Immigrants, trial lawyers, and Democrats are destroying our healthcare system

[BaliBabyDoc]

I forgot to give my customary July warning about avoiding teaching hospitals, but this article was a great reminder. We are breaking in a new crop of MDs so beware of where you get your healthcare for the next few months.

Canadian Healthcare Technology . . . nosey Canucks

WASHINGTON ? Medication errors harm 1.5 million people and kill several thousand each year in the United States, costing the nation at least $3.5 billion annually, the Institute of Medicine concluded in a report released on July 20.

According to the report, titled ?Preventing Medication Errors?, drug errors are so widespread that hospital patients should expect to suffer one every day they remain hospitalized, although error rates vary by hospital and most do not lead to injury, the report concluded.

I guess the trial lawyers don't have to chase too much if they've got over a million potential 'customers' served up every year.

The report is the fourth in a series done by the institute, the nation?s most prestigious medical advisory organization, that has called attention to the enormous health and financial burdens brought about by medical errors.

The first report, ?To Err Is Human,? was released in 1999 and caused a sensation when it estimated that medical errors of all sorts led to as many as 98,000 deaths each year ? more than was caused by highway accidents and breast cancer combined.

After the first report, health officials and hospital groups pledged reforms, but many of the most important efforts have been slow to take hold.

The problem is the trial lawyers. You see if you make it hard to sue then hospitals won't have to worry about making mistakes. And if we don't worry about mistakes . . . we will make fewer mistakes.

Electronic medical records can help ensure that patients do not receive toxic drug combinations. The 1999 report urged widespread adoption of these systems. The July 20, 2006 report called for all prescriptions to be written electronically by 2010 . . . just 3% of hospitals have electronic patient records.

In all seriousness, I do lament the fact that physicians cannot reliably write appropriate medication orders/prescriptions.

Even simple medication safety recommendations ? block printing on hand-written prescription forms ? are widely ignored.

As a person with atrocious handwriting, I always write in block print . . . never cursive. Further, my hospital does forbid the use of certain jargon/scripting that's easily misunderstood by normal people.

Arthur Levin, director of the Center for Medical Consumers and an author of the 1999 report, said that just about everyone in the health system was to blame. ?This country has not taken seriously the alarms we sounded in 1999,? Mr. Levin said. ?Why??

Two answers . . . who is going to pay and who is going to profit!

 

[Aisengard]

If we don't worry about making mistakes, we will make fewer mistakes?

And what happens when that incompetent doctor operates on the wrong leg? Slap on the wrist? You sir, are an idiot. Please revise your post to get actually serious responses.

 

[LunarRay]

Originally posted by: Aisengard
If we don't worry about making mistakes, we will make fewer mistakes?

And what happens when that incompetent doctor operates on the wrong leg? Slap on the wrist? You sir, are an idiot. Please revise your post to get actually serious responses.

I think BBD is far far far from being an idiot...

I don't read that at all.. I could but in context with the rest ... the jist of what BBD is saying I get...

Right... the cause of mistakes is worry over them happening.. not that the MD's are incompetent... that trial lawyers make them that way.. heheheh The newbie MD's are not up to speed and need electronic safeguards.. and that will prevent mistakes... not law suits..

edit.. to the patient who dies.. the lawsuit is not the answer...

 

[BaliBabyDoc]

Originally posted by: Aisengard
If we don't worry about making mistakes, we will make fewer mistakes?

And what happens when that incompetent doctor operates on the wrong leg? Slap on the wrist? You sir, are an idiot. Please revise your post to get actually serious responses.

Get a sarcasm meter noob . . .

 

[Aisengard]

So your post was sarcastic, and you don't think that not having consequences for mistakes will result in fewer of them?

With LunarRay's serious response, I'm now just confused as to what the point of this post was.

 

[BaliBabyDoc]

Originally posted by: Aisengard
So your post was sarcastic, and you don't think that not having consequences for mistakes will result in fewer of them?

With LunarRay's serious response, I'm now just confused as to what the point of this post was.

Just skip over this thread . . .

 

[LunarRay]

Originally posted by: Aisengard
So your post was sarcastic, and you don't think that not having consequences for mistakes will result in fewer of them?

With LunarRay's serious response, I'm now just confused as to what the point of this post was.

I'm sorry.. I wrote what came to my mind.. although I don't often do that.. cuz it is meaningless unless you are also in my mind laughing at what I had read..

I see how I may have confused you further..

 

[fitzov]

to the patient who dies.. the lawsuit is not the answer...

what is the answer to the patient who dies?

 

[Red Dawn]

generation

Originally posted by: fitzov

to the patient who dies.. the lawsuit is not the answer...

what is the answer to the patient who dies?

Regeneration

 

[Rainsford]

Apparently I'm the only one here with a working sarcasm meter...

On a similar topic that I hope BBD can answer, why are only some hospitals teaching hospitals? It seems like the best approach would be to spread out the interns over all hospitals to avoid concentrating newbies in any particular place. Not only will people be able to more easily keep an eye on them, but they'll probably learn faster too.

 

[BaliBabyDoc]

Originally posted by: Rainsford
Apparently I'm the only one here with a working sarcasm meter...

On a similar topic that I hope BBD can answer, why are only some hospitals teaching hospitals? It seems like the best approach would be to spread out the interns over all hospitals to avoid concentrating newbies in any particular place. Not only will people be able to more easily keep an eye on them, but they'll probably learn faster too.

Good question . . . but all I can offer is some background info since I'm not now (nor ever will be) in administration.

1) Teaching hospitals (residency programs) are a self-selected lot . . . just like medical schools. There is no central planner that says UNC, Duke, WFU, ECU you do residency programs while other private and public hospitals do not.

2) As implied in #1 many residency programs (in the new era) evolved from an association with medical schools and vice versa. As we produced more medical graduates it was necessary to produce more places for them to get graduate medical education.

3) It costs a lot of money to train a doctor AFTER they graduate from medical school. I'm not talking about med malpractice but more germane things like salary/stipends, salaries for needed for supervision (a lot), support staff, ordering excessive testing, etc. Of course, this ignores the fact that hospitals get paid for the services we render.

4) Residency programs are like a minor league farm system . . . seriously. But the difference is that once a 'prospect' is ready to move up, they can go anywhere they want. Naturally, many hospitals . . . particularly for-profit aren't interested in investing hundreds of thousands in training a resident that will then leave for the highest bidder (or favored locale).

For instance, a chief resident in neurosurgery (year 6) pulls down a little north of 50k for a 100+ hr workweek. This guy (or gal) teaches/abuses the 5 years of residents under them, teaches/abuses the medical students rotating through the service, does administrative tasks (more likely scuts it to one of his underlings), and most importantly largely manages pre-op, intra-op, and post-op care of the patients. If they are really good that means a lot of surgical time for which the attending(s) will pull down several hundred grand. But in a year or two (fellowship), the former chief will easily get a "1" and possibly a "2" or "3" in front of their prior pay.

It's even worse in ortho. During my tour of duty, several attendings really did just 'attend'. Granted, we can't learn unless we do . . . or as the motto goes . . . "see one, do one, teach one." For a intramedullary femur repair that he 'witnesses' at 2AM; the attending will collect his (very few female ortho attendings) surgical fee (a couple of grand) while residents will be paid with a learning experience and 6AM rounds.

5) The feds provide several billion (probably less than 4) a year in direct graduate medical education payments to offset some of the costs of educating residents. Most of the money comes from Medicare but some is VA, and DOD. Naturally, the teaching hospitals say its not enough, the small ones complain they don't get their fair share, the big ones complain they don't get their fair share, non-academic health centers complain that it subsidizes care at the academic centers, etc etc.

6) Given all of the above it's not surprising that many hospitals choose not to operate as a teaching facility.

 

[fitzov]

Originally posted by: Red Dawn
generation

Originally posted by: fitzov

to the patient who dies.. the lawsuit is not the answer...

what is the answer to the patient who dies?

Regeneration

I vote for Frankenstein's methods.

 

[alchemize]

1. Do lawsuits reduce mistakes?

To some degree, yes they do. But they are also a driver in the increasing costs of healthcare. There are 3 components:
a) Increased cost of malpractice insurance and settlements
b) Increased cost of defending lawsuits
c) The most expensive (and probably most difficult to measure) - lawsuit-prevention treatments. What's that? Well, here's an example. Once I busted up my foot pretty good. An x-ray didn't show a fracture though - so a bone scan was ordered. Simple enough, right? Scan the foot, on my way. Well no - this hugely expensive piece of equipment and an expensive technician scanned my entire body. Why? Because the hospital had been sued when somebody had bone cancer and they had an isolated bone scan elsewhere.

So what should have been a 10 minute procedure instead took 90 minutes - 9 times longer. Hospitals and doctors don't care - that's more revenue anyhow.

2. Medical errors
Humans will always make mistakes. Period. That means people will die. I think the not-for-profit system is ahead of the for-profit system since they are recognizing that they are failing in their mission of "doing no harm".


What would I propose (for starters)?

1. Take lawyers out of the picture all-together, unless it is a case of intentional neglect (and then it should be pursued as a criminal matter). Establish a medical errors "fee schedule" of what a person/family is paid on an error. Lose a leg, 100K, lose your life, 500k, etc. Take the lawsuit lottery factor out of the equation, nationalize malpractice insurance.

2. Make hospital/doctors 'track record' publicly available via metrics. Bad hospitals and bad doctors will get weeded out of the system as patients, and payors choose not to utilize them.

3. Begin making best practices mandatory - for example, prescription writing programs like iScribe, prescription dispensing systems, and electronic medical records.

How well this would work would be evidenced by the uproar you would hear from hospitals, doctors, pharmacists, insurance companies, and trial lawyers.

 

[Kwaipie]

Premise: The state of health care in the USA became dismal when care providers had stockholders to listen to.

 

[BaliBabyDoc]

1) The increased cost of malpractice insurance and settlements has fallen primarily on hospitals and doctors. Those costs have not been passed on to consumers. But it sux if you are an Ob-Gyn in Miami.

In fact, proactive hospitals (such as Ann Arbor) have dramatically reduced their liability costs by acknowledging mistakes, compensating patients, and taking corrective action.

In essence, if costs are rising at your hospital it isn't the lawyers . . . it's the hospital.

2) There's no such thing as lawsuit prevention treaments or defensive medicine. It's a fantasy made up by advocates for insurance companies and hospitals. If your doctor orders an unnecessary test . . . it means they sux! That's it! Residents order excessive tests due to a lack of experience. Licensed MDs order excessive testing b/c they just aren't good doctors.

But you are right about one thing. If hospitals and doctors are indifferent to the cost of healthcare they will use it inappropriately . . . seems like that would explain a lot of healthcare costs, eh?

3) Your solutions naturally started with the least important. Reverse the order . . . or better yet call your #2 and #3 . . . 1b and 1a, respectively.

1a) All facilities/providers observe best practice parameters to the extent possible.
1b) All facilities/providers track what they do and some authority JCAHO, IOM, etc publishes the results and then corresponding regulatory agencies treat the bad actors accordingly.

2) Change the healthcare culture to favor prevention instead of intervention.

3) Remove some of the profit-motive . . . there's minimal evidence it drives quality healthcare.

4) Consider a clearinghouse for policies such as those at UMich-Ann Arbor to help other hospitals reform themselves. This will effectively minimize abuse of the system while also facilitating appropriate compensation for bad outcomes.

It's foolish to set a bar of intentional neglect b/c that would mean that incompetence wouldn't be grounds for compensation. And for the record, most patients going in for procedures sign a consent that basically says 'crap happens . . . don't say we didn't tell ya.'

 

[vi edit]

Electronic medical records can help ensure that patients do not receive toxic drug combinations. The 1999 report urged widespread adoption of these systems. The July 20, 2006 report called for all prescriptions to be written electronically by 2010 . . . just 3% of hospitals have electronic patient records.

I'm really curious to see the stats behind this. For every major 500+ bed medical center that has a very complex electronic record system, you might have 25 little dinky regional hospitals with less combined beds than the one system.

It's kind of misleading. You need to compare the number of patients under care that are not part of an electronic system. Not the number of hosptials.

 

[LunarRay]

Originally posted by: fitzov

to the patient who dies.. the lawsuit is not the answer...

what is the answer to the patient who dies?

Preventative measures.. like the electronic patient record which keeps track of medicine currently being used on the patient and any adverse effects suffered by the patient historically. This proactive measure insures to a large degree that a patient wont be issued two drugs that conflict with each other or should not be used additionally..

 

[GarfieldtheCat]

How about actually policing up the bad physicians? There is such a "old boy" network at my hospital, and other, that there may be several docotrs that are bad, and everyone will say that about them behind their back, but officially, every doctor will say that these bad docs are fine.

Hospitals will screw their staff 6 ways to Sunday, all the while letting doctors screw the hospital out of money so they can keep it for their own practices.

Until the physcians get under control, nothing will change.

 

[BaliBabyDoc]

Originally posted by: GarfieldtheCat
How about actually policing up the bad physicians? There is such a "old boy" network at my hospital, and other, that there may be several docotrs that are bad, and everyone will say that about them behind their back, but officially, every doctor will say that these bad docs are fine.

Hospitals will screw their staff 6 ways to Sunday, all the while letting doctors screw the hospital out of money so they can keep it for their own practices.

Until the physcians get under control, nothing will change.

I'm not saying we aren't part of the problem but it's unfair to scapegoat MDs. The system sux.

FDA and drug companies suxsux

WASHINGTON - A federal prescription drug directory fails to list more than 9,000 medications but catalogs tens of thousands more that are no longer on the market, according to a report Monday.
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The omissions and errors limit the usefulness of the directory, which is meant to help the FDA and other government agencies in handling recalls, identifying medication errors and controlling imports, the IG's report said.
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Most of the omissions and inaccuracies are related to the failure of drug companies to comply with mandatory listing requirements, the report found. While unlisted drugs are considered "misbranded" as of August 2005, the FDA had not subjected any manufacturer to criminal or regulatory action solely because it failed to list a product, according to the report.

The directory has more than tripled in size since 1990, when it listed just 39,000 prescription drugs.

So many drugs that even FDA can't keep track of them. The drug companies don't give a crap, while FDA often acts like it works for industry instead of the public.

But when something goes wrong . . . it's always the doctor's fault.:disgust:

 

[BaliBabyDoc]

Who says we have bad bedside manners?

CONCORD, N.H. - The state Board of Medicine voted to dismiss its disciplinary case against a doctor accused of telling a patient she was so obese she might only be attractive to black men and advising another to shoot herself following brain surgery.

For the record, it's well noted that patients don't sue doctors they like . . . regardless of outcome.

 

[LunarRay]

Perhaps for those of us who would be edified on the time it takes to actually become a Licensed MD could you out line the steps ... in years.. to say.... become an Internist..

I think we'd appreciate better just what a physician puts into it all...

 

[BaliBabyDoc]

Originally posted by: LunarRay
Perhaps for those of us who would be edified on the time it takes to actually become a Licensed MD could you out line the steps ... in years.. to say.... become an Internist..

I think we'd appreciate better just what a physician puts into it all...

1) 4 years of med school
2) 3 year residency in General Internal Medicine
3) 1-2yr fellowship in subspecialty of choice such as - Cardiology (heart), Pulmonology (lungs), Gastroenterology (crap)

Resdients are licensed to 'learn' medicine but you have to complete residency and Boards before you can apply for a 'real' license in a given state.

Another gem . . .

How Physicians Would Disclose Harmful Medical Errors to Patients

Results Wide variation existed regarding what information respondents would disclose. Of the respondents, 56% chose statements that mentioned the adverse event but not the error, while 42% would explicitly state that an error occurred. Some physicians disclosed little information: 19% would not volunteer any information about the error's cause, and 63% would not provide specific information about preventing future errors. Disclosure was affected by the nature of the error and physician specialty. Of the respondents, 51% who received the more apparent errors explicitly mentioned the error, compared with 32% who received the less apparent errors (P<.001); 58% of medical specialists explicitly mentioned the error, compared with 19% of surgical specialists (P<.001). Respondents disclosed more information if they had positive disclosure attitudes, felt responsible for the error, had prior positive disclosure experiences, and were Canadian.

 

[LunarRay]

Some how I figure your 'signature' statement says much..

And answers what should be done in the matter of errors.. The patient should be informed in most cases.. I think..

 

[GarfieldtheCat]

BBD, I agree witth you that physicians aren't the whole problem, but they do contribute to it. I don't agree with what most of the lawyers do (all the crazy malpractice suits), but when the physicians themselves won't get rid of their own "problem docs", it makes them look bad, and gives the lawyers plenty of cases to work on.

For non-teaching hospitals, it's all about billing procedures (for the physicians), and specialties will compete to get patients so they can get the money. That's not the best way to practice medicine. Of course, in a teaching hospital, it probably is a better environment.

 

[BaliBabyDoc]

Originally posted by: GarfieldtheCat
BBD, I agree witth you that physicians aren't the whole problem, but they do contribute to it. I don't agree with what most of the lawyers do (all the crazy malpractice suits), but when the physicians themselves won't get rid of their own "problem docs", it makes them look bad, and gives the lawyers plenty of cases to work on.

For non-teaching hospitals, it's all about billing procedures (for the physicians), and specialties will compete to get patients so they can get the money. That's not the best way to practice medicine. Of course, in a teaching hospital, it probably is a better environment.

You're a little bit of a noob so you don't know my history. I'm not contending that physicians are masterful, benevolent angels serving the needy with little concern for our compensation or working conditions . . . yet we fight the good fight against the big bad healthcare system. That's fantasy. I am saying it's gotten beyond our control. There's so much money . . . $1.6T spent on healthcare each year . . . and so many groups/people clamoring to get their share . . . that it's better described as a wealth distribution program . . . than calling it a healthcare system.

Healthcare in America is kinda like DOD. We are tasked with a general function. But there's essentially no broad oversight and funding isn't dependent on performance. Hence, there's no accountability. The 'consumer/payer' often doesn't see the true cost so they don't care. Many (not all) of the 'providers' only care about getting paid. And there's such vast sums available that it attracts the best (and the worst) people.