: Why We Trust Doctors This patient is no fool, and she does’t award trust liberally. … Yet, somehow, (Mary) Morse-Dwelley never lost faith in Pellegrini. She’d hear the click of her doctor’s shoes in the hallway, see her blond hair and funky glasses, and feel confident that she was in good hands. This, too, represents a broad trend: As we have become better-informed patients, we have grown more cynical about a health care system that is ever more corporate and reliant on technology. Nevertheless, our faith in physicians has proved incredibly durable. Gallup, which has polled on public trust in professionals every year since 1976, reports high and rising marks for doctors. In the latest survey, from 2011, 70 percent of respondents rated medical doctors as high or very high when asked about their “honesty and ethical standards,” a record. When the Kaiser Family Foundation asked Americans whom they trusted in 2009—the height of the debate over the health care law—78 percent said they believed that their doctors put patients’ interests ahead of their own (Margot Sanger-Katz, 4/26).

: Bariatric Surgery Maintains, Doesn’t Gain In a way, bariatric surgery is like the member of the chorus who spent years waiting for a big break, got it, became a star, and then found out that success was harder than it looked. After decades of slow growth since the first procedure was performed in 1954, rates escalated rapidly in the first few years of the 2000s but hit a wall recently. That wall may not be so easy to get past, even if the economy fully recovers. A total of 36,700 bariatric surgeries were carried out in 2000, and then jumped 29% to 47,200 in 2001, according to the American Society for Metabolic & Bariatric Surgery. An additional 63,100 were carried out in 2002, an increase of 34% from the previous year. In 2003, 103,200 procedures were performed for an annual growth rate of 64%, the biggest increase in the previous decade. Hospitals and large health systems opened bariatric surgery centers as revenue builders and to serve their communities. General surgeons started specializing in the procedure (Victoria Stagg Elliott, 4/23).

: Why the Mandate Is Constitutional: The Real Argument The Supreme Court’s hearings in the health care case, US Department of Health and Human Services v. Florida, over a nearly unprecedented three days of oral argument in late March, generated all the attention, passion, theater, and constant media and editorial coverage of a national election or a Super Bowl. Nothing in our history has more dramatically illustrated the unique role of courtroom drama in American government and politics as well as entertainment. … The prospect of an overruling is frightening. American health care is an unjust and expensive shambles; only a comprehensive national program can even begin to repair it. One in six Americans lacks any health insurance, and the uninsured of working age have a 40 percent higher risk of death than those who are privately insured (Ronald Dworkin, 5/10).

: Debt Collectors In The E.R. And Delivery Room: Is Profit-Driven Medicine At A Breakpoint? Imagine that you’ve brought your child to the emergency room and you’re revealing your most private health information to the hospital staff member at the desk, desperate because you fear your child’s very life is at risk. But the desk clerk seems more concerned about getting paid than giving care, and even makes veiled threats against your credit score if you’re not able to cough up the money to cover the bill. Who is this heartless bureaucrat? Is it a hardened triage nurse? A bored clerk? Would you believe it could be a third-party bill collector posing as a hospital staffer? Welcome to 21st-century American medicine (Maia Szalavitz, 4/25).

: Women Rejoice: Time To Bid Farewell To Your Annual Pap Smear For fifty years an annual Pap smear has been the gold standard of screening for cervical cancer in women. Now a federal advisory group and the nation’s leading cancer organization have changed their tune. They no longer recommend that women have a Pap test each year. The recommendations do not apply to women who are at very high risk for cancer, such as those who have been diagnosed with a high-grade precancerous cervical lesion or who have weakened immune systems. The US Preventive Services Task Force, (USPSTF) a panel of independent experts convened by the government, and the American Cancer Society (ACS) have each released new guidelines for cervical cancer screening that recommend against routine yearly testing. Instead, the guidelines recommend testing every 3 years for women aged 21 to 65 (Susan H. Scher, 4/24).

: Health System Changes Inspire More Med Students To Pursue Dual Degrees As they contemplate careers in a rapidly changing health care landscape, a growing number of medical students are deciding that a medical degree is not enough. Most U.S. medical schools offer students the chance simultaneously to get advanced degrees in a variety of other areas, such as public health, law, business administration, mass communications and the sciences. Some schools have offered the programs for more than two decades. However, more recently, dual degrees are growing in popularity as prospective physicians feel they must develop expertise beyond medicine to compete in a dynamic health care market. Combined enrollment nationwide in MD/PhD, MD/JD and MD/MBA programs alone has increased 36%, from 3,921 in 2002 to 5,349 in 2011, according to the Assn. of American Medical Colleges. Most of them, 5,023, are in MD/PhD programs. The AAMC suspects its MD/JD and MD/MBA tallies are undercounted (Carolyne Krupa, 4/23).

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However, as states face tough budget decisions, such programs are increasingly on the chopping block.

“These services have just come under pretty serious attack at the state level,” said Jill Kagan, program director of the . “The current economic climate that we’re in and that every state is facing has made it really difficult to expand any services at all. This comes on top of the fact that there was not enough respite for family caregivers to begin with.”

States are facing the following proposed and recently enacted cuts, accordingÌýto members of state respite coalitions and ARCH networks:

• : $76.3 million from community services for people with developmental disabilities, including defunding the University of Illinois-Chicago’s Developmental Family Clinics and a program that provides respite care for parents of children with developmental disabilities, plus trimming $56 million from group homes, day centers and employment programs.
• : More than $182,000 cut from a variety of state programs, including the Family Support Program, which funds many different services for people with disabilities, including respite care.
• Rhode Island:Ìý A 25 percent cut to State Community Grants, which includes a $136,680 grant to the Catholic Diocese of Providence for a program providing respite to caregivers of theÌýelderly.
• : Suspension of Alzheimer’s respite funds from the state budget.
• :Ìý Proposed elimination of $2.9 million of and $3.9 million in federal matching funds for the 11 statewide Caregiver Resource Centers, which provide services including respite care, to families and caregivers of adults withÌýchronic and disabling health conditions.

Many experts believe reductions could have adverse consequences as the population ages and as more senior parents struggle to care for adult children with severe disabilities. They also point out that respite is cost-effective, since it helps keep patients out of more expensive institutional care.

Respite services are often hard to find and funded from a patchwork of sources at the federal, state and local level, as well as through private foundations. In 2006, Congress authorized the Lifespan Respite Care Program, a federal program to better coordinate and expand state-funded respite services in selected states. However, it wasn’t funded until 2009 and since then has struggled with a $2.5 million annual budget.

Elizabeth Weglein, a board member of the Maryland Respite Care Coalition and the governor’s chair for the Maryland Caregivers Support Coordinating Council, described respite as a “lynchpin to keep people at home and allow the system to work effectively.” Still, she said that it’s often difficult to demonstrate its effectiveness to budget makers since respite often occurs in people’s homes.

“It can be intangible, we can have letters of thanks from the various respite recipients, but when they’re looking at hard numbers at where we should slash, it’s easy to slash a respite program,” Weglein said.

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: The Doctor Will See You–If You’re Quick Something in the world of medicine is seriously amiss. Unhappy patients gripe about their doctors’ brusque manner and give them bad marks on surveys and consumer websites like HealthGrades and Angie’s List. They tell tales of being rushed out of the office by harried doctors who miss crucial diagnoses, never look up from their computers during an exam, make errors in prescriptions, and just plain don’t listen to their patients. …ÌýAnd things don’t seem much better from the other side of the stethoscope. In a recent survey by Consumer Reports, 70 percent of doctors reported that since they began practicing medicine, the bond with their patients has eroded (Shannon Brownlee, 4/16).

: How Exercise Could Lead To A Better Brain For more than a decade, neuroscientists and physiologists have been gathering evidence of the beneficial relationship between exercise and brainpower. But the newest findings make it clear that this isn’t just a relationship; it is the relationship. Using sophisticated technologies to examine the workings of individual neurons — and the makeup of brain matter itself — scientists in just the past few months have discovered that exercise appears to build a brain that resists physical shrinkage and enhance cognitive flexibility. Exercise, the latest neuroscience suggests, does more to bolster thinking than thinking does (Gretchen Reynolds, 4/18).

: Up In Smoke The raids on (Richard Lee’s) properties are only the most telegenic instances of a much wider federal crackdown (onÌýmarijuana)Ìýthat has taken states and counties by surprise. Dispensaries, and even landlords of dispensary-operators, all over California, Colorado and Montana have been getting menacing letters. Many have closed shop. … The question is why the federal government is doing this. On the one hand there is a federal law, the Controlled Substances Act, which recognises no exception for medical marijuana and thus considers all use and trade of it criminal. But on the other hand the Obama administration originally signalled that it would not deliberately clash with the states about weed. … The overall effect has been to confuse everybody and leave matters entirely at the discretion of individual prosecutors (4/14).

: Using Social Media To Prevent Suicide College students and adolescents now congregate in online social networks just as much as they do in dormitory common rooms. So organizations like the National Suicide Prevention LifeLine seek to be present in these environments. The LifeLine recently developed a Facebook chat add-on that enables users to report updates to Facebook that they feel are indicative of suicidal behavior. These then trigger a connection to a trained counselor. The service functions in ostensibly the same manner as the LifeLine’s telephone service, which took its first call in January of 2005. There are two ways of accessing the chat — either by clicking on the user’s post or by reporting it to the Facebook Help Center. The user is then contacted by a crisis center via email, encouraging them to either call the help line or click on a link to start an online chat with a counselor(Anna Codreo-Rado, 4/18).

: T-Cell Army In the last hundred years, progress in the treatment of cancer has come mostly from radiation and chemotherapy. Previously fatal blood-cell cancers, such as childhood leukemia and Hodgkin’s disease, are now curable. But solid tumors, which grow in the lungs, the colon, and the breast, have stubbornly resisted treatment once they spread beyond their initial site. … Targeted therapies, which are designed to disarm these mutations, are now at the forefront of care. The first successful targeted therapy was Gleevec, which caused rapid remissions in chronic myelogenous leukemia, with few and mild side effects. … But now patients who did not respond to available therapies have shown dramatic and unexpected responses to a new series of treatments that unleash the immune system (Jerome Groopman, 4/23).

: Why Patients Should Be Paid For Good Health Over the past few years, insurers and Medicare officials have fostered the idea that physicians should be reimbursed on a pay for performance (P4P) basis.Ìý Many articles, both pro and con, have been written regarding P4P.Ìý I have been strongly opposed to P4P, believing that the sole purpose of the performance indicators designed by the government and insurers is to reduce payments to docs and hospitals.Ìý I also believe that the establishment of performance guidelines will lead to the mechanization of medical care as physicians and hospital administrators will learn what they need to do to “perform” and practice guideline-based medicine as opposed to providing personalized care. Recently, I have reassessed my P4P stance and believe that a system that pays patients for performance could work.Ìý Yes. “patient pay for performance (PP4P)” would be a good thing (Stewart Segal, April 2012).

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and other health care workers can slip or fall orÌýstrain themselves trying to lift people or equipment. They also face unique hazards such as workplace violence, exposure to “bloodborne pathogens,”ÌýinfectiousÌýdiseases such as tuberculosis or dangerous chemicals and drugs.

The U.S. Department of Labor’s Occupational Safety and Health Administration wants to do somethingÌýto make the jobs safer. ÌýOSHA hasÌýa , theÌýNational Emphasis Program for Nursing and Residential Care Facilities, which calls for increased outreach efforts and a rise in inspections of on-the-job hazards. The Labor Department says they will initially target facilities that have a ratio of days-away-from-work of 10 or higher per 100 full time workers.

Nursing aides, orderlies and attendantsÌý of work-related injuries or illnesses than even “hand laborers and freight, stock and material movers.” In 2010,Ìýwork-related injuries and illness was 2.3 times higher in the nursing and residential care sector than all private industry overall, according to the .

“These are people who have dedicated their lives to caring for our loved ones when they are not well. It is not acceptable that they continue to get hurt at such high rates,” said Dr. David Michaels, assistant secretary of labor for occupational safety and health, in a prepared statement.

The new program plans to offer specific guidance on ergonomics and workplace violence, according to OSHA.

“We’re really glad they’re doing it,” said Carol Regan, director of government affairs at , an advocacy group for direct care workers. “This has been a long-time coming because we’ve been concerned about the lack of standards for this industry.”

While many workers advocates and unions have welcomed the new program, some believe more should be done for home-basedÌýdirect care workers.

“Home care workers are really susceptible because they’re on their own, they’re in people’s houses, they often don’t have supervisors right there,” Regan said. She added that she hopes OSHA will extend such efforts to better train direct care workers about risks in the homes but says that since she recognizes that it will be nearly impossible for OSHA to inspect personal homes, she hopes they will emphasize better training.

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: Can Autism Really Be Diagnosed In Minutes? Autism is an extremely complex diagnosis. Parental insight, physician observations and hours of data can factor into determining whether a child actually has the condition or is just a little on the quirky side. Now a Harvard researcher, Dennis P. Wall, has published research about a Web-based tool he developed that promises to diagnose autism in minutes, not hours — a proposition that Wall has floated for some time now and has some autism experts so skeptical they’re not even willing to speak on the record about it. Wall, director of the computational biology initiative at the Center for Biomedical Informatics at Harvard Medical School and associate professor of pathology at the school, combines computer algorithms along with a seven-point parent questionnaire and a home video clip to make a speedy online assessment of whether a child has autism (Bonnie Rochman, 4/11).

: Teaching Old Drugs New Tricks Even as the medical world makes great advances in drug testing, development cycles can still take years, if not decades. In the case of cystic fibrosis, for instance, scientists were able to detect the disease’s molecular cause by as early as 1989 — but it’s taken nearly three decades to push a drug to market. Could there be a faster way to cures? If NIH director Francis Collins has his way — perhaps. By studying the human genome and noticing similarities among the molecular effects of certain diseases, Collins believes pharmaceuticals designed to target one affliction can have surprisingly positive effects on other illnesses. We just need to match the right drugs with the right diseases (Brian Fung, 4/11).

: Club Med This year, a few hundred thousand intrepid American travellers will head to places like Thailand and Costa Rica, in search of something that they can’t find in the United States. They won’t be looking for Mayan ruins or ancient Buddhist temples, but something a bit more practical: affordable medical care. These medical tourists will be getting root canals, knee surgeries, and hip replacements at foreign hospitals. If health-care costs in the U.S. keep rising—and especially if Obamacare is overturned by the Supreme Court—more of us may soon be joining them. For decades, wealthy people from developing countries have come here for care, but these days medical tourists travel all over the world. And while it’s hard to disentangle the stats from the hype—a number of countries portray themselves as favored destinations—it’s clear that millions of people are now doing this. The Bumrungrad hospital, in Bangkok, treats four hundred thousand foreign patients annually. Malaysia had almost six hundred thousand medical tourists last year. And South Korea had more than a hundred thousand, nearly a third of them American. For Americans, the attraction is obvious: medical care is a lot cheaper abroad (James Surowiecki, 4/16).

: California, Vermont Consider Tougher Vaccine-Exemption Rules Recent outbreaks of vaccine-preventable diseases and a growing immunization opt-out rate are pushing physician organizations in California and Vermont to seek greater restrictions on exemptions from school-entry immunization requirements. Every state allows exemptions for children with medical contraindications verified by a physician, and all but two states let parents with religious objections skip immunizing their children. An additional 20 states allow exemptions based on parents’ philosophical or personal beliefs. Requirements for securing personal-belief exemptions vary by state but are often as easy as signing a form (Kevin B. O’Reilly, 4/9).

: The War On Cancer In this era of pink ribbons and yellow Livestrong bracelets and a proliferation of races to cure cancer, it’s easy to forget that just three or four decades ago, a cancer diagnosis was likely a death sentence. In the early 1970s, the five-year survival rate for all invasive cancers was a dismal 43 percent, and the treatments — disfiguring surgery, almost unbearably toxic chemotherapy, indiscriminate radiation — were so dreadful that many patients considered them worse than the disease. Today, the five-year survival rate for all cancers is 67 percent. Surgery, chemotherapy and radiation — still the triad of successful cancer treatment — are more precise, causing much less pain and disfigurement. But the real turning point for patients … occurred in 1971, with the signing of the National Cancer Act (Tom Slear, April/May 2012).

Ìý

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: Women’s Health Care Is Stronger Thanks To The Health Care Law In many families, women are the health care decision makers. When children go for their checkups, we are often the ones who make the appointment and sit in the room holding their hand. When elderly parents see a new specialist, we are the ones carrying the folder with all their health information.Ìý… In the past, this also meant that many women would take care of their own health last. By the time they got around to it, women found a system stacked against them. But thanks to the health care law, that’s changed (Kathleen Sebelius, 3/20).

: Holding Court Late last year, a three-judge panel of the D.C. Circuit [Court of Appeals] voted, two to one, to uphold President Obama’s health-care reform, known as the Affordable Care Act (ACA). [Brett M.] Kavanaugh dissented, primarily on the ground that the lawsuit was premature. … “Under the Constitution,” Kavanaugh wrote, “the President may decline to enforce a statute that regulates private individuals when the President deems the statute unconstitutional, even if a court has held or would hold the statute constitutional.” … In other words, according to Kavanaugh, even if the Supreme Court upholds the law this spring, a President Santorum, say, could refuse to enforce ACA because he “deems” the law unconstitutional. That, to put the matter plainly, is not how it works (Jeffrey Toobin, 3/26).

: What Will The Supreme Court Ask About Health Reform? If the court decides to rule on the lawsuit, a decision is expected by the end of June before the conclusion of the court’s current session. That decision has heavy implications for states. The ACA includes an extensive expansion of Medicaid (expected to add up to 20 million people to the program’s rolls) and asks states to create a health insurance exchange where individuals and small businesses can compare and purchase insurance plans. Market reforms, such as rules for the medical loss ratios that insurance companies must maintain, would also require cooperation from state governments (Dylan Scott, 3/15).

: The Most Scientific Birth Is Often The Least Technological Birth When I ask my medical students to describe their image of a woman who elects to birth with a midwife rather than with an obstetrician, they generally describe a woman who wears long cotton skirts, braids her hair, eats only organic vegan food, does yoga, and maybe drives a VW microbus.Ìý… Many medical students, like most American patients, confuse science and technology. They think that what it means to be a scientific doctor is to bring to bear the maximum amount of technology on any given patient. And this makes them dangerous. In fact, if you look at scientific studies of birth, you find over and over again that many technological interventions increase risk to the mother and child rather than decreasing it (Alice Dreger, 3/20).

: Inside America’s Drug Shortage Lynn Divers thought she had heard the worst of it when doctors told her that her daughter Alyssa had cancer. … Then came the truly heartbreaking news. In late February, when Divers called the hospital to confirm Alyssa’s upcoming chemotherapy treatment, the nurse informed her that there was a drug shortage. The hospital couldn’t be sure that there would be enough methotrexate — the cornerstone of therapy for some childhood cancers, including leukemia and osteosarcoma — to treat Alyssa, now 10. … How did this happen? How could hundreds, perhaps thousands of cancer patients suddenly find themselves without the drug treatments that could save their lives? (Alice Park, 3/19).

: The ABCs Of Health Literacy One in three patients has “basic” or “below basic” health literacy, meaning he or she struggles with tasks such as completing a health insurance application or understanding a short set of instructions about what liquids to avoid drinking before a medical test. This literacy gap has medical consequences. A wide body of research has found that patients with poor literacy skills have much worse health outcomes than patients who can read well. They make more medication or treatment errors, are less compliant and are 50% likelier to be hospitalized, says the National Patient Safety Foundation. Low-literacy patients with chronic diseases … rack up four times more in annual medical costs than patients with higher reading ability (Kevin B. O’Reilly, 3/19)

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for a change in regulations has come under assault from segments of the home care industry, especially for-profit companies. Officials in the industry worry the proposal wouldÌýincrease costs for these servicesÌýand could cause employers to reduce hours for workers, potentially makingÌýit more expensive and harder for clients to get the care they need. Still, 15 states already provide minimum wage and overtime regulations and another five states and Washington, D.C. require minimum wage.

Wynn Esterline, who owns an in-home companionship care business in Michigan, told the congressional panel that similar efforts in his state led families to cut back on services because of the higher expenses and workers’ hours were reduced to meet the new standards. “No one is better off than they were before this change went into effect, not me, not my clients, and certainly not my employees,” he said in his prepared remarks.

The House Subcommittee on Workforce Protections, chaired by Rep. Tim Walberg, R-Mich., held the hearing, which came a day before the Department of Labor closes its comment period on the new regulations.

Since the exemption was enacted nearly 40 years ago, the home care industry has grown exponentially. Labor groups and advocates for home care workers have long complained that poor pay and limited benefits create high turnover in the profession, which leads to instability for the growing numbers of seniors and disabled who depend on such services.

“The exclusion of these more than two million home care workers from basic minimum care protections has been undermining the care they do and the care that consumers receive,” said Catherine Ruckelshaus, legal co-director at the National Employment Law Project in her prepared testimony for the hearing.

form the backbone of the long-term care industry, and provide basic care such as bathing, dressing and feeding as well as light housekeeping to allow seniors and disabled people to stay in their homes and avoid moving to nursing homes.

Between 2010 and 2020, health care support is expected to be the fastest growing occupation, expanding at 34.5 percent. During that time, an additional 706,000 home health aides and 607,000 personal care aides are expected to enter the labor force, according toÌýfrom the Bureau of Labor Statistics.

That ongoing growth has meant large profits for home care companies. In 2010, theseÌýcompanies earned an average profit of 19.4 percent, which caused the panel that advised Congress on Medicare to propose lower reimbursement rates for them, according to a in USA Today.

“The for-profit companies are doing very well on the backs of the exemption. … The profits are pretty good in this industry and because there are relatively low barriers to entry, the for-profit companies and franchises are entering in in droves,” Ruckelshaus said.

Meanwhile, home care workers often and nearly half of them live in households that receive food stamps, Medicaid or other government aid, according to PHI National, an advocacy group for direct-care workers.

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: Peter Goodwin: The Dying Doctor’s Last Interview (Video) Dr. Peter Goodwin, a family physician and right-to-die activist, took his own life on March 11, 2012, at age 83. He did it legally, with the blessing of his family and doctors, under the Oregon law allowing physician-assisted suicide — the first such law in the country — that Goodwin was instrumental in creating.Ìý… He did not look like a dying man; he was chirpy and alert … However, as a result of his fatal disease — a Parkinsons-like condition called coritcobasal degeneration — he could not use his right hand or do much reliably with his left. … “I can no longer eat in public,” Goodwin said. “My balance is gradually deteriorating. My three doctors agree that I’m within six months of dying. My attending physician has given me a prescription for medication to end my life and I have had it filled”Ìý(Belinda Luscombe, 3/14).

: The Doctor Is Out: Young Talent Is Turning Away From Primary Care Couple the lifestyle and the training experience with the huge debt burden that U.S. medical students accrue, and deciding on a hospitalist career becomes a rational choice. Dr. Wachter of UCSF compares hospital medicine to site-based specialties that came before it: emergency medicine and critical care. All of these specialties represent a convergence of high-complexity and high-cost care in a single location, where it makes sense to have well-trained specialists who handle the specific set of problems encountered thereÌý(John Henning Schumann, 3/14).

: How Selling A Practice Kept It In The Family For the past 30 years, Domingo Ngo, MD, has loved being a gastroenterologist owning a solo practice and the small, one-story building it occupies on a tree-lined street in Stuart, Fla. His wife, Josefina Ngo, RN, was the practice’s nurse. … If Dr. Ngo retired and was unable to find another physician to take his place, there was a chance it would have closed. He hoped it would be able to continue if his son (Benjamin Ngo, MD) joined him. They wanted to work together, but the son … didn’t want to be a solo-practice physician. … Dr. Domingo Ngo did what many other practices have done, or are considering doing — he contacted a local hospital to see whether it would buy the practice (Victoria Stagg Elliott, 3/12).

: Daddy Issues Recently, a colleague at my radio station asked me, in the most cursory way, as we were waiting for the coffee to finish brewing, how I was. To my surprise, in a motion as automatic as the reflex of a mussel being poked, my body bent double and I heard myself screaming: “I WAAAAAAAANT MY FATHERRRRRR TO DIEEEEE!!!”Ìý…Ìýlet us begin by considering A Bittersweet Season, by Jane Gross. A journalist for 29 years at The New York Times and the founder of a Times blog called The New Old Age, Gross is hardly Kafkaesque. An ultra-responsible daughter given to drawing up to-do lists for caregivers and pre-loosening caps on Snapple bottles, Gross undertook the care of her mother in as professional a way as possible. …ÌýWhat could go wrong? (Sandra Tsing Loh, March 2012).

: Hospitals May Be The Worst Place To Stay When You’re Sick Today, more than a decade into the fight against medical errors, there’s little reason to believe the risks have declined substantially for the 37 million people hospitalized each year. In fact, recent studies suggest a problem that’s bigger and more complex than many had imagined. A report released in January on Medicare patients found that hospital staff did not report a whopping 86 percent of harms done to patients. If most errors that harm patients aren’t even reported, they can never be tracked or corrected (Katharine Greider, 3/1).

: Should Health Journos Use Hospital Safety Data? In a highly touted effort to improve the quality of hospital care, the federal government has started disclosing data that ostensibly reveals which hospitals are best (and worst) at keeping their patients safe. But a few weeks ago, Kaiser Health News presented some not entirely unexpected news that turned conventional wisdom about patient safety data into, well, not-so-conventional wisdom. A piece by Jordan Rau raised serious questions about the efficacy of the federal government’s efforts to turn patients into savvy shoppers. The data, it seems, may not be ready for prime time. I rang up Rau, a veteran health journalist and an expert in these matters, for a Q and A to help all of us who may be tempted to use the data in ways we probably shouldn’t (Trudy Lieberman, 3/12).

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: Santorum In ’93: More Government Needed in Health Care If elected president, Santorum vows, he will end the “tyranny” of President Obama’s Affordable Care Act. Yet as an up-and-coming congressman in the early 1990s, Santorum took a much different line. Then—like now—health care was one of the nation’s most divisive issues. In 1993, Republicans were up in arms about a health care reform bill spearheaded by Hillary Clinton and pushed by President Bill Clinton. … During that fiery debate, Santorum said it would be a mistake to allow the delivery of health care services to be determined only by the market. He asserted that Republicans were “wrong” to let the marketplace decide how health care works. He instead argued that government should play a “proactive” role in shaping the health care marketplace “to make it work better” (Andy Kroll and Tim Murphy, 3/5).

: Making The Best Of What Is Often The Very Worst Time Of Our Lives (Book Excerpt) As difficult as things are now, these may turn out to be the good old days. How we die is already a public health crisis, and care for people through the end of life is poised to become a generation-long social catastrophe. … Very soon, for the first time in human history, older people will outnumber younger people on our planet. In the United States, one in five adults is 65 or older. … Those of us who are concerned about long-term care have good reasons to worry. The nursing homes of the future — our future! — may make today’s nursing homes look like luxury hotels. It doesn’t have to turn out that way (Ira Byock, 3/7).

: Legal Risks Of Going Paperless System breaches. Modification allegations. E-discovery demands. These issues are becoming common courtroom themes as physicians transition from paper to EMRs, legal experts say. Not only are EMRs becoming part of medical negligence lawsuits, they are creating additional liability.Ìý… Studies are mixed about how EMRs will impact liability for physicians. … Whatever the future holds for EMRs, it’s important that doctors reduce their liability risks during system implementation, legal experts say. Being aware of potential legal pitfalls prevents doctors from falling victim to technology intended to do good — not cause hardship (Alicia Gallegos, 3/5).

: Talking About Sex Is the Only Way To Stop HIV [The United States has] been stuck at about 50,000 new infections each year for more than a decade. Compared with the challenges facing places like sub-Saharan Africa, our failure is particularly galling: we have plenty of drugs that work, the money and systems to administer them, and effective, if not particularly popular, ways to interrupt the spread (condoms, clean needles, abstinence). So why aren’t we doing better? The answer is blindingly simple: sex. Almost all HIV in the U.S. is spread by sexual intercourse, yet when faced with this fact, we act like a bumbling junior-high-school kid hearing about the birds and the bees for the first time. As a result, we have before us an unabated 30-year epidemic of a sexually transmitted disease (Kent Sepkowitz, 3/5).

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: The GOP Plan To Give Your Boss ‘Moral’ Control Over Your Health Insurance In their latest move in the battle over contraception coverage, top Republicans in Congress are going for broke: They’re now pushing a bill that would allow employers and insurance companies to pick and choose which health benefits to provide based simply on executives’ personal moral beliefs. … Last week, Sen. Roy Blunt (R-Mo.) offered a “conscience amendment,” to the law, pitching it as a way to allay religious employers’ qualms about providing birth control to their employees. But Blunt’s proposal doesn’t just apply to religious employers and birth control. Instead, it would allow any insurer or employer, religiously affiliated or otherwise, to opt out of providing any health care services required by federal law—everything from maternity care to screening for diabetes. Employers wouldn’t have to cite religious reasons for their decision; they could just say the treatment goes against their moral convictions (Adam Serwer, 2/14).

: First Person Singular: Reina Vasquez, 50, Woodbridge, Home Health Care Provider I was with one lady for 10 years. You see a lot happen to someone in 10 years, big changes and small things that only you notice at first, until that person doesn’t look like herself anymore. She had been a lieutenant colonel, very high up, very respected, and when I started she was still in charge. She still was running her life. But the longer I was with her, the more I did. I cried and cried at her funeral. … After she died, I said, “No more.” This is just too hard. It hurt too much.Ìý … (Then), I had to start doing home health care again; it’s what I know best. It’s where my heart is.Ìý… I am trying not to get too close. I do my job, but it is not easy to not care too much, you know? My job is to care (Amanda Long, 2/9).

: Relationships, Menopause, And Health Who you spend time with and the quality of your relationships not only says a lot about who you are as a person, but it has a tremendous impact on your health. A now classic study published in the Journal of the American Medical Association showed that — even after controlling for risk factors like smoking, poverty low socio-economic status, alcohol consumption, lack of exercise and obesity — lack of social relationships, personality dispositions, and acute stress, including the stress of racism were better predictors for increased risk of death and disease. Other studies have shown that you are more likely to be overweight (and suffer from all of the resulting health consequences) if your friends are overweight than if your parents are overweight. And we are now learning that when you join together in community to lose weight and heal you are far more likely to succeed (Dr. Mark Hyman, 2/15).

: Obama’s Budget Could Shift Medicaid Costs To States As Medicaid costs escalate and states prepare for further implementation of the Affordable Care Act (ACA), President Barack Obama sought to address both of those areas of concern in his fiscal year 2013 budget, released Monday. According to the White House’s budget for the U.S. Department of Health and Human Services (HHS), Obama’s proposal would save nearly $360 in Medicare and Medicaid over the next 10 years: $56 billion would come through Medicaid reforms. Those reforms, though, could result in greater costs to states, policy analysts say (Dylan Scott, 2/13).

: The Secret of American Health Care: Surprise! It’s Already Socialized The furor over Donald Berwick reflects a broader, fundamental disagreement over the nature of health insurance. Should it be “social” insurance, with which financial risk is leveled between those who are ill and healthy, so the carefree twentysomething and diabetic elderly man pay equally into the system? Or would it be better structured as “actuarial” insurance, where those expected to consume more shell out more, just as those who drive flashy, expensive cars or rack up speeding tickets pay higher auto insurance rates? … This dispute is central to continuing political wrangling over the 2010 health reform legislation, the main provisions of which are scheduled to take effect in a few years. But Americans made their choice clear long before Barack Obama ever signed the law—and they picked social insurance (Darshak Sanghavi, 1/31).

ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).