Tweet
As I discovered from the responses to my post on tort reform yesterday, there is something of a sacrosanct atmosphere connected with medicine. Of course, having had really good doctors for the most part, I am generally respectful of the practitioners of medicine, too.
One good friend who also was a good doctor reminded us that calling doctors’ profession a “practice” had a lot of meaning. Each person, and each medical episode, is unique. In order to treat it, that particular doctor realized, usually a certain amount of uncertainty was involved. He also noted that if he found himself looking at something as just another episode of uninteresting routine, he should not continue practicing medicine.
One leading medical research projects involved imposing a check list before medical procedures could be performed. Dr. Pronovost of Johns Hopkins, who performed the research, encountered indignation and irascibility, but his findings show the acute need for such a step.
Peter Pronovost, a Johns Hopkins anesthesiologist who has convinced some of the country’s most prestigious hospitals to fight infections with a simple five-point checklist.His message: If health care workers took five steps as easy as washing their hands and wearing sterile gloves and gowns, they could virtually eliminate one of the most lethal infections among their sickest patients.
(snip)
When a medical team introduces a checklist into its routine, he says, a nurse can remind a surgeon that he or she hasn’t done the requisite hand-washing—something that many nurses wouldn’t dare to do in a traditional hospital setting.
“In 1990, people wouldn’t have been talking about checklists at all. This whole approach to patient-centeredness and consumerism in medicine—those are all relatively new concepts,” said cardiac surgeon Dr. William Berry, a Harvard researcher who is working on the Safe Surgery Saves Lives Initiative with the World Health Organization.
Measures that work would appear to be exactly what would best serve the public. It’s the shame of the present dominant, right wing, element in our government that it does not try to do its job of protecting the public. Their method of reducing public safety by preventing suits against doctors looks increasingly like the sham it is
Check lists are not hard work, they are a basic safety measure. When their pride is getting in the way of treating patients, our medical personnel are incompetent.
Tort reform looks increasingly like the last refuge of scoundrels.
24 Comments
You are right. It is not hard. Spraying down fixtures with a clorox mixture after each patient is not hard either.
Six years ago my oldest son had a car crash and was whisked to the emergency room. While they reset his shoulder and pulled out class shards they needed to wait for blood work and more x-rays to be read before administering pain medications.
The child was wrenching with pain and all over the bed. When they finally finished with him and we packed up to go home we thought it was over except for the healing.
About a month later he started having these horrible painful lesions. When diagnosed by the family doc it turned out to be MRSA!
It cannot be cured, only treated on outbreaks. It erupts when he is sick with regular colds and flu and when he is nervous or anxious about everyday life things.
Does the hospital care? HELL NO! I’ll say it again, “ENTER AT YOUR OWN RISK!”
recommended
Thanks. The increasing incidence of MRSA shows that medical facilities are putting safety of patients below their own agenda, which all too often headlines profits. When actual Results are made the first rule for our medical professions, that attitude will change for the better.
When their professional self respect is gone and they act only as tools of the medical industry, they just do not care.
I also knew someone who died of “care-associated MRSA” (HA-MRSA; link: http://www.mayoclinic.com/health/mrsa/DS00735 ). Much later, in early 2009, I bumped into a Kentucky nurse whose speciality was instruments and their proper preparation (sterility is just one piece of the work). She told me that the hospital management in her hometown had become so focused on money extraction and cutting corners that she was being harassed for performing her job to established medical standard. So she left and went to a more lawful State jurisdiction where they were happy to have a specialist like her. She had lots of other things to say about the industry, so I sat and just listened as she was pretty upset at the state of medicine in her area these days.
I remember seeing surgeons checking underneath an ICU patient’s fairly complicated dressing, and he had not washed hands nor put on gloves.
I love the checklist idea.
My mother has just moved to rehab from the hospital where she had a knee replacement. She did comment on the nurses and aides at the hospital being careful to use and discard gloves and use the hand sanitizer dispenser mounted in her room. I did have issues with some of the care she received, but that’s another story.
The CW among legal theorists is that we can either regulate medicine through the tort system or through a regulatory regime. Countries tend to have one or the other: in Canada or the UK, for example, there is a robust regulatory regime but malpractice suits are either precluded or law or rare as a matter of practice (ie, they have displaced tort w/ regulation and eliminated tort in large part).
Tort seems to be a pretty darn inefficient method of regulating medical practice. Despite X years of medical malpractice tort law, we’re still wanting for basic safety measures like checklists and simple hygiene.
Liberals, I think, should be looking toward ditching tort law in favor of a regulatory regime (like virtually the rest of the world), but since the GOP seems to want neither tort nor regulation, joining forces w/ them in ditching the tort system is a dicey proposition.
Actually, I also watched some one contract MRSA and die – after several rounds of treatment for cancer. It was truly awful. This was at a reputable, but pricey, hospital in D.C. I have strong reservations about going to anyone I don’t know very well.
Sadly true.
That’s good and I hope she does well, and gets her mobility back soon.
Tort, regulating after the fact, is really not the best way by any means. Deregulation has always been in the interest of the criminals, and by promoting it the right wing shows its disdain for humanity.
State of nebraska has a cap on the amount you can receive in a law suit. Most states today have a cap. AND you can’t sue for things like MRSA…but let’s for a second consider my case and the cost to society.
I had insurance. Had surgery to repair an incarcerated hiatal hernia exacerbated by two pregnanies in my late forties. (it was an emergency surgery performed because I was bleeding from my stomach and because my stomach twisted up in my chest). The surgery was a sucess…I never have heart burn anymore. However, about a month after the surgery I was running low grade fevers and having pain…feeling sicker and sicker…like the flu. Went to my internal medicine doc and he ordered me to the hospital where the surgeon who performed the original surgery engaged in trying to cover up the fact that I had an infection. They treated me with vancomycin for a week..and told me there was no infection that the fluid in my body was simply a seroma. (sterile). My internal med doc, said “I don’t care what the surgeon is saying, you had an infection”. This was in 2001 before we knew much about mrsa. I went away but continued to have problems with my surgical sight for years. It herniated they put in mesh. Years later…now 2010, the mesh became infected and it was mrsa. I got septicemia and it almost killed me. Fast forward…this time, new hospital they tell me I was carrying the infection all these years and it blew up. Surgeon did not want me to have surgery but infectious disease docs wanted the mesh out of me in hopes of removing the source of infection.
Friend of a friend hears about my case, she’s a surgeon and she literally tracks me down because she wants to do the surgery for me. She even sets my apt up with a co surgeon and tells me to be there. I go, they tell me they can remove my mesh lickety split. Should be fine and get rid of infection. Yay! good deal. I’ve been through hell missed a lot of work (self employed) but I’ll go for it if I can get rid of this stuff. I did my research, their plan seemed sound. I knew there was risk of new infection or other even worse complications. I took the risk.
Long story short…I ended up with multiple infections, all hospital acquired. Psuedamonas, c-diff and mrsa. Now we don’t know if these are gone or lurking in my body. I was on expensive antibiotics that cost more than the original surgery for almost 6 months. I had 4 surgeries total in the end and spent a total of about 20 days in ICU.
Bottom line, one surgery to repair an incarcerated hiatel surgery and because of infection…11 years later…literally over a hundred thousand in total cost, all because of one surgery and subsequent infection. Can you imagine what this does to the cost of insurance?? And I sure as hell do not have the power to change this.
They blame us for being fat, they blame law suits…but we never really talk about the problem. I can’t sue, because infections are so common and are part of the risk. I doubt they did anything “WRONG”. But it’s amazing how much has been spent on this bug MRSA and now psuedamonas…we aren’t really talking about the cost in lives and expenses.
Great diary.
Thanks. Your experiences are being repeated all too often, and you are absolutely right, the mounting costs are unbearable. Worse, they’re avoidable with decent care and precautions. Trying to portray victims of malpractice as grasping opportunists is yet another cynical avoidance of reality in the service of their ideology – another proof that the wingnuts are sub-human and getting worse.
Profound. We become simply worker bees for the system.
Pilots have mandatory safety checklists. Why shouldn’t doctors and nurses, particularly since they keep negligently killing 200,000 people per year in hospitals and there is no downside to following a checklist?
Mason,
There are pilots who are taking what is learned about aviation safety to the medical profession.
Talking with such a pilot, I learned he thought the hardest thing he had to do was, in a meeting with staff (not just doctors), to get just one doctor to admit they made mistakes. Once someone in the meeting admits that they have made a mistake, he said nearly everyone jumps in and finds solutions, like checklists.
Thank God for the pilots!
Didn’t know that. Come to think of it, more than a few doctors own their own planes. I wonder if some cross fertilization is going on?
Although, come to think of it, I think doctors have a disproportionately higher rate of crashes due to pilot error than other people who own their own planes.
Do you know if it’s the professional pilots, like commercial airline pilots, who are working with the medical profession, or is it doctors who own their own planes?
Way to go, sister Ruth!
Now you’re telling it like it is.
Well…part of the problem is that we treat docs like “kings”. I asked for a second opinion while I lay in the hospital waiting for the surgeons to allow them to test a “collection of fluids” that had formed in my abdomen. My surgeons would not admit it could be infection despite the growing read patches on my bellie outlined with ink pen by every doc that looked at me. I was so naseated but I lay with this collection of fluid in me, while they continued to tell me they thought it was “the flu” and not related to the surgery. I knew what it was, cause I had never felt like this before and my tummy was not only sick but sore. They got so angry at me for asking for some intervention, that they told me about it at every turn. It was miserable to be in the hospital and having the surgeons make it clear they are pissed at you for asking for more help. Help that would cause for them to be scrutinized. I got middle of the night visits and panicked discussion about “what did you tell them”. I also got “punished” by the surgeons who said rude things to me while I was so sick. It was terrible.
They don’t like to be questioned AT ALL!
It is my view that Tort Deform, the weakening of legal recourse for people who have been harmed by the medical industry, is in material part responsible for the chaos and incompetence we experience in hospitals and at the hands of providers on at all levels. They are just not deterred any longer by the prospect of law suits. Tort deform advocates have succeeded in framing patients, their families and the lawyers they hire to represent them, as greedy system-gamers.
The one I know just retired as a commercial airline pilot. He told me USAir, among others, has done terrific work in safety and a few of the retirees are trying to get a company off the ground to bring those concepts to the medical community.
I suggested they talk with the medical insurance companies and seek benefits for medical facilities such as (much) lower premiums, etc. to use as a selling point. Even to suggesting that such facilities put themselves under a “SMS”, “Safety Management System”, if I remember correctly, program, even to plea for lower penalties if embroiled in a lawsuit.
He said he thought that SMS could be used to freely disseminate safety information amongst facilities, reducing the “moat and castle” or siloing (I think he said) format many facilities use today when it comes to safety.
Peter Pronovost, Robert Wachter, and the other “guideline” and “checklist” advocates talk a good line, and indeed their approach is generally a major improvement over the haphazard approach that went before. But the fundamental problem has to do with people’s motivations and cognition, and no set of guidelines or checklists can be an adequate substitute for good will, competence, creative thinking, and (above all) freedom from conflicts of interest. Not only the individual clinician’s thinking needs to be free from conflicts of interest, but also the managers and policymakers at a higher level, and the medical researchers providing the information on which clinical practice is based. But freedom from conflicts of interest cannot be attained, or even approximated, as long as the private-sector insurance and pharmaceutical industries are allowed to exist. Law and medicine could do better (especially in ending the us-versus-them, fraternity-hazing indoctrination that afflicts education in both professions), but Big Insurance and Big Pharma are the most fundamental problem.
All too often, clinical guidelines come right out of the PR department of a pharmaceutical company. This has been (infamously) documented for the sepsis guidelines, in particular, which were hopelessly compromised in the effort to sell one specific drug, Xigris (drotrecogin alfa). Another example is the campaign to reconceptualize stroke as “Brain Attack”, which was pitched to the general public as well as to health professionals; the whole elaborate “education” program was a disguised sales pitch for clotbuster drugs. Likewise, guidelines are all too often influenced by profit-driven work-speedup motives right out of Karl Marx’s account of the basics of capitalism, more than by the safety considerations used to sell them to the health professions and the public. Revenue-driven overtreatment does battle against cost-driven undertreatment, and the result has little relevance to the patient’s needs.
Read Jerome Groopman’s How Doctors Think (2008) to get a perspective on next-generation thinking (beyond guidelines and checklists) about quality of care, although even Groopman does not go nearly far enough in drawing the necessary conclusions about the practical steps that need to be taken. Also read Wendell Potter’s Deadly Spin to understand the full extent to which the insurance and PR industries shape health to their own profit and the patient’s detriment.
‘But freedom from conflicts of interest cannot be attained, or even approximated, as long as the private-sector insurance and pharmaceutical industries are allowed to exist.’
Excellent point. The basic nature of doing what ought to be done is an argument that other influences are taking far too much autonomy in the medical, as in business, fields.
For more about the malign influence of the pharmaceutical industry, check out Marcia Angell’s The truth about the drug companies: how they deceive us and what to do about it (2005). She stresses how much of private-sector “drug development” amounts to private theft of public property: the drug companies profit from discoveries made in academia and funded by the government. But even Angell stops short of recommending the abolition of the private pharmaceutical industry. Like many reformers in the USA, she overfocuses on what she thinks is feasible in the near term, rather than what is the minimum change necessary to create a stable and tolerable situation. Serious reflection on this minimum leads inexorably to the conclusion that it lies well beyond what even most activists would currently be comfortable with, let alone the general public. We need to devote a considerable fraction of our effort to expanding the boundaries of the feasible, and not just to working within them as they currently exist.
In my opinion, the most compelling motivation for socialism in general – and for nationalization of the drug and insurance industries in particular – is that as long as private for-profit industries are allowed to exist, their enormous financial resources and their ability to work in secrecy (rationalized by the need to protect trade secrets) will make regulatory capture and deception of the public inevitable. Any reforms will be short-lived; they will only be achieved by massive arousal of public opinion, and as soon as the public’s attention wanders, they will be drowned in a flood of bribes and covert PR.
If we want our reforms to endure, we must eradicate the enemy’s secure bases. That means abolition of business corporations, private capital, and trade secrecy. This approach is applicable to industry in general, but is especially compelling in the contexts of health insurance and pharmaceutical development, because of the uphill battles that even the most informed consumers face in those contexts.