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BackPage Online, October 2019

doi: 10.1097/01.BACK.0000585376.32411.c8
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Computers a Looming Barrier Between Doctors and Patients

Spine care providers sometimes spend as much as a third of their consultation time with patients staring into, and typing into, computers. Though this may facilitate the formation of the electronic medical record, it clearly interferes with the practice of medicine. And in fields such as back and spine care it means that patients sometimes never get a chance to fully air their symptoms and related problems.

University of Chicago researcher Wei Wei Lee, MD, acknowledges this disconnect. “Most patients want to go to the doctor to feel that they're heard and really be able to talk to the doctor about what's bothering them. When the computer is not used well, often it can make that patient less likely to go back to that physician if they felt like there was a disconnect in the way that they communicated. Other things that can happen are medical errors. If the doctor is more distracted during that visit, they may put in wrong orders for medications or not record a part of the history that is pertinent,” she noted in an article and podcast at Kaiser Health News.

However, Lee says there are low-tech ways that physicians can work around this disconnect and facilitate communication with patients.

Here is a link to the article and podcast:

https://khn.org/news/when-a-doctors-screen-time-detracts-from-face-time-with-patients/

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Evidence-Based Guidelines Haven't Consistently Led to Better Spine Care. Why Not?

At the beginning of the evidence-based guideline movement there was hope that they might revolutionize medicine, back care included. However, they haven't consistently done so for a variety of reasons. Although the content of the major national evidence-based back pain guidelines has been reasonably consistent, that is not true of the hundreds of guidelines employed in hospitals, healthcare centers, and clinics. And guidelines, of course, are a passive method of education. They have to attract followers, and be utilized consistently, to have an impact. Here is an article from the Health Affairs blog by health policy analysts Gilbert Benavidez, PhD and Austin Frakt, PhD on the challenges posed by clinical guidelines and efforts to implement them.

https://www.healthaffairs.org/do/10.1377/hblog20190730.874541/full/

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New Twist on Medical Tourism: Take a US Surgeon Abroad

A New York Times articles describes a new twist on medical tourism—the practice where US patients have major surgical procedures abroad to beat high US surgical charges. This practice is being enthusiastically endorsed by some American companies and their insurers. The North American Specialty Hospital or NASH has developed a medical business model where pre- and postsurgical care take place in the United States but surgery occurs in a hospital in Cancun, Mexico that has Joint Commission accreditation. US fellowship-trained surgeons are imported for the operations. There is a luxury hotel attached to the Cancun hospital. Thus far NASH is specializing in knee and hip replacement, but has plans to move into spine surgery as well. The operations in Mexico generally cost less than half of what they would in the United States.

Here is a link to the New York Times article:

https://www.nytimes.com/2019/08/09/business/medical-tourism-mexico.html?action=click&module=Top%20Stories&pgtype=Homepage

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