need to be a presence on these platforms for the benefit of our patients and their parents,” she said. She acknowledged that she has not been active in posting on social media in the past but said that she has been speaking with administrators in her organization about how to become involved in a responsible way that can be useful to patients.
Candrice R. Heath, MD, assistant professor of dermatology at Temple University, Philadelphia, has been active on social media for several years, posting content on her own account, which is not related to her academic affiliation. She posts for many reasons, not least of which is drawing attention to her expertise.
Like Dr. Landriscina, she recognizes that users of these platforms are guided by the content to make decisions about health care. She also agreed that physicians should not ignore this phenomenon.
Tips on providing content
Given the fact that the algorithm is intended to produce posts that go viral, Dr. Landriscina urged clinicians to make their content easy to watch. He said it is not necessary to overthink content beyond providing accurate information, but he advised that videos be made with attention to adequate lighting and other simple factors to promote visual quality. He said that accurate information is not necessarily dull.
“Some facts can actually be surprising to patients,” he said. He noted that a calm, coherent video can be particularly effective in attracting an audience when it is in reaction to information that has gone viral but is misleading or patently incorrect.
Dr. Landriscina has been an influencer associated with multiple social media platforms, including TikTok. He has in the past been paid for consulting work for TikTok. Dr. Wright and Dr. Heath reported no potential conflicts of interest.
A version of this article first appeared on Medscape.com.
ASHEVILLE, N.C. – , warned an expert at the annual meeting of the Society for Pediatric Dermatology.
“If we don’t get involved, we are basically letting misinformation win. We need to be there,” said Angelo Landriscina, MD, director of dermatology at a Mount Sinai Doctors Clinic in New York.
Most of the content currently available on medical topics, including dermatology and pediatric dermatology, is not created by health care professionals, Dr. Landriscina noted. Not surprisingly, given that much of the content is based on personal opinion from individuals who have no expertise in medical care, he described the information as being of “low quality” when not fully erroneous.
Dr. Landriscina has been active on social media, including TikTok, for several years. Most of his posts involve responses to misinformation. When he sets the record straight on the basis of existing evidence, he often supports his counterargument with references.
He acknowledged that when he became involved in social media he faced criticism from colleagues about participating on an entertainment platform that many considered unworthy of providing objective information. If that was ever true, he argued, it is no longer the case.
“TikTok has adopted a new strategy. The goal is to unseat Google as a search tool, and it’s working,” he said. He explained that many people now use TikTok and other social media sites as their primary source of information on essentially every topic, from where to eat to whether to be screened for cancer.
The particular problem with TikTok – one of the most popular social media outlets – is that there is no mechanism for vetting the source of information. YouTube, by contrast, now requires some sort of validation for anyone who claims to have a medical degree or any other verifiable qualification, according to Dr. Landriscina. TikTok, like many other platforms, has no such requirement.
“Anyone can buy a pair of scrubs [implying expertise] and then post a video,” Dr. Landriscina said.
Even if information from one content provider is more valid than information from others, the TikTok algorithm is specifically designed to emphasize content that has the potential for going viral, which means it favors videos that are provocative over those that are not.
“The algorithm favors any content that is more controversial, more surprising, and keeps viewers engaged,” Dr. Landriscina pointed out.
This does not mean that objective and factual information is ignored, but the algorithm is indifferent to the validity of information, meaning that it allows videos to be posted without regard to whether the content is true, untrue, purposefully misleading, or utter nonsense. For that reason, it is often easier to attract attention by responding to a post that has already gone viral. Information that is clear and digestible can attract viewers and therefore is distributed more widely with the TikTok algorithm.
Parents are on Tiktok too
There is a misperception that the TikTok audience is younger, according to Dr. Landriscina. While peak use in the United States fell among people between the ages of 25 and 34 years in 2022, he said the number of users falls off relatively slowly with subsequent 10-year increments in age. In 2022, there were nearly 20 million users in the peak 10-year age range, but 7.5 million users were 55 years of age or older.
“Pediatric dermatologists should recognize that it is not just kids who are looking for information about their skin diseases, but also their parents,” Dr. Landriscina said.
The top three dermatology topics searched on TikTok in a recent period were acne, alopecia, and cysts. But top searches are very fluid and are extremely hard to quantify, because the basis of the algorithm, which is a proprietary secret, is not only unknown but produces different results for every user.
“The second you touch the app, it changes,” Dr. Landriscina said. He explained that an inquiry about any subject, including those that are medically related, yields content that is different, or at least ordered differently, “depending on how you behaved on the app in the past.”
The phenomenon that drives social media predates this technology. Dr. Landriscina cited a study in 1956 that described the “parasocial interaction theory.” The theory was based on the observation that those who consume media, such as television, which was relatively new in 1956, believed that they had a personal relationship with media figures.
“The users begin to trust influencers as a source, like a friend providing them advice,” Dr. Landriscina said. As an example, he suggested that a fan of the television show Friends who follows actor Jennifer Aniston on social media platforms may begin to think of her as a trusted source of information on any topic, including those for which she may not have expertise.
The reason that he urges medical professionals to become active on TikTok and other social media platforms is that they have a potentially critical role in responding to information that is not just wrong but harmful.
On TikTok and other social media platforms, “there is a lot of interest in content about dermatologic conditions in children. There is a real need for accurate information,” he said,
In the question-and-answer session following his presentation, Dr. Landriscina’s message was not uniformly embraced. One risk, according to an audience member, is that medical professionals will begin to express their own personal opinions rather than rely on evidence, with the result that they will “just add to the sea of misinformation.”
However, this opinion appeared to be the minority view. Most of those who commented took a “that-ship-has-sailed” stance, recognizing the irreversible ascendancy of social media.
“Whether you like it or not, social media is here to stay. We cannot fight it. Rather, we need to embrace it in a responsible way,” said Dakara R. Wright, MD, a dermatologist at the Mid-Atlantic Kaiser Permanente Group, Halethorpe, Md. She, like others, reported that she has come to recognize that social media is a major source of medical information for her patients.
“We need to be a presence on these platforms for the benefit of our patients and their parents,” she said. She acknowledged that she has not been active in posting on social media in the past but said that she has been speaking with administrators in her organization about how to become involved in a responsible way that can be useful to patients.
Candrice R. Heath, MD, assistant professor of dermatology at Temple University, Philadelphia, has been active on social media for several years, posting content on her own account, which is not related to her academic affiliation. She posts for many reasons, not least of which is drawing attention to her expertise.
Like Dr. Landriscina, she recognizes that users of these platforms are guided by the content to make decisions about health care. She also agreed that physicians should not ignore this phenomenon.
Tips on providing content
Given the fact that the algorithm is intended to produce posts that go viral, Dr. Landriscina urged clinicians to make their content easy to watch. He said it is not necessary to overthink content beyond providing accurate information, but he advised that videos be made with attention to adequate lighting and other simple factors to promote visual quality. He said that accurate information is not necessarily dull.
“Some facts can actually be surprising to patients,” he said. He noted that a calm, coherent video can be particularly effective in attracting an audience when it is in reaction to information that has gone viral but is misleading or patently incorrect.
Dr. Landriscina has been an influencer associated with multiple social media platforms, including TikTok. He has in the past been paid for consulting work for TikTok. Dr. Wright and Dr. Heath reported no potential conflicts of interest.
A version of this article first appeared on Medscape.com.
AT SPD 2023
Time to end direct-to-consumer ads, says physician
One has to be living off the grid to not be bombarded with direct-to-consumer (DTC) pharmaceutical advertising. Since 1997, when the Food and Drug Administration eased restrictions on this prohibition and allowed pharmaceutical companies to promote prescription-only medications to the public, there has been a deluge of ads in magazines, on the Internet, and, most annoying, on commercial television.
These television ads are quite formulaic:
We are initially introduced to a number of highly functioning patients (typically actors) who are engaged in rewarding pursuits. A voiceover narration then presents the pharmaceutical to be promoted, suggesting (not so subtly) to consumers that taking the advertised drug will improve one’s disease outlook or quality of life such that they too, just like the actors in the minidrama, can lead such highly productive lives.
The potential best-case scenarios of these new treatments may be stated. There then follows a litany of side effects – some of them life threatening – warnings, and contraindications. We’re again treated to another 5 or 10 seconds of patients leading “the good life,” and almost all of the ads end with the narrator concluding: “Ask your doctor (sometimes ‘provider’) if _____ is right for you.”
Americans spend more money on their prescriptions than do citizens of any other highly developed nation. I have personally heard from patients who get their prescriptions from other countries, where they are more affordable. These patients will also cut their pills in half or take a medication every other day instead of every day, to economize on drug costs.
Another “trick” they use to save money – and I have heard pharmacists and pharmaceutical reps themselves recommend this – is to ask for a higher dose of a medication, usually double, and then use a pill cutter to divide a tablet in half, thus making their prescription last twice as long. Why do Americans have to resort to such “workarounds”?
Many of the medications advertised are for relatively rare conditions, such as thyroid eye disease or myasthenia gravis (which affects up to about 60,000 patients in the United States). Why not spend these advertising dollars on programs to make drugs taken by the millions of Americans with common conditions (for example, hypertension, diabetes, heart failure) more affordable?
Very often the television ads contain medical jargon, such as: “If you have the EGFR mutation, or if your cancer is HER2 negative ...”
Do most patients truly understand what these terms mean? And what happens when a patient’s physician doesn’t prescribe a medication that a patient has seen on TV and asks for, or when the physician believes that a generic (nonadvertised) medication might work just as well? This creates conflict and potential discord, adversely affecting the doctor-patient relationship.
An oncologist colleague related to me that he often has to spend time correcting patients’ misperceptions of potential miracle cures offered by these ads, and that several patients have left his practice because he would not prescribe a drug they saw advertised.
Further, while these ads urge patients to try expensive “newest and latest” treatments, pharmacy benefit plans are working with health care insurance conglomerates to reduce costs of pharmaceuticals.
How does this juxtaposition of opposing forces make any sense?
It is time for us to put an end to DTC advertising, at least on television. It will require legislative action by our federal government to end this practice (legal, by the way, only in the United States and New Zealand), and hence the willingness of our politicians to get behind legislation to do so.
Just as a law was passed to prohibit tobacco advertising on television, so should a law be passed to regulate DTC pharmaceutical advertising.
The time to end DTC advertising has come!
Lloyd Alterman, MD, is a retired physician and chairman of the New Jersey Universal Healthcare Coalition. He disclosed having no relevant financial relationships.
A version of this article first appeared on Medscape.com.
One has to be living off the grid to not be bombarded with direct-to-consumer (DTC) pharmaceutical advertising. Since 1997, when the Food and Drug Administration eased restrictions on this prohibition and allowed pharmaceutical companies to promote prescription-only medications to the public, there has been a deluge of ads in magazines, on the Internet, and, most annoying, on commercial television.
These television ads are quite formulaic:
We are initially introduced to a number of highly functioning patients (typically actors) who are engaged in rewarding pursuits. A voiceover narration then presents the pharmaceutical to be promoted, suggesting (not so subtly) to consumers that taking the advertised drug will improve one’s disease outlook or quality of life such that they too, just like the actors in the minidrama, can lead such highly productive lives.
The potential best-case scenarios of these new treatments may be stated. There then follows a litany of side effects – some of them life threatening – warnings, and contraindications. We’re again treated to another 5 or 10 seconds of patients leading “the good life,” and almost all of the ads end with the narrator concluding: “Ask your doctor (sometimes ‘provider’) if _____ is right for you.”
Americans spend more money on their prescriptions than do citizens of any other highly developed nation. I have personally heard from patients who get their prescriptions from other countries, where they are more affordable. These patients will also cut their pills in half or take a medication every other day instead of every day, to economize on drug costs.
Another “trick” they use to save money – and I have heard pharmacists and pharmaceutical reps themselves recommend this – is to ask for a higher dose of a medication, usually double, and then use a pill cutter to divide a tablet in half, thus making their prescription last twice as long. Why do Americans have to resort to such “workarounds”?
Many of the medications advertised are for relatively rare conditions, such as thyroid eye disease or myasthenia gravis (which affects up to about 60,000 patients in the United States). Why not spend these advertising dollars on programs to make drugs taken by the millions of Americans with common conditions (for example, hypertension, diabetes, heart failure) more affordable?
Very often the television ads contain medical jargon, such as: “If you have the EGFR mutation, or if your cancer is HER2 negative ...”
Do most patients truly understand what these terms mean? And what happens when a patient’s physician doesn’t prescribe a medication that a patient has seen on TV and asks for, or when the physician believes that a generic (nonadvertised) medication might work just as well? This creates conflict and potential discord, adversely affecting the doctor-patient relationship.
An oncologist colleague related to me that he often has to spend time correcting patients’ misperceptions of potential miracle cures offered by these ads, and that several patients have left his practice because he would not prescribe a drug they saw advertised.
Further, while these ads urge patients to try expensive “newest and latest” treatments, pharmacy benefit plans are working with health care insurance conglomerates to reduce costs of pharmaceuticals.
How does this juxtaposition of opposing forces make any sense?
It is time for us to put an end to DTC advertising, at least on television. It will require legislative action by our federal government to end this practice (legal, by the way, only in the United States and New Zealand), and hence the willingness of our politicians to get behind legislation to do so.
Just as a law was passed to prohibit tobacco advertising on television, so should a law be passed to regulate DTC pharmaceutical advertising.
The time to end DTC advertising has come!
Lloyd Alterman, MD, is a retired physician and chairman of the New Jersey Universal Healthcare Coalition. He disclosed having no relevant financial relationships.
A version of this article first appeared on Medscape.com.
One has to be living off the grid to not be bombarded with direct-to-consumer (DTC) pharmaceutical advertising. Since 1997, when the Food and Drug Administration eased restrictions on this prohibition and allowed pharmaceutical companies to promote prescription-only medications to the public, there has been a deluge of ads in magazines, on the Internet, and, most annoying, on commercial television.
These television ads are quite formulaic:
We are initially introduced to a number of highly functioning patients (typically actors) who are engaged in rewarding pursuits. A voiceover narration then presents the pharmaceutical to be promoted, suggesting (not so subtly) to consumers that taking the advertised drug will improve one’s disease outlook or quality of life such that they too, just like the actors in the minidrama, can lead such highly productive lives.
The potential best-case scenarios of these new treatments may be stated. There then follows a litany of side effects – some of them life threatening – warnings, and contraindications. We’re again treated to another 5 or 10 seconds of patients leading “the good life,” and almost all of the ads end with the narrator concluding: “Ask your doctor (sometimes ‘provider’) if _____ is right for you.”
Americans spend more money on their prescriptions than do citizens of any other highly developed nation. I have personally heard from patients who get their prescriptions from other countries, where they are more affordable. These patients will also cut their pills in half or take a medication every other day instead of every day, to economize on drug costs.
Another “trick” they use to save money – and I have heard pharmacists and pharmaceutical reps themselves recommend this – is to ask for a higher dose of a medication, usually double, and then use a pill cutter to divide a tablet in half, thus making their prescription last twice as long. Why do Americans have to resort to such “workarounds”?
Many of the medications advertised are for relatively rare conditions, such as thyroid eye disease or myasthenia gravis (which affects up to about 60,000 patients in the United States). Why not spend these advertising dollars on programs to make drugs taken by the millions of Americans with common conditions (for example, hypertension, diabetes, heart failure) more affordable?
Very often the television ads contain medical jargon, such as: “If you have the EGFR mutation, or if your cancer is HER2 negative ...”
Do most patients truly understand what these terms mean? And what happens when a patient’s physician doesn’t prescribe a medication that a patient has seen on TV and asks for, or when the physician believes that a generic (nonadvertised) medication might work just as well? This creates conflict and potential discord, adversely affecting the doctor-patient relationship.
An oncologist colleague related to me that he often has to spend time correcting patients’ misperceptions of potential miracle cures offered by these ads, and that several patients have left his practice because he would not prescribe a drug they saw advertised.
Further, while these ads urge patients to try expensive “newest and latest” treatments, pharmacy benefit plans are working with health care insurance conglomerates to reduce costs of pharmaceuticals.
How does this juxtaposition of opposing forces make any sense?
It is time for us to put an end to DTC advertising, at least on television. It will require legislative action by our federal government to end this practice (legal, by the way, only in the United States and New Zealand), and hence the willingness of our politicians to get behind legislation to do so.
Just as a law was passed to prohibit tobacco advertising on television, so should a law be passed to regulate DTC pharmaceutical advertising.
The time to end DTC advertising has come!
Lloyd Alterman, MD, is a retired physician and chairman of the New Jersey Universal Healthcare Coalition. He disclosed having no relevant financial relationships.
A version of this article first appeared on Medscape.com.