Residents in the general surgery program at Washington University in St. Louis, Mo., participate in monthly “pizza grand rounds,” in which they discuss ethics-fraught situations they encounter. Some of the situations are the subjects of papers published in Surgery. Here are summaries of a few of those published situations. The papers intentionally do not mention the actions ultimately taken, so that the attention remains on the principles and questions involved.
Departments » Everyday Ethics
Certain well-established care delivery models for otolaryngologists have long defined the specialty. But, like pharmacology, surgical techniques and treatment therapies, practice models evolve. And while traditional models continue to dominate the scope of most otolaryngology practices, the field is seeing a gradual shift to new constructs. Among them…
Close on the heels of the evidence-based medicine movement comes increasing pressure for physicians and health care institutions to develop and implement quality improvement measures that will not only improve quality of care, but also reduce medical costs and provide a way to measure performance by physicians and institutions. Integral to this process is the development of appropriate metrics by which to measure outcomes and physician performance that accurately reflect otolaryngology and its subspecialties. Two sessions at the recent 2011 American Academy of Otolaryngology–Head and Neck Surgery Annual Meeting held here Sept. 13 highlighted issues that are important for otolaryngologists striving to meet the growing demand for quality improvement.
Here’s a telling statistic: The average time patients wait in an office to see an otolaryngologist is 24 minutes, according to Press Ganey Associates, Inc., a South Bend, Ind., health care performance measurement and improvement firm. If that doesn’t sound bad, or if you think your practice exceeds that benchmark, consider that otolaryngology ranked 19th in overall satisfaction among 25 medical specialties measured in Press Ganey’s 2010 Medical Practice Pulse Report.
Although steroids are widely used to treat a variety of otolaryngologic conditions, the short- and long-term side effects remain a concern and fuel the need to better understand their proper role. Contributing to the ongoing controversy over their use are gaps in the evidence, panelists said here Sept. 12 at the American Academy of Otolaryngology-Head and Neck Surgery Annual Meeting.
Although the new U.S. health care law does not specifically alter the current fee-for-service payment structure, changes to how physicians and hospitals will be reimbursed for services are under construction. These changes are reflected by the growing focus on the development and implementation of quality improvement and physician and institutional performance measures on which reimbursement will increasingly be made, panelists said here on Sept. 11 at the 2011 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Annual Meeting.
Balancing the risks and benefits of concurrent reirradiation and chemotherapy for recurrent head and neck cancers is difficult for physicians at even the most experienced centers. Research recently published in Cancer, however, suggests that selection of patients who may benefit from this therapy should be based on the patient’s previous treatment and the amount of time that has elapsed since initial treatment…
As tenants of medical office spaces, physicians often create special leasing issues. Medical tenants use hazardous materials, generate biomedical waste, demand confidentiality of patient records and require compliance with occupational safety standards—all unique aspects of the medical profession. Yet, often, physicians will sign “form” medical office lease agreements provided by the landlord without the benefit of legal counsel. Typically, the landlord provides a standard fill-in-the-blank lease form with the tenant’s name and the general business terms (including the term of lease, rental rate and commencement date). Tenants may gloss over the legal boilerplate provisions included in the lease agreement, assuming that these terms are standard to all leases and are not subject to negotiation.
The science of medicine continues to expand rapidly, and this is obviously good for humanity. The art of medicine, on the other hand, has been largely forgotten. This skill is the basis of the time-honored physician-patient relationship and is an important aspect of good patient care. So why have so many physicians forgotten this basic skill? Why would a caring physician disregard any expertise that would benefit his patient?