Article Round-up: Early Inductions, Practice Variation and Baby-Snatching

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By Jill Arnold

 

An assortment of articles I’ve read recently. Pardon the lack of rhyme or reason.

 

This ABC News article covers NYU School of Medicine’s new, patient-centric Curriculum for the 21st Century, which has students shadow patients rather than doctors.

NYU’s Abramson said, “It’s very nice to have a doctor that you love and who puts an arm around you, but not if that doctor makes bad medical decisions.

“Compassion is important but compassion without competence is not a virtue.”

A doctor may see up to 30 patients a day. But every visit — no matter how short — is an opportunity to show empathy, Abramson said.

 

 

Dr. Zachary Meisel’s article, Googling Symptoms Helps Patients and Doctors, on Time.com attracted the attention of patient advocates and bloggers last week.

But to debate whether patients should or should not Google their symptoms (which a surprising number of doctors seem to enjoy engaging in) is an absurd exercise. Patients already are doing it, it is now a fact of normal patient behavior, and it will only increase as Internet technology becomes ever more ubiquitous. The average Joe has more health information at his fingertips — both credible and charlatan — than all the medical libraries ever built put together. So the real question is, What can professionals do to translate this phenomenon into better health for their patients and the public?

 

 

The Leapfrog Group, a non-profit organization that compares hospitals on national standards of safety and quality, asked hospitals to voluntarily report their rate of elective deliveries before 39 completed weeks of pregnancy. The hospital’s rate of elective deliveries is the percentage of non-medically indicated (without a medical reason) births between 37 and 39 weeks gestation, that were delivered by caesarean section or induction.

Hospital rates of elective deliveries are listed by state here.

 

 

Childbirth Connection published a new section titled Induction of Labor today, which covers:

How can I make sense of what I hear about induction of labor?

What normally causes labor to begin?

What is the safest point in pregnancy for the baby to be born?

Why are so many women experiencing induced labor?

 

 

Dave deBronkart, patient advocate and contributor to Defending Ourselves against Defensive Medicine, blogged “Practice variation”: an essential e-patient awareness topic last month, listing the following as his nutshell version of the issue (Note: I botched his sub-bullets. See original post.):

Very large parts of healthcare are delivered inconsistently from area to area.

In other words, the care you get depends on where you live.

That’s right; very often, care decisions aren’t based on some objective standard of care. The same patient in a different local area might or might not get a prescription for treatment. Very often.

Which one is right? Is one overtreated, or is the other undertreated?

This isn’t a matter of economics: it’s a matter of local medical practice. It cuts across all economic levels.

That’s why it’s not called discrimination, it’s called practice variation.

The people involved – the doctors – mostly don’t know they’re doing it.

Bottom line: depending on where you live, you may be getting care you don’t need – hospitalizations and even surgery.

Since both of those carry risks of infection and even death, e-patients need to be aware so they can make informed, empowered choices.

 

 

Someone (thanks, Laura) sent me a year-old post on Slate titled Invasion of the Baby-Snatchers: Our irrational fear of infant abduction could be causing real harm, which is making the rounds again after the recent confession to abduction of a newborn from a New York hospital in 1987. Nestled within the article is a fascinating take on managed care in the 80’s, marketing directly to the consumer and the proposed remedy for a fear of a problem rather than an actual problem.

So if baby-snatching was never much of a problem to begin with, why are health care administrators across the country so focused on its prevention? The history of the panic—with its abrupt beginning in the late 1980s and gradual inflation over the following decade—mirrors a broader shift in the medical industry. Hospitals now advertise their services directly to the public, and their efforts are directed, first and foremost, at the most valuable health care demographic: young, pregnant women.

The idea that patients might be wooed with perks and gimmicks emerged in the 1980s and 1990s with the rise of managed care. The size and scope of HMOs helped insurance companies squeeze lower rates from the providers. (“Cut your prices, or you’re out of the network.”) So the hospitals were forced into a more aggressive posture: They stayed in business by actively recruiting customers.

From the beginning, women of child-bearing age were central to the business plan. Maternity wards provided a steady source of revenue in uncertain times. But it wasn’t the babies the industry was after so much as the moms. Studies showed that women were responsible for 60 to 80 percent of the health care decisions for their entire families. If you could get a young woman into your hospital when she was just starting a family, you’d have a shot at locking down four or five customers for life.

So began the “Maternity Wars.” Birth centers across the country were renovated and ramped up to attract market share, and the maternity ward started to resemble a luxury hotel. Hospitals advertised single-occupancy rooms with flat-screen TVs, plush bathrobes, and deep Jacuzzi tubs. (The unspectacular New York City hospital where I was born in the 1970s now sports Italian glass tile, elegant sconces, and decorative mirrors.) Once all these perks were in place, enhanced infant security was a logical next step. Come for the lakeside views, the fresh-baked cookies, and the motion-activated surveillance cameras …