News-Record.com

My Sunday article examined why there's so much medicine being practiced in the U.S. that's either unproven or ineffective, and what it's costing us in lives and health-care dollars. Feel free to discuss it here. (Coincidentally, the Wall Street Journal's health blog has two articles on that subject today -- one on the painkiller Vioxx, now withdrawn from the market, and one on cellulite treatments).

If you're not sure about a diagnosis you've received or a course of treatment your doctor has suggested, one often-worthwhile option is to seek a second medical opinion. In fact, research suggests that far more Americans should be doing it than actually do.

Via the Wall Street Journal's Health Blog, here's a story from the San Diego Union-Tribune that talks about why you might want to do it and how best to go about it.

I've had one occasion to seek a second opinion, and it confirmed the first in every respect. Have you ever gotten a second opinion that has resulted in a significant change in your diagnosis or treatment?

It has become conventional wisdom that women should examine their breasts regularly to feel for lumps or other irregularities that could be, or become, cancerous. But is this really an effective approach?

Some researchers say no, and Al Tompkins at the Poynter Institute for Media Studies has compiled a lengthy list of links to articles and resources on the subject. (You might also want to read the comments on t Tompkins' post. There are two as I write this, both defending breast self-exams.)

Coincidentally and quasi-relatedly, my article on how the local nonprofit Friends for an Earlier Breast Cancer Test's grant kicked off some research into breast-cancer detection at the Mayo Clinic ran here today.

One of the phrases currently in vogue in medicine is "never events," which refers to things, particularly mistakes, that are so preventable that they should never happen. Insurance companies are even threatening to refuse to reimburse hospitals for costs incurred when a "never event" occurs.

Here's a Boston Globe blog post about one such "never event" that took place this week at Beth Israel Deaconess Medical Center there. The nature of the procedure hasn't been disclosed, but in general what happened was that the wrong side of a patient was operated on. Fortunately, the patient is recovering and will suffer no lasting damage.

The Health Care Blog republishes a memo sent to hospital staff that is remarkable for its openness. It says two important things: 1) There are procedures in place to prevent this type of mistake from happening, and 2) in this case those procedures were not followed.

Medical professionals and patients alike can learn from this. The pros are reminded that these procedures exist for a reason and must be followed without exception. Patients are reminded that they need to ask questions of those who care for them to ensure that "right patient, right procedure, right side" is where the operation goes. (When I underwent shoulder surgery several years ago, the surgeon put a big X on the appropriate shoulder before surgery. I asked if that was to make sure the wrong shoulder didn't get operated on, and his response was something along the lines of, "You're darned right."

Some patients have taken it upon themselves to mark or label the wrong side with phrases like "Other side, please" or "Not this one." Some do it as a joke, but as this incident shows, it ain't funny. If the patient in question had been, say, having a cancerous kidney removed, he'd be in serious trouble.

I should stress that these events are very rare. But the potential consequences could be deadly. Procedures are in place for a reason. Docs, nurses and patients need to know about them and make sure they're followed.

The U.S. Department of Health and Human Services has unveiled Hospital Compare, a Web site that lets people see how hospitals compare with one another, or with state and national numbers, in terms of treating certain conditions. I'm busy on some stories and don't have any time at the moment to play with it, but if you want to take a look and post your reactions in the comments, please feel free.

It's not online, but I had an article in Wednesday's paper about a talk given Tuesday night by Dr. Ed Weisbart at a forum sponsored by the League of Women Voters and the Moses Cone-Wesley Long Community Health Foundation.

Dr. Weisbart talked about the need to use more generic drugs, instead of brand-name prescriptions, primarily because doing so would save between $20 billion and $40 billion a year. He also said generics are safer because any safety issue with a drug tends to surface while it is still in the brand-name phase, before its generic equivalent can come on the market.

The article prompted an e-mail from Dr. John Lusk, a retired local physician active in the Greater Greensboro Society of Medicine. He writes:

A caveat for patients seeking less costly drugs is that they should realize that generics and brand name drugs are not all equal.

One should be certain that the generic being offered has been made by a reputable manufacturer. The major chains and the locally owned pharmacies most probably vet the source of their non-brand named drugs.

Your readers should be careful if drugs are ordered via the internet. This is especially true if the order is place with an off-shore supplier. Some of these medications have the potential to be counterfeit, and contain none of the active ingredient.

As you are more than likely aware, the FDA requires that tablets and capsules carry some type of identification, printed or embossed. I've seen some "ineffective" pills without these markings.

Another potential difference is the use of different excipients and binders. Occasionally one of these compounds will react with the active ingredient to render it inactive. I have sometimes seen evidence that pills pass thru an intestinal tract intact and almost unchanged in appearance.

I suppose the old advice is the best advice: Talk to your doctor and your pharmacist.

The U.S. Centers for Medicare and Medicaid Services now has (the singular verb is correct; it's one agency) two Web sites up that are aimed at helping consumers compare hospitals on the basis of cost and quality.

The Hospital Compare Web Site lets consumers check on a hospital's accreditation, get information on how patients rated their experience as well as how much Medicare paid for certain procedures. (Medicare payments often serve as a basis for what private insurers will pay.)

You also can see data from the Hospital Consumer Assessment of Healthcare Providers and Systems. Making the data available is aimed at providing a meaningful, objective basis for comparing hospitals and, through this level of transparency, create incentives for hospitals to improve care.

The Health Care Blog has more information and background here. Note some of the caveats raised in the comments to this post.