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Some doctors shield whole truth from patients, survey shows

A majority of physicians told a patient that his or her prognosis was more positive than the medical facts warranted within the previous year. More than a third say it is sometimes OK to shield significant medical errors from affected patients or hide financial relationships with pharmaceutical companies and device makers from patients. These are just a few of the areas in which at least some physicians say that always telling patients the whole story is not the right way to go, according to a nationwide survey of nearly 2,000 doctors across seven specialties in the February issue of Health Affairs. "Despite widespread acceptance of communication principles and commitments by professional organizations, substantial percentages of U.S. physicians did not completely endorse these precepts, and many reported behaving in ways that deviated from these norms," said the study. For example, 11% of physicians said they might sometimes tell a patient something untrue, and about the same ...

CMS rejects California Medicaid co-pays

Federal health officials on Feb. 6 denied a request by California to charge a variety of co-payments to most of its Medicaid enrollees. The co-pays would have ranged from $3 for prescriptions filled at pharmacies to $100 for inpatient hospital stays. The state expected the co-pays to generate $600 billion beginning in October 2013, said Norman Williams, spokesman for the California Dept. of Health Care Services, the state's Medicaid agency. But the state cannot implement the co-pays under a demonstration waiver, as it requested in December 2011, according to a letter from Centers for Medicare and Medicaid Services acting Administrator Marilyn Tavenner to California's Medicaid agency. The co-pays are neither temporary nor targeted at a specific population, both of which are requirements in federal Medicaid law. California is examining its options, including administratively appealing the federal decision, Williams said. California Medical Assn. President James T. Hay, MD, ap ...

Defensive medicine seeping into physician training, study says

Practicing defensive medicine to avoid medical liability lawsuits may not be a formal part of medical school curriculum, but it's still being taught to medical students and residents, a study shows. A survey of 202 fourth-year medical students and third-year residents at Northwestern University Feinberg School of Medicine in Chicago found that 94% of students and 96% of residents have seen examples of defensive medicine in their clinical training. Nearly two-thirds of students and three-quarters of residents said their attending physician implied that they take medical liability concerns into consideration when making clinical decisions. Nearly half of respondents said their attending directly instructed them to do so, says the study in the February Academic Medicine. Educators should reframe such conversations to focus on reducing liability risk by improving patient safety and communication, said Kevin O'Leary, MD, lead study author and associate professor and associate chief ...