UBL Notes PDF

UBL 13: Burnout rates in physicians have been a concern for decades, and may be partially responsible for physician suicide rates. A recent meeting at the Medical University of South Carolina saw physicians discussing the insomnia, emotional exhaustion, trauma, and burnout they had e...

UBL 13: Burnout rates in physicians have been a concern for decades, and may be partially responsible for physician suicide rates. A recent meeting at the Medical University of South Carolina saw physicians discussing the insomnia, emotional exhaustion, trauma, and burnout they had experienced. One physician, Melanie Gray Miller, stated that while she has family and friends to talk to, no one truly understands what she is going through. Grant Goodrich, director of ethics at the hospital system, acknowledged that the occupational hazard of the industry often downplays the difficult reality of the job. Goodrich stated that "most people don't see kids die", in reference to the experience of pediatricians. Some physicians believe that primary care may be more stressful than other specialties, even though the pay is often less. Daniel Crummett, a retired primary care doctor, questions why anyone would go into primary care when they could make twice as much money with half the stress in another specialty. Primary care physicians face demands imposed by hospital administrators, health insurance companies, and patients, particularly early in their careers. This can lead to routinely prioritizing their work over their mental health. The culture of medicine encourages simply bearing grief and trauma, rather than processing it. The number of physicians entering the profession is not growing fast enough to meet the strong demand. This exacerbates workforce shortages and may contribute to burnout as the remaining physicians are stretched thin. The Association of American Medical Colleges projects the US will be short as many as 48,000 primary care physicians by 2034. This is a higher number than any other single medical specialty. A 2022 survey published by the Physicians Foundation, a nonprofit focused on improving health care, found that more than half of the 1,501 responding doctors didn't have positive feelings about the current or future state of the medical profession. More than 20% of respondents said they wanted to retire within a year. A 2022 AMA survey found that a majority of physicians felt burned out. Of the 11,000 doctors and other medical professionals surveyed, more than half reported feeling burned out, and indicated they were experiencing a great deal of stress.  The COVID-19 pandemic appears to have worsened physician burnout. Seventy percent of primary care providers and 89% of primary care residents reported feeling burnt out, even before the pandemic. Gregg Coodley, author of the 2022 book Patients in Peril: The Demise of Primary Care in America, stated that everyone in healthcare feels overworked. Coodley acknowledged that other specialists have issues too, but stated that in primary care, “It’s not the worst problem.” The high level of student loan debt carried by most medical school graduates, combined with salaries that are among the lowest of all medical specialties, may deter many physicians from pursuing primary care. Many primary care doctors consider quitting medicine midcareer. Physicians in other specialties are paid significantly more than their counterparts in primary care. American physicians often stay in their jobs instead of leaving the profession in their 30s or 40s, but retire early. Daniel Crummett, who retired from the Duke University hospital system in 2020 when he turned 65, said that he would have enjoyed working until he was 70 if not for the burdens of practicing medicine. These burdens included bureaucratic burdens from insurance companies, including the need to get prior authorization from insurance companies before providing care, navigating cumbersome electronic health record platforms, and logging hours of administrative work outside the exam room. Crummett said that he really enjoyed seeing his patients and working with his co-workers. Jean Antonucci, a primary care doctor in rural Maine, retired from full-time work at age 66. She would have kept working if not for the hassle of dealing with hospital administrators and insurance companies. Antonucci had to call one insurance company by landline and cellphone simultaneously to get prior authorization to conduct a CT scan, even though her patient was in pain and did not need the scan. Whitney Marvin, a pediatrician who works in the pediatric ICU at the Medical University of South Carolina, said that hospital culture implicitly teaches doctors to tamp down their emotions and to “keep moving”. Marvin said that doctors are not supposed to be weak, cry, or have emotions because that would mean they have not historically suppressed their emotions enough. This mindset prevents many doctors from seeking help they need, which can lead to burnout and worse. An estimated 300 physicians die by suicide each year, according to the American Foundation for Suicide Prevention. The problem is particularly pronounced among female physicians, who die by suicide at a significantly higher rate than women in other professions.  A March 2022 report from Medscape found that of the more than 9,000 doctors surveyed, 9% of male physicians and 11% of female physicians said they have had suicidal thoughts. The report noted that elevated rates of suicidal thoughts in physicians have been documented for 150 years. Gary Price, a Connecticut surgeon and president of The Physicians Foundation, said it is ironic that physicians, who have the easiest access to mental health care, are experiencing a mental health crisis. Corey Feist, president of the Dr. Lorna Breen Heroes' Foundation, said that reluctance to seek help is unfounded. There is an unspoken residency rule that seeking mental health treatment could jeopardize the physician's livelihood. Feist's sister-in-law, emergency room physician Lorna Breen, died by suicide in the early months of the pandemic. Breen had sought inpatient treatment for mental health, but feared that her medical license could be revoked. The foundation works to change laws across the country to prohibit medical boards and hospitals from asking doctors invasive mental health questions on employment or license applications. In Charleston, psychologists are made available to physicians during group meetings like the one Miller attended, as part of the resiliency program. Fixing the burnout problem also requires a cultural change, especially among older physicians. Until that change happens, the medical field will continue burning out physicians within the first three years of their careers. UBL 14: Purpose: To analyze how physician characteristics and prior working relationships influence physicians' attitudes toward nurse practitioners (NPs) Background: ○ NPs are playing an increasingly crucial role as primary care providers, particularly in medically underserved areas. ○ This rise presents challenges, including potential competition between physicians and NPs. ○ Previous research suggests that physicians' attitudes toward NPs can be influenced by factors like working alongside them. Study Design: ○ Data was collected from a survey of actively practicing physicians in Mississippi in 2007. ○ The survey assessed physician demographics, practice characteristics, and attitudes toward NPs. ○ Statistical analysis techniques were used to examine the relationships between these variables. Results: ○ Physicians who had worked alongside NPs in their current positions had significantly more positive attitudes toward NPs. ○ This positive attitude was particularly noticeable regarding NPs' contributions to primary care, their ability to provide a different care dimension, and their role in expanding access. ○ The length of time a physician had been in practice was positively associated with more positive attitudes toward NPs. ○ Male physicians and generalists had slightly more positive attitudes toward NPs. Discussion: ○ The findings support the idea that familiarity with NPs through direct work experience can foster more positive attitudes. ○ The study's authors suggest that this positivity may stem from physicians' firsthand observations of NPs' competence and value in healthcare delivery. ○ The lack of negative attitudes from physicians who have not worked with NPs could be due to a lack of direct experience or competition.  ○ The study highlights the importance of collaborative work environments and the potential for interprofessional education to improve interdisciplinary relationships. Limitations: ○ The study focused on physicians in Mississippi, which may limit the generalizability of the findings. ○ The cross-sectional design prevents conclusions about causality. Implications: ○ Understanding factors that influence physicians' attitudes toward NPs is crucial for fostering collaborative care models. ○ Early exposure and positive experiences working with NPs in educational and training settings could promote more accepting attitudes among future physicians. The study suggests that as the role of NPs continues to expand, particularly in underserved areas, ensuring positive working relationships between physicians and NPs will be essential for maximizing access to care and achieving optimal healthcare outcomes. UBL 15: Medical errors are a significant public health concern in the US, representing the third leading cause of death. They result in approximately 400,000 hospitalized patient deaths annually. The cost of medical errors is estimated to be between $17 billion and $29 billion each year. This includes healthcare costs and lost productivity. Medical errors can negatively impact patients, their families, and healthcare providers. They can lead to physical and psychological harm, legal action, and compound the stress of an already difficult situation. There is no universally accepted definition of "medical error". Some experts suggest avoiding the term altogether due to its negative connotations.  Common types of medical errors include: ○ Surgical errors: These involve performing surgery on the wrong site, the wrong patient, or using incorrect surgical techniques. ○ Diagnostic errors: These involve the failure to establish an accurate and timely diagnosis. They are a leading cause of death and injury to patients. ○ Medication errors: These can occur at any stage of the medication process, from prescribing and dispensing to administration. ○ Equipment failures: These involve malfunctions or failures of medical equipment. ○ Hospital-acquired infections: These are infections that patients acquire while receiving care in a healthcare facility. ○ Falls: These are a common cause of injury in healthcare settings, particularly among older adults. ○ Communication failures: These can occur between healthcare providers, between providers and patients, or between providers and families. Understanding the different types of medical errors and their potential impact on patient care is essential for developing effective prevention strategies. Active errors are specific events that directly cause patient harm. Examples include operating on the wrong site or administering the wrong medication. Latent errors are system weaknesses or flaws that contribute to the occurrence of active errors. These errors may go unnoticed for a long time and are often rooted in inadequate processes, faulty equipment, or poor system design. ○ An example of a latent error is a malfunctioning ventilator machine. The clinician's failure to check the device before use is an active error. Adverse events are defined as patient injuries resulting from medical care rather than the patient's underlying condition. They include complications from prolonged hospitalization, infections, and preventable adverse events.  ○ Preventable adverse events are caused by medical errors and do not meet the standard of care for a given situation. Near misses are medical errors that could have resulted in patient harm but were caught before causing harm. Analyzing near misses can help identify potential areas for improvement in safety protocols. Potentially compensable events are medical errors that could lead to malpractice claims. These events can involve prolonged hospitalization, disability, or death. Never events are medical errors that should never happen, such as surgery on the wrong site. Noxious episodes are diagnostic or treatment modalities that cause adverse events or prolonged hospitalization. A root cause analysis (RCA) is a structured process used to identify the underlying causes of an adverse event or sentinel event. The goal of an RCA is to develop and implement strategies to prevent similar errors from occurring in the future. Sentinel events are defined by the Joint Commission as any unexpected occurrences involving death, serious physical or psychological injury, or the risk thereof. They signal a need for immediate investigation to discover the cause and develop corrective measures. Failure mode effects analysis (FMEA) is a proactive safety analysis method that identifies potential failures in a process or system and develops strategies to mitigate the risks associated with those failures. Healthcare professionals should be familiar with the different types of risk factors that contribute to adverse events. These include: ○ individual factors (e.g., fatigue, distractions) ○ systemic factors (e.g., inadequate staffing, poor communication)  Implementing strategies to address these risk factors can help improve patient safety and reduce the incidence of medical errors. Surgical errors can be reduced by implementing specific strategies, such as: ○ using a preoperative checklist to ensure that the correct patient, site, and procedure are identified ○ timing-out before the procedure to confirm all necessary information ○ adopting radio-frequency counting sponges to prevent retained surgical instruments ○ communicating clearly among the surgical team. Diagnostic errors can be reduced by: ○ using cognitive aids like checklists and algorithms ○ encouraging second opinions for complex cases ○ improving communication and follow-up with patients. Medication errors can be prevented through: ○ barcode medication administration to verify the correct patient, drug, and dose ○ using medication profiles to track patient medications ○ providing real-time medication information to clinicians ○ educating patients about their medications. Device and equipment errors can be reduced by: ○ implementing protocols for reporting and tracking device-related adverse events ○ training healthcare staff on the proper use and maintenance of medical equipment ○ using standardized connections for medical devices to prevent misconnections.  Hospital-acquired infections can be prevented by: ○ promoting hand hygiene ○ using appropriate infection control measures (e.g., isolation precautions) ○ educating healthcare workers about infection prevention strategies. Falls can be prevented by: ○ instituting fall prevention protocols ○ identifying patients at high risk for falls and implementing appropriate interventions ○ educating patients and families about fall prevention strategies ○ improving communication and teamwork among healthcare providers. Effective communication is essential for patient safety. Communication errors can be minimized by: ○ using standardized communication techniques ○ encouraging a culture of open communication ○ providing training on effective communication skills ○ using technology to support communication (e.g., electronic health records). Creating a culture of safety in healthcare settings is crucial for reducing medical errors. This involves encouraging reporting of errors, analyzing errors to identify system weaknesses, and implementing strategies to prevent future errors. Enhancing healthcare team outcomes can significantly reduce medical errors. Focusing on clinical education, implementing healthcare protocols that address common errors, and utilizing error reporting and standardized communication systems can help prevent medical mistakes. Nurses play a crucial role in patient safety and error prevention. Organizations should provide them with adequate training, resources, and support to ensure patient well-being  and safety. ○ The Institute of Medicine (IOM) recommends: avoiding extended work hours limiting consecutive 12-hour shifts providing adequate rest periods between shifts. Effective interventions to improve patient safety include: ○ providing education for medical errors and safety principles ○ creating an organizational culture that encourages adherence to safety principles ○ implementing non punitive, focused, and effective feedback to improve safety. Addressing medical errors requires a multifaceted approach that involves individual and system-level changes. Healthcare professionals must be aware of the potential for error and take steps to minimize risks. Organizations must create a culture of safety that encourages reporting and learning from errors. UBL 16: The source discusses the concept of moral determinants of health, arguing that the prevailing focus on proximate medical causes of health issues overlooks the broader societal factors that significantly impact health outcomes. The author emphasizes that the investment community and multinational corporations wield excessive influence, and the political landscape is overly favorable to their interests. This imbalance has resulted in a healthcare system that prioritizes profit over the well-being of the population. The source uses the analogy of "the subway map" to illustrate the stark contrast in life expectancy between individuals living just a few miles apart in Chicago. This disparity highlights how socioeconomic factors, rather than individual choices, play a major role in health outcomes. Examples of social determinants of health include: ○ vast disparities in life expectancy ○ high incarceration rates, especially among racial minorities ○ widespread homelessness and poverty ○ inadequate access to quality education and employment opportunities. The author argues that addressing these social determinants is crucial for improving population health and reducing health inequities. The source contends that the current healthcare system is "too deeply invested in the interests of the healthcare economic and lobbying community" to effectively address the root causes of poor health. The author calls for a shift in focus from solely addressing proximate medical causes to tackling the underlying social determinants of health. This shift requires a commitment to social justice and a reallocation of resources to address societal inequities.  The source suggests several actions that individuals and organizations can take to promote social justice and improve health equity, including: ○ Advocating for policies that address poverty, homelessness, and lack of access to healthcare. ○ Engaging in political action by voting, contacting elected officials, and supporting organizations that advocate for social justice. ○ Raising awareness about the moral determinants of health and educating others about the impact of social factors on health outcomes. ○ Supporting organizations that work to address social determinants of health, such as those providing housing, food security, and job training. The author criticizes the United States' failure to ratify the UN Convention on the basic human rights treaties, which highlights the nation's insufficient commitment to upholding fundamental human rights as a pathway to improving health outcomes. The source concludes by emphasizing that achieving meaningful improvements in health requires a collective effort to address the social determinants of health. This entails a commitment to social justice and a fundamental shift in priorities, moving away from solely medical interventions toward addressing the broader societal factors that shape health. UBL 17 HELLLLLLLLL Overview The U.S. spends more on healthcare as a percentage of GDP than any other nation studied but consistently ranks last in performance. Countries like Australia, the Netherlands, and the UK lead in overall health system performance. Key Performance Indicators 1. Access to Care: ○ The U.S. ranks poorly due to high costs and significant barriers to access. ○ Other countries like the UK and the Netherlands excel with universal coverage and low out-of-pocket costs. 2. Administrative Efficiency: ○ The U.S. has a fragmented system with complex insurance processes, leading to inefficiencies. ○ Countries with centralized or single-payer systems perform better. 3. Equity: ○ The U.S. exhibits substantial health disparities based on income, race, and geography. ○ Equity is better achieved in nations with robust universal healthcare policies. 4. Health Outcomes: ○ The U.S. scores the lowest in life expectancy and preventable deaths, highlighting gaps in effective care delivery. ○ Peer countries achieve better results due to stronger primary care systems and proactive public health measures. Key Findings Despite high expenditures, U.S. outcomes are subpar, suggesting inefficiencies in the allocation of healthcare resources. Lessons could be drawn from nations that prioritize universal coverage, cost control, and integrated care systems. Recommendations Investing in preventative care and improving primary care access. Streamlining administrative processes to reduce waste. Expanding healthcare equity to address disparities in access and outcomes.