Myth or fact: Berwick does not believe in rationing.
Fact: he does not believe in rationing. “I cannot imagine that a civilized, developed country is actually going to deny highly effective and humane care to its people, that we’re going to say to Americans, ‘Too bad, medical science has something that can help you but you just can’t have it.’” Don Berwick, plenary speech “Squirrel,” IHI’s 21st National Forum, 08 December 2009.
He goes on to talk about both giving everyone the care they need and spending less to do it — a solution based on health care whose focus is, in my words, “to enable people to lead the lives they want.”
Myth or Fact: a medical home is some kind of “hospice . . . halfway house . . . [or] group home for patients.”
Fact: a medical home is none of these. It is instead likely to be a primary care doctor’s office that uses a team of professionals to pay much more attention to prevention, to coordination of care, to managing chronic diseases effectively, and to staying on top of a ton of details needed to help ensure that you get good results.
The quotation above is a bewildered patient’s guess about the meaning of the term “medical home,” as reported in “Putting Patients at the Center of the Medical Home,” by Pauline Chen, New York Times, 15 July 2010.
Myth or Fact: Doctors know what they need to about drugs and other treatments; there’s no need for more research into what treatments work best.
Fact: only about 20-25% of treatments have enough facts backing them up to say whether they actually help or not. See Sean R. Tunis, “Reflections of Science, Judgment, and Value in Evidence-Based Decision-Making: A Conversation with David Eddy,” Health Affairs, 19 June 2007.
Myth or fact: health care causes so many problems, it’s best just to avoid it at all costs.
Fact: Avoiding all health care isn’t an effective approach to dealing with its problems. For one reason, sometimes injuries or illnesses occur even in people who take excellent care of themselves — if you are in an automobile accident, you still need a cast put on your broken arm even if you always eat your vegetables. If your approach is to avoid health care, you may be spectacularly unprepared to deal with it when you or someone you care about ends up in the emergency room.
Myth or fact: It’s no big deal if the elderly get “confused” during a hospital stay. It’s temporary and doesn’t really matter.
Fact: After even short bouts of delirium, older patients are “placed in nursing homes 75 percent of the time, five times as often as those without delirium. Nearly one-tenth die within a month.” (Belluck, see Monday’s earlier entry below.)
Myth or fact? “More is better.” Any seven-year-old who observes Christmas will tell you that getting more from Santa Claus is better than getting less. Is the same true of health care?
Fact: With health care, it turns out, “more” is often “more likely to kill you.” See, for example “Supply-Sensitive Care,” The Dartmouth Atlas Project Topic Brief, downloaded 20 June 2007, http://www.dartmouthatlas.org/topics/supply_sensitive.pdf. “Patients . . . in high-spending areas had 82 percent more physician visits, 26 percent more imaging exams, 90 percent more diagnostic tests and 46 percent more minor surgery. Compared to low-intensity regions, patients with hip fractures, colon cancer and heart attacks . . . in high-intensity regions had higher mortality rates and worse ‘scorecards’ on measures of quality.”
Myth or fact? “Berwick is a Washington insider steeped in politics.”
Fact: Berwick is a pediatrician and a professor at the Harvard Medical School. He is also the highly respected founder of the Institute for Healthcare Improvement, which for more than 20 years has led the charge in many national efforts to get hospitals to stop injuring people who enter them. He is not a political insider in Washington.