A Cultural Disconnect

It's not often when my relatively off the grid town of Riverside becomes a focal point for national news.  Riverside, California is known for its former glory for citrus, smog, and other current attractions such as The Mission Inn, Lunar Festival, Festival of Lights (Mission Inn), and a new UCR School of Medicine, now has become a focal interest for Wuhan's Corona Virus.

Flashback ten or more years ago when the former March Air Force Base was in operation.  It was a major Strategic Air Command location. In those days in the 1950s and 60s, there was a ready alert squadron parked their with dark and looming B 52 Stratofortress bombers and their pilots poised at the southern end of the 13000-foot runway ready to be launched at a moment's notice.

Their daily practice sessions could not be missed with the roar of engines and a trail of smoky engine exhausts.

What a difference, this week 195 souls arrived from the consul in Wahun, China.  There was no fanfare, and there was no rumbling noise heard.  Jet engine technology is much quieter and fuel-efficient.  No one would have known about it, but not for the internet.

Riverside may be known now for the repatriation of our diplomats from China, or it may be known as the entry point for Corona Virus.  Hopefully, the quarantine will be successful.  Although I just hear about an attempted escape from the March Air Reserve Gulag.

I missed seeing the arrival of the chartered Boeing 747,  even though I am able to see departing aircraft (FEDEX, C117s, and occasionally Air Force One. MARB, as it is now known, has been proposed for many things, a medical destination, housing for the homeless. For a time it was a haven for developers.

Most people had no awareness of this once in a lifetime event.  I have not witnessed an outbreak of facial masks, other than the ones some people wear to void off bad air.

So it is now time to segway to the Cultural Disconnect.

LOS ANGELES — Several staff members of a small community health clinic in L.A.’s historic Chinatown spoke on the phone with patients Tuesday while wearing face masks that muffled their voices.

The masks are a recent phenomenon at the clinic, located inside the Chinatown Service Center, a nonprofit community assistance organization that serves mainly Chinese immigrants.

Staffers showed up for work wearing the masks Monday, a day after public health officials confirmed the first two California cases of the new coronavirus, in Los Angeles and Orange counties, said Dr. Felix Aguilar, the clinic’s chief medical officer.

 Bright-yellow warning signs instruct patients to tell staff immediately if they have just traveled out of the U.S. and are experiencing cough or fever or are having trouble breathing. (Anna Almendrala/California Healthline)

At the Chinatown Service Center medical clinic in downtown Los Angeles, which serves predominantly Chinese immigrant patients, administrative staff wore medical face masks after local health officials confirmed the presence of two cases of the novel coronavirus in Los Angeles and Orange counties. (Anna Almendrala/California Healthline)

As China grapples with the growing coronavirus outbreak, Chinese people in the Los Angeles area — home to the third-largest Chinese immigrant population in the United States — are encountering a cultural disconnect as they brace for a possible spread of the virus in their adopted homeland. 

 The use of face masks is common in China, to protect against both germs and pollution. But when Chinese immigrants wear them in the U.S., it often conflicts with guidance from officials, who warn that they offer minimal protection and could lull wearers into a false sense of security. It can also draw suspicious gazes from passersby.

“In the U.S., if you’ve got a mask, people will sort of look at you like you’re doing something unusual, whereas in Asia it’s fairly common to do this, and people don’t give it a second thought,” said Dr. Bryant Lin, co-director of the Center for Asian Health Research and Education at the Stanford University School of Medicine.

Alhambra Unified School District in Los Angeles County, where a significant proportion of students are from Mandarin-speaking families, is getting a lot of pushback against school rules that ban face masks for students, said Toby Gilbert, a spokesperson for the district.

“There is no evidence that the mask-wearing in a school setting does anything but create fear,” Gilbert said. “It keeps people from remembering that the primary defense is hand-washing.”

The Los Angeles County Office of Education, which encompasses 80 school districts, notes that the U.S. Centers for Disease Control and Prevention and the L.A. County Department of Public Health do not recommend the use of masks for preventive purposes. It reiterates the view of the county health department that there is “no immediate threat to the general public and no special precautions are required.”

Nonetheless, local stores have run out of masks.

As a final welcome to Riverside, I offer you a bag of oranges and grapefruit.

https://tinyurl.com/v8uwn5d

Chronic Disease Management, A better Way

The management of chronic health conditions such as prevention, obesity, diabetes, and hypertension creates a burden upon health care providers. There are now the means to have better monitoring by non-physicians. Access to monitoring and decision-makers are augmented by several offerings.

One example follows:

Integrated Chronic Care Platforms have transformed disease management and prevention, replacing episodic care with combination therapy of smart connected devices, AI learning, and expert coaching. This digital care model helps payors and large employers lower costs and improve member and employee health.

• Health data monitoring from smart, connected health devices.
• Translation of health readings into insights to make healthy habits and behaviors last.
• A digital health company with outcomes in all of diabetes, hypertension, and prediabetes.
• Scalable care with seamless deployment and enrollment that integrates and doesn't silo.

Chronic disease management takes place in the home, and workplace, requiring a mobile platform (smartphone). Employer-based systems enable employees to access their management programs.  The employer may choose to offer this support to employees as a benefit added to the value of health insurance.

An ideal platform would integrate the employee, employer, and health care provider(s) for chronic disease management.

Help Health Plans and Employers

Prevent and Better Manage Chronic Conditions.

The change from FFS (fee for service) to APM (alternative payment model) requires demonstrated improved outcomes and the use of preventive measures for chronic illness to be proactive rather than waiting for bad outcomes. These new AI-driven programs offer that ability without direct healthcare provider involvement, leading to considerable time and cost-savings

These programs for prevention can be integrated with genetic programs, such as 

23andME

Rather, by integrating information from 23andMe into Lark’s proven and peer-reviewed AI coaching programs for diabetes prevention and weight loss, there is simply an added layer of personalization for customers. The integration uses information from a number of reports already available to 23andMe customers. Those include 23andMe’s reports on Genetic Weight, Saturated Fat and Weight, Lactose Intolerance, Caffeine Consumption, Deep Sleep, Sleep Movement, Bitter Taste and Sweet v. Salty Preference.

Cautionary Note

Here’s the breakdown on the Lark Apps:

• The Wellness Program will tap into data from the 23andMe genetic reports, and the A.I. coach will focus on suggestions around nutrition, sleep, and exercise. The program can also seamlessly merge data from more than 70 other types of monitors or apps to incorporate that information that in turn can improve the personalization of the A.I. recommendations. To integrate Lark’s Wellness Program and use it with your 23andMe results, it will cost $19.99 a month. There is now a special introductory offer of just $14.99 per month.
• The CDC-recognized Diabetes Prevention Program is a yearlong program meant to lower the risk of developing type 2 diabetes. This program includes specialized coaching, a digital scale, and a Fitbit, and some insurance providers cover it. You can find out if you are eligible by downloading  Lark and taking a survey. For those who do not qualify for insurance coverage, they can still self-pay for the Diabetes Prevention Program. The price for this self-pay option includes a digital scale but not a Fitbit.

COMPARING THE 3 TOP CONSUMER GENETIC ANALYSIS PROGRAMS

The above illustration is but one example of what will be developed in the next several years.  Given the relative shortage of   primary care physicians treating both acute illness and chronic management the development of similar digital AI aids will be cost effective, especially in the era of APM

A New Definition for Hypertension

Categories of Blood Pressure

A new analysis shows no harm in diastolic blood pressure higher than 80 mmHg, but 2017 AHA/ACC guidelines could cause millions to be considered hypertensive and possibly treated inappropriately, authors assert.

Isolated diastolic hypertension is now more prevalent, owing to the definition of hypertension used in the most recent US blood pressure guidelines, but the condition does not appear to be associated with increased risk for cardiovascular outcomes, a new study suggests.

The findings and recommendations are controversial. 

Association of Isolated Diastolic Hypertension as Defined by the 2017 ACC/AHA Blood Pressure Guideline With Incident Cardiovascular Outcomes

Importance  In the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline, the definition of hypertension was lowered from blood pressure (BP) of greater than or equal to 140/90 to greater than or equal to 130/80 mm Hg. The new diastolic BP threshold of 80 mm Hg was recommended based on expert opinion and changes the definition of isolated diastolic hypertension (IDH). 

McEvoy, who is professor of preventive cardiology at the National University of Ireland, Galway, added: "Our data suggest there is no harm of having a diastolic pressure above 80 mmHg if the systolic is below 130 mmHg and that the new 80 mmHg diastolic threshold means that 12 million adults in the US will be labeled as hypertensive but will not benefit from the diagnosis and may be given unnecessary treatment."

The recommendation to lower the diastolic threshold for hypertension from 90 mmHg to 80 mmHg was based on expert opinion, not on trial data. This change has major implications with respect to isolated diastolic hypertension, now defined as a systolic blood pressure <130 mmHg with a diastolic pressure ≥80 mmHg, the authors write.

McEvoy said he is a strong proponent of the new 130 mmHg threshold for systolic pressure. "But the lowering of the diastolic threshold from 90 to 80 was just based on expert opinion. There is no solid evidence behind this recommendation. Our data suggest there is no harm of having a diastolic over 80, and I do not believe it is appropriate to use diastolic pressure for defining hypertension and treatment targets."

Controversy Now Moves to New Diastolic BP Threshold:

HOW DOES YOUR DOCTOR TRAVEL TO EMERGENCIES ?

Does Medical Specialty Determine Speeding Drivers?  Your will be surprised about the worst offenders. 

According to US research, psychiatrists are more likely to speed when driving to a medical emergency than surgeons and obstetricians. Also cardiologists are more likely to drive flashier cars (41% of all cardiologists) while General Practitioners (GPs) are the least likely speciality to be in a luxury car when booked (20%).

Researchers at the Harvard Medical School in Boston, analysed the speeding tickets issued to 5372 doctors and 19,639 non-doctors in Florida from 2004-17 to determine whether fast driving, luxury car ownership and leniency by police officers differed among medical specialities.

They hypothesised that rates of extreme speeding would vary across specialties, owing to underlying personalities and specific professional requirements. “For example, physicians in some specialties may exhibit thrill-seeking behaviour, whereas physicians in certain specialties such as obstetrics and surgery might be called from home to attend medical emergencies”, they said.

However, they found specialists had broadly similar speeding patterns below extreme speeding levels, traveling an average 24km/h over the limit.

The team found psychiatrists had the highest rate (31% of all psychiatrists booked) of extreme speeding, categorised as more than 32km/h over the speed limit. This is a “behaviour that based on prior research cannot be explained by wanting to get to the golf course in a hurry,” they wrote in the BMJ.

Overall, more than one-quarter of doctors given a speeding ticket were clocked extreme speeding.

“The need-for-speed record belonged to a general internist, who drove at nearly 113km/h above the limit”, they reported.

Further, they found doctors can expect little special treatment from police with rates of ‘speed discounting’, a practice that lessens the offence, similar between specialties and between doctors and the public.

But female doctors did score fewer tickets (18%) despite making up one-third of the workforce.

Also recently it was found that certain car manufacturers appeal to physicians across the age spectrum. Toyota topped the preference list at 20%, followed by Honda (15%) [2].

Are you a speedster, road demon or hoon?

Ref:  SERMO

How Digital Health Technology Can Help Manage The Coronavirus Outbreak

Modern Epidemiology has had the benefit of computer modeling of epidemics, which forecast the development of epidemics and pandemics.

Chinese health authorities say an outbreak of a pneumonia-like illness has sickened 305 people and killed five”...   There are many similarities between the current outbreak to the SARS one from its geolocation to its spread to the viruses themselves. 

However, much has changed within the 17-year gap between those two pandemics. For one, technology in the healthcare sector has known an exponential boom. New technologies that were nonexistent or poorly developed in 2003 are now more affordable and widespread and can help manage and even prevent such cases. Let’s see how this can be the case.

Electron Microscopy of Intracellular Corona Virus

A.I. to detect the spread of an epidemic

At the beginning of the SARS outbreak, China covered up the existence of the virus from both its citizens and the world. Even if China seems to have become more transparent in those matters, some might still not be convinced. To circumvent those trust issues, artificial intelligence can be a solution.

Toronto-based health monitoring A.I. platform Bluedot beat both the WHO and the CDC to the punch when issuing warnings about the Wuhan virus’s spread. It even correctly predicted the virus’s likely path from Wuhan to Tokyo after its initial appearance. Bluedot calls itself “a digital health company that uses big data analytics to track and anticipate the spread of the world's most dangerous infectious diseases”. By going through piles of information about news reports, airline data, and reports of animal disease outbreaks, Bluedot’s algorithm can identify a trend which is then analyzed by epidemiologists. The company then shares the information with its clients.

Source: Products :

Interactive maps for monitoring

The Center for Systems Science and Engineering at Johns Hopkins University developed an online dashboard to visualize and track the reported cases on a daily timescale. They also made the complete set of data downloadable as a google sheet. The map shows new cases, confirmed deaths, and recoveries.  The data they use to visualize this is collected from various sources including WHO, CDC, China CDC, NHC and DXY, a Chinese website that aggregates NHC and local CCDC situation reports in near real-time, providing more current regional case estimates than the national level reporting organizations are capable of and is thus used for all the mainland China cases reported in the dashboard.  U.S. cases are taken from the U.S. CDC, and all other country case data is taken from the corresponding regional health departments. The dashboard is intended to provide the public with an understanding of the outbreak situation as it unfolds, with transparent data sources. 

Other new technology can be integrated with machine learning and epidemiology. 

New tech for faster detection

As we’ve mentioned in the introduction, technology has dramatically evolved since the days of the SARS virus. For the current coronavirus outbreak, the culprit was identified within a week of the public announcement and the first diagnostic test was developed shortly after that. “Back then, it took days to sequence,” Georgetown University infectious diseases physician Daniel Lucey who worked on SARS in 2003 said. “Now, it can take hours.” Thanks to technological progress, scientists don’t need to cultivate a sufficient amount of viruses before examining them anymore. Minute amounts of viral DNA can be detected directly from a patient’s spit or blood sample.

Another company based in Singapore, Veredus Laboratories, is working on a portable Lab-on-Chip detection kit that is expected to be commercially available as soon as this February 1st. With faster and portable detection solutions, identifying infected individuals for proper medical care will also be quicker by medical teams on the ground, especially when hospitals are overcrowded.

Genome sequencing to find potential vaccines

The Wuhan virus’ genome was completely sequenced by Chinese scientists in less than a month since the first case was detected. Since the first sequencing was done, almost two dozen more have been completed. In comparison, the SARS virus outbreak started around the end of 2002 and its complete genome was only available in April 2003. This is again thanks to advances in technology and a drive for international collaboration. Richard Ebright, a biologist at Rutgers University, told Stat News that those genome sequences “will be crucially important for the development of diagnostics [and] vaccines”.

Indeed, the Coalition for Epidemic Preparedness Innovations (CEPI) has supported pharma companies with millions in funding so as to have a vaccine against the virus ready for human testing in just 16 weeks, a process that normally takes years. With such an ambitious aim, the genome sequences will prove to be very valuable. As we will be able to sequence pathogens’ genome quicker with evolving technology, the rate of finding adequate therapies will also speed up and help save more lives in the process.

Robots to the rescue

As it has been determined that the 2019-nCoV virus can spread from human to human, medical staff are at high risk of being infected. However, impervious to cross-infection are medical robots. These can be real game-changers in cases of viral outbreaks.

We’ve seen one such case already in the U.S. where man, diagnosed with the Wuhan coronavirus, is being treated by a robot. The latter allows physicians to communicate with the patient via a screen and it is also equipped with a stethoscope, helping doctors take the man’s vitals while minimizing exposure to the staff. True, it won’t be possible in a jam-packed hospital in China with hundreds of such patients but with time quarantined patients could be better monitored with the help of robots.

No alt text provided for this image

Source: https://edition.cnn.com/

Going further, drones for medical deliveries could also be deployed in similar settings so as to reach quarantined zones like Wuhan currently is with medicines and/or supplies. 

One of the first things to decrease the spread of epidemic illnesses such as SARS or Corona Virus is containment, isolation or quarantine. The movement of personnel and supplies can be replaced by drones or other automated delivery systems.

In any case, the management and prevention of such situations will largely rely on professionals and international collaboration. With the help of technology, containment and eventual treatment of outbreaks can be run more smoothly.  

 #themedicalfuturist #digitalhealth #future #healthcare #medicine #technology #fromchancetochoice #wuhanvirus #coronavirus #epidemics #wuhan

 How Digital Health Technology Can Help Manage The Coronavirus Outbreak 

ARE YOU A STEM CELL TOURIST ?

Stem cell tourism is a term recently coined to describe a growing practice among patients to pay large sums of money to private clinics for often unproven stem cell therapies. Patients can be desperate because conventional medicine has failed to provide a solution for their particular condition. For diseases affecting children, emotions may run particularly high: the children themselves cannot make properly informed decisions, so parents face the additional conflict of wanting the best for them while, at the same time, having to protect them from undue risk. Advertisements for these clinics, often outside the patient’s own country, claim that stem cell treatment can benefit or cure complaints ranging from diabetes, stroke, paralysis caused by spinal cord injury, cerebral palsy, and Lou Gehrig’s disease (ALS), to wrinkles in the skin and age-related hair loss in men.

Potential Risks of Stem Cell Therapies
Uta Kunter, Jürgen Floege, in Regenerative Nephrology, 2011

Stem cell therapies are very likely to have a major impact on regenerative medicine, but for them to succeed we need to be aware of their specific challenges to avoid setbacks as experienced in the first gene therapy trials. In stem cell therapies, just as in gene therapy, malignancies are a major concern. Other concerns relate to contamination of cell preparations and unwanted formation of ectopic tissue (maldifferentiation), but also to the validity of experimental results, e.g. stem cell markers and heterogeneity of stem cell preparations. Consequently, this chapter will address both the medical safety aspects of stem cell therapies and the scientific safety of stem cell-related data. In reflection of the current literature on stem cell therapies in nephrology, the main focus here is on mesenchymal stem cells (MSCs) and other adult bone marrow preparations. However, with rapid developments in the field, safety aspects concerning stem cells other than MSCs may gain importance in the near future and therefore will be mentioned throughout this chapter.

Although there is some progress using stem cells (MSC) in animals, human clinical research has many ethical issues. Questions have arisen about the safety of stem cell transplantation.  There are those who are against 'letting the genie out of the bottle". Concerns regarding maldifferentiation, cancer, and ectopic tumor development have been raised. The Federal government banned the use of Federal money to fund research with HESCs (Human embryonic stem cells)
Ethical concerns included the definition of human life and the pluripotent nature of embryonic stem cells.

There are no FDA guidelines regarding stem cell usage. Neither have there been any documented regulations as to the preparation, indications, side effects, dosing, adverse reactions.  The typical label which accompanies all FDA approved medications provide that type of information for medications you purchase at your pharmacy.

Currently, the only stem cell therapies approved by the FDA use cells from bone marrow or cord blood to treat cancers of the blood and bone marrow. But doctors in the Cell Surgical Network have moved ahead with using cells for autoimmune, neurologic, and other serious conditions.

If you are interested in the current network of private and commercial stem cell doctors or clinics refer to the Cell Surgical Network. Health Train Express advises extreme caution in choosing this option.  Many of these stem cell doctors are no longer offering this treatment as a result of a court action with a permanent injunction regarding these sources of stem cell treatments. There is also a monograph by Dr. Elliottt Lander and Dr. Mark Berman on the history of Stem Cell treatments along with several anecdotal stories.

FDA Regulation of Human Cells, Tissues, and Cellular and Tissue-Based Products (HCT/P's) Product List

If readers wish to learn more and read peer-reviewed scientific articles can be found at PubMed or Google Scholar

Important HIPAA Update: New Penalties - Clinics get $85,000 Fines for NOT Releasing Data to Patients

Important HIPAA updates can have a far-reaching impact. Learn how to stay compliant. 

Yes Virginia HIPAA defines what is secret and confidential and also what must be transparent to the patient.  It is their data!

Everyone thinks of HIPAA as a security lock-down law, and indeed it is: a major part of HIPAA regulations is about the data holder’s responsibility to be careful with it. There have been huge penalties for allowing data leaks.  

Fewer people realize that HIPAA regulations have also always included a “right of access” - here’s that page on the HHS website. It means that patients are allowed to request copies of their records, and providers must comply. This has always been true, but there’s an important change: in 2019, the government settled its first two major cases (with big fines) where a patient asked for their data and the provider dragged its feet.

The right of access has never been enforced. But that has changed.

How would you like an $85,000 fine? Plus a year-long corrective plan?  That’s what Korunda Medical (in Florida) agreed to in December. It’s also what Bayfront Medical settled for in September. For deeper information about both settlements, see this blog post by Deven McGraw, who many believe is the world’s leading HIPAA authority. Her company Ciitizen’s scorecard project showed that half of the providers were in violation.

Each $85,000 fine was for a single violation - a single (but persistent) failure to honor one patient’s legal request.

If they ask for it by email, you must deliver it by email

Another commonly misunderstood issue is whether a patient can request that their information be delivered by email. Commonly, providers (even their HIPAA compliance people) refuse to do this, because ordinary email is unsecured and hackable. But if the patient requests it by email, the provider must comply.

This is so widely misunderstood that it’s now on a Frequently Asked Questions page. Here’s a screen capture Dec 17 from HIPAA FAQ #570, on the Office for Civil Rights website: 

You’re not allowed to say “Regardless of the law, we don’t do that.”

Unfortunately, if the law says you have to do it, you’re not allowed to have a “policy” that says “not me.” That’s like saying “My policy is that I do get to steal your car.”

The community created a Google Doc containing those screen captures and a slew of additional information: bit.ly/HIPAAemail with links to the above and numerous other details. 

Be informed. Stay out of trouble. Save money.

You can imagine that in both of those cases that ended with $85,000 fines, the provider incurred far greater costs in the months of dealing with investigators, not to mention the impact on their reputation in the local community of all the resulting news coverage. 

Avoiding this is straightforward - not necessarily trivial, but not complicated: know the law. Study HIPAA’s “right of access,” look at the links in that google doc, and do the right thing. It’s a lot easier than coping with the consequences of getting caught. And it’s the right thing to do for the patients.

Want to know more about HIPAA and other regulations in relation to patient communication? Read our free guide, "Become a Text and Email Compliance Guru."

Learn how to become a text and email compliance Guru

HIPAA Update: New Penalties - Clinics get $85,000 Fines for NOT Releasing Data to Patients:

More drugmakers hike U.S. prices as new year begins

 Drugmakers including Bristol-Myers Squibb Co (BMY.N), Gilead Sciences Inc (GILD.O), and Biogen Inc (BIIB.O) hiked U.S. list prices on more than 50 drugs on Wednesday, bringing total New Year’s Day drug price increases to more than 250, according to data analyzed by healthcare research firm 3 Axis Advisors. 


Reuters reported on Tuesday that drugmakers including Pfizer Inc (PFE.N), GlaxoSmithKline PLC (GSK.L) and Sanofi SA (SASY.PA) were planning to increase prices on more than 200 drugs in the United States on Jan. 1.

Nearly all of the price increases are below 10% and the median price increase is around 5%, according to 3 Axis.

More early year price increases could still be announced.

Soaring U.S. prescription drug prices are expected to again be a central issue in the presidential election. President Donald Trump, who made bringing them down a core pledge of his 2016 campaign, is running for re-election in 2020.

Many branded drugmakers have pledged to keep their U.S. list price increases below 10% a year, under pressure from politicians and patients.

The United States, which leaves drug pricing to market competition, has higher prices than in other countries where governments directly or indirectly control the costs, making it the world’s most lucrative market for manufacturers.  Drugmakers often negotiate rebates on their list prices in exchange for favorable treatment from healthcare payers. As a result, health insurers and patients rarely pay the full list price of a drug.  Bristol-Myers said in a statement it will not raise list prices on its drugs by more than 6% this year.  The drugmaker raised the price on 10 drugs on Wednesday, including 1.5% price hikes on cancer immunotherapies Opdivo and Yervoy and a 6% increase on its blood thinner Eliquis, all of which bring in billions of dollars in revenue annually.  Gilead raised prices on more than 15 drugs including HIV treatments Biktarvy and Truvada less than 5%, according to 3 Axis. Biogen price increases included a 6% price hike on multiple sclerosis treatment Tecfidera, according to 3 Axis.

More drugmakers hike U.S. prices as new year begins - Reuters:

A THROAT SWAB FOR $ 25,000 . ?

Good morning, it's Sunday morning, if you are tired of watching the Trump Impeachment Carnival, have your coffee watching this story. (it is a true story)

Insurance companies are supposed to LOWER healthcare costs by fighting inappropriate price gouging, right? WRONG. Here's why.

The story is all too common. Next time your physician orders a test, image or any service from an outside vendor.

A routine doctor's visit for a sore throat brought more than $28,000 in charges for one woman. In our Bill of the Month partnership with Kaiser Health News and NPR, we take a look at unexpected medical costs. The woman’s visit shows even when insurance does cover medical charges, costs can still skyrocket in the long run. David Begnaud reports, and Kaiser Health News editor-in-chief Dr. Elisabeth Rosenthal joins “CBS This Morning” to discuss the findings.

1. Ask how much it will cost

2. Don't believe what he says, because he does not know. If he refers you to one of his staff ask him/her.

3. Tell the staff member to order it from an in-network provider.

The Latest Breaking News about Physician Burnout

Physician burnout: Which medical specialties feel the most stress?

An online survey of doctors finds an overall physician burnout rate of 42%, which is down from 46% five years ago. Three new entries in the top six specialties with the highest rates of burnout compared with last year’s edition of the survey provide medical students and residents with new insight into their future careers.

The numbers of physicians who report burnout vary greatly between specialties.

In the Medscape survey, the highest percentage of physician burnout occurred among these medical specialties:

Urology: 54%.
Neurology: 50%.
Nephrology: 49%.
Diabetes and endocrinology: 46%.
Family medicine: 46%.
Radiology: 46%.

The lowest rates of burnout were reported by physicians in these medical specialties:

Public health and preventive medicine: 29%.
Ophthalmology: 30%.
Orthopedics: 34%.
Psychiatry: 35%.
Otolaryngology: 35%.
General surgery: 35%.

These findings correlate well with other studies by the AMA, Mayo Clinic and Stanford.

Reasons for burnout vary among specialties.

Interference with lifestyle and home life.
Long hours
Unrelenting stress
Disappointment with choice of specialty, or mode of practice setting.
Physical or Emotional disturbance.
Medico-legal issues

What has been left out is pre-morbid emotional disturbances, such as bi-polar spectrum disorder, depression, anxiety. The selection of a particular specialty is often secondary or directly attributable to personality type. Social anxiety disorder would lead a physician into a specialty such as a pathology, or anesthesiology.

What is burnout?

Burnout among physicians was measured using the emotional exhaustion and depersonalization scales of the Maslach Burnout Inventory (MBI), a validated questionnaire considered the criterion standard tool for measuring burnout.28, 29, 30, 31 Consistent with convention,10, 32, 33 we considered physicians with a high score on the depersonalization and/or emotional exhaustion subscale of the MBI as having at least one manifestation of professional burnout.28

Concurrent validity of single-item measures of emotional exhaustion and depersonalization in burnout assessment

Although the MBI is the criterion standard for the assessment of burnout,28 its length and expense limit feasibility for use in long surveys addressing multiple content areas or in large population samples. Thus, to allow comparison of burnout between physicians and population controls, we measured burnout in both groups using 2 single-item measures adapted from the full MBI. These 2 items correlated strongly with the emotional exhaustion and depersonalization domains of burnout measured by the full MBI in a sample of more than 10,000 individuals,34, 35 with an area under the receiver operating characteristic curve of 0.94 and 0.93 for emotional exhaustion and depersonalization, respectively, for these single items relative to the full MBI.

Ocam's Razor

The simplest solution is often the correct one.  In this case, 3 out of four times  one criterion yields a correct answer to the question, In this case, depersonalization, The single question with the highest factor loading on the emotional exhaustion (EE) (“I feel burned out from my work”) and depersonalization (DP) (“I have become more callous toward people since I took this job”) 





















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