It is surprising that some vocal commentators simultaneously rail against health care spending and against rationing, without considering a solution that will naturally reduce usage (and hence costs) without rationing anything; ensuring that health care’s focus becomes “to enable people to lead the lives they want.”
July 30, 2010
July 23, 2010
Patients Get Lost in the Shuffle in Virtually All Fixes for Health Care
It’s no surprise that a recent study found that patients had gotten lost in the shuffle in medical homes. Patients get lost in the shuffle in virtually all attempted fixes for health care. While medical homes offer many benefits over care that is less coordinated, they still tend to focus on what doctors/nurses/others do rather than on the impact of their actions on the patient and whether they advance the patients’ goals.
See Killer Cure: Why health care is the second leading cause of death in America and how to ensure that it’s not yours. Chapter Thirteen, “The Blind Men and the Elephant,” discusses twelve fixes for health care and why their failure to focus on the patient means that they can’t possibly succeed as planned today.
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July 16, 2010
Is Comparative Effectiveness Research Helpful?
Opposing Comparative Effectiveness Research is like opposing stop lights because you don’t want anyone telling you what to do. It’s like opposing having scales in doctors’ offices out of concern that the information might be used to suggest to people who are overweight that they may benefit by making some lifestyle changes. Wouldn’t you want to know — and want your doctor to know — if one treatment helped 75% of people like you who had a disease you have, and another treatment helped only 35%? Which of those treatments would you want to try first? Today, your doctor may not have any idea which treatment works best — because very little Comparative Effectiveness Research has been done — so there’s a good chance you’ll waste time and money and get sicker trying a treatment that’s less likely to help you.
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July 2, 2010
Greek Tragedies: Hop Off the Conveyor Belt
Sometimes people die or are seriously harmed because they think that it’s not okay to call a time out and ask some questions. It’s as if they feel like they’re on a moving conveyor belt and it’s bad form to hop off. But unless it’s a life-threatening emergency, there’s usually time to ask the relevant questions.
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June 25, 2010
Hospital Delirium: Assuming That People Are Simply Machines
One study showed that people who develop delirium during a hospital stay are 13x as likely to die in the hospital as equally sick people who don’t develop delirium. (Wes Ely, see 20 Jun Overview for attribution.)
So what’s going on here? What’s the root cause? In my opinion, the largely unrecognized epidemic of hospital-acquired delirium has a simple psychological error on the part of health care professionals at its root: patients are viewed as mechanical and chemical objects to whom mechanical and chemical treatments can be applied with little thought to the effects of those treatments on their minds.
When a mechanic changes the oil in a car, he doesn’t worry about the impact of that oil change on the car’s mind. The health care system tends to treat patients the same way. I suspect that when people are physically and chemically restrained — via ventilators, IV lines, in some cases wrist and ankle restraints, drugs like fentanyl (which, besides being used in ICUs, doubles as a drug “to incapacitate people in hostage situations” according to Princeton University’s WordNet) and midazolam — their minds make a break for it in an attempt to escape the confinement.
In the process, they often suffer terrible, violent hallucinations in which captivity, torture, and profoundly brutal, bloodthirsty opponents loom large. My take on it is that those hallucinations represent their minds’ interpretation of the hostage-like situation in which they find themselves, a situation in which they are physically and mentally almost paralyzed.
People in intensive care may be “receiving doses of sedatives, narcotics and anesthetics high enough to make even healthy people stop breathing on their own.” (Gina Kolata, see 22 Jun for attribution.) One doctor wondered whether the sedatives keeping patients comfortable might actually be making them worse. He “tried an experiment, waking patients briefly every day by turning off their infusion of sedatives. Not everyone approved. ‘People were concerned about waking patients every day, that that might put patients in a state of fear and dread and anxiety,’ he said. But, he added, ‘we found, to the contrary, that patients actually did better’ and even had a significantly lower rate of post-traumatic stress disorder.” (Kolata, as above.)
Note the assumption on the part of most care providers that people can simply be drugged into oblivion. It doesn’t work. Their minds don’t turn off. They struggle valiantly to escape the captivity — and they break.
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June 18, 2010
June 11, 2010
Not Asking Questions
“In our survey, 41 percent of respondents reported that they had not asked questions or told their doctor about medical problems, because the doctor seemed rushed or they were unsure about how to talk to him or her.”
From the Health Affairs study referenced on June 07, below.
It’s a challenge to get good results from health care without telling the doctor what your problems are, and without asking questions. Imagine trying to buy a house without telling the real estate agent what you need and without asking any questions about the houses she suggests. It’s a similar issue in health care. Unlike Santa Claus, who may be expected to mysteriously divine what a child’s wants and needs are, doctors depend on you to tell them what your biggest problems are and to work with them to address your needs.
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June 4, 2010
Ten Million People Are Tested for Cancer “in an Organ That They Don’t Have”
| Nearly ten million women every year are tested for cancer of the cervix when they don’t have a cervix. These women get Pap smears after they have had their cervixes completely removed “for reasons other than cancer.”
“Dr. Brenda E. Sirovich, a research associate at the Outcomes Group at the Veterans Affairs Medical Center in White River Junction, Vt., and the study’s lead author said . . . ‘These women are being screened for cancer in an organ that they don’t have.”’ Gina Kolata, “10 Million Women Who Lack a Cervix Still Get Pap Tests,” New York Times, 23 June 2004. No reputable organization recommends Pap smears under these circumstances. |
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May 28, 2010
Don Berwick’s Personal Experience with Health Care Failures
| Don Berwick, eminent Harvard-trained physician, has told stories about the high volume of medical errors, medication errors, fragmented care, and other grave problems in health care delivery that have caused grievous harm — in his own family: stories about the care received by his father, by his wife, and by Dr. Berwick himself. No one is exempt; big changes are needed throughout the health care system for health care to enable people to lead the lives they want. |
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May 21, 2010
Be Persistent in Reporting Side Effects
| “When patients feel they might be having an adverse drug effect, doctors will very often dismiss their concerns. . . . Physicians seem to commonly dismiss the possibility of a connection . . . even for the best-reported adverse effects of the most widely prescribed class of drugs.”
Anne Harding, “Docs Often Write Off Patient Side Effect Concerns,” Reuters Health, 28 August 2007. |
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