According to an article in the recent edition of AM News, a survey has found that at least some docs are beginning to accept that they play a role in the disparity in the quality of care provided to minority populations. Some of the survey results from the article:

The AMA Institute for Ethics surveyed nearly 2,000 primary care

physicians about health care disparities. Among the findings:



* 89% said they thought it was possible to provide high-quality

care to all of their patients.

* 88% cared for minority patients during their training “often” or

“very often.”

* 87% cared for a patient within the previous month who did not

speak English fluently.

* 75% said they were in a position to make a difference in the

quality of care that minority patients receive.

* 70% reported being well-informed about possible cultural

differences between themselves and their patients.

* 55% agree that minority patients generally receive lower quality

care than white patients.

* 50% worked with someone who had a special interest in improving

the health of minority patients.

* 41% said their curriculum included some classes specifically

devoted to minority health issues.

Medzilla has some good advice on how pharmaceutical sales representatives can plan more efficient and effective meetings with doctors, which can just last a minute or less. It takes a lot of preparation to get everything across in such a short amount of time, as any pharma sales trainer could tell you, and these guidelines appear to form a good basis for any sales training program.

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Maybe it’s because I’m in the throes of writing an article about New Jersey’s new law requiring mandatory  cultural competency training, but I keep running into articles like this one:

The more discrimination African-American women report, the more likely

they are to have coronary artery calcification, a buildup of calcium in

the vessels that is associated with atherosclerosis, according to a

study presented at the American Heart Association’s 45th Annual

Conference on Cardiovascular Disease Epidemiology and Prevention

This is something docs need to know for their African-American female heart patients, don’t you think? If they don’t know, then they won’t know to ask about their experiences with discrimination and possibly provide supports that can help them deal better with the stress it induces (if only we could just get rid of discrimination altogether…).

MudFud   gets creative in this week’s Grand Rounds with a med school format. Of particular interest to Capsules readers are these posts:

Galen discusses the effects of pharm marketing on prescribing habits in Who Benefits?   In Ask Your Doctor,  DB from DB’s Medical Rants explains some effects of Direct to Consumer Advertising.  Corpus Callosum follows up with Direct to Consumer Advertisements of Antidepressents.  To close the session, Aaron at Two Terms Later gives a student perspective on the issue in To Take or Not To Take?

This article from the Journal of Bone and Joint Surgery is pretty interesting. It presents results from an outcomes investigation that was performed to compare physicians’

performance and attitude in a procedure-related CME activity.

The kicker is that while they found a correlation between increased confidence and

improved performance, but there was an even greater correlation between

increased confidence and their personal perception of improvement. As an alert reader who gave me a heads up on this article said in an e-mail, "A skeptic

might observe that, while CME improves doctors’ performance, it also makes them

develop a false sense of confidence." (Thanks, Irwin!)

This post courtesy of Anne Taylor-Vaisey: Here is a new page for you to view:
http://www.sacme.org/SACME_Meetings/Spring_2005/highlights.htm

We

will add more presentations, photographs and other exciting features as they

become available.

You can also link from the "What’s New" page:
http://www.sacme.org/new.htm

Please

note that PowerPoint presentations are posted with the permission of the

authors. Also, abstracts and presentations are available to SACME members

only.

That’s the question raised in this article in AM News, citing the recent disgrace caused by the Centers for Medicare & Medicaid Services’ chief medical officer, Sean R. Tunis, MD, who is accused of lying about his CME credits.

I don’t think stepping monitoring to make sure those seats actually were in the seats is the answer to reining in those who would cheat, scam, lie, etc.–those who will game one system will inevitably find a way to game a new one.

Since the whole point of CME isn’t that they log the hours, but that physicians learn things they can use to better treat patients, this just to me seems like one more loud scream for outcomes measurement. If they say they went to a CME course on X topic, test ‘em to see what they learned. Then find out if they’re using it. This makes a whole lot more sense to me than having the CME police come in to check to see if your forms are legit–do we really care? I don’t. What I care about is that they learned something. Even better, they learned something they can use–and then they use it.

There’s an interesting article in SFGate today about why docs prescribe drugs off-label. Since CME is one of the few places off-label use can be talked about, I thought this particular section was noteworthy:

Defenders of off-label use see it as a form of "innovative medicine” that may make therapeutic advances available to patients when an FDA review isn’t available. Doctors rely on research studies, their own observations and the shared experiences of colleagues.




"Probably the most important thing takes place at meetings, in the hallways,” said Dr. Michael Franzblau, a clinical professor of dermatology at UCSF. "Doctors ask each other, ‘What do you do for this?’ ”




The publication of research studies can also start a chain of events by which some drugs come into widespread off-label use, even if the data are never submitted to the FDA. Such studies, whose quality can vary widely, are cited in practice guidelines written by medical experts, and included in drug compendia that health plans consult when deciding what medicines they’ll pay for.




Wary observers such as Harvard’s Avorn, however, say all these routes from the drug factory to the prescription pad are much too vulnerable to manipulation by pharmaceutical firms. Avorn said doctors are markedly influenced by drug company salespeople who provide free dinners, free samples and questionable information. Doctors sometimes rely on substandard studies that they’re ill-prepared to assess, he said.




Physicians at medical meetings may not realize that a fellow practitioner vouching for an off-label use has been hired by the drugmaker to give the presentation. The FDA forbids drug firms to plug off-label uses, but industry watchers say the practice has been rampant at some companies.

This post courtesy of Anne Taylor-Vaisey: The following article was recently published in Medical Education Online:

Creating a Culture for Interdisciplinary Collaborative Professional Practice

C.A. Orchard, EdD, V. Curran, PhD, S. Kabene, PhD

Abstract: The future of the health system is dependent on health

professionals re-tooling the way we practice together. No longer can a

multi-disciplinary model support the complex health needs of many clients

nor can any one-health profession have all the knowledge needed to provide

total patient-centred care. However, our current education and health

systems are structured around a multi-disciplinary model of practice with

physicians or nurse practitioners as decision-makers and rarely are

clients included in care planning.True interdisciplinary practice is

defined as a partnership between a team of health professionals and a

client in a participa! tory, collaborative and coordinated approach to

shared decision-making around health issues,requires a revamping of how

future health professionals are educated and how the system can

accommodate shared decision-making. A client-centered collaborative

professional practice model is proposed in this paper as a means for

fostering and facilitating the culture for this change.

You can access it here.

This post courtesy of Anne Taylor-Vaisey: The following article was recently published in Medical Education Online:

Creating a Culture for Interdisciplinary Collaborative Professional Practice

C.A. Orchard, EdD, V. Curran, PhD, S. Kabene, PhD

Abstract: The future of the health system is dependent on health

professionals re-tooling the way we practice together. No longer can a

multi-disciplinary model support the complex health needs of many clients

nor can any one-health profession have all the knowledge needed to provide

total patient-centred care. However, our current education and health

systems are structured around a multi-disciplinary model of practice with

physicians or nurse practitioners as decision-makers and rarely are

clients included in care planning.True interdisciplinary practice is

defined as a partnership between a team of health professionals and a

client in a participa! tory, collaborative and coordinated approach to

shared decision-making around health issues,requires a revamping of how

future health professionals are educated and how the system can

accommodate shared decision-making. A client-centered collaborative

professional practice model is proposed in this paper as a means for

fostering and facilitating the culture for this change.

You can access it here.