Sunday, November 08, 2009

Limits on British surgeons' working hours 'will harm training and place patients at risk'

New limits on surgeons' working hours will harm their training and place patients at risk, experts have warned. Controversial new European working laws mean all doctors, including surgeons, are allowed to work only 48 hours a week. Introduced in August they have provoked fierce criticism from surgeons who say that new trainees will struggle to master their complex specialism in such a restricted time.

But the Government insists that having fewer exhausted doctors on wards means that patients are safer. However, experts writing in the British Medical Journal say that complications and readmissions increase when restrictions are placed on how long surgeons can work. They highlight recent working hours restrictions in America and say that they had a negative impact on training because surgeons do not have enough time to practise their skills. This was even though doctors in America were still allowed to work almost twice as long as they are now able to in Britain.

John Tarpley and Gretchen Jackson, both from Vanderbilt Children’s Hospital in Nashville, warn that limited hours cause “alarming trends” in surgery. Studies have shown an increase in preventable complications and injuries caused to patients when working hours are restricted, they claim. They also say there is evidence that surgeons perform fewer complicated procedures to ensure they do not breach their weekly working hours.

They also point to evidence that following the introduction of an 80-hour week limit in America the amount of time that junior surgeons spent on cases involving fell by more than half. First year trainees also assisted in 85 per cent fewer operations overall than their predecessors.

The doctors estimate that it takes an average of between 15,000 and 20,000 hours to become a highly experienced surgeon. They called for fewer restrictions to allow flexibility over how long doctors work. “Surgery is a body contact sport, there is no question about it,” they write. “You cannot be a good armchair surgeon.”

John Black, president of the Royal College of Surgeons, said: “This BMJ paper provides yet more compelling evidence that the need for both cognitive ability and manual dexterity in surgery cannot be shortcut by reduced hours. “The European Working Time Directive has limited the hours that are available for surgeons in training well below the 15,000-20,000 the report suggests are optimal – a flexible approach that will allow surgeons to work up to 65 hours we believe will redress this balance and deliver future surgeons who can practice independently.”

A spokesman for the Department of Health said that there were no plans to allow doctors to wok longer hours. He said: "Our overriding priority will continue to be ensuring that patients experience high quality, safe and effective care in the NHS.”


Incompetent African doctor stood down from Australian public hospital

The cases of incompetent overseas doctors in Australian public hospitals never stop coming -- despite all the checks that are supposed to be done. Why? Because Australia does not train enough of its own doctors and public hospitals are desperate for staff

AUTHORITIES will investigate a doctor over concerns he was not fully qualified for his job and examine why it took a month for knowledge of a past criminal charge to reach the top. Queensland Health stood down Zimbabwe-trained Dr John Chibanda over concerns he was working outside the scope of his credentials at Emerald Hospital. The matter will be investigated by both the Health Quality and Complaints Commission and the state's Crime and Misconduct Commission.

Dr Chibanda, an Australian citizen, had previously worked at Katherine Hospital in the Northern Territory without incident. He started work in obstetrics at Emerald Hospital in late 2007 and was supervised due to the level of his experience. After complaints about the standard of his work around August 2008, he was stood down from obstetrics, but continued to work in emergency and other general areas of the hospital. He was again investigated after further complaints in May this year, and a Google search in late September turned up a criminal charge for fraud in Zimbabwe.

Health Minister Paul Lucas said Dr Chibanda was challenged about the information - which related to the fraudulent supply of a death certificate for insurance purposes - and he claimed the conviction had been quashed. "However, the form that one is required (to fill in) when one seeks registration as a doctor in Queensland clearly requires ... that one disclose not just criminal convictions but if one has ever been charged with a criminal offence," Mr Lucas said.

"I want to make it crystal clear. "I expect there to be a full and rigorous investigation of these matters. "If there is anyone who has misled, if the wrong thing has been done, then there will be no forgiveness, no mercy, there will be very, very strong action."

About a dozen complaints were made about Dr Chibanda - some from patients and some from nurses - but none relate to deaths or permanent injuries.

Also under investigation is why it took about a month for his criminal history to be reported to the top, with Queensland Health's centre for healthcare improvement chief Dr Tony O'Connell saying he only became aware of the matter this week.

Mr Lucas said the appropriate checks through medical bodies and referrals were done, in addition to an earlier Google search that had failed to pick up the fraud matter. "I would have thought that we would be bending over backwards to check these things," Mr Lucas said. "I would have thought that the relatively modest things that you can do in addition to the rigorous checks would be second nature, and I want it investigated as to why this happened."

Dr O'Connell said "a few dozen" obstetrics cases handled by Dr Chibanda and hundreds of other cases would be reviewed. Patients with concerns about treatment by the doctor were urged to come forward. Dr Chibanda is the second doctor to be stood down from Emerald Hospital within months. A doctor at the hospital was suspended in September over a disciplinary matter.


The "Costs" of Medical Care

by Thomas Sowell

One of the strongest talking points of those who want a government-run medical care system is that we simply cannot afford the high and rising costs of medical care under the current system.

First of all, what we can afford has absolutely nothing to do with the cost of producing anything. We will either pay those costs or not get the benefits. Moreover, if we cannot afford the quantity and quality of medical care that we want now, the government has no miraculous way of enabling us to afford it in the future.

If you think the government can lower medical costs by eliminating "waste, fraud and abuse," as some Washington politicians claim, the logical question is: Why haven't they done that already? Over the years, scandal after scandal has shown waste, fraud and abuse to be rampant in Medicare and Medicaid. Why would anyone imagine that a new government medical program will do what existing government medical programs have clearly failed to do?

If we cannot afford to pay for doctors, hospitals and pharmaceutical drugs now, how can we afford to pay for doctors, hospitals and pharmaceutical drugs, in addition to a new federal bureaucracy to administer a government-run medical system?

Nothing is easier for politicians than to rail against the profits of pharmaceutical companies, the pay of doctors and other things that have very little to do with the total cost of medical care, but which can arouse emotions to the point where facts don't matter. As former Congressman Dick Armey put it, "Demagoguery beats data" in politics.

Economics and politics confront the same fundamental problem: What everyone wants adds up to more than there is. Market economies deal with this problem by confronting individuals with the costs of producing what they want, and letting those individuals make their own trade-offs when presented with prices that convey those costs. That leads to self-rationing, in the light of each individual's own circumstances and preferences.

Politics deals with the same problem by making promises that cannot be kept, or which can be kept only by creating other problems that cannot be acknowledged when the promises are made. Price controls are a classic example. At various times and places, in countries around the world, price controls have been put on any number of goods and services-- going all the way back to the days of the Roman Empire and ancient Babylon. Price controls create lower prices for open and legal transactions-- but also black markets where the prices are higher than they were before, because the risks of punishment for illegal activity has to be compensated. Price controls also lead to shortages and quality deterioration.

But politicians who take credit for lower prices blame all these bad consequences on others. Diocletian did this in the days of the Roman Empire, leaders of the French Revolution did this when their price controls on food led to hungry and angry people, and American politicians denounced the oil companies when price controls on gasoline led to long lines at filling stations in the 1970s. It is the same story, whatever the country, the times or the product or service.

The self-rationing that people do when prices are free to convey the inherent impossibility of any economy to supply as much as everybody wants is replaced, under price controls, with rationing imposed by government, which cannot possibly have the same knowledge of each individual's circumstances and preferences-- least of all when it comes to medical care, where patients differ in innumerable ways.

Here, as elsewhere, there is no free lunch-- even though politicians get elected by promising free lunches. A free lunch in medical care is one of the most dangerous illusions of all.

Waiting in long gasoline lines at filling stations was exasperating back in the 1970s, but waiting weeks to get an MRI to find out why you are sick, and then waiting months for an operation, as happens in countries with government-run medical systems, can be not only painful but dangerous. You can be dead by the time they find out what is wrong with you and do something about it. But that will "bring down the cost of medical care" because you won't be around to require any.


Do Bluedogs believe Obamacare fairy tales?

Members of the House could vote as early as this weekend on House Speaker Nancy Pelosi's 1,900-plus page proposal to create a government-run health care system in America. While virtually all House Republicans will vote against the Pelosi plan, a key question is whether the 40 or so conservative Blue Dog Democrats will cave to pressure from House leaders to support the Pelosi plan. If they do, they will have to start believing the following eight Obamacare fairy tales:

Tale #1: You can keep your coverage

Earlier this year, President Obama said "I intend to keep this promise: If you like your doctor, you'll be able to keep your doctor; if you like your health care plan, you'll be able to keep your health care plan." Not surprisingly, the administration walked back this statement, telling the Associated Press, "White House officials suggest the president's rhetoric shouldn't be taken literally."

This is partly because the bill will bury your doctor in tens of thousands of pages of new regulations. And although the federal government might not literally force people to change insurance, they may well force your insurance plan to disappear or change beyond recognition.

The bill will also create a new set of cost incentives such that your employer might benefit by getting rid of your company insurance plan altogether. The Lewin Group, an independent econometrics firm, estimated that under the original House bill, some 88 million Americans could thus lose their employer health insurance.

Tale #2: Health care will not be rationed under the government plan

The Obama administration has boldly declared "health care will not be rationed." If you make the perfectly logical assumption that the government cannot supply an unlimited amount of health care to everyone on demand, this is clearly false. Nor can private providers provide an unlimited supply of health care -- they, too, ration. However, when private providers ration, consumers have options. They can pay more to get the care they need, or in some cases they can resort to legal action to get the coverage they are owed. When you're denied treatment under a public plan, good luck suing the government.

Tale #3: The "public option" will be able to provide insurance at cheaper rates than the private sector

The Congressional Budget Office (CBO) says that a public health insurance plan could save money compared to private insurance through lower administrative costs. However, a major reason why public health plans have lower administrative costs compared to private insurance is the government's inattention to fraud. Medicare loses an estimated $60 billion a year in fraud, seven times as much as the combined profits of the 14 health insurance companies on the Fortune 500.

CBO warns that a public option is less likely to manage efficiently how much treatment each person gets and will attract more unhealthy patients, driving up costs. Costs will likely vary wildly depending on the state, but they could make the public plan's premiums "somewhat higher than the average premiums for the private plans in the exchanges."

Tale #4: The "public option" will keep private insurers honest by forcing their rates down

Even if the public option plan ends up charging higher premium prices to patients, it might still pay significantly less to health providers than private insurers pay them. And when government underpays, doctors and hospitals charge more to private insurers to make up the difference, which in turn drives up health insurance premiums for ordinary Americans.

This phenomenon is pervasive within the Medicare and Medicaid programs, which underpay doctors and hospitals for most services. Their underpayment results in an average $1,800 per year overcharge for every American household with private health insurance, according to the Milliman consulting firm.

The new House bill removes from the old one a provision setting public option payment rates at Medicare plus 5 percent -- which would have dramatically increased this cost-shifting. Still, the public plan's payment rates are left up in the air by the new House bill, to be negotiated by the Secretary of Health and Human Services.

Tale #5: Medicare benefits won't be reduced

At a teleconference sponsored by AARP in July, President Obama assured seniors they would not see a reduction in Medicare benefits. "What we do want is to eliminate some of the waste that is being paid for out of the Medicare trust fund," he said. As an example of waste, he cited $177 billion in subsidies given to insurance companies who participate in Medicare Advantage -- a program to get private insurance through Medicare.

Medicare Advantage is more expensive than Medicare, but that's because it provides more benefits and better access to doctors than regular Medicare. The number of seniors enrolled in a Medicare Advantage program has nearly doubled from 5 million to 10 million in the last six years and accounts for 22 percent of all Medicare patients, Thirty-five percent of all Medicare patients in California, 37 percent in New York and 42 percent in Oregon. Both the House and Senate bills contain deep cuts to Medicare Advantage.

Tale #6: Illegal immigrants won't be covered

The Senate health care reform bill was beefed up following Rep.Joe Wilson's, R-SC, "you lie!" outburst during the president's address to a joint session of Congress on health care. Since then, the White House has made it known that it does not want illegal immigrants covered or subsidized by health reform legislation.

Despite this, it remains an open question whether the House health reform bill will allow illegal immigrants to buy insurance from government-established health insurance exchanges.

Tale #7: Health care reform won't increase the deficit

Democrats have engaged in some shady counting to claim that health care reform is deficit neutral. The Congressional Budget Office only tallies a bill's cost over an immediate ten year horizon. The Senate bill begins collecting taxes immediately but the major spending provisions don't kick in until 2014. That makes the $800 billion bill appear deficit neutral through 2019, but in fact it will cost as much as $1.8 trillion in its first ten years of operation, according to some estimates.

House Speaker Nancy Pelosi insists that the House Health Care bill will cost a mere $894 million over the next ten years, but a recent reports put the House bill's cost at $1.2 trillion and rising. Nobody knows what the final price tag will be, but it's more than likely the House bill will add to the deficit.

Tale #8: Health care reform won't fund abortions.

Democrats have repeatedly insisted that their health care reform proposals won't fund abortion and is consistent with the Hyde amendment -- a 1976 law that bars almost ll federal funding of abortion. However, the House bill gives subsidies to people to buy private insurance plans that do cover abortion. The bill would therefore, in effect, fund abortions. Pro-life Democrat Rep. Bart Stupak of Michigan claimed last week that 40 House Democrats will vote against the House health care reform bill if it is not altered to exclude abortion funding.


Obamacare is government-by-coercion, not consent

If the Founding Fathers knew what Speaker Pelosi was up to, they'd be rolling in their graves.

America's Founding Fathers established a government based on the consent of the governed. They never envisioned a government that ran the lives of its citizens with or without their consent. Suffice it to say they would turn in their graves if they read the 1,900-plus-page health care reform bill the House of Representatives is scheduled to vote on Saturday. (Proponents of the bill have promoted it for months using multiple fairy tales that are ably exposed on page 21 by The Examiner's David Freddoso and Mark Hemingway.)

That American citizens should be fined or even put in federal prison for refusing to purchase government-approved health insurance is as un-American as any idea we can imagine. But such a mandate is the very heart of the bill written behind closed doors by House Speaker Nancy Pelosi and her privileged pals. If their bill is approved by the House tomorrow, we will be a big step closer to the day when everybody gets their health care insurance through the government or from an approved insurer offering policies that meet meticulously detailed specifications contained in thousands of pages of federal regulations.

Welcome to America, land of the formerly free, and home of citizens covered by a nationalized health care system crafted by the same government that can't care for American Indians on their reservations or deliver swine flu shots on time.

It would be one thing if Democrats were simply trying to insure the uninsured, but their bill goes far beyond this modest goal. Democrats believe they must first tighten their regulatory grip on what's left of the private health care industry, then squeeze with all their bureaucratic might to force costs down by effectively rationing health care.

Besides rationing care, the bill adds expensive new mandates on people (compulsory insurance for all), as well as costly new regulatory burdens on insurance companies (thus increasing premiums) and on your employer (which will reduce your wages). The Democrats' bill also creates multiple new layers of federal bureaucracy to look over your doctor's shoulder.

This plan is doomed to fail, but in failing it will likely inflict severe collateral damage on the quality of your health coverage and your health care. As Medicare staggers toward bankruptcy, Democrats in Congress -- led by Pelosi, Senate Majority Leader Harry Reid and, of course, President Obama -- want another massive, unsustainable new federal program to save the massive, unsustainable old federal program. When do we stop the vicious, self-defeating cycle of heaping government fiats upon government fiats to fix problems government creates?


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