More than 40 percent of inpatient operations and 33 percent of outpatient procedures are performed on older adults each year in the United States. And that number is expected to mushroom as the boomer population ages (per a July 2019 article from AARP). To improve the surgical experience for patients 75 and older, the American College of Surgeons has released 30 patient-centered standards of care. It's called the Geriatric Surgery Verification (GSV) Program. It was developed over a four-year period with input from over 50 stakeholders, including hospitals, patients, and providers.
Topics: Dr. Ken's Corner
When work hours for residents in training were capped at 80 hours per week, two questions came up:
- Will residents have enough time to learn everything they need to know?
- Will the residents' future patients suffer as a consequence?
The study's investigators faced persistent "speculation that physicians completing residency today have less robust clinical experience before entering unsupervised practice compared with pre-reform residency cohorts" (per July 2019 BMJ research.) They assumed, however, that "it might also be possible that residents who are less fatigued consolidate their knowledge better and have equivalent or greater clinical competency both during and after residency."
Only two countries worldwide allow direct-to-consumer (DTC) advertising of prescription drugs: The United States and New Zealand. Over 20 years (1997 to 2016) DTC prescription drug advertising in the U.S. increased from $1.3 billion to $6 billion "with a shift toward advertising high-cost biologics and cancer immunotherapy" (JAMA Network, January 1/8, 2019). According to the JAMA-published study, pharmaceutical companies bombarded the American consumer with 4.6 million ads in 2016. This includes 663,000 TV commercials (compared to 72,000 in 1997). The authors' conclusions: "Despite the increase in marketing over 20 years, regulatory oversight remains limited."
Topics: Dr. Ken's Corner
Instead of retiring at age 65, many doctors choose to continue practicing medicine well into their 70s and 80s. A national trend to test the competency of these older physicians appears to be gaining momentum, especially among some of the nation's largest hospital systems. Hospitals report growing concern that the mental and physical skills of some of their older physicians have deteriorated to the point of putting patient safety at risk. Paying special attention to "weeding out" impaired physicians once they have reached a certain age is proving to be a sensitive issue, to say the least.
Robotic surgery, gene therapy, and deep brain stimulation are so-called "frontiers" of medicine. Now there's a new frontier--telemedicine. "Research firm IHS Markit estimates that telemedicine visits will soar from 23 million in 2017 to 105 million by 2022" (Associated Press, 2/6/19). By then, one in ten doctors' visits could be via telemedicine. This could be an understatement if practitioners, health systems, and investors keep discovering new ways to expand telemedicine's reach.
Despite reports of burned out doctors abandoning their careers, many other doctors simply want some time off -- perhaps a year or more -- to take a breather, spend time with family, or take a sabbatical abroad. The AMA warns that leaving clinical practice for an extended period of time should not be taken lightly: "Lack of retraining before reentry raises questions about patient safety and the clinical competence of reentered physicians." Doctors need to be aware that, "getting back in the game is expensive, time-consuming, and sometimes nearly impossible. So before you take a hiatus from medicine, ask yourself--can you afford it?" (medpage.com)