The Moral Crisis of America’s Doctors

Wendy Dean & Elisabeth Rosenthal

The New York Times

Orignally posted 15 July 23

Here is an excerpt:

Some doctors acknowledged that the pressures of the system had occasionally led them to betray the oaths they took to their patients. Among the physicians I spoke to about this, a 45-year-old critical-care specialist named Keith Corl stood out. Raised in a working-class town in upstate New York, Corl was an idealist who quit a lucrative job in finance in his early 20s because he wanted to do something that would benefit people. During medical school, he felt inspired watching doctors in the E.R. and I.C.U. stretch themselves to the breaking point to treat whoever happened to pass through the doors on a given night. “I want to do that,” he decided instantly. And he did, spending nearly two decades working long shifts as an emergency physician in an array of hospitals, in cities from Providence to Las Vegas to Sacramento, where he now lives. Like many E.R. physicians, Corl viewed his job as a calling. But over time, his idealism gave way to disillusionment, as he struggled to provide patients with the type of care he’d been trained to deliver. “Every day, you deal with somebody who couldn’t get some test or some treatment they needed because they didn’t have insurance,” he said. “Every day, you’re reminded how savage the system is.”

Corl was particularly haunted by something that happened in his late 30s, when he was working in the emergency room of a hospital in Pawtucket, R.I. It was a frigid winter night, so cold you could see your breath. The hospital was busy. When Corl arrived for his shift, all of the facility’s E.R. beds were filled. Corl was especially concerned about an elderly woman with pneumonia who he feared might be slipping into sepsis, an extreme, potentially fatal immune response to infection. As Corl was monitoring her, a call came in from an ambulance, informing the E.R. staff that another patient would soon be arriving, a woman with severe mental health problems. The patient was familiar to Corl — she was a frequent presence in the emergency room. He knew that she had bipolar disorder. He also knew that she could be a handful. On a previous visit to the hospital, she detached the bed rails on her stretcher and fell to the floor, injuring a nurse.

In a hospital that was adequately staffed, managing such a situation while keeping tabs on all the other patients might not have been a problem. But Corl was the sole doctor in the emergency room that night; he understood this to be in part a result of cost-cutting measures (the hospital has since closed). After the ambulance arrived, he and a nurse began talking with the incoming patient to gauge whether she was suicidal. They determined she was not. But she was combative, arguing with the nurse in an increasingly aggressive tone. As the argument grew more heated, Corl began to fear that if he and the nurse focused too much of their attention on her, other patients would suffer needlessly and that the woman at risk of septic shock might die.

Corl decided he could not let that happen. Exchanging glances, he and the nurse unplugged the patient from the monitor, wheeled her stretcher down the hall, and pushed it out of the hospital. The blast of cold air when the door swung open caused Corl to shudder. A nurse called the police to come pick the patient up. (It turned out that she had an outstanding warrant and was arrested.) Later, after he returned to the E.R., Corl could not stop thinking about what he’d done, imagining how the medical-school version of himself would have judged his conduct. “He would have been horrified.”

The info is here, paywalled.

Summary: The article explores the moral distress that many doctors are experiencing in the United States healthcare system. Doctors are feeling increasingly pressured to make decisions based on financial considerations rather than what is best for their patients. This is leading to a number of problems, including:

• Decreased quality of care: Doctors are being forced to cut corners on care, which is leading to worse outcomes for patients.
• Increased burnout: Doctors are feeling increasingly stressed and burned out, which is making it difficult for them to provide quality care.
• Loss of moral compass: Doctors are feeling like they are losing their moral compass, as they are being forced to make decisions that they know are not in the best interests of their patients.

The article concludes by calling for a number of reforms to the healthcare system, including:

• Paying doctors based on quality of care, not volume of services: This would incentivize doctors to provide the best possible care, rather than just the most profitable care.
• Giving doctors more control over their practice:This would allow doctors to make decisions based on what is best for their patients, rather than what is best for their employers.
• Supporting doctors' mental health: Doctors need to be supported through the challenges of providing care in the current healthcare system.

Dozens of telehealth startups sent sensitive health information to big tech companies

Katie Palmer with

Todd Feathers & Simon Fondrie-Teitler 

STAT NEWS

Originally posted 13 DEC 22

Here is an excerpt:

Health privacy experts and former regulators said sharing such sensitive medical information with the world’s largest advertising platforms threatens patient privacy and trust and could run afoul of unfair business practices laws. They also emphasized that privacy regulations like the Health Insurance Portability and Accountability Act (HIPAA) were not built for telehealth. That leaves “ethical and moral gray areas” that allow for the legal sharing of health-related data, said Andrew Mahler, a former investigator at the U.S. Department of Health and Human Services’ Office for Civil Rights.

“I thought I was at this point hard to shock,” said Ari Friedman, an emergency medicine physician at the University of Pennsylvania who researches digital health privacy. “And I find this particularly shocking.”

In October and November, STAT and The Markup signed up for accounts and completed onboarding forms on 50 telehealth sites using a fictional identity with dummy email and social media accounts. To determine what data was being shared by the telehealth sites as users completed their forms, reporters examined the network traffic between trackers using Chrome DevTools, a tool built into Google’s Chrome browser.

On Workit’s site, for example, STAT and The Markup found that a piece of code Meta calls a pixel sent responses about self-harm, drug and alcohol use, and personal information — including first name, email address, and phone number — to Facebook.

The investigation found trackers collecting information on websites that sell everything from addiction treatments and antidepressants to pills for weight loss and migraines. Despite efforts to trace the data using the tech companies’ own transparency tools, STAT and The Markup couldn’t independently confirm how or whether Meta and the other tech companies used the data they collected.

After STAT and The Markup shared detailed findings with all 50 companies, Workit said it had changed its use of trackers. When reporters tested the website again on Dec. 7, they found no evidence of tech platform trackers during the company’s intake or checkout process.

“Workit Health takes the privacy of our members seriously,” Kali Lux, a spokesperson for the company, wrote in an email. “Out of an abundance of caution, we elected to adjust the usage of a number of pixels for now as we continue to evaluate the issue.”

The info is here.

COVID Medical Coverage is Over: Insurers are restoring deductibles and co-pays, leaving patients with big bills

Christopher Rowland

The Washington Post

Originally posted 18 Sept 21

Here is an excerpt:

But this year, most insurers have reinstated co-pays and deductibles for covid patients, in many cases even before vaccines became widely available. The companies imposed the costs as industry profits remained strong or grew in 2020, with insurers paying out less to cover elective procedures that hospitals suspended during the crisis.

Now the financial burden of covid is falling unevenly on patients across the country, varying widely by health-care plan and geography, according to a survey of the two largest health plans in every state by the nonprofit and nonpartisan Kaiser Family Foundation.

If you’re fortunate enough to live in Vermont or New Mexico, for instance, state mandates require insurance companies to cover 100 percent of treatment. But most Americans with covid are now exposed to the uncertainty, confusion and expense of business-as-usual medical billing and insurance practices — joining those with cancer, diabetes and other serious, costly illnesses.

(Insurers continue to waive costs associated with vaccinations and testing, a pandemic benefit the federal government requires.)

A widow with no children, Azar, 57, is part of the unlucky majority. Her experience is a sign of what to expect if covid, as most scientists fear, becomes endemic: a permanent, regular health threat.

The info is here.

Active shooter drills may do more harm than good, study shows

Katie Camero
Miami Herald

Originally posted 3 September 20

Here is an except:

The research team discovered that social media posts alone displayed a 42% increase in anxiety and stress from the 90 days before active shooter drills to the 90 days after them. The frequent use of words such as “afraid, struggling and nervous” served as evidence, according to the report.

Signs of depression increased by 39% based on posts that featured the words “therapy, cope, irritability and suicidal” following drill events. Concerns about friends grew by 33%, concerns about social situations rose by 14% and concerns about work soared by 108%, the researchers found.

“I can tell you personally, just as an educator, we were not okay [after drills]. We were in bathrooms crying, shaking, not sleeping for months. The consensus from my friends and peers is that we are not okay,” one anonymous K-12 teacher wrote on social media, according to the report.

Worries over health also jumped by 23% while fears about death rose by 22%. “The analysis revealed words like blood, pain, clinics, and pills came up with jarring frequency, suggesting that drills may have a direct impact on participants’ physical health or, at the very least, made it a persistent topic of concern,” the researchers wrote.

An anonymous parent tweeted, “my kindergartener was stuck in the bathroom, alone, during a drill and spent a year in therapy for extreme anxiety. in a new school even, she still has to use the bathroom in the nurses office because she has ptsd from that event.”

The info is here.

How Wilbur Ross Lost Millions, Despite Flouting Ethics Rules

Dan Alexander

Forbes.com

Originally published December 14, 2018

Here is an excerpt:

By October 2017, Ross was out of time to divest. In his ethics agreement, he said he would get rid of the funds in the first 180 days after his confirmation—or if not, during a 60-day extension period. So on October 25, exactly 240 days after his confirmation, Ross sold part of his interests to funds managed by Goldman Sachs. Given that he waited until the last possible day to legally divest the assets, it seems certain that he ended up selling at a discount.

The very next day, on October 26, 2017, a reporter for the New York Times contacted Ross with a list of questions about his ties to Navigator, the Putin-linked company. Before the story was published, Ross took out a short position against Navigator—essentially betting that the company’s stock would go down. When the story finally came out, on November 5, 2017, the stock did not plummet initially, but it did creep down 4% by the time Ross closed the short position 11 days later, apparently bolstering his fortune by $3,000 to $10,000.

On November 1, 2017, the day after Ross shorted Navigator, he signed a sworn statement that he had divested everything he previously told federal ethics officials he would. But that was not true. In fact, Ross still owned more than $10 million worth of stock in Invesco, the parent company of his former private equity firm. The next month, he sold those shares, pocketing at least $1.2 million more than he would have if he sold when he first promised to.

The info is here.

Tom Price Flies Blind on Ethics

Editors
Bloomberg View
Originally published September 21, 2017

Under the lax ethical standards President Donald Trump brought to the White House, rampant conflicts of interest are treated with casual indifference. This disregard has sent a message to his entire administration that blurring lines -- between public and private, right and wrong -- will be not just tolerated but defended. At least one cabinet member appears to have taken the message to heart.

Health and Human Services Secretary Tom Price took five chartered flights last week, including one to a conference at a resort in Maine. Two of the flights -- round-trip from Washington to Philadelphia -- probably cost about $25,000, or roughly $24,750 more than the cost of an Amtrak ticket, for a trip that would have taken roughly the same amount of time. Total costs for the five flights are estimated to be at least $60,000.

The department has yet to reveal how many times Price has flown by charter since being sworn into office. There would be no problem were he picking up the tab himself, as Education Secretary Betsy DeVos reportedly does. But cabinet secretaries -- other than for the Defense and State departments, who often ride in military planes -- typically fly commercial. Taxpayers should not have to foot the bill for charters except in emergency situations.

The article is here.

The GOP's risky premium pledge

Jennifer Haberkorn
Politico.com
Originally posted June 5, 2017

Senate Republicans may be all over the map on an Obamacare repeal plan, but on one fundamental point — reducing insurance premiums — they are in danger of overpromising and underdelivering.

The reality is they have only a few ways to reduce Americans’ premiums: Offer consumers bigger subsidies. Allow insurers to offer skimpier coverage. Or permit insurers to charge more — usually much more — to those with pre-existing illnesses and who are older and tend to rack up the biggest bills.

Since there’s no appetite within the GOP for throwing more taxpayer money at the problem, Republicans will need to make some hard decisions to hit their goal. But the effort to drive down premium prices will inevitably create a new set of winners and losers and complicate leadership’s path to the 50 votes they need to fulfill their seven-year promise to repeal Obamacare.

“Anyone can figure out how to reduce premiums,” said Sen. Chris Murphy (D-Conn.). “You can reduce premiums by kicking everybody that has a pre-existing condition off insurance or dramatically reducing benefits.”

Republicans say that Obamacare’s insurance regulations are responsible for making coverage prohibitively expensive and contend that premiums would fall if those rules are rolled back. They say they have multiple ideas about how to roll those back while also insulating the most vulnerable but have yet to weave those together into actual legislation.

The article is here.

Aetna Shows Why We Need a Single-Payer System

By Robert Reich
Robert Reich Blog
Originally posted August 16, 2016

The best argument for a single-payer health plan is the recent decision by giant health insurer Aetna to bail out next year from 11 of the 15 states where it sells Obamacare plans.

Aetna’s decision follows similar moves by UnitedHealth Group, the nation’s largest insurer, and Humana, one of the other giants.

All claim they’re not making enough money because too many people with serious health problems are using the Obamacare exchanges, and not enough healthy people are signing up.

The problem isn’t Obamacare per se. It’s in the structure of private markets for health insurance – which creates powerful incentives to avoid sick people and attract healthy ones. Obamacare is just making the structural problem more obvious.

The entire blog post is here.

In medical market, shoppers lack savvy

By Peter Ubel
The News and Observer
Originally posted April 6, 2016

Even before Obamacare became the law of the land, the U.S. health care system was undergoing a dramatic transformation. Millions of people were shifting from generous health insurance plans to consumer-directed ones that pair low monthly premiums with high out-of-pocket costs.

This shift has been encouraged by employers, eager to reduce the cost of employee benefits. It has also been encouraged by market enthusiasts who contend that the U.S. health care system needs to be more like the traditional consumer economy.

In theory, a family with a high deductible plan – on the hook for, say, the first $5,000 of health care expenses each year – will scrutinize the cost and quality of health care alternatives before deciding whether to receive them. In practice, health care consumerism doesn’t always play out at the bedside in ways that promote savvy medical decisions.

The article is here.

Highlights:

• A shift from generous health insurance plans to consumer-directed plans has not helped people

• Most patients, or doctors, do not know how to discuss out-of-pocket health care costs

• Frustration with our system often distracts physicians from dealing with patients’ financial concerns