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Maybe Christian Science is on to something
You know there's something wrong with a given trade when it launches a feel-good ad campaign; the question is only a matter of what. So when American Medical Association launched its new "Everyday Heroes" campaign, you had to wonder: is the group worried about the public awareness of medical errors? ...its reputation as an opponent of patients' rights? ...its sagging membership?
Well, I don't know, but there has been a lot of solid reportage lately on the sorry state of American medicine. I'm currently reading the illuminating and surprisingly level-headed (given the title) Internal Bleeding: The Truth Behind America's Terrifying Epidemic of Medical Mistakes. There's also been a spate of good newspaper and journal articles. And by "good" I mean frightening.
"Speak Not of Error: Does legal fear increase the risk of medical error?"
(Regulation, Spring 2005)
From the authors we learn that "Medical error is the eighth-leading, sixth-leading, or third-leading
cause of death in the United States, depending on the source." Yet the AMA has been a major force in pressing for tort "reform" -- limiting a patient's rights to sue for medical malpractice. Somehow the AMA and similar lobbyists have managed to promote the argument that holding medical practitioners and institutions accountable for medical errors *increases* errors. But David A. Hymen (University of Illinois) and Charles Silver (University of Texas) handily debunk such nonsense in this readable journal article.
One group of doctors changes its ways
I
mentioned this earlier but I'm blogging it again in case the above
isn't enough to convince you. It's about anesthesiologists'
novel way of lowering the malpractice insurance costs: by
improving patient safety.
"Bad Practices Net Hospitals More Money:
High Quality Often Loses Out In Medicare"
(Washington Post, July 2005)
The
first in a three-part series on the upside-down economics of Medicare,
which gives the worst doctors and hospitals the biggest bag of money.
Parts two and three.
"Plague of Errors"
(Governing, August 2005)
"Hospital infection rates are rising and killing 90,000 patients a year. Can the states put a stop to it?"
Take Action! via Consumers' Union
Convenient links for taking action to improve patient safety in your state.
Posted by Carrie McLaren on 08/09/2005 | Permalink
Comments
Wonder how much connection this has to the flight of the best and brightest away from the medical profession and the rise of "managed care" in turning health care into a factory, with quotas and cost targets. Look at how many serious procedures are now done as "out patient" (i.e., on the cheap) and the tremendous pressures doctors are now under to push patients through. No wonder mistakes are on the rise. I know two doctors who left obstetrics because they couldn't take the bullshit.
Posted by: Jim | Aug 9, 2005 9:04:46 AM
This is great stuff, Carrie, and of particular interest to me. I'm the single dad of a daughter with special medical needs. I could tell you some serious horror stories concerning insurance companies, hospitals, doctors, and the medical industry (trust me... it's an industry, not an institution in this country) as a whole.
I'm going to have to come back and go through these links in more detail later. Sooooo much to do today.
Posted by: andy | Aug 9, 2005 1:59:51 PM
This is one of those topics that produces such reflex indignation that one can formulate whatever nonsense one wants and if you make up an imflammatory enough title, your book will sell. The irony being that the lawyers pretend to hold the high ground here, pretending to be only concerned about patients rights and welfare, when everyone knows or should know the sole defining characteristic af an attorney is an all-comsuming desire for money, and no ethical or moral framework cannot be violated in their relentless pursuit of a 30-50% contingency fee.
I've been a doctor for 21 years, and I've seen errors, of course. The most common error is that an order is written, and not carried out. This can happen for several reasons. Anything from the ward secretary missing it, to the nurse being too busy, to the pharmacy technician not noting it, etc. The vast majority of such errors do not result in any great harm. The critical point is how one defines "error."
The statistics that are bandied about are just plain nonsense. Even if they were true, however, who has designed a system involving complex multiple subsystems, staffed with every kind of HUMAN employee, whose training runs from high school graduate to 20+ years of postgraduate training, that will not produce errors? The medical system is the only system in which the expected error rate is zero. I agree that would be nice, but a system made of humans will produce errors. Malpractice awards have much more to do with bad outcomes than with errors. The current model is equivalent to one that would sue Tiger Woods every time he doesn't win a golf tournament. Don't we have the right to expect perfection from our golfers (read doctors, nurses, EMT's, ward secretaries, orderlies, xray technicians, phlebotomists, transcriptionists, pharmacists, hospital administrators, middle managers, hosptial security workers, scrub technicians, sterile supply workers, transporters, nurses aides, physical therapists, occupational therapists and housekeepers)?
And yes, the tort system does inhibit prevention of mistakes, since the penalty for revealing a mistake, and thereby improving the system, is punished severely by the trial attorneys and plaintiffs who want to cash in on their personal lottery.
For every anecdote that someone can relate, true or not, about some horrendous medical error, I can give eye witness stories of unbelievable lawsuits. (Just one out of the air: A 22 year old female who is driving the getaway car for her boyfriends who have just held up a Target store. She attmpts to run over a policeman on the scene. He shoots at her, and the bullet hits her and breakes her femur. She is transported to the University of California San Diego trauma unit (at taxpayer expense), where her femur fracture is treated with surgery. She develops a chronic infection (not uncommon for gunshot wounds) She wues the UCSD hospital and doctors b/o the infection.)
And on and on.
The solution to this is to let the government take over the whole thing. However, no one should be so naiive as to think that the system will remain as responsive. Care will be rationed (as in England and Canada and Germany, etc), there will be more mistakes, and you won't be able to sue anyone, because the government will simply not put up with the lawsuits.
Posted by: Mitch | Aug 18, 2005 8:16:45 PM
