Residents' hours; liability crisis; Canadian pharmacies
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The Accreditation Council for Graduate Medical Education has approved final standards that generally limit residents to a maximum of 80 duty hours a week, including in-house call (limited to one every three nights). Residency programs will be able to increase that time by 10 percent "if doing so is necessary for optimal resident education and patient care."
The new rules, which take effect July 1, require a minimum of 10 hours off between daily duty periods and after in-house call. They also theoretically limit work to no more than 24 consecutive hours, but house staff may be required to remain on duty for up to six additional hours "to hand off patients to new teams, maintain continuity of care, or participate in educational activities."
A stateside physician who consulted via telephone and e-mail with doctors treating a boy with sickle cell anemia in Germany can't be held liable for the child's death, a US District Court has ruled. Doctors treating the boy at an Army hospital contacted a specialist at Walter Reed Army Medical Center seeking treatment recommendations. After the boy's death, his parents brought a wrongful death suit, contending that the consulting physician had failed to give appropriate advice.
The court, however, found that the consultant had no "duty of care" since her involvement was neither extensive nor continuous. Furthermore, the court noted, the mere fact that a treating physician informally seeks advice from a specialist doesn't impose on the consultant the duty to decide whether to order a specific test. "If it did," the court said, "no specialist would undertake to advise a primary care physician" on how to deal with a crisis.
Rep. Bernie Sanders (I-VT) has introduced legislation to prevent pharmaceutical companies from cutting off Canadian pharmacies that supply American patients. If enacted, manufacturers who try to prevent US consumers from purchasing their drugs from Canadian sources would be subject to civil money penalties of up to $1 million. The bipartisan legislation, which has 49 co-sponsors, is a response to GlaxoSmithKline's recent move to cut off Canadian pharmacies and wholesalers who sell the company's products to patients in the US. Meanwhile, The Canadian DrugStore, an Internet pharmacy, is urging its more than 100,000 customers to boycott GSK's over-the-counter products.
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Approximately 95 percent of physicians log onto the Internet for professional reasons, and more than 70 percent say the information they find there is having an impact on the way they interact with patients, diagnose illnesses, and determine what treatment to provide.
A growing number of physicians are also attending conferences and completing CME courses online. Forty-two percent of respondents said they'd attended a virtual conference in 2002, up from 31 percent a year earlier. Similarly, 58 percent had completed CME course work online last year, an increase of 29 percent over 2001.
The study was conducted by The Boston Consulting Group, a management consulting firm.
|Research clinical information||90%||90%|
|Read articles from medical journals||78||74|
|Communicate with colleagues||61||63|
A new survey from the Medical Group Management Association among group practices suggests that liability insurance premiums are indeed spiraling out of control and beginning to threaten access to care. Practices reported an average hike in premiums of 53 percent from 2002 to 2003. In response, 26 percent of the practices surveyed said that some of their physicians would retire, relocate, or limit their services over the next three years. In the same period, 23 percent will refer certain high-risk patients elsewhere.
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Joan Rose. UPDATE: Focus on practice. Medical Economics 2003;7:14.