Enjoy this post. It says a lot about our health care system and what we can do about it.
Revolutionizing Health Care
by GREGG HAKE on SEPTEMBER 27, 2012
As a private pilot who has spent the better part of my professional life navigating the labyrinthine health care industry, I am intrigued by Dr. Marty Makary’s recent comparison of aviation and health care in the Wall Street Journal, adapted from his book “Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care”:
When there is a plane crash in the U.S., even a minor one, it makes headlines. There is a thorough federal investigation, and the tragedy often yields important lessons for the aviation industry. Pilots and airlines thus learn how to do their jobs more safely.
The world of American medicine is far deadlier: Medical mistakes kill enough people each week to fill four jumbo jets. But these mistakes go largely unnoticed by the world at large, and the medical community rarely learns from them. The same preventable mistakes are made over and over again, and patients are left in the dark about which hospitals have significantly better (or worse) safety records than their peers.
Dr. Makary continues:
As doctors, we swear to do no harm. But on the job we soon absorb another unspoken rule: to overlook the mistakes of our colleagues. The problem is vast. U.S. surgeons operate on the wrong body part as often as 40 times a week. Roughly a quarter of all hospitalized patients will be harmed by a medical error of some kind. If medical errors were a disease, they would be the sixth leading cause of death in America—just behind accidents and ahead of Alzheimer’s. The human toll aside, medical errors cost the U.S. health-care system tens of billions a year. Some 20% to 30% of all medications, tests and procedures are unnecessary, according to research done by medical specialists, surveying their own fields. What other industry misses the mark this often?
I’m not sure I have an answer to that question (maybe our present prison or educational systems would be in the running?) but what really intrigues me is the fact that this industry, warts and all, remains one of the most profitable and prosperous in the country. It’s astonishing, really.
Dr. Makay goes on to make a number of excellent suggestions as to how to improve the situation. He focuses on increasing accountability through a variety of means, including:
- creating online dashboards that include such metrics like its rates for reinfection, readmission, surgical complications and “near event” errors (like leaving a sponge or surgical tool inside a patient)
- generating safety culture scores to help shed light on the 98,000 annual deaths from medical errors in the U.S.
- installing cameras to improve compliance with best practices and established procedures and to allow for reviews and to determine retraining needs when serious mistakes are made (like the “black box” in airplanes)
- using an “open notes” system where patients and other doctors are given real-time access to their doctors’ notes
- moving away from gagging to a system of transparency to allow free market forces to work in medicine, with the aim of improving accountability and restoring patients’ choice in a system that has grown to be secretive if not arrogant
My own impression is that what we deliver is as important as how we deliver it. We need to re-prioritize our treatment protocols. The entire system is biased toward eleventh-hour, expensive and typically highly invasive interventions which are more often than not laden with unintended and unhelpful side-effects. The system we have competently deals with acute situations, medical emergencies and the like, but demonstrates an impressive incompetence when confronting the more prevalent, complex and burdensome spectrum of chronic diseases.
I have the utmost confidence that we can revolutionize health care. We can revitalize medicine in a way that reignites the passion of its practitioners and restores the confidence of its patients.
