How to stop hospitals from killing us

"A few years ago, Long Island's North Shore University Hospital had a dismal compliance rate with hand washing—under 10%. After installing cameras at hand-washing stations, compliance rose to over 90% and stayed there."<p>There's something seriously wrong with the medical profession if doctors only wash their hands 90% of the time, even if they know they're being watched. The words "reckless disregard for human life" spring to mind. How many deaths from infections per year could be prevented if hospitals just fired any doctors who didn't wash their hands? (Hospitals are a breeding ground for antibiotic-resistant pathogens like MRSA.)<p>Another interesting article is Atul Gawande's "The Checklist" [1] (later expanded into a book), which describes how the use of simple checklists, similar to those that pilots use, can prevent medical errors like operating on the wrong body part.<p>[1] <a href="http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande?currentPage=all" rel="nofollow">http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_...</a>

The US is rated worst among developed nations for this sort of thing: <a href="http://www.commonwealthfund.org/News/News-Releases/2005/Nov/International-Survey--U-S--Leads-in-Medical-Errors.aspx" rel="nofollow">http://www.commonwealthfund.org/News/News-Releases/2005/Nov/...</a><p>I was in hospital following an accident last year. When I was discharged from the ICU the following day, the nurse gave me the paperwork for the patient in the next room. I didn't notice, being still rather beaten up by the whole episode - it was my wife who spotted it. For a 12 hour stay I ended up paying over $15,000, and then I hard to fork over an extra $90 to get copies of the medical record. On paper.<p>I'll take socialized medicine any day of the week. the private sector does a terrible job of healthcare.

From the submitted article:<p>"Nothing makes hospitals shape up more quickly than this kind of public reporting. In 1989, the first year that New York's hospitals were required to report heart-surgery death rates, the death rate by hospital ranged from 1% to 18%—a huge gap. Consumers were finally armed with useful data. They could ask: "Why have a coronary artery bypass graft operation at a place where you have a 1-in-6 chance of dying compared with a hospital with a 1-in-100 chance of dying?"<p>"Instantly, New York heart hospitals with high mortality rates scrambled to improve; death rates declined by 83% in six years. Management at these hospitals finally asked staff what they had to do to make care safer. At some hospitals, the surgeons said they needed anesthesiologists who specialized in heart surgery; at others, nurse practitioners were brought in. At one hospital, the staff reported that a particular surgeon simply wasn't fit to be operating. His mortality rate was so high that it was skewing the hospital's average. Administrators ordered him to stop doing heart surgery. Goodbye, Dr. Hodad."<p>So we have a known model that improves results. Let the patients who decide which hospitals to visit know beforehand how hospitals compare in getting good results for patients. Give patients power to shop. That provides incentives for hospitals to do better, and nudges hospital managers to do what is necessary to win the trust of informed patients.<p>This kind of reform would be very good to apply to schools as well. Already, one state in the United States that is conspicuous among all fifty states in educational achievement (the state I live in) allows all residents of the state to enroll in the public schools of ANY school district anywhere in the state. (The school district I live in has inbound open-enrollment students from the geographical territories of forty-one other school districts.) In general, the power to shop is the incentive factor to bolster by government regulation, letting each consumer decide what trade-offs are important. That works considerably better in driving improvement than regulating outcome goals, and better still than regulating inputs into the provision of the important service being regulated.

It's amazing how easy it is for tiny mistakes to result in serious consequences.<p>I have a medical condition that took over two years to officially diagnose. During one of my hospital stays toward the beginning of that ordeal, a doctor had decided that my issue required major surgery involving the removal of an organ. Less than one day before the scheduled surgery, the doctor decided to do "one more test" for an easily treatable condition. As it turned out, he had misread a previous doctor's note suggesting a possible diagnosis, as a dismissal of the diagnosis.<p>I'll never know whether the confusion was due to poor handwriting or poor attention to detail, but I feel lucky that the error was caught in time. I met multiple people during my numerous, lengthy visits whom I suspect were not as lucky.

"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."<p>This is wrong, it's <i>at least</i> the third leading cause of death. And realistically if you don't smoke and you exercise once in a while, medical 'oopsy daisies' are probably your #1 risk of death:<p>C.f. The IOM's report To Err is Human: <a href="http://wps.pearsoneducation.nl/wps/media/objects/13902/14236351/H%2007_To%20Err%20Is%20Human.pdf" rel="nofollow">http://wps.pearsoneducation.nl/wps/media/objects/13902/14236...</a><p>And then also read Lucian Leape's commentary in JAMA on why it is probably a huge underestimate: <a href="http://jama.jamanetwork.com/article.aspx?articleid=192842" rel="nofollow">http://jama.jamanetwork.com/article.aspx?articleid=192842</a><p>(Leape is one of the authors of the original IOM report, and the report cites a lot of his own research, including his study estimating that only 5% of medical errors are ever discovered.)<p>C.f. also Barbara Starfield's estimate in JAMA: <a href="http://jama.jamanetwork.com/article.aspx?articleid=192908#REF-JCO00061-1" rel="nofollow">http://jama.jamanetwork.com/article.aspx?articleid=192908#RE...</a><p>Realistically, all of these estimates are at the low end. In fact most of them only count deaths in hospitals (and severely undercount them), when at least half of all medical errors are thought to happen at local doctors offices, plastic surgery clinics, nursing homes, etc.<p>C.f. also the CDC figures for Hospital Acquired Infections, which IIRC the IOM report doesn't count as being medical errors:<p><a href="http://www.cdc.gov/HAI/pdfs/hai/infections_deaths.pdf" rel="nofollow">http://www.cdc.gov/HAI/pdfs/hai/infections_deaths.pdf</a><p>My personal rule of thumb is to avoid taking any drugs or getting any non-trivial medical procedure unless I've read at least three books about it. The problem is that all the papers published in medical journals are basically complete bullshit (except the occasional well-done NIH ones), which means if you want real information about a given drug then the only way to get it is to subpoena the FDA, or read a book written by someone who has.<p>The way drug approval works is that you need 2 tests demonstrating that the drug is better than a placebo, but you're allowed infinite tries to get there. So often a drug will be better than a placebo in only 2 out of 10 trials, but it will still get approved and only those two trials will get published in medical journals. And then those journal articles will have very little in common with the actual data from the FDA trials because the pharma companies completely spin it, which is why the vast majority of the most popularly prescribed drugs are not only no more effective than placebos, but in fact significantly worse when you look at the total quality/length of life.

It would be interesting to see stats compared between 'socialized' systems (we call it the public system) and private systems. When everyone has the same boss (Minister of Health) and is working within the same rules and guidelines it must do something to the stats. We do have a private healthcare service, but its basically restricted to simpler day stay (or slightly longer stays) surgery and less complex procedures. There are no private emergency healthcare hospitals here that I know of. New Zealand is the country. The system is far from perfect here, but I'm yet to learn of a system I'd prefer.

The NHS already provides this data:<p><a href="https://indicators.ic.nhs.uk/webview/" rel="nofollow">https://indicators.ic.nhs.uk/webview/</a><p>The spreadsheet:<p><a href="http://indicators.ic.nhs.uk/download/SHMI/July_2012/Data/SHMI.xls" rel="nofollow">http://indicators.ic.nhs.uk/download/SHMI/July_2012/Data/SHM...</a><p>Sadly, you can pretty much guess the results. Poorer areas = higher death rates.

In an industry as tightly regulated as medicine, it's not surprising that such enormous inaccuracies have not been worked out. No matter what medical professionals might say about wanting to save people's lives, the ubiquitous motivator of economics is a much more powerful incentive. Unfortunately, since the industry is not open to being influenced by the free market, it will be very difficult to break into the industry and jump start that innovation.<p>It will be very interesting to see if developing countries manage to leapfrog our current system and establish a medical industry that is less dependent on people.

The current state of medicine is extremely frightening.<p>Note 1: My comments here relate to the German health system, with which I am most familiar with, but I assume that other systems work similar, if not less efficiently.<p>In my opinion, there are many other problems in the broad field of medicine, but the following two points could be resolved with the support of IT, so I will confine my remarks to those.<p>1. Plausibility checks<p>Virtually no plausibility checks will be carried out in todays hospitals. Often conflicting drugs are prescribed, which produce uncomfortable side effects. One should start to make all medications and treatment measures subject to automatic (computer based) plausibility checks. This would also lead to a cognitive relief of the clinical staff.<p>2. Statistical evaluations (data mining)<p>The lack of inadequate statistical analysis is another concern. Germany has begun to build a national cancer database only this year. One can only imagine what valuable information is hidden in those statistics and have been missed up to this day. Imagine an international database in which all patients who are admitted as an emergency to the hospital are captured statistically. This data could be stored completely anonymous. The only thing of importance would be the provision of relevant laboratory values and the patient's symptoms described in the context of the (verified) final diagnosis. Such a system could support the finding of completely new knowledge (data mining) and support the doctor in finding the right diagnosis.<p>And of course the hospitals need strong incentives to implement these measures. Which is why I support the author's call for absolute transparency.

I feel sorry for everyone involved in this complex industry, no arena of which is aligned with the goal of people's long term health.<p>The common sense suggestions in this article are a good step towards improving things by increasing transparency and accountability via documentation but may not address the root problems.

But the malpractice lawyers are terrible! Tort reform!

The only real solution to healthcare is to reduce costs by eliminating hospitals/doctors altogether using big data/telerobotics/smartphones. Sadly, because of the AMA and FDA this innovation will have to occur offshore first.