Doctors Order Fewer Lab Tests When They Are Aware of the Prices
Doctors order fewer laboratory tests during a patient’s hospital stay if they know how much the tests cost, according to a new study.
Researchers found that doctors at one U.S. hospital ordered about 9 percent fewer lab tests - such as blood work - when their computerized records system displayed the price. “(Before the study) we saw a lot of waste. We saw a lot of tests that didn’t need to be ordered,” said Dr. Leonard Feldman, the study’s lead author from The Johns Hopkins University School of Medicine in Baltimore.
Part of the reason doctors order a lot of tests could be that they don’t know how expensive they are, according to the researchers. It’s estimated that the U.S. healthcare system wasted about $226 billion on overtreatment and unnecessary use of lab tests during 2011, Feldman and his colleagues wrote in JAMA Internal Medicine on Monday.
A scanning electron micrograph of human red blood cells. Courtesy of Wellcome Images.
When a tumor grows beyond a certain size, it begins to shed cells, not unlike particles flaking off dry skin. Exactly when or why this happens in humans isn’t known, but these cells, called “circulating tumor cells” or CTCs play a major role in the spread of cancer to other parts of the body, the process more formally known as metastasis.
Scientists believe CTCs could be a new and invaluable source of information in the diagnosis and prognosis of cancer, but a big part of the current challenge is finding enough them: For every million or so circulating blood cells, there may be only a few CTCs. It’s the proverbial search for a needle in a haystack, only the needle is infinitesimally smaller and moving inside the human body. CTCs are also not generally inclined to announce their presence – at least not until they’ve lodged somewhere else (a distant organ, for example) to colonize and grow a new tumor.
The existing gold standard for isolating and identifying CTCs is an assay in which blood samples are exposed to magnetic beads coated with an antibody that binds to specific proteins on the surface of cancer cells. The capturing efficacy of this method ranges between 60 and 90 percent, but it also takes time and is prone to contamination from leukocytes – white blood cells that may also stick to the beads.
Recently, researchers at the University of California, San Diego School of Medicine and Moores Cancer Center described a new, alternative filtering technique that employs microbubbles. Writing in the March issue of PLOS One, principal investigator Dmitri Simberg, PhD, assistant project scientist, and colleagues said each microbubble is about half the diameter of a blood cell, filled with perfluorocarbon gas (for buoyancy and stability) and coated with an antibody. Exposed to a blood sample, the bubbles quickly attach themselves to any CTC encountered and puls them into a greater concentration (think soda bubbles rising to the top of a glass).
In tests using blood samples from mice and humans, Simberg said the microbubble assay worked better and faster than existing approaches, reducing the risk of contamination or sample degradation.
Though more research is required, he noted that the microbubble method may represent “the emerging field of blood biopsies, in which highly pure CTCs could be used as a source of tissue for personalized molecular diagnostics.”
5 Ways To Get More Productive Today
Want to get more done in the next hour? Take 5 minutes to read this.
There might be some productivity-minded part of you that scoffs at the whole idea of reading about how to be more productive. After all, why would you read about doingwhen you could do?
Well, you can tell that part of you to stop being so addicted to being right and acknowledge that you can work smarter, not just harder. And when you can tap a multitude of perspectives of how to work smarter, you can get extremely productive.
Alice Boyes at Psychology Today has done that by gathering the productivity insights of a range of psychologists. Let’s unpack a few here.
“Without realizing it, I spent years trying to be productive in the most unproductive way,” says Susan Newman, “sitting at a desk for hours.”
Now she de-tethers by getting away from the office. She finds that moving around—be it to grab a cup of coffee, water a planet, or take a walk, makes her sharper. While it runs against what Anne Marie Slaughter calls “time macho” culture—“a relentless competition to work harder, stay later, pull more all-nighters, travel around the world and bill the extra hours that the international date line affords you”—more and more research shows that if you spend less time doing, you can get more done.
L. Kevin Chapman starts his productivity quest by closing the door to his office. While he likes to welcome colleagues and students, closing the door ensures that he stays on task. The next move: scheduling the tasks he wants to avoid. If he puts the put-off tasks into his schedule (and sets reminders on all devices), he is sure to tackle what needs to get done. “Action precedes motivation,” Chapman says. “These small steps facilitate more action and lead to me feeling accomplished.” And apps can help, too.
“Plan exercise breaks,” advises Craig Malkin. “Stress leads to binary (either/or) thinking, distractability, and procrastination.”
We know at least one company that’s putting that into practice. Why does stress relief help you get better work done? You’ll stay sharp, Malkin says, and you’ll boost your capacity for creative problem solving. That’s because creativity is a mammalian trait—and the protective parts of you won’t let it come out unless you feel safe.
We’ve discussed how where you work affects the work that you do, like how if you’re cold, you’re being physically distracted from the task at hand. Similarly, what you associate with your environment affects what happens there.
That’s why you should work in a place you associate with work, says Amy Przeworski, like an office building, library, cafe, or maybe a coworking space. If you need to keep your attention on something for a long time, it’s going to be hard to do so in a place you usually relax in—ever notice how you can’t work as well in the family room?
“Your surroundings set the stage for your focus,” Przeworski says. “If they are associated with work, you will focus on work.”
The space can also make your work a pleasure—that’s how Susan Cain sidesteps writer’s block. The Quiet author trained herself to love writing by “always writing in a beautiful cafe while drinking a latte and eating a chocolate chip cookie”—that’s one sweet way to love your work.
Kristine Anthis says that while you can’t always decide what projects you take on, when you do—like your college major or if your boss lets you select from a range of assignments—go after what you’re most interested in. It worked for her.
“Being passionate about what I do means that juggling the demands of teaching, writing, mentoring students, conducting research, and serving on committees is not necessarily always effortless,” she says, “but certainly gratifying.”
It’s also how you know if you have a career—or just a job.
[Image: Flickr user botterli]
What an octopus can teach you about management…
All of Earth’s successful organisms have thrived without analyzing past crises or trying to predict the next one,”writes Rafe Sagarin in HBR, free of “planning exercises,” “predictive frameworks,” or other buzzy human constructions. “Instead,” he says, “they’ve adapted.”
Consider the octopus: Fleet of tentacle and prismatic of color, the cephalopod is a paragon of flat, startup-style organizational structure:
An octopus … doesn’t order each arm to change a certain color when it needs to hide quickly. Rather, individual skin cells across its body sense and respond to change and give the octopus a collective camouflage.
If we take managers to be the brains of the octopus—a frightening proposition—employees, especially those with a customer touch point, are the spectacular, tentacular, color-shifting cells—a credo of the connected company. When you move with your feelers (or suckers, as is the case with eight-arms over there), you can move much quicker than your centralized competitors: Wikipedia over Brittanica, Google Flu Trends over the CDC.