Friday, February 8, 2013

we read journals

Remember the nice article about how most people getting chemo for incurable cancers thought their chemo had a good chance of curing them? There were a bunch of great letter to the editor in the 1/31/13 NEJM about that article. The first one concludes with "Thus, interpretation of patient-survey items must account for the fact that what we think we are asking patients may be different than what patients mean by their responses." which I think hits the nail on the head with that issue. The second letter mentions that "high patient-satisfaction ratings are associated with poor patient outcomes and increased costs of care. Although we cannot assume causality, these findings arouse concern." As many doctors know, several payors are suggesting patient satisfaction as a metric to help determine what physicians are paid as part of "pay for performance." I'm not sure that that is in anyone's best interest at this point.
The JAMA from 2/6/13 also has a very newsworthy article in it about "Change in End-of-Life Care for Medicare Beneficiaries." There are several articles in the popular press that summarize and extend it. I think a summary might be that care of medicare beneficiaries who die is becoming more aggressive in some ways with more ICU usage and more transfers at end of life in 2009 than in 2000, but more are signing onto hospice. The average Medicare decedent spent 6.6 of their last 30 days on hospice. I think the write who talked about people using hospice as an add-on after aggressive care was right. That issue also has a nice article on the medical issues associated with transgenderism. I have had a handful of transgendered patients over the years and have had a hard time finding useful information. It's nice that they have put the basic issues together for providers. Finally, a short article putting the evidence for opioids for arthritis pain together for clinicians.
It turns out that the article I reviewed was rejected which I think was the right decision (although I argued for its publication, having overlooked its biggest flaw in favor of its other charms). I suspect they will find a less prestigious journal to publish it; I hope so at least.

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