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Physician Burnout May Be An Economic Burden

[bctt tweet=”Heavy workloads for physicians may lead to increased physician turnover and reduced clinical hours resulting to unprecedented economic problems” username=”Z6Mag”]

Medical Readiness and Training Exercise 15-3 | US Army Africa | CC BY 2.0

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Physicians, undoubtedly, have one of the most demanding jobs out there. Their role requires intense medical training, increased work hours, and a very diverse workload ranging from clinical to administrative work. As a result, some physicians experience what we call burnout, which is described as having physical, spiritual, and emotional exhaustion as well as feeling cynical, ineffective, or unaccomplished at work.

Burnout among physicians is associated with direr consequences since they handle the lives and well-being of human patients. This may lead to worsened health and work-life balance as well as the inability to deliver high-quality care for patients and increased incidences of medical errors.

Although anyone can experience burnout, estimates believe that burnout among physicians is twice the rate than those among other industries. Some factors that may have contributed to the high prevalence of physician burnout are the long working hours, fear of committing malpractice and being sued for it, as well as, the heavy burden of doing documentation and filling out medical records.

According to a study from the American Medical Association, 44% of U.S. physicians reported at least one symptom of burnout in 2017, while a 2018 report from the Physicians Foundation stated that about 78% among their surveyed participants admitted that they feel burnt out at least sometimes. Aside from the rising trend of physician burnout, the suicide rate among physicians is also increasing throughout the years.

Dr. Edward Ellison, who is the co-CEO of the Permanente Federation and executive medical director for Southern California Permanente Medical Group in Pasadena, wrote in an editorial that “beyond the anxiety, depression, insomnia, emotional and physical exhaustion, and loss of cognitive focus associated with physician burnout, an estimated 300 to 400 U.S. physicians take their own lives every year. That number is higher than the suicide rate for the general public by 40% for men and an astonishing 130% for women.”

Aside from the adverse effects of physician burnout to both the physician and the patients, there is also an accompanying economic burden. However, this concept is still poorly understood.

To have a better understanding regarding this matter, researchers from Stanford University, the Mayo Clinic, and the American Medical Association created a mathematical model that allows them to estimate burnout-associated costs-related to physician turnover and physicians reducing their clinical hours. The study was recently published in the Annals of Internal Medicine.

The model estimated that about $4.6 billion — with a range of $2.6 billion to $6.3 billion — can be attributed to physician burnout every year in the United States. These costs are taken into account concerning physician turnover and reduced clinical hours.

Moreover, at an organizational level, the cost is about $7600 — with a range of $3,700 to $11,000 — per employed physician every year. Compared to previous ones, this study’s cost estimate related to physician burnout is significantly lower. The annual burnout-related cost estimate of the 2018 healthcare task force report was $17 billion.

With the use of related research and industry reports, they considered costs of replacing a doctor who leaves their job, including costs to advertise the position, costs needed to hire and train a new physician, as well as the losses of a healthcare organization when the position remains vacant. However, several other factors were not considered because of the difficulty in quantifying, and these include malpractice lawsuits, loss of reputation, indirect lost revenue, and lower quality of care.

Some advocates worry that the trend of physician burnout may be expected to increase in the following years because of the growing aging population coupled with a possible shortage of physicians by 2030.

The co-author of the study, Joel Goh, who is also an assistant professor at the National University of Singapore, even said that “over the next 20 or 30 years, it looks as if the demands are projected to increase, and the supply is basically not going to be able to catch up. We’re starting to feel some of the effects today,” according to Time. With this pressing issue, there could be a more substantial and problematic economic burden in the future, aside from the reduced quality of patient care.

Fortunately, this could be prevented when healthcare organizations start to prioritize the well-being of their physicians. There should be efficient workloads, flexible schedules, as well as an effective support system.

In Cleveland Clinic, the Icahn School of Medicine, and Stanford Medicine, they have initiated the appointment of chief wellness officers to help in addressing the issue regarding burnout among their physicians.

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Doctors can now cure Ebola with a 90% survival rate

Two new ebola drugs have been found effective to treat infected patients and will be used to administer in the Democratic Republic of the Congo.

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Ebola can no longer be considered as an incurable disease, scientists claim as positive results have been found in a trial run of drugs in the Ebola-struck country of the Democratic Republic of the Congo.

According to the research, which is still in its early stages, two of the four drugs in the trial was found to increase the survival rate of patients already infected by Ebola by up to 90% if treated early.

The trial is being conducted by an international research group coordinated by the World Health Organization (WHO) consisting of the US National Institute of Allergy and Infectious Diseases (NIAID), and pharmaceutical companies.

“From now on, we will no longer say that Ebola is incurable,” said Prof Jean-Jacques Muyembe, the director-general of the Institut National de Recherche Biomédicale in DRC, which has overseen the trial. “These advances will help save thousands of lives.”

Although there is a pre-existing experimental vaccine against Ebola that medical practitioners are offering, it does little for the thousands of others that are already infected by the disease.

Just a month ago, the World Health Organization announced that the deadly Ebola virus is now an outbreak in the Democratic Republic of Congo making the virus a global health emergency.

The outbreak in Congo has been ongoing for almost a year, with 2,418 confirmed cases and 1,676 deaths. The WHO estimates 12 new cases are reported daily, making the situation the second deadliest Ebola epidemic ever.

In an effort to mitigate the ongoing outbreak and amid rising tensions in Congo, the research team sought to test four drugs to treat Ebola and measure its effectiveness.

Primarily, a drug called ZMapp is currently considered the standard of care during Ebola outbreaks. It had been tested and used during the devastating Ebola epidemic in West Africa in 2014 where the virus killed more than 11,000 people. In Particular, ZMapp was used in Sierra Leone, Liberia, and Guinea.

Patients who took Zmapp experienced an overall mortality rate of 49%, while the numbers can go as high as 75% for patients who do not seek medical treatment, Anthony Fauci, director of the NIH’s National Institute of Allergy and Infectious Diseases said.

The trial was initiated back in November where patients from four treatment centers in the east side of the country—where the infection was the worst—were randomly assigned to receive one of four investigational therapies. Patients could either receive an antiviral drug called Remdesivir or one of three drugs that use monoclonal antibodies. 

The goal of the trial was to determine whether or not any of the four drugs administered were promising or effective enough to outperform the currently used Zmapp drug.

Based on the initial results of the experiment, scientists were able to significantly say that two of the four drugs—particular to those with monoclonal antibodies, which block the virus—had substantially more effect than Zmapp.

The preliminary data from the first 681 patients (out of a planned 725) showed results strong enough to prompt the WHO to stop the trial and to start administering the two effective drugs and to stop using both Zmapp and Remdesivir.

“This trial – the first-ever multi-drug randomized trial for Ebola – has happened despite such highly complex and challenging circumstance,” said Dr. Jeremy Farrar, the director of Wellcome and the co-chair of the WHO Ebola therapeutics group. “A long-running outbreak like this takes a terrible toll on the communities affected and it is a sign of just how difficult this epidemic has been to control that there have already been enough patients treated to tell us more about the efficacy of these four drugs.”

The monoclonal antibody cocktail produced by a company called Regeneron Pharmaceuticals had the biggest impact on lowering death rates, down to 29%, while NIAID’s monoclonal antibody, called mAb114, had a mortality rate of 34%. Consequently, death rates dropped to 11% with mAb114 and just 6% with Regeneron’s drug.

Comparatively, ZMapp’s mortality rate was 24% and 33% with Remdesivir.

Monoclonal antibody drugs are effective because they are a cocktail, and have become a mainstay of modern medicine. Primarily, these type drugs are used to create specific antibodies that hamper viruses like Ebola from infecting other cells but specifically is meant to effectively target Ebola’s shape-changing characteristics where drugs—that aren’t cocktails—are not effective of doing so.

Now, a new trial will start but this one will mainly focus on the effectiveness of the two drugs and to test particular situations where the drugs can be administered, according to the WHO’s director of health emergencies, Mike Ryan.

“Today’s news puts us one more step to saving more lives,” said Ryan. “The success is clear. But there’s also a tragedy linked to the success. The tragedy is that not enough people are being treated. We are still seeing too many people staying away from treatment centers, people not being found in time to benefit from these therapies.”

“We won’t ever get rid of Ebola but we should be able to stop these outbreaks from turning into major national and regional epidemics,” Farrar said.

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Canada-US Drug Import Plan Set To Provide Cheaper Alternative

Trump administration wants to make drugs imported from Canada legal and safe.

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In hopes for re-election, the Trump administration announced Wednesday that it would create a way for Americans to legally and safely import prescription drugs from Canada to address public outcry regarding price hikes.

President Donald Trump is feeling the pressure from a 2016 campaign promise, where he said to weaken the import ban on pharmaceutical drugs to provide cheaper alternatives.

If the promise goes through, this would be the first time that Canada will be allowed to import drugs to its neighbor country — reversing years of refusals by health authorities.

Health and Human Services Secretary, Alex Azar, made the announcement and said that the administration recognizes that prescription drug — manufacturing and distribution — is now international.

“The landscape and the opportunities for safe linkage between drug supply chains [have] changed,” Azar said.

“That is part of why, for the first time in HHS’s history, we are open to importation. We want to see proposals from states, distributors, and pharmacies that can help accomplish our shared goal of safe prescription drugs at lower prices,” the secretary added.

Previous administrations had been skeptical with the import of prescription drugs and have sided with the industry on the importation — noting concerns that those drugs could expose patients to risks from counterfeit or substandard medications.

However, this system has allowed U.S. pharmaceutical companies to raise prices without competition. In light of the upcoming 2020 election, health care has been a heated topic of debate, and candidates have made bold promises of changing the system to cater all Americans.

Furthermore, consumer complaints have also made waves, demanding legislation to change to rein in costs for life-sustaining drugs.

“For too long American patients have been paying exorbitantly high prices for prescription drugs that are made available to other countries at lower prices,” Azar said in a statement.

Most patients take affordable generic drugs to manage conditions such as high blood pressure or elevated cholesterol.

The prices for life-sustaining medications such as for cancer or hepatitis C infection annual costs can run up to $100,000 or much more. And long-available drugs like insulin have seen consecutive price increases that forced residents with diabetes to ration their doses.

As a form of protest, two groups have recently visited Canada to buy their much-needed insulin dosages, where a regular $350 to $450 vial in the U.S. can be purchased for only $35 to $45.

The second group was part of Vermont Sen. Bernie Sanders’ campaign to roll back prices on insulin and other drugs and lead an example of how he wants to implement the same healthcare system in Canada to the U.S.

While U.S. regulations cannot keep prices low enough for low-income Americans, the Trump administration’s latest announcement will at least provide a cheaper alternative compared to the overpriced variants available in the country.

Azar, who used to be skeptical of drug importation, and was once quoted dismissing it as a gimmick, said U.S. patients would be able to import medications safely and effectively — with oversight from the Food and Drug Administration. This will also be able to qualm concerns regarding the quality of drugs being introduced in the country.

However, according to Azar, the complex regulations that the government is trying to create could take “weeks and months.” He called on Congress to pass legislation that would lend its muscle to the effort, making it harder to overturn the policy in court.

“The FDA has the resources to do this,” said acting FDA Commissioner Ned Sharpless.

“The agency is interested in considering any reasonable proposal that maintains the bedrock of safety and efficacy for the American consumer,” the commissioner added.

Per usual, the pharmaceutical industry opposed the move and indicated that it would be reckless and jeopardizes patients.

Stephen Ubl, president of the industry group Pharmaceutical Research and Manufacturers of America, called the plan “far too dangerous” for American patients.

“There is no way to guarantee the safety of drugs that come into the country from outside the United States’ gold-standard supply chain,” Ubl said in a statement. “Drugs coming through Canada could have originated from anywhere in the world.”

Other than from the American side, Canadian pharmacists fear changes to medication purchasing regulations in the U.S. will lead to further drug shortages during an already stressful period.

Canadian pharmacies are already experiencing shortages of more than 1,000 medications, amounting to the worst deficit seen in more than 30 years.

Joelle Walker, the vice president of public affairs for the Canadian Pharmacists Association, worries that on top of the potential drug shortages, the change in regulation could also increase the prices of drugs for Canadians.

“Pharmacists are there every day; they want to help patients that walk through their doors,” she said. “Our concern is what policies can be put in place to make sure that we’re not seeing massive amounts of medications that are designed for the Canadian market that end up going to the United States?”

Meanwhile, in response to speculation regarding the reliability and safety of drugs coming from Canada, the office of Health Minister Ginette Petitpas Taylor said in a statement that they are proud of Canada’s health care system and that the U.S.’ interest in Canadian medications is evidence of their “commitment to more affordable prescription drugs.”

Furthermore, addressing fears for Canadian drug supplies, Taylor said:

“Ensuring that Canadians have access to the medicines they need is one of our top priorities,” the statement continues. “We constantly monitor Canada’s drug supply, will be working closely with health experts to understand the implications for Canadians better and will ensure there are no adverse effects to the supply or cost of prescription drugs in Canada.”

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Two Competitive Teens Suffered Kidney Failure Because Of Squatting Too Much

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Two teenage girls from China went straight to the ICU after an uber-competitive match of who could do the most squats went out of control.

For 2 to 3 hours, the two girls claimed to have done at least 1,000 squats — an impressive number for someone who frequents the gym — but terrifying if you’re not the most active type of person.

“This is too embarrassing to say. I was chatting with [my friend] in Guandong over the Internet,” one of the girls, Xiao Tang, a 19-year-old sophomore at a college in Chongqing, China told China Press from the hospital.

Both of them started the competition over chatting online and bickering who had better stamina. Thus, they decided a squatting match would be a light exercise for them to determine who bested who.

Notably, both Xiao and her friend had immense competitive drives, and neither one of them are willing to back down and stop squatting.

“We both did not want to lose, and so we kept trying to beat each other,” she explained.

Eventually, both of them reached up to a thousand squats until they decided to call the match even.

Given that they were not entirely new to the idea of a workout, a little soreness and pain was expected.

But when the pain started to become unbearable, they figured that this was not the result of a simple workout.

“Something was wrong in the morning,” Xiao said. “First of all, my leg was not only sore, but I couldn’t bend it. Then I went to the bathroom and [my] urine was brown.”

Upon discovering the color of her urine, and along with the tremendous pain she was in, Xiao decided to seek medical treatment with the help of her boyfriend.

Doctors diagnosed Xiao with rhabdomyolysis, a severe condition caused by skeletal muscle injury.

It is not often for people to get diagnosed with this complication due to the result of extreme exercise or stress, but it remains to be a possibility.

Rhabdomyolysis occurs when the bloodstream is pumped too much with dead muscle fibers, to the point where they can overwhelm the kidneys.

Once both kidneys are compromised because of the amount of these dead muscle fibers that it needs to filter from the body, it could lead to severe and potentially fatal complications such as kidney failure and death.

In essence, because Xiao’s kidney was beginning to show signs of giving up and inability to do its job, her urine turned brown.

However, dead muscle fibers in the body’s bloodstream are not a bad sign at all. It is a natural result every time the body exerts physical effort.

It is basically how we build muscles, break them down every time we go on a long run, or lift some weights for them to heal, be better, and stronger. Each time we do this, we send out a protein called myoglobin through the bloodstream and to your kidneys, which filter them out.

The problem started for both these girls when they worked out too fast in such a short time. Meaning, their bodies were not accustomed to performing extremely strenuous activities; in this case, squatting 1,000 times when they have hardly done any prior exercise.

The way the body works is that it can train itself to handle heavier loads of strain, but this is developed over time. Doctors are not saying that doing a thousand squats is a bad thing, but doing so without proper training could certainly lead to severe complications.

”Getting this condition through extreme exercise is rare, ” Dr. Bruce Cohen, a medical officer for the FBI, told Live Science. ”Squats aren’t dangerous in and of themselves. The girls likely exerted themselves well above their physical limits to cause the condition.”

Rhabdomyolysis can also develop due to trauma, heatstroke, or the use of certain drugs, but for young people, overexertion seems to be a common cause. In 2018, a 17-year-old boy was hospitalized for five days after one strenuous, 90-minute weight-lifting session (he had not worked out for several years before the incident.) Another teen was diagnosed with it in 2015 after completing two strenuous football practices on the same day.

“Listen to your body,” Cohen said. “Don’t be stupid.”

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