Using Patient-Oriented Evidence to Reduce Health Disparities

David Slawson, MD, one of the founders of InfoPOEMs®, gave a provocative talk during the concurrent sessions on Sunday, October 19, 2008 at the 2008 Midwest Chapter/MLA and MHSLA joint meeting.

David Slawson, MD, one of the founders of InfoPOEMs®, gave a provocative talk during the concurrent sessions on Sunday, October 19, 2008 at the 2008 Midwest Chapter/MLA and MHSLA joint meeting. He pointed out that according to WHO rankings, the U.S. is 12th out of 13 countries in regard to quality, but first in regard to health care costs. Because of inequities in access to health care in the U.S., and our reluctance to ration care, he stated, “We don’t ration services, we ration people.” He discussed fallacies regarding rationing.
In the U.S., overuse and misuse of treatments and screening tools has led to large increases in costs while decreasing value. Value (value is equal to quality divided by cost) will not increase until doctors use evidence to make rational treatment decisions, thus decreasing costs. Because doctors are the ones who decide what treatments to use, they are the key to the control of costs and value. They must use the evidence when providing care and deciding on what treatments to use. He stated that we can “safely eliminate at least 20% of what we currently do” in the U.S. He added, “We must limit unnecessary services (or deny care to more people).”
For example, he believes that based on the evidence, women who have had hysterectomies for benign reasons and women who have had consecutively normal Pap smears do not need to have yearly Pap smears. In another example, he points out that doctors frequently ignore recommendations about treatment for hypertension, using the newest drug or samples that they have on hand, rather than prescribing the cheaper beta blockers and diuretics that are recommended as the first step in treatment. He quoted David Eddy (Clinical Decision Making: From Theory to Practice, Jones and Bartlett, 1996) who said, “In a field filled with uncertainty and doubt, the difference between ‘when in doubt, do it’ and ‘When in doubt, stop’ could easily swing $100 billion a year.”
Dr. Slawson and his co-author, Allen F. Shaughnessy, have several prescriptions:

  • “Analyze practices at the level of specific indications, e.g. mammography, other cancer screening, BMD, others.”
  • “Accept that resources are limited.”
  • “Change our way of thinking from qualitative to quantitative reasoning.”
  • “Focus on populations rather than on individuals.”
  • “Help patients understand consequences.”
  • “Ensure that measures used to judge value of services lead to an increase in quality while decreasing costs.”
  • “For the individual practitioner: ‘When in doubt, don’t.’”

The slides for Dr. Slawson’s presentation (titled “The True Mission of Information Mastery: Using “Medical Poetry” to Remove the Inequities in Health Care Delivery”) are available at http://snipurl.com/4ts8y or from the University of Virginia Health System’s Information Master Practicum and Course page at
http://snipurl.com/4tscd.
Mary K. Taylor, Natural Sciences Librarian
Morris Library, Southern Illinois University Carbondale
mtaylor AT lib.siu.edu

Chapter Business Meeting Report

The Midwest Chapter Business Meeting on October 20 was an eventful one. Along with all the normal usual business meeting agenda items, the revised bylaws were passed. Thank you to Sheryl Stevens and the Bylaws Review Special Committee for all their hard work!
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Of course, the highlight of the business meeting is the announcement of our chapter award winners. Logan Ludwig, Associate Dean, Loyola University Health Sciences Library is the 2008 winner of Distinguished Librarian of the Year award.
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Gundersen Lutheran Library and Health Information Services Department (LaCrosse, WI) was awarded the 2008 Jean Williams Sayre Innovation Award for their work on the GLine database of publications by hospital researchers. Mary Jo Boland accepted the award.
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Our scholarship and professional development award winners were also introduced to the membership during the business meeting. Watch for their conference reports in the upcoming issue of MIDLINE!

Conference Evaluation Survey

This year the conference planners are doing something a little different. Instead of being asked to fill out the usual paper conference evaluation and drop it in a box on the registration table, we will be using SurveyMonkey to provide our feedback. Bright and early this morning Valerie posted the link to the evaluation survey on the Vital Signs website. The information provided by conference evaluations is invaluable for the planners of future conferences.
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So follow that link and fill out your conference evaluation today! Your intrepid blog editor has already completed her evaluation. Your feedback counts!

2008 Midwest MLA/MHSLA Conference Photos

Go right now and check out the photos of our 2008 conference that have been posted on Flickr! Your intrepid blog editor uploaded her favorites this evening. She is not the only buy generic cialis online with mastercard conference photographer who has added photos to the site.
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We’ve tagged the conference photos midwestmla08 so you can find them easily. Click here to view all the fun!

MLA Reminders

This week, Karen Hanus our chapter’s Alternate Representative to the MLA Chapter Council sent out a couple of reminders to the Midwest Chapter discussion list.
Karen serves as one of the co-chairs of Chapter Council Presents Sharing Roundtables Committee and invites us to participate in their topics survey:

If you haven’t completed the Chapter Council Presents Sharing Roundtables survey yet, please do so by October 24. Your input is important to us.
The 2008 Chapter Council Presents Sharing Roundtables event in Chicago, IL was a great success! Each year, this popular event attracts many participants. Eight chapters supported attendance at the roundtables either by sponsoring attendance of members of their own chapters or of new MLA members. Thank you all for your support and generosity! The discussion summaries can be viewed on the Chapter Council website: http://www.chaptercouncil.mlanet.org/roundtables/2008/.
Chapter Council needs your help to ensure that the topics at the event remain useful and interesting. Please take a few minutes to complete an online survey at to help us decide on discussion topics for MLA ’09 in Honolulu. The roundtable topics are determined from the previous events’ attendee evaluations and the survey; therefore, your feedback is important.
The survey is online at: http://www.surveymonkey.com/s.aspx?sm=mk2PjIfKn0OsIHnUGGbROw_3d_3d.
The topic selections for the Chapter Council Presents Sharing Roundtables reflect what you want to discuss, so please complete the survey by October 24, 2008. If you have any questions, please contact Karen Hanus (khanus AT mcw.edu) or Angela Dixon (Angela_Dixon AT URMC.Rochester.edu), co-chairs, Chapter Council Presents Sharing Roundtables Committee.

Karen also reminded us that MLA offers a variety of scholarships and grants to assist qualified students in graduate library science programs and to enable practicing health sciences librarians to take advantage of opportunities for continuing professional development.
You can get downloadable applications and information on the MLA Website at http://www.mlanet.org/awards/grants/. For more information, you should contact the jury chair for the grant/scholarship you are interested in. Most of the awards have a December 1 application deadline. The Donald A. B. Lindberg Fellowship has a November 15 application deadline.