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Groups aim to teach resident physicians to weigh costs in care

With health care expenditures projected to reach nearly 20% of the nation’s gross domestic product by 2020, more physicians need to learn to weigh the costs and benefits of care to patients, say officials with the American College of Physicians and the Alliance for Academic Internal Medicine. The two organizations have teamed up to offer a free curriculum designed to educate internal medicine residents about how to avoid contributing to rising health care costs with unnecessary care. “Physicians receive little specific training about identifying and eliminating wasteful diagnostic and treatment options,” said Cynthia D. Smith, MD, the ACP’s senior medical associate for content development. “Residency training is an excellent time to introduce the concept of high-value, cost-conscious care, because the habits that residents learn during training have been shown to stay with them throughout their professional careers.” The lessons are intended to give residents an un ...

Surgeons balk at withdrawing life support after medical errors

Nearly two-thirds of surgeons are unwilling to honor a patient’s request to end life support after operating on that patient, and they are less willing to do so when a surgical error occurs, said a study in Annals of Surgery in July. Researchers surveyed 912 neurosurgeons, cardio-thoracic surgeons and vascular surgeons who performed an average of 10 high-risk procedures a month about how they would respond to a scenario specific to their specialty. The vignette in the survey concerns a high-risk surgery for a 75-year-old woman with emphysema and stable coronary artery disease who has an intra-operative stroke and weakness in her arm and leg upon awakening after surgery. She struggles post-surgery and is re-intubated twice, and after seven days has developed pneumonia and needs ventilator care. The patient and family request withdrawal of life support, saying her future quality of life is unacceptable. Faced with that scenario, 63% of surgeons said they would be “not at all” ...

Heart condition that puts young women at greater risk sometimes overlooked

Chest pain should not be dismissed in young, fit patients because it could be a symptom of spontaneous coronary artery dissection, which often affects otherwise healthy individuals, a new study says. Women appear to have a greater risk of developing the condition than do men, said Rajiv Gulati, MD, PhD, lead author of the study published online July 16 in Circulation. More research is needed to determine the cause of spontaneous coronary artery dissection, he said. But potential factors associated with the condition include fibromuscular dysplasia, extreme physical activity and hormones (the condition was most common in women during the three months after giving birth). An estimated 800 new cases of spontaneous coronary artery dissection occur in the U.S. each year, the study said. But many other cases go undiagnosed, in part, due to the difficulty of identifying the problem on an angiogram, Dr. Gulati said. “SCAD is not related to plaque buildup that more commonly causes ...