It turns out that all those reports of medical residents being humiliated by senior residents and made to endure sleepless shifts are true.
Ninety-three percent of U.S. medical residents report they've been mistreated at least once during their first year after medical school, according to a survey published last week in the Journal of the American Medical Association.
Most fledgling doctors also have watched their colleagues mistreat patients or make sleep-impaired decisions, says the survey of 1,277 medical residents across the U.S.
Nevertheless, residents gave their first year after medical school an average rating of good.
"They weren't ecstatic about it, but they didn't hate it either," says Steven Daugherty, a researcher at Rush Medical College in Chicago who oversaw the 1991 survey.
About half of residents said they felt belittled or humiliated by more senior residents. The mistreatment was often verbal, including public scolding and threats to their reputations or careers. But almost 39% also said they'd been slapped, pushed or hit, most often by patients.
Nearly two-thirds of women residents reported sexual harassment and discrimination. Some women, however, say the situation has improved.
"We are deeply troubled by the findings of the study," says Randolph Smoak Jr., M.D., vice chairman of the American Medical Association board of trustees. But he added that since the survey was conducted in 1991, significant reforms have been implemented at many hospitals.
Cursing their cursive.Maybe being so tired is what starts doctors down the road to bad penmanship, which studies have found affects everything from drug prescriptions to follow-up treatment. Well, Indiana University's medical school is taking a small step toward addressing the problem.
Beginning this fall, part of the school's new competency-based curriculum will include a "cursory examination of students' cursive abilities," says Antoinette Hood, M.D., an assistant dean and professor at the school. She emphasizes that while it will be a minor part of the curriculum, it will address an important problem. She says physicians who can't communicate proficiently-or legibly-only do a disservice to their patients and their profession. "But we're certainly not going to flunk anybody, and we're not going to make them take a test. After all, these are grown-ups," she says.
In one exercise, med students will write fictitious orders and then determine if the university's nursing students can read their writing. If not, the future docs will be strongly encouraged to get some training from a penmanship coach.
Hush money.Communities trust the board members of public and not-for-profit hospitals to protect their interests. And serving the poor is a core goal of such hospitals. But recent developments have called into question how much trustees need to know to enforce that benevolent mission.
The board of trustees at Halifax Medical Center in Daytona Beach, Fla., was kept in the dark about the hospital's having paid $34,000 to settle "patient dumping" charges. At least it was until MODERN HEALTHCARE* reported that Halifax and five other hospitals had settled fraud charges made by HHS' inspector general's office. The report, based on a freedom of information request, was followed up by a longer story in the Daytona Beach News-Journal.
Only one board member, Chairman James Foster, expressed disappointment in the hospital administration's decision to keep the settlement quiet. "Once a decision is made to settle something, that's when I think the board should have been informed," Foster told the News-Journal.
The rest of the board didn't seem to mind. When Halifax Chief Executive Officer Ron Rees apologized to board members for not telling them about the settlement, "several commissioners said Rees didn't need to apologize and, with a unanimous vote, applauded Rees for the way he handled the situation," the News-Journal reported.
Patient dumping is the illegal practice of turning away emergency room patients for lack of ability to pay. While Halifax did not admit to any wrongdoing in its settlement with the federal government, a state senator is using the settlement in his quest to abolish local tax districts throughout the state that provide money for county hospitals. Halifax receives about $15 million in public funding from one of these districts. The $15 million is used for indigent care.
Background checks.Verifying physician credentials costs more than $260 million annually for physicians, hospitals and health plans, according to Healthcare Credentials Management Services, a subsidiary of Deerfield, Ill.-based MMI Cos.
That's only 0.0003% of annual U.S. healthcare spending. But in the real world, it's still a big chunk of change.
Physicians and their office staffs spend more than 1 million days each year completing 1.5 million credentialing applications for hospitals and insurers at a cost of $112 million, according to HCMS. For hospitals and health plans, processing and collecting information costs $150 million to $375 million.
Of course, HCMS didn't release the figures for their entertainment value. The company is marketing a new Internet-based product that claims to improve efficiency and cut costs for physicians by 50%.
The name game.Vencor, a Louisville, Ky.-based long-term-care provider, recently engaged in a highly publicized spinoff of its real estate operations into a separate company called VenTrust. Now the firm will have to ensure that the industry knows what a Ventas is.
That's the new name for the real estate investment trust. It seems authorities in Delaware, where Vencor is incorporated, denied permission for the VenTrust name. They said that under state law, only banks can use the word "trust" in their name, says Susan Moss, Vencor's vice president of corporate relations.
Executives went back to the company's roots to come up with Ventas, which in Spanish means "sales." In French, vent is the root of the word for wind. When the company was launched 14 years ago, it sold ventilators as part of its long-term-care operations.
We're winded just following all this.