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Morning Report

The Morning Report provides a quick look at today’s medical news, research and features.  









Panel Recommends Changes To U.S. Doctor Training System
An expert panel recommended Tuesday completely overhauling the way government pays for the training of doctors, saying the current $15 billion system is failing to produce the medical workforce the nation needs. The federal government, mostly via the Medicare program, currently provides more than $11 billion per year in payments to support the training of doctors who have graduated medical school. Most of that goes to the hospitals that sponsor interns and residents. States, through the Medicaid program, contribute nearly another $4 billion annually.

But there are little data on how those funds are spent and how well they contribute to the preparation of a medical workforce needed for the 21st century. Despite a growing public investment in graduate medical education (GME) support, there are persistent problems with uneven geographic distribution of physicians, too many specialists and not enough primary care providers, and a lack of cultural diversity in the physician workforce, the report found.

Not only that, the authors note, “a variety of surveys indicate that recently trained physicians in some specialties cannot perform simple procedures often required in office-based practice and lack sufficient training and experience in care coordination, team-based care, and quality improvement.”

Among those that would be most immediately affected are major teaching hospitals in the Northeast, which currently account for a disproportionate amount of Medicare medical education funding and number of doctors-in-training. The panel called for an end to the current system of payments that favor those hospitals, and instead for Medicare to make a flat “per resident” payment to training sponsors based on the national per-resident amount, adjusted for geography. (Physicians News)

Judges Reveal Secrets To Successful Malpractice Trials
When it comes to the outcome of a medical malpractice jury trial, a physician’s attitude, demeanor, and presentation make all the difference, say judges who’ve presided over many such cases.

“The fact finder has to look at them and find them credible and sincere when they’re hearing their story,” said Lorenzo F. Garcia, chief magistrate judge emeritus for the U.S. District Court for the District of New Mexico. “There’s truth and there’s perception, and perception can trump the truth. In litigation, being right isn’t always good enough. You can be right in a claim or right in a defense and still lose if the fact finder doesn’t believe the testimony or dislikes a person, witness, or an attorney.”

Exhibiting arrogance or defensiveness when testifying can quickly sway a jury against a defendant doctor, adds Judge Garcia, who provided trial insight with several other judges at the American Conference Institute’s obstetric malpractice claims forum. When taking the stand, it helps to remain respectful at all times, refrain from acting combative, and demonstrate concern when discussing patients who were injured, he said.

Physicians should also be aware of how their attorneys are presenting themselves and interacting with legal parties. Being rude to judges, litigants, or attorneys can have a negative impact on jurors’ view of that particular side, said Sandra Mazer Moss, a retired Philadelphia Court of Common Pleas judge. (Clinical Psychiatry News)

How To Correct That ‘Gummy Smile’
Susanna Miller-Pence’s teeth weren’t the problem; her gums were. When she smiled, her upper lip stretched up so high that a ribbon of pinkish gum was exposed, giving her a so-called “gummy smile.” She hated it. Fifteen years ago, she had a gingivectomy, an operation to remove some of the extra gum tissue. A month later, she was grinning broadly. “Now everyone comments on my smile,” she said.

Gummy smiles occur for a variety of reasons, most commonly a short upper lip, excessive gum tissue or small teeth, all of which are genetic. It’s hard to know how many operations are done annually to correct a gummy smile. In the past, surgery was the main treatment option, but that is often costly and painful. Doctors sever the muscles that elevate the upper lip so it can no longer rise as high, or they do a crown lengthening procedure that cuts away gum tissue so the crown appears longer.

Now people are going another route: onabotulinumtoxinA, otherwise known as Botox.

For the last few years, dentists have been injecting Botox into the upper lip “elevator” muscles. It paralyzes the muscles, inhibiting contraction of the upper lip when smiling to prevent the gummy smile.

In contrast to surgery, Botox is quick and easy, doctors who do the procedure say. And cheap. Botox costs around $350. Ms. Miller-Pence paid about $15,000 for her surgery and crowns, which was not covered by insurance. (NYT)


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