5-Star Friday: That’s a great question …

5-Star Friday

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Good journalism, like good medical research, often begins with a clear and simple question.

Followed by clear and simple writing.

The articles our staff chose to highlight this week are good examples of this.

Can less be more? Why do some of our most vulnerable lack good care … or a good place to live? When does screening hurt more than help? And how do we know when a brain is really “dead”?

Great questions answered by some great journalists. Enjoy!

Gary Schwitzer

Gary Schwitzer | Publisher & Founder

In Defense of Less-Is-More • by John Mandrola, MD • Medscape

We usually shine a light on news stories in this 5-Star Friday feature. But this is an opinion piece written by a physician who is also very active on social media. Dr. John Mandrola wrote in response to an article in The New England Journal of Medicine by Dr. Lisa Rosenbaum entitled, ‘The Less-Is-More Crusade—Are We Overmedicalizing or Oversimplifying?’ Although Mandrola states that he and Rosenbaum are friends, he writes in disagreement with nearly every one of her points. It is far more important than a philosophical disagreement between physician-authors. It is an issue that is important for the general public, patients, and policy makers to consider. Both Rosenbaum’s original piece and Mandrola’s reaction have received a great deal of attention. Mandrola’s conclusion:

I believe there is a correct side of the medical waste/overuse argument. I want to be on that side.

The foundation of sound medical care, listening to patients, sharing decisions, and reading the literature critically are inexpensive, just, and likely to deliver improved outcomes. More and more, these basics need an advocate.

I will continue to be a proud less-is-more crusader—being against waste and overuse is not to be an enemy of nuance or innovation.

Kevin Lomangino

Kevin Lomangino | Managing Editor

A Baby Girl, Ready to Go Home, Is Still in the Hospital 400 Days Later • by Caroline Chen • Bloomberg

The fruit of more than a year’s worth of reporting, this piece portrays another example of the ways our health care system fails the most vulnerable among us. It recounts, with heartbreaking clarity, the plight of children with chronic illnesses who could be cared for at home, but who are stuck in the hospital due to lack of coverage for home nursing care.

Unlike the elderly, for whom a certain level of health care is guaranteed under Medicare, children in the U.S. have no overarching protections. While children with medically complex problems from the poorest families receive some coverage for home nursing through federally funded Medicaid, other lower-income and middle-income families can wait years to get their child approved for such coverage. Most private insurance doesn’t cover nursing care at all.

Chen’s description of the heroic efforts some parents make to bring their children home will bring tears to your eyes. And it will make you wonder: What kind of system would inflict such cruelty on those who are already dealing with tragedy?

Jill Adams

Jill U. Adams | Associate Editor

Doing More Harm Than Good? Epidemic of Screening Burdens Nation’s Older Patients • Liz Szabo • Kaiser Health News

This story opens with an anecdote:

An 89-year-old woman with dementia gets a mammogram. However, the screening is not recommended for people with a limited life expectancy; also, it’s expensive and it may cause harm. A perfect quote that brings the doctor’s credo to mind:

“We find something that wasn’t going to hurt the patient, and then we hurt the patient,” said Dr. Sei Lee, an associate professor of geriatrics at the University of California, San Francisco.

The story highlights all the caveats about screening, weighing benefits and risks, which only become more exaggerated in the very old (age 75 and older) and describes several efforts to curb the practice. So why are older people still being screened for cancer? Patients want to continue and they don’t want to be told their odds of dying in 10 years. Also, Szabo writes, over screening is “a result of medical culture, aggressive awareness campaigns and financial incentives to doctors.”

Joy Victory

Joy Victory | Deputy Managing Editor

Alive Inside • Mike Hixenbaugh • Houston Chronicle

Patients who suffer severe brain injuries are often written off too soon by medical professionals as either brain dead or vegetative, reports Mike Hixenbaugh of the Houston Chronicle, when in fact they may be capable of healing:

Thousands of people are discharged to nursing homes or acute care hospitals each year, assumed to be unconscious after suffering a severe brain injury. Experts now believe a staggering number of these patients — more than 40 percent, according to some estimates — are covertly aware, in what scientists have dubbed the “minimally conscious state.”

Through the story of Nick Tullier, a Louisiana sheriff’s deputy who was shot in the head, we see exactly what that looks like. After months of lingering in a hospital bed, Tullier is transferred to one of the few facilities in the nation that focus on what’s dubbed “disorders of consciousness.” It quickly becomes apparent that he was, as the series explains, alive inside. This story, which was published in late 2017, clocks in at 12,000 words, but it’s a fast, wild and often heartbreaking ride examining how we should take care of the critically brain wounded.

Michael Joyce

Michael Joyce | Writer-Producer

A physician homebuilder tries to upend the nursing home industry — and give seniors back their independence • by Bob Tedeschi • STAT

We cover a lot of interventions each week at HealthNewsReview.org … drugs, surgeries, medical devices, food, drinks, exercises, and oils … but never to my knowledge have we dipped into architecture and design.

You can file this article under “thinking outside the box” or “turning the status quo upside down” because the physician at the heart of this story one day decided that nursing homes, as we know them, don’t seem to work. His solution is one part tiny house movement, the other part commune (ADA compliant, of course!).

It’s good reporting by Tedeschi who gives us an intimate view into the unconventional thinking of a passionate advocate, but still takes his subject to task, and leaves us wondering: “is there a better way?”

Please Note: These stories have not been subject to our rigorous, 10-criteria systematic review for accuracy, balance, and completeness. Rather, they represent pieces of health care journalism that members of our staff found compelling and wanted to share with others.

If you’d like to browse some of our previous 5-Star Fridays click HERE.

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