Ethics (clinical and business)

Ethics and Ebola

by Dr. Bartho Caponi MD, FHM The Ebola panic has died down; while many are under monitoring, there have been no further de novo U.S. cases since October 15, and only two more "imported" cases. Travelers are being screened and resources are heading to areas where they are needed. At my institution, Hospitalists have led the way; over half my division volunteered up-front to provide necessary care. I ended up in a lot of planning and policy meetings, where we internally crafted a comprehensive plan to deal with any Ebola-related eventuality. Nationally, the Centers for Disease Control and Prevention (CDC) have created many useful resources for people and institutions needing them. We now have guidelines for speaking to our children about Ebola and for taking care of Ebola-exposed pets, in addition to more trenchant issues. We now have "Ebola centers," hospitals capable of caring for suspected or confirmed Ebola patients…

Shunshine Act

The Physician Payment Sunshine Act (PPSA) is intended to expose any financial relationships that could compromise a physician’s research integrity or patient care. In response to the PPSA, CMS created the “Open Payments” database, into which device-drug-supply manufacturers publicly report any financial transfers to physicians or teaching hospitals. This includes 3 types of payments: “general” payments, research payments, and physician ownership information. The database was released last week and contains ~2/3 of the payments made by manufacturers in the last 5 months of 2013, including $3.5 billion made to 1,360 teaching hospitals and 560,000 physicians.1 While the intent of the Sunshine Act seems laudable, there are flaws that should be considered by those attempting to digest the information included in the database. As outlined by a recent Annals article, the inclusion of research funding (which includes donated drugs) can result in extraordinary dollars attributed to well-meaning and successfully funded researchers.2…

You think you know what predictive analytics means, huh?

  This month's Health Affairs dedicates itself to the subject of big data, a term in the news quite a bit these days.  If you think you know what big data implies, mainly dredging data sets to build the clinical decision support in your EMRs, you would be incorrect. We are talking much, much bigger. One article grabbed my attention, whose lead author practices both law and bioethics.  The piece delves into how information requires handling--legally, medically, entrepreneurially, and ethically.  I got way more out of reading the citation than I thought. To whet your appetite, think about the quote below: (more…)

Frankenstein’s Monster

I'm afraid this blog post will be a bit of a rant, having just been fired by a patient. This patient was tragic and miserable with the rolling eyes and flaring nostrils of a wild horse confronted with a rattlesnake. And I, dear reader, was the rattlesnake. And what could have possibly been the crime for which I was so unceremoniously exited from the opportunity of helping one so desperately in need of help? Yes, you may have already guessed. I stopped the IV narcotics. Those of you engaged, as I often say, in the sacred and unfortunately often profane gumbo that is caring for inpatients must recognize this eternal dance of damnation. You, as a medical provider recognize there is absolutely no identifiable or supportable reason why your professional patient, who has been in and out of various hospitals on a monthly basis for a year or so, should…

Hospitalists and the Federation of State Medical Boards (FSMB): A CEO Q&A

Humayun J. Chaudhry, D.O., M.S., MACP, FACOI, President and Chief Executive Officer, Federation of State Medical Boards    1. Firstly, Hank, thanks so much for spending a few minutes with our readers.  As you know, hospitalists devote most of their time in acute and subacute settings. Many of their clinical apprehensions relate to hospital and physician regulation and quality monitoring and how these rules intersect with inpatient care.  The Federation of State Medical Boards (FSMB) has a broad mission. What should hospitalists know about your organization given these concerns and do you have a role to play in assisting inpatient providers to improve patient care? To understand the mission of the Federation of State Medical Boards (FSMB), it’s helpful to understand the mission of state medical boards. States are authorized under the 10th Amendment to the U.S. Constitution to establish laws and regulations protecting the health, safety and general welfare of their citizens. To…
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