Sunday, January 04, 2015

Oh, NS-LIJ, we hardly knew ye.

In a post below, I wondered whether a publicity campign by a urologist to encourage women to get their male mates to have PSA and testosterone tests was only the product of that doctor or was it also endorsed by the North Shore-LIJ Health system.  Well, the answer has come through, thanks to Dan Goldberg and Laura Nahmias at Capital New York.  Along with quoting my blog, they reported:

Dr. Davi Samadi, chair of urology and chief of robotic surgery, has something called “The Samadi Challenge. It sounds a little like the ice bucket challenge. Women ask men in their lives to get their prostate and testosterone levels checked, then record a video challenging three other women to do the same.

 ...I asked L.I.J. for their response: “The seminar we are organizing is simply a community education/awareness initiative, pegged to the fact that women are the primary healthcare decision makers in most families. No other motivation. Because Dr Samadi maintains a high profile, he tends to be an occasional target of health care colleagues.”

We could spend a lot of time deconstructing what's going on here, but let's get to the basics:

An otherwise well respected health care system--one of the leaders in patient safety and quality of care--is now endorsing tests that have been the subject of tremendous recent controversy.  When the question is raised about this program or its tendency to promote overuse of diagnostic tests, the health system's response is to assert that the criticism is based on the personality of the doctor in question.  The system makes no attempt to address the legitimate issues of medical science raised.

Let's compare this type or response to the well considered message previously set forth in the "Commitment to Excellence" section of the system's website:

North Shore-LIJ has adopted a strategic plan for quality that is directly aligned with the national healthcare agenda. Our goal is to deliver exceptional quality service to every patient, in every care setting during each healthcare encounter. Our capacity to measure and report healthcare outcomes, realize cost efficiencies, and ensure patient safety through adherence to best practices are instrumental to providing high quality medical care to the communities we serve.

Or to this statement from the system's CEO about the system's strategic objectives:

Medical tests, which are overused in the US, will be reduced. 

Oh, NS-LIJ, we hardly knew ye.  Are the commercial wars so transformative?  How have you changed so quickly?


nonlocal MD said...

More likely they just bought a(nother) robot and have to pay for it, most likely with Intuitive's help. Who knows, maybe they even suggested the mode of advertisement.

Paul Levy said...

I feel compelled to include some recent dilogue from Facebook. Read on!

I'll present it as separate comments here, between Jonathan Giftos and David Samadi.

Jonathan Giftos said...

Update from NSLIJ re: the "Samadi Challenge", in which women encourage men in their lives to get PSA and testosterone testing, despite the fact that there is no evidence to support this practice in an unselected patient population. Every false + PSA, of which there are numerous, can result in anxiety, biopsy and even prophylactic prostatectomy, with its known side effects. The USPSTF recommends against testing PSA. This practice is considered test overuse for financial gain (Samadi made > $5 million per year while at Sinai), but according to NSLIJ:

“The seminar we are organizing is simply a community education/awareness initiative, pegged to the fact that women are the primary healthcare decision makers in most families. No other motivation. Because Dr David B Samadi maintains a high profile, he tends to be an occasional target of health care colleagues.”

Ah, I see. NSLIJ is suggesting Samadi is simply a target because he is high profile. Not because he (and by association, the health system) is promoting the overuse of a test for personal financial gain, or to pay for their some fancy new robot. Sigh.

David Samadi said...

Thank you for bringing attention to our event and we expect it to be a big success, january 8th at Lenox Hill Hospital. The idea is that women should be helping men in their screening and knowledge about men's health. False positive PSA is not a reason to get the test. You need a smart doctor to figure it out for you and look at the trend and your exam to see if you need a biopsy or not. This seminar is not just about the PSA test but encourage men to know about their urinary patterns, testosterone and what to do. This seminar and similar ones will not pay for our robot. This is to give back to community and educate people out there. Instead of being bitter, please educate yourself and I am happy to send you our T shirt. Thank you

Jonathan Giftos said...

If systems like North Shore-LIJ, with CEO's like Michael Dowling who promote stewardship and responsible test ordering, cannot he held accountable. What hope do we have more nationally?

David Samadi said...

Northshore LIJ system is one of the finest healthcare system in the country and their sole purpose is to help our community. This is an educational program to make and bring men's health topics to the surface and bring more awareness. Men in general are not aware of their health issues, do not go to doctors and do not get tested. For heart issues, prostate, colon etc.... So this is a noble initiative out of Lenox Hill and we hope it can save lives. Northshore should get credit for endorsing such inititatives.

Jonathan Giftos said...

With all due respect, the USPSTF recommends against the screening PSA, especially in an unselected patient population that your campaign targets. I am a general internist and I am familiar with the data. Sure, men need access to good primary care. Not by way of a poorly performing test that has the potential to cause more harm than good. Also, out of curiosity, who pays for your robot?

Shannon Brownlee ‏@ShannonBrownlee said...

From Twitter:

The first nickel bag is free. PSA testing is the loss leader for robotic surgeries.

CrusaderRN said...

Methinks Dr. Samadi doth protest too much...

Barry Carol said...

The PSA test is usually done in conjunction with other blood tests that are part of routine physicals, an annual wellness visit that Medicare now pays for and some checkups. Often the patient doesn’t know ahead of time whether or not it will be among the blood tests he gets. Even though the USPSTF now recommends against PSA testing for men with no history of prostate disease, lots of doctors continue to order it anyway.

Patients don’t seem to mind as long as it’s not painful or invasive and someone else is paying for it. Many patients think more care is better care even when it isn’t and they also equate more testing with “thorough” care. If the test comes back in the normal range, it’s reassuring. If it doesn’t, it may subject the patient to unnecessary risk but, then again, it may catch prostate cancer early too.

For doctors, there is also the matter of the litigation environment which in New York and New Jersey is not good especially in and around the large cities. In other parts of the country, it’s not as big an issue.

As for NS-LIJ, I would like to know more about the age range of the women they are targeting to come to their event and just how many PSA false positives there are as a percentage of both total positives and total tests done.

I’ve gotten the PSA test for years but I also had surgery for BPH 11 years ago so maybe I’m an appropriate candidate for ongoing monitoring. I don’t know. As we get older, our risk of getting prostate cancer rises but even if we get it, most of us will die with it and not from it.

Andrew Goldstein said...

From Facebook:

The NNT of mass screening is infinite (no benefit), and the NNH is 5.

Currently these poor outcomes and significant costs are not felt by clinicians or health systems; the patients and payers are the only ones who bear these harms. Perhaps one way of addressing this is to attend Dr. Samadi's event (as we have been invited), meeting other guests and getting their contact information, and then helping the 1 in 5 that are invariably harmed pursue legal recourse for the substandard, evidence-less care that they have received.

Kwvstavtivos Giftos said...

From Facebook:

When you use a robotic hammer everything looks like a nail.

Zackary Berger, MD ‏@ZackBergerMDPhD said...

From Twitter:

@NorthShoreLIJ is not alone. Many hosps talk a good game but sponsor webinars, etc w specialists as "education"

I have long meant to see if any literature has addressed academic medical centers' public communication: #EBM or not?

Deb Soc ‏@dsoq said...

From Twitter:

So key ?, WHY such wide ldrship failure on safety? Not implying all weak execs, MBA progs poor, etc? So..wrong $ incents? Or..?

Anonymous said...

"The highest-paid doctors in New York City are raking in millions of dollars each year, with some, even at struggling hospitals, getting six-figure bonuses, a Post review of hospital-based MDs has found."

"The city’s top earner was urologist and prostate-cancer specialist Dr. David ­Samadi, whose 2012 compensation came to $7.6 million. He was chief of robotics and minimally invasive surgery at Mount Sinai Hospital before moving to Lenox Hill Hospital last June."

akhan13 said...

Dr. Samadi, please do include the AUA guidelines and their evidence-based reasoning for targetted screening in your discussions. Thanks.

Anonymous said...

Dr Samadi, come clean. This is all about marketing - nothing more and nothing less.