The landscape of modern medicine has always evolved with science, technology, and social change. But in 2025, the most aggressive force reshaping healthcare delivery has been political. This year, physicians worldwide have felt a tightening grip of political authority around their clinical autonomy. From reproductive care to mental health access, from Vaccine distribution to gender-related treatment policies, medicine is increasingly at the mercy of lawmakers. These aren't peripheral issues-they're core matters of patient care, ethics, and scientific integrity. The medical community is now reckoning with a difficult truth: politics is no longer outside the clinic; it's in the room with the patient.

In the United States, legislative battles around abortion have reached new levels of complexity. Since the fall of Roe v. Wade, over a dozen states have passed or expanded laws that criminalize doctors for performing or even recommending certain reproductive procedures, even in medically urgent situations. In 2025, several high-profile cases have shown physicians facing prosecution for providing standard miscarriage management or ectopic pregnancy care. The legal environment is now so precarious that hospitals in restrictive states often delay critical care while waiting for legal teams to weigh in. This creates moral distress for physicians, many of whom now practice in constant fear of lawsuits or even arrest-just for doing what they were trained to do.

Outside the U.S., similar trends are unfolding. In parts of Latin America and Eastern Europe, governments have tightened control over what is considered "acceptable" reproductive care, often under the guise of protecting national values or traditional family structures. Physicians in countries like Hungary and El Salvador report mounting pressure to withhold information or restrict access to contraception and abortion, even when it goes against clinical guidelines. Meanwhile, international NGOs trying to provide comprehensive reproductive health services are being blocked or defunded. These constraints have created a two-tiered healthcare system-one for those with means to travel and another for those left behind.

One of the most heated and politically charged areas in 2025 has been gender-affirming care. Several countries have enacted legislation banning or severely limiting this type of care for minors, while others are placing restrictions on adult services as well. As doctors, we're taught to respect patients and evidence-but this issue has become increasingly fraught. Some physicians, myself included, have genuine concerns about the long-term impacts of hormone therapy and surgical interventions in adolescents. We've seen cases where patients later regret transitioning or feel they were rushed into decisions without adequate psychological assessment. These concerns are not rooted in hatred, but in caution, ethics, and a responsibility to "do no harm." Yet raising such concerns today often leads to accusations of bias or professional misconduct. Political and institutional forces seem determined to silence even respectful debate within the medical field, leaving many physicians to navigate these dilemmas quietly, without guidance or support.

The politicization of public health has also disrupted our ability to respond effectively to infectious disease outbreaks. In several countries, Vaccine programs have stalled due to partisan interference. In India, for instance, regional governments have delayed the rollout of a new dengue Vaccine due to internal power struggles, despite surging infection rates. In the U.S., routine childhood vaccination rates continue to decline, fueled by political figures who cast doubt on their safety or necessity. Physicians are once again in the position of defending settled science in the face of misinformation, while battling mistrust from patients who view every public health recommendation as a political statement.

Another major impact of politics this year has been on mental health funding and policy. In the wake of post-COVID burnout, economic strain, and social polarization, demand for mental health services has skyrocketed. Yet several governments-particularly in the UK, Italy, and Australia-have cut funding for public mental health programs as part of broader austerity agendas. In practice, this has left general practitioners, emergency room physicians, and pediatricians scrambling to manage complex psychiatric cases without adequate support. Waiting lists have ballooned. Suicide rates have risen in several countries. And physicians are increasingly asked to take on roles they are not fully trained for, simply because the systems meant to support them are collapsing under political pressure.

Even international medical collaboration has suffered. Geopolitical tensions, especially among NATO, BRICS, and non-aligned states, have made global health data harder to access. Projects on infectious disease surveillance, antibiotic resistance, and climate-related health threats have stalled due to nationalism and protectionism. Several governments are now blocking cross-border data sharing unless certain political conditions are met. This slows response time during outbreaks, stifles innovation, and undermines trust among health professionals who once relied on international cooperation to advance their work.

Ultimately, what 2025 has taught us is that medicine cannot remain insulated from politics. Whether we like it or not, our clinical decisions, patient relationships, and professional obligations are now being shaped by external forces-sometimes subtly, sometimes overtly. Physicians must adapt to this new reality. We must stay informed, protect our ethical ground, and advocate where needed. And we must find ways to voice dissent, even within a system that increasingly prefers compliance. The health of our patients-and the integrity of our profession-depends on it.

Few moments in medicine are as morally charged as the decision to allocate scarce resources. Whether in an intensive care unit overwhelmed by pandemic patients, on a battlefield with limited medics, or in a rural clinic with a single ventilator, doctors are sometimes forced to decide who receives life-sustaining care - and who does not. In these moments, life itself becomes, unavoidably, a number. The tension between the sanctity of the individual and the needs of the many has long been the subject of moral philosophy, from Aristotle's virtue ethics to John Stuart Mill's utilitarian calculus, and it is one that medicine cannot escape.

Triage, from the French trier, meaning "to sort," was formalized by Dominique Jean Larrey, Napoleon's chief surgeon, who prioritized treatment for those most likely to survive, regardless of rank or status. His approach was revolutionary - rejecting the aristocratic idea that a general's life was inherently worth more than a soldier's - yet it also set the precedent for using survival probability as a moral metric. In modern disaster medicine, frameworks like the Crisis Standards of Care developed by the Institute of Medicine extend Larrey's principle, favoring patients who will benefit most from limited interventions. On paper, this maximizes lives saved; in practice, it demands that physicians act as both healers and moral mathematicians.

The utilitarian logic is compelling in its efficiency, but it carries a hidden moral cost. To reduce a patient's worth to statistical likelihoods risks dehumanizing them. The philosopher Immanuel Kant warned against treating people merely as means to an end, no matter how noble that end might be. For example, an elderly patient with advanced comorbidities may be passed over for a younger, healthier patient in a triage scenario. While this may seem rational from a resource-allocation standpoint, it also raises painful questions about ageism, ableism, and the societal value of experience, relationships, and dignity.

Real-world crises show the complexity of applying theory to practice. During the height of COVID-19 in Lombardy, Italy, some hospitals resorted to age-based cutoffs for intensive care admission, sparking fierce ethical debate. In the U.S., ventilator allocation guidelines often combined the Sequential Organ Failure Assessment (SOFA) score with "tie-breaker" criteria, such as younger age or healthcare worker status, arguing that saving those who could in turn save others was a multiplier of good. Critics countered that such criteria risked reinforcing systemic inequalities - those already disadvantaged by social determinants of health might also be the ones more likely to be deprioritized.

Even within medicine, cultural perspectives vary. In certain Indigenous frameworks, value is placed on community continuity rather than individual survival probability, leading to allocation decisions that prioritize elders as cultural knowledge keepers. In contrast, Western bioethics often emphasizes impartial numerical fairness. These differences reflect broader philosophical divides: whether justice is best served by maximizing aggregate benefit or by protecting the intrinsic worth of each life, regardless of outcome.

The emotional toll on clinicians in such scenarios is profound. Moral injury - the distress from perpetrating, failing to prevent, or witnessing acts that transgress one's moral beliefs - is a common consequence of triage decisions. Studies from emergency medicine and military healthcare show that even when clinicians believe they made the "right" choice by guidelines, the human cost of knowing someone was left untreated can linger for years. As Paul Farmer once wrote, "The idea that some lives matter less is the root of all that is wrong with the world." Doctors may know, intellectually, that they acted justly in the aggregate, yet still grieve for the individual lost.

Black patients are less likely than White patients with a nonspecific diagnosis of interest to receive related diagnostic testing in the emergency department, according to a study published online Aug. 27 in JAMA Network Open.

Michael I. Ellenbogen, M.D., from the Johns Hopkins School of Medicine in Baltimore, and colleagues used a previously validated diagnostic intensity index to assess differences in diagnostic testing rates by race and ethnicity in an acute care setting. The study included emergency department discharges, hospital observation stays, and hospital admissions using administrative claims among emergency departments and acute care hospitals in Kentucky, Maryland, North Carolina, and New Jersey from 2016 through 2018. To estimate rates of nondiagnostic testing, nonspecific principal discharge diagnoses (nausea and vomiting, abdominal pain, chest pain, and syncope) were paired with related diagnostic tests.

Most (80.6 percent) of the 3,683,055 encounters in the study were emergency department discharges. The researchers found that compared with White patients, Black patients discharged from the emergency department with a diagnosis of interest had an adjusted odds ratio of 0.74 for having related diagnostic testing. In none of the acute care settings were other racial or ethnic disparities of a similar magnitude observed.

"White patients discharged from the emergency department had higher rates of nondiagnostic testing, suggesting higher levels of testing overuse. Although Black patients were subjected to less test overuse, this may have come at a risk of undertesting and missed diagnoses," the authors write.

One author disclosed being an inventor on a provisional patent for smartphone-based stroke diagnosis in patients with dizziness, as well as receiving industry grants.

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Our system must better balance profits with the needs of patients.

I'm the only physician in the emergency room. There are still several patients to see. The waiting room is overflowing, and the mountain of paperwork grows. I know there are consequences if I don't document what I've done, what I've seen, thought, heard, and who I've talked to. But then a patient's family member knocks on the door and says "Doc, can we talk about my mom? I'm worried."I want to talk with this person. I want to talk about her mom's prognosis and how her family should prepare. But I have other patients, and that mountain of paperwork keeps nagging at my subconscious. I speak with her, but I'm in a rush. She senses that. She is upset. But so am I. This family doesn't feel like I've listened to them. And it's extremely important that I do -- for the sake of their mother's health, but also for my mental well being as a caregiver.

The simple act of taking time and listening is one of the most important components of patient care. But as physicians we feel we do not have time to listen, much less harness and demonstrate compassion. According to a University of Chicago study from last year, it would take a primary care physician 26.7 hours per day to provide complete, guideline-based care for their average number of patients. These facts have consequences. Patients believe that healthcare systems put profit over patients.Healthcare workers enter the field to help patients. And patients expect us to help them. They want to be heard. They want us to listen. They want to be treated equitably, with compassion, and ultimately, to feel better. Compassionate care involves acknowledging the emotional distress and suffering of others, along with acting to improve their situation through motivation and relational efforts. Many physicians and nurses attribute burnout to the increasing corporatization of medicine, where companies prioritize "profits over patients."...Read more

Do you feel that capitalism and compassion are at odds? Does the need for profit hinder your care of patients? 

WEDNESDAY, April 17, 2024 (HealthDay News) -- There was a 67.4 percent increase in head and neck computed tomography angiography (CTA) ordering for emergency department patients presenting for headache or dizziness from 2017 through 2021, according to a study published online March 21 in Internal and Emergency Medicine.

Grant H. Rigney, from Harvard Medical School in Boston, and colleagues examined trends in head and neck CTA ordering in patients with emergent concerns for nonfocal neurological complaints and determined whether a correlation exists between imaging utilization and positivity rates. The analysis included data from 24,892 patients presenting with headache and/or dizziness to the emergency department of a single quaternary referral center (January 2017 through December 2021).

The researchers found that 9.1 percent of patients underwent head and neck CTA imaging, with an increase in the percentage of patients who received a scan from 7.89 percent in 2017 to 13.24 percent in 2021. This increase represents a 67.4 percent increase from baseline (odds ratio, 1.14). Over time, the positivity rate (the percentage of scans ordered that revealed attributable acute pathology) declined from 16.8 percent in 2017 to 10.4 percent in 2021 (odds ratio, 0.86), a 38 percent reduction in positive examinations.

"This finding suggests the increasing trend does not reflect increasing need, and that hospitals should take steps to ensure that imaging is appropriately used," co-senior author Marc Succi, M.D., also from Harvard Medical School, said in a statement.

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FRIDAY, May 12, 2023 (HealthDay News) -- Outside advisers for the U.S. Food and Drug Administration voted Thursday to recommend approval of Neffy, the first epinephrine nasal spray for severe allergic reactions.

Although most of the Pulmonary-Allergy Drugs Advisory Committee members supported the spray for adults (16:6) and children (17:5), key questions linger about whether more data are needed from its maker, ARS Pharmaceuticals, CBS News reported.

But Richard Lowenthal, cofounder, president, and CEO at ARS, said in a company statement following the vote, "We believe our clinical data from more than 600 individuals demonstrate Neffy's absorption-enhancing nasal spray technology is comparable to injectable products in delivering potentially lifesaving epinephrine, but with unique advantages of being small, needle-free, and conveniently sized."

Neffy delivers a 2-mg dose of epinephrine. Instead of large clinical trials, the drug company compared its product to already approved injectable epinephrine products, such as the EpiPen. It showed the results for Neffy were neither substantially higher or lower than injectable epinephrine.

"The effects of epinephrine on blood pressure and heart rate are surrogates for efficacy and are important in determining if someone is responding to treatment," Carlos Camargo, M.D., a professor of emergency medicine at Harvard Medical School in Boston, said in the company's news release. "With Neffy, blood pressure and heart rate are comparable to EpiPen with a single dose -- and with a second dose of Neffy, increases in systolic blood pressure were statistically higher, even better than revealed in the available data from EpiPen, which is crucial for patients requiring a second dose for a severe allergic reaction."

Epinephrine has been used since 1901 via injection. It was never put through the same approval process as drugs are now because it was on the market before the FDA existed, CBS News reported. That means the FDA does not have a lot of data it can use to compare Neffy's effectiveness in saving patients who are having a severe allergic reaction. As a result, it is not entirely clear whether the nasal spray will work as well as injectable epinephrine.

The FDA is expected to make its decision on whether to approve Neffy by the middle of this year. The company has said it could start selling the spray in late 2023. The drug is designed to work for patients who weight at least about 66 lb.

The company's research included a survey showing that people would be likely to use the spray 18 minutes earlier than an injectable medication, and as many as 35 percent more people would carry it with them.

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In election results that showed protecting women's reproductive freedoms matter to a majority of Americans, abortion rights measures passed in seven states and failed in three.

Missouri, Arizona, Nevada, Colorado, New York, Maryland and Montana all backed those rights, while such amendments were defeated in Florida, Nebraska and South Dakota, leaving those state bans intact.

Voters in Missouri cleared the way to undo one of the nation’s most restrictive abortion bans, while Nevada voters also approved a similar measure. However, the Nevada measure will have to be passed again in 2026 for it to take effect, the Associated Press reported.

“Today, Missourians made history and sent a clear message: decisions around pregnancy, including abortion, birth control and miscarriage care are personal and private and should be left up to patients and their families, not politicians,” Rachel Sweet, campaign manager of Missourians for Constitutional Freedom, told the AP.

The abortion landscape changed dramatically in the summer of 2022, when the U.S. Supreme Court overturned the landmark Roe v. Wade decision. That 2022 ruling erased a nationwide right to abortion and cleared the way for state bans to take effect.

Missouri becomes the first state where a vote will undo a ban that’s already in place. Currently, abortion is barred at all stages of pregnancy, except when a medical emergency puts a woman’s life at risk.

Meanwhile, Florida became the first state since Roe v. Wade was overturned where abortion opponents won on a ballot measure. While most voters supported an amendment to make abortion a constitutional right, it fell short of the required 60% for passage. Unlike Florida, most states only require a simple majority for constitutional amendments.

Marjorie Dannenfelser, president of the national anti-abortion group SBA Pro-Life America, said in a statement that the result is “a momentous victory for life in Florida and for our entire country.”

The defeat makes permanent the removal of Florida as a destination for abortion for women from nearby Southern states with tough bans. The nearest states with looser restrictions are North Carolina and Virginia, the AP reported.

“The reality is, because of Florida’s constitution, a minority of Florida voters have decided Amendment 4 will not be adopted,” Lauren Brenzel, campaign director for the Yes on 4 Campaign, told the AP.

Still, other states guaranteed abortion rights.

Arizona’s amendment will replace a law that bans abortion after the first 15 weeks of pregnancy. The new measure guarantees the right to an abortion until viability, the AP reported.

In Maryland, the abortion rights amendment won’t make an immediate difference to abortion access because the state already allows it.

Meanwhile, the Colorado measure exceeded the 55% of support required to pass. Besides enshrining access, it also undoes an earlier amendment that barred using state and local government funding for abortion.

And in New York, an equal rights law that will bolster abortion rights also passed. It bans discrimination on the basis of “pregnancy outcomes, and reproductive health care and autonomy,” the AP reported.

At this point, 13 states are enforcing bans at all stages of pregnancy, with some exceptions, the AP reported. Four more bar abortion in most cases after about six weeks of pregnancy -- a time period before most women realize they’re pregnant.

Despite state bans on abortion, a recent report found the number of monthly abortions in the United States has risen slightly, mostly because of the growing use of abortion pills and organized efforts to help women travel for abortion.

More information

The National Library of Medicine has more on abortion.

SOURCE: Associated Press

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WEDNESDAY, May 24, 2023 (HealthDay News) -- Four red-flag signs and symptoms may signal an elevated risk for early-onset colorectal cancer (CRC), according to a study published online May 4 in the Journal of the National Cancer Institute.

Cassandra D. L. Fritz, M.D., from Washington University in St. Louis, and colleagues used data from 5,075 incident early-onset CRC among U.S. commercial insurance beneficiaries and matched controls with two or more years of continuous enrollment (2006 to 2015) to identify red-flag signs/symptoms between three months to two years before the index date among 17 prespecified signs/symptoms.

The researchers found that four red-flag signs/symptoms (abdominal pain, rectal bleeding, diarrhea, and iron deficiency anemia) were associated with an increased risk for early-onset CRC (odds ratios [ORs], 1.34 to 5.13). Risk increased with more of these signs/symptoms (one: OR, 1.94; two: OR, 3.59; three or more: OR, 6.52). Even stronger associations were seen for younger ages and rectal cancer. Roughly one in five cases (19.3 percent) had their first sign/symptom occur between three months and two years before diagnosis (median diagnostic interval, 8.7 months), whereas 49.3 percent had the first sign/symptom within three months of diagnosis (median diagnostic interval, 0.53 months).

"It's also crucial to spread awareness among primary care doctors, gastroenterologists, and emergency medicine doctors," a coauthor said in a statement. "To date, many early-onset colorectal cancers are detected in emergency rooms, and there often are significant diagnostic delays with this cancer."

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Inappropriate antibiotic prescribing is common with or without a plausible antibiotic indication, and inappropriate prescribing is also common in U.S. emergency department visits, according to a study published online April 26 in the Journal of General Internal Medicine and a second study published May 14 in Antimicrobial Stewardship and Healthcare Epidemiology.

Joseph B. Ladines-Lim, M.D., Ph.D., from the University of Michigan in Ann Arbor, and colleagues examined the differences in inappropriate prescribing with or without a plausible indication between safety-net and non-safety-net populations. The analyses included 67,065,108 and 122,731,809 weighted visits for children and adults, respectively. The researchers found that the prevalence of inappropriate antibiotic prescribing was 11.7 and 22.0 percent, respectively, with a plausible indication among children in the safety-net and non-safety-net populations and 11.8 and 8.6 percent, respectively, without a plausible indication. For adults, the corresponding prevalence was 12.1 and 14.3 percent and 48.2 and 32.3 percent.

In a second study, Ladines-Lim and colleagues used national emergency department visit data from 2016 to 2021 to estimate the proportion of visits with inappropriate antibiotic prescribing. There were 819,395,799 weighted emergency department visits; 18.6 percent of these visits had one or more antibiotic prescription. The researchers found that 27.6 percent of the visits with antibiotic prescriptions had inappropriate prescribing, with 14.9 and 12.7 percent, respectively, with and without a plausible antibiotic indication. Of visits with inappropriate antibiotic prescribing, 54.0 and 46.0 percent had and did not have a plausible antibiotic indication, respectively.

"Emergency department antibiotic stewardship initiatives should focus both on reducing antibiotic prescribing for infectious, antibiotic-inappropriate conditions and on improving coding quality for antibiotic prescriptions," write the authors of the second study.

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MONDAY, July 24, 2023 (HealthDay News) -- For patients with gout and type 2 diabetes, sodium-glucose cotransporter-2 inhibitors (SGLT2is) are associated with a reduced risk for recurrent gout flares and gout-primary emergency department visits and hospitalizations, and they confer cardiovascular benefits, according to a study published online July 25 in the Annals of Internal Medicine.

Natalie McCormick, Ph.D., from Massachusetts General Hospital in Boston, and colleagues compared gout flares and cardiovascular events among patients with gout and type 2 diabetes initiating SGLT2is versus dipeptidyl peptidase 4 inhibitors (DPP-4is) in a propensity score-matched cohort study.

The researchers found that the flare rate was lower among SGLT2i initiators than DPP-4i initiators after propensity score matching (52.4 versus 79.7 events per 1,000 person-years, respectively; rate ratio [RR], 0.66; rate difference [RD], −27.4 per 1,000 person-years). For gout-primary emergency department visits and hospitalizations, the corresponding RR and RD were 0.52 and −3.4 per 1,000 person-years. For myocardial infarction, the corresponding hazard ratio and RD were 0.69 and −7.6 per 1,000 person-years. The hazard ratio for stroke was not significantly lower. A higher risk for genital infection was seen for those who initiated SGLT2is (hazard ratio, 2.15); the risk for osteoarthritis encounter was not altered.

"Given the pleiotropic cardiometabolic benefits associated with SGLT2is among patients with type 2 diabetes, this class of medications may be a particularly attractive addition to our current urate-lowering therapies to simultaneously address the high burden of gout and cardiometabolic sequelae," the authors write.

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The U.S. Supreme Court announced Monday that it would hear a case on a Tennessee law that bans transgender minors from receiving certain medical treatments in that state.

The banned treatments include puberty-blocking drugs or hormonal therapies.

It's the first time the court will hear arguments regarding transitional medical care for transgender youth.

The issue is whether the new law violates the Constitutional rights of those seeking such care, according to the Biden Administration, which has asked that the court take up the case, United States v. Skrmetti.

The administration asserts that a ban prohibiting treatment for gender dysphoria in youths “frames that prohibition in explicitly sex-based terms.”

According to a petition to the court from Solicitor General Elizabeth Prelogar, the Tennessee law bans transgender medical care but “leaves the same treatments entirely unrestricted if they are prescribed for any other purpose.”

The case has already moved through federal courts, which have rendered varying decisions.

Republican-led states around the nation have pushed for laws in recent years focused on restricting gender-transition care, and at least 20 states have passed measures that do so, the New York Times reported.

Earlier this spring, the Supreme Court justices temporarily allowed Idaho to curtail medical treatment for transgender youth, based on a state ban passed by the state's Republican-led legislature. The law makes it a felony for physicians to provide minors with transgender medical care such as hormonal therapies.

The nine Supreme Court justices passed that measure based on an emergency application, and votes appeared to split along ideological lines, the Times reported, with liberal judges dissenting.

The court is also being asked to consider a case in Kentucky, known as S.B. 150, which bans doctors from providing gender-transition surgery, puberty blockers or hormone therapy to people under 18, the Times reported.

The laws enacted in both Kentucky and Tennessee underwent a temporary hold last summer as federal judges in both states temporarily blocked the laws days before key sections were set to go into effect.

Later, a divided panel of the U.S. Court of Appeals for the Sixth Circuit overturned those decisions, and the treatment bans were reinstated in each state. The plaintiffs in each case have now brought their cases to the Supreme Court, the Times reported.

More information

Find out more about transgender health care at Johns Hopkins Medicine.

SOURCE: New York Times, June 24, 2024

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Finding evidence of what is known as "anchoring bias," UCLA-led research suggests that patients with congestive heart failure experiencing shortness of breath are less likely to be tested in the emergency department for a potentially fatal pulmonary embolism, or a blood clot in the lung, when the reason for the visit noted during the initial emergency department check-in process specifically mentions congestive heart failure instead of the broader "shortness of breath."Specifically, the authors found in this study that when the visit reason mentioned a patient's known congestive heart failure, the likelihood that the emergency room physician would test the patient for pulmonary embolism was reduced by one-third, even though that could be the cause of the shortness of breath. The study was published June 26 in JAMA Internal Medicine.

Rates of pulmonary embolism within 30 days of the emergency department visit were equal between patients with visit reasons that mentioned congestive heart failure and patients that did not have such visit reasons, suggesting that anchoring bias may have led to delays in diagnosis. Cognitive biases are believed to influence physician decision making. Among them is anchoring bias, which is when a physician focuses on a single, initial piece of information in the clinical decision-making process without sufficiently considering subsequent information about the patient's condition...Read more

How do you check yourself for 'Anchoring bias'?

Rules-based electronic triggers (e-triggers) are useful for post hoc detection of missed opportunities in diagnosis (MODs) in emergency department visits, according to a study published online Dec. 2 in JAMA Internal Medicine.

Viralkumar Vaghani, M.B.B.S., from the Baylor College of Medicine in Houston, and colleagues assessed the performance of a portfolio of e-triggers for identifying MODs in emergency departments. The analysis included treat-and-release emergency department visits at 1,321 Veterans Affairs health care sites.

The researchers found that 203 trigger-positive records were identified for high-risk stroke, 1,981 for symptom-disease dyads, 170 for high-risk abdominal pain, 116,785 for unexpected emergency department return, 14,879 for unexpected hospital return, and 2,090 for abnormal test results not followed up. From 625 randomly selected patient records, 47 MODs (positive predictive values [PPV], 47.0 percent) were identified for stroke, 31 MODs (PPV, 25.8 percent) for abdominal pain, 11 MODs (PPV, 11.0 percent) for emergency department returns, 23 MODs (PPV, 23.0 percent) for hospital returns, 18 MODs (PPV, 18.0 percent) for symptom-disease dyads, and 55 MODs (PPV, 52.4 percent) for test results. The most common diagnostic process breakdown involved the patient-clinician encounter for 108 of 130 MODs (excluding MODs related to the test result e-trigger). For 20 of 185 total MODs, patients experienced severe harm (10.8 percent), and 54 patients experienced moderate harm (29.2 percent).

"Interventions to target emergency department work system factors are urgently needed to support patient-clinician encounters and minimize harm from diagnostic errors," the authors write.

One author disclosed ties to the health information technology industry.

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FRIDAY, March 31, 2023 (HealthDay News) -- System- and patient-level interventions, including taking a best possible medication history (BPMH) in the emergency department, can reduce medication discrepancy rates, according to a study published online March 22 in BMJ Quality & Safety.

Jeffrey L. Schnipper, M.D., M.P.H., from Brigham and Women's Hospital in Boston, and colleagues conducted a study involving 4,947 patients at 17 North American hospitals that participated in the second Multicenter Medication Reconciliation Quality Improvement Study. The association of each system- and patient-level intervention on the adjusted number of medication discrepancies per patient in admission and discharge orders was analyzed.

The researchers found that patient exposure to seven of the eight system-level component categories was associated with modest but significant reductions in discrepancy rates (adjusted rate ratios [ARRs], 0.75 to 0.97), as were 15 of 17 individual system-level intervention components, including hiring, reallocating, and training personnel to take a BPMH and training personnel to perform discharge medication reconciliation. Independent associations were seen for receipt of five of seven patient-level interventions with large reductions in discrepancy rates, including receipt of a BPMH in the emergency department by a trained clinician and admission and discharge medication reconciliation (ARRs, 0.40, 0.57, and 0.64, respectively). The lowest discrepancy rates were experienced by patients who received both a BPMH in the emergency department and discharge medication reconciliation by a trained clinician (ARR, 0.08 per medication per patient).

"These findings provide specific guidance that hospitals and health systems can use to improve medication safety and protect patients from discrepancies," Schnipper said in a statement.

One author disclosed financial ties to Synapse Medicine.

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MONDAY, Jan. 29, 2024 (HealthDay News) -- For patients with acute pulmonary embolism (PE), the rates of discharge from the emergency department were stable between 2012 and 2020, according to a study published online Jan. 30 in the Annals of Internal Medicine.

Nathan W. Watson, from Harvard Medical School in Boston, and colleagues examined whether the proportion of discharges from emergency departments for acute PE changed from 2012 to 2020 in a serial cross-sectional analysis. There were approximately 1,635,300 visits for acute PE between 2012 and 2020.

The researchers found that the emergency department discharge rates remained constant over time, with rates of 38.2 and 33.4 percent between 2012 and 2014 and between 2018 and 2020, respectively (adjusted risk ratio, 1.01 per year; 95 percent confidence interval, 0.89 to 1.14). None of the baseline characteristics predicted an increased likelihood of emergency department discharge, including established risk stratification scores; however, the likelihood of receiving oral anticoagulation at discharge was increased for patients at teaching hospitals and those with private insurance. Overall, 35.9, 33.1, and 34.8 percent of patients who were considered low-risk according to their Pulmonary Embolism Severity Index (PESI) class, simplified PESI score, and hemodynamic stability, respectively, were discharged from the emergency department setting.

"Our findings show that outpatient management seems to have remained relatively unchanged during that period and that a considerable proportion of low-risk patients are still managed with inpatient hospitalization," the authors write.

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As scorching summer temperatures drive Americans indoors and millions travel for vacations and family gatherings, COVID infections are again climbing, U.S. health officials warned Monday.

In evidence that suggests a COVID summer wave is underway, case counts are most likely increasing in 39 states and aren’t declining anywhere in the country, new data from the U.S. Centers for Disease Control and Prevention show.

While the CDC no longer tracks COVID cases, it still estimates spread of the virus using data on emergency department visits. Both COVID deaths and emergency department visits have risen in the last week, while hospitalizations climbed 25% from May 26 to June 1, according to the latest CDC data.

“It looks like the summer wave is starting to begin,” Dr. Thomas Russo, chief of infectious diseases at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences, told NBC News.

Several new COVID variants are likely contributing to the summer spike in cases, Dr. Dan Barouch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center in Boston, told NBC News.

“We’re seeing the start of an uptick of infections that is coincident with new variants that are developing: KP.2 and KP.3 and LB.1. It does appear that those variants do have an advantage over the prior ones,” he added.

All three variants are descendants of JN.1, the version of the coronavirus that dominated this winter.

KP.2 became the dominant variant last month, and then KP.3 took over in early June, NBC News reported. Along with a third variant that shares the same key mutations, KP.1.1, the group now accounts for around 63% of all COVID infections in the United States, CDC data show.

Meanwhile, LB.1 accounts for another 17.5% of COVID infections. Experts said its rapid growth indicates that it’s likely to become dominant soon.

Still, “it’s sort of the newest kid on the block,” Barouch said. “There’s not much known about it.”

A preprint study released this month, which hasn’t yet been peer-reviewed, suggests LB.1 is more infectious and could be better at evading protection from vaccines or previous infections.

“Assuming that preliminary data is true, that it’s more immune-evasive and that it’s more infectious than KP.2 and KP.3, that’s a winning formula to infect more people,” Russo noted.

Apart from variants, experts said cases will probably continue to rise as people retreat indoors to escape the heat and gather to celebrate the Fourth of July.

Russo recommended that people who are vulnerable to infection and severe illness, or who are more likely to attend large parties or gatherings, consider getting the latest COVID vaccine.

He added that a monoclonal antibody drug called Pemgarda has been available since April for immunocompromised people. The antiviral medication Paxlovid can also lower the likelihood of hospitalization or death.

As for young, healthy people, they can hold out for the updated COVID vaccines expected to arrive this fall, experts said.

This month, the U.S. Food and Drug Administration advised vaccine manufacturers to target the KP.2 variant. The CDC’s Advisory Committee on Immunization Practices is set to meet Thursday to decide who should get those shots.

More information

The CDC has more on COVID vaccines.

SOURCES: U.S. Centers for Disease Control and Prevention, data, June 24, 2024; NBC News

Copyright © 2020 HealthDay. All rights reserved.

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