I received this comunication from the American Society for Reproductive Medicine
MEETING ANNOUNCEMENT —The Adequacy of Assisted Reproductive Technology Oversight
Monday, December 14, 2009
8:30 am – 3:00 pm
Mandarin Oriental Hotel
Washington, DC
Given the rather high profile incidents in infertility therapies that came to light in 2009, the leaders in reproductive medicine are asking questions about how best to prevent such incidents from occurring again. While little factual information is available on the specific incidents, we can and should assess where general oversight of the field is, and seek ways to improve it, if necessary
Accordingly the American Society for Reproductive Medicine is convening a meeting in Washington, DC to gather input on this important topic. Information will be exchanged between government agencies, patients, physicians, leading academic experts, and others.
Featured speakers will include:
Maurizio Macaluso, MD, DrPH, Centers for Disease Control and Prevention
James Goldfarb, MD, President, Society for Assisted Reproductive Technology
Jake Mayer, PhD, the Jones Institute, Eastern Virginia Medical School
Stuart S. Howards, MD, American Board of Urology
Barbara Collura, RESOLVE, The National Infertility Association
6 Steps to get more accurate medical diagnoseswas just printed by US News and World Reports along with Newsday. I was interviewed for this segment and asked to share some of the methods I developed and use to deliver the best possible results for my patients with infertility at Gold Coast IVF in Syosset, NY. I provided tip # 1 — don’t assume just because you have been given a diagnosis that it’s complete or accurate and make sure you have a chance to share all the details of what’s happening to you with the doctor. This is the most vital step to start the diagnostic process to help maximize results.
Thea article describes an all too common problem I see in fertility treatments (and medicine in general) - doctors who jump to conclusions and make diagnoses based on assumptions rather than facts- and then lead the patient down treatment paths that may not be optimal – or even correct!
The article goes on to say some doctors mistakenly decide in 18 seconds! I usually spend more than an hour with a new infertility patient asking and listening to determine exactly what the potential issues are. Unfortunately the article says some decide in just 18 seconds.
My Threshold First Step – Make sure you can tell your whole story- insist on an accurate diagnosis before treatments begin. As it states in the article:
If your doctor appears to be in a rush and interrupts frequently, you’re at greater risk of being misdiagnosed. “Don’t assume that just because someone has given you a diagnosis that it’s necessarily accurate and complete,” says Dr. Steven Palter, medical and scientific director of Gold Coast IVF of Syosset, a reproductive medicine and surgery center. “The patient should communicate to the physician all of their concerns and symptoms. . . . There’s rarely only one treatment option, so the patient should ask what are the risks and benefits, and what options does the doctor have experience with and what they don’t.”
The Six Steps:
Make sure you can tell your whole story
Ask your doctor three questionsafter he or she comes up with a possible diagnosis
BREAKING NEWS: First description- full free slideshow with audio of project and podcast
I am honored to share with you on docinthemachine.com my Presidential Report from the CGE of the launch of the Center of Excellence Program of the AAGL CGE. With 38 years leadership in Gyn Minimally Invasive Surgery the AAGL is uniquely qualified to share its educational mission by verifying those Centers that meet these standards.
The AAGL Global Society for Gynecologic Minimally Invasive Surgery Launches Center of Excellence in Minimally Invasive Gynecologic Surgery Program at Annual Meeting November 16-20, 2009 in Orlando, Florida —dedicated to establish and verify standards at surgical facilities and hospitals.
(click green play arrow to hear presentation audio and automatically advance slides)
The primary objective of the AAGL and its professional interest partner the Council of Gynecologic Endoscopy (CGE) is to promote the adoption of minimally invasive gynecologic surgery with its reduced morbidity, shorter post-operative recovery time, less invasiveness, and reduced costs.
OurAnalysis of patient and provider needs worldwide showed that there are widely divergent qualities of practice and that patients and providers have difficulty in identifying excellence. There is a lack of national standards to improve outcomes. While payors seek to control costs/outcomes patients lack access to the educational resources to direct them to the appropriate center to meet their needs in many cases. As I stated in my address:
We recognize in the modern era of health care we have a unique opportunity as well as an obligation to use our educational resources and multidisciplinary expertise to help promote those systems and procedure which can improve patient outcomes in women’s health while reducing costs to both patient, payor, and society as a whole.
The CGE has therefore launched two new programs to address these needs.
First is an individual registry of physicians based upon peer review of operative experience and complications. The CGE, founded in 1996 has over 1100 individual gyn surgeons who have meet its standards. The new program integrates an evaluation based on today’s complexity of procedures in minimally invasive surgery. It is a tiered system with 3 levels of practice (based on procedure complexity) and 4 areas of proactive experience and specialization (General Gynecology Procedures, Fertility Enhancement Surgery Procedures, Repair of Pelvic Floor Defects & Urogynecology Procedures, Gynecologic Oncology Procedures)
Second is a Center of Excellence Program In Minimally Invasive Gyn Surgery. This is in recognition of the modern notion that to achieve best-in classs surgical outcomes requires not only an expert surgeon, but an integrated multidisciplinary surgical facility with systems and procedures in place to maximize quality cost effective safe outcomes for patients.
9 Requirements: Areas of Review To Qualify as a COEMIG:
Institutional Commitment to MIGS
Director of Division
Medical Staff Physician Qualifications
-Dedicated Educational Program
-Formalized Credentialing Guidelines & Systems to Introduce New Procedures
-Procedures for Minimizing Complications
Sufficient Experience with Procedures
A Full Complement of required Non-Surgeon Consultative Staff
Ancillary Staff
-Dedicated Team-Based Concept
-Dedicated non-physician Educational Program
Equipment Guidelines
-Availability & maintenance
Treatment pathways
-Linked to Peer reviewed Practice Guidelines
HIPAA Compliant prospective Outcomes Data Tracking
In my presentation launching this program at the AAGL annual meeting I shared
The AAGL is extremely excited and totally committed to the concept of Gynecologic Minimally Invasive Surgery Centers of Excellence. It represents a unified vision for women’s health that integrates our entire educational mission and expertise over the past 38 years.
First Ever Global Opportunity for Standards of Excellence:I was equally excited to present the concept to the Affiliated Societies of the AAGL which is made of representatives of National Minimally Invasive Gyn Societies from around the World. Our dedication to this concept and recognition of its value was shared by representatives of Partner Societies from South America, Europe, and Asia. We agreed to work together collaboratively to establish a shared Global Standard and to establish a shared program to advance Women’s health under the AAGL CGE COEMIGS program in cooperation with each Nation’s Society.
I will share further details of the program with you here as they are released!
In a docinthemachine exclusive first I am excited to share with you a new endometriosis scoring staging system that is the first ever to predict a patients chance of getting pregnant without IVF.
The EFI or endometriosis fertility index was just presented by Dr David Adamson, a fertility specialist at the 38th annual Global Congress on Gynecologic Minimally Invasive Surgery– the annual meeting of the AAGL in Florida. As a fertility specialist and surgeon myself it was starred on my agenda not to miss as a highlight of the entire congress. Here’s all the details of his presentation and the scoring system.
Here’s my podcast interview with the lead author Dr Adamson just after he gave his talk at the 38th AAGL Global congress in Orlando
Dr David Adamson Endometriosis Fertility Index Podcast with Docinthemachine.com[ 17:12 ]Play Now | Play in Popup | Download
In a docinthemachine exclusive first I am excited to share with you a new endometriosis scoring staging system that is the first ever to predict a patients chance of getting pregnant without IVF.
The EFI or endometriosis fertility index was just presented by Dr David Adamson, a fertility specialist at the 38th annual Global Congress on Gynecologic Minimally Invasive Surgery– the annual meeting of the AAGL in Florida. As a fertility specialist and surgeon myself it was starred on my agenda not to miss as a highlight of the entire congress.
Why Its Important: Every staging system up to now were made by committee trying to guess what would be an important factor– but none have ever directly predicted a patient’s chance of pregnancy– they main thing they need to know. This study was mathematically devised and DOES the allow a patient to know her direct chance of having a baby after surgery!!!
Background- What’s endometriosis? Endometriosis is a devastating disease where the cells that normally line the uterus and grow each month in preparation for a baby grow abnormally outside the uterus on it surface or on the tubes ovaries or other internal organs. These cells bleed cyclically each month internally an cause inflammation resulting in pain, infertility , and damage to other organs. It affects 5% of the population who have no symptoms but up to 25-33% of women with infertility or pelvic pain. A valuable resource is the endometriosis association who I work with frequently.
Lead Author–is my friend collegue and mentor from a distance Dr David Adamson. He’s and ob gyn fertilit specialist who is on the faculty of both UCSF and Stanford and who specializes in both fertility and reproductive surgery — he’s served as president of both our fertility society ASRM and our surgical society AAGL.
The Results– Predicting Fertility: Chances of pregnancy by Stage
The risk of listeriosis in pregnant women and their fetuses is greater than previously thought, researchers said.
Listeria monocytogenes — one of the most dangerous foodborne pathogens in the U.S. — can cause miscarriages and stillbirths, according to Mary Alice Smith, PhD, and colleagues at the University of Georgia in Athens.
Top 10 Healthcare Systems by Revenue (ranked by net patient revenue $ millions)
1. U.S. Veterans Affairs Dept $40,686.5
2. HCA, Inc. $28,374.0
3. Ascension Health $12,720.6
4. Community Health Systems $10,840.1
5. NY Presbyterian Healthcare Sys $8,458.3
6. Tenet Healthcare Corp. $8,348.0
7. Catholic Health Initiatives $7,817.1
8. Catholic Healthcare West $7,596.2
9. Sutter Health $6,874.0
10. Mayo Clinic $6,143.5
Top Ten’s Cumulative Revenue: $137,858.3 (Source: Modern Healthcare, 2009)
I Just received notifiction from the American College of Ob Gyn that new recommendations for women’s health care will be released on Monday, November 16, at 5 pm EST. The recommendations are under embargo until then. At that time the college will issue a “response” so sounds like we don’t agree with them! I’ll post the recommendation as soon as it comes out (or sooner if its leaked) — until then here is the office ACOG email
Office of the President
Gerald F. Joseph, Jr., MD, FACOG
Dear Colleague:
The College is providing you with advance notice that new recommendations for women’s health care will be released on Monday, November 16, at 5 pm EST. The recommendations are under embargo until then, but we will share them with you as soon as the embargo expires. Please visit www.acog.org after 5 pm EST Monday, November 16, for the new recommendations and the College’s response.
Sincerely,
Gerald F. Joseph, Jr, MD
President
American College of Obstetricians and Gynecologists
I have been getting great feedback on my DITM medical technology podcast which starts the podcast series I’ll be doing regularly. Several people wrote to ask if I could post a version with just the interview since they loved it so much and wanted to share that segment. The original podcast starts with FDA approvals then has an interview with Sony Exec Bob Ott on the future of video technology in entertainment and medicine that we did a the NAB broadcast meeting in Vegas.
Here’s an edit version with just the interview enjoy and share with your friends!
