1 December 2016

Five Medical Practices That May Soon Be Outdated

With scientific advances and better health knowledge changing the health care industry almost daily, it’s sometimes worth reflecting on the policies and practices best left in the past. In the face of great systemic changes anticipated for 2017, a recent STAT article theorized about five industry activities that may soon become as outdated as hospital cigarette shops and cure-all bloodletting treatments. 

1. Advising doctors not to apologize

Doctors have only been saying sorry to patients within the last decade, which marks a change from the previous industry status quo of doctors not acknowledging or disclosing mistakes. Medical errors were considered incidental lapses, and an admittance of error could increase the likelihood of patients filing malpractice suits against the hospital, using the apology as incriminating evidence.

With the industry’s enduring emphasis on value-based care, silence has given way to a new culture of medical transparency. Hospitals are now training their doctors and medical staff on the proper ways to disclose mistakes in treatment and apologize to their patients. Many medical errors are now considered symptoms of larger systemic problems, making hospitals more comfortable with the potential legal and financial consequences of disclosure. As of 2014, 36 states and Washington, D.C. have passed laws allowing medical staff to apologize for errors without legal reprisal, and multiple studies have shown that the disclosure of medical errors reduces the rate of malpractice suits. 

2. Prescription labels that leave off what the drug is treating

​For all the important information that is included on drug labels – such as patient information, the name of the drug, required dosage and directions for use – drug labels typically do not include information on what the drug treats. Not only can this be generally confusing for patients, especially those who have multiple prescriptions, but the confusion can even be deadly, leading to accidental misuse, negligence, prescription mixing and other unintended consequences.

Doctors don’t always write intended treatment information in the patient’s medical record, and pharmacies might not print doctors’ notes. There are also concerns (pdf) about patient privacy and the consequences of narrowly defining what a drug can treat, especially when it comes to drugs that are being used experimentally. However, heightened patient safety is now a key concern for the health care industry, and some doctors are starting to advocate for the inclusion of what drugs treat on prescription labels.

3. Watching hospital staff wash their hands

With the ever-present threat of infection that plagues hospitals settings, especially now in the face of antimicrobial-resistant pathogens, or “superbugs,” hospitals have been quick to try and curb the spread of disease among their hospital staff. Along with mandating frequent switching of scrubs and providing antibiotic-free meat for meals, hospitals have also stationed observers to watch and encourage medical staff to wash their hands properly. While initial results yielded high rates of hand-washing, it unfortunately became apparent that overt observation caused superficial behavior change, as hand-washing rates significantly declined under more covert observations.

As hygiene is an important part of patient safety, there have been numerous initiatives to encourage hand-washing without the need to monitor medical staff. The Joint Commission Center for Transforming Healthcare created a tool to identify the reasons why staff were not washing their hands, ranging from schedule distractions to soap dispensers being too far away. By isolating these contributing factors, hospitals can now enact more permanent environmental changes for better personal care among medical staff. 

4. Spending more time on paperwork than on patient care

Doctors face a large burden when it comes to maintenance of patient information, especially in the modern health care system. While doctors have approved of the implementation of electronic health records (EHR) as a readily accessible database of patient information, the time-consuming nature of data entry has left little time for doctors to treat patients in an effective and compassionate manner. Further, this hindrance in providing patient care may signal that excessive data entry is an indirect contributing factor in physician burnout.

With the final MACRA rule, CMS plans to simplify EHR use for patient medical documentation and required reporting. In addition, some hospitals are now trying to ease the paperwork burden by adding staff who can transcribe notes and allow doctors more time to focus on their patients.

5. Making it hard for patients to get medical records quickly

If it was difficult to get doctors to admit they made a mistake in treating their patients, it was all but impossible for patients to gain access to their medical records until recently. As with apologies, the health care industry feared patients filing malpractice suits based on the information in their medical reports. Further, blocking access to medical information also shielded patients from bad news about their health, theoretically allowing doctors more time to treat patients and prevent concern over difficult but ultimately treatable ailments.

However, transparency and awareness of patient needs are starting to quickly reverse this medical trend. Recently, the Office for Civil Rights in the United States Department of Health and Human Services released a series of guidelines to educate patients on their rights to access their medical information under HIPAA. The increased use of EHR has greatly expanded and simplified the process of accessing patient medical records as well, removing the traditional obstacles of unnavigable, expensive and time-consuming paper documentation. While some patients and physicians have voiced concerns about electronic records, such as limited access to all personal medical history and doctors’ notes, continued technological improvements and encouragement from the federal government could further progress this trend of expanded patient engagement.