Monday, September 22, 2008

To Err is Buckner..To Forgive is Costly

Ten years ago, if you needed your hip joint “tapped”, you could go to your local hospital about thirty minutes before the procedure, sign some consent forms, have the X-ray-guided aspiration and be out of there – barring unforeseen delays – in an hour….hour-and-a-half.

Today, thanks to the IOM’s (Institute of Medicine) staggering unchallenged assertion that 98,000 people are killed yearly by “medical errors” you better make plans to stay the day. Oh, and get ready to be put on wallet suction. Because the assumption that “of course” we are making these medical errors has lead to the biggest change in corporate behavior since bosses stopped pinching asses.

Only this change costs a lot more.

Today, before the hospital will allow the aspiration of your hip you will need to arrive three hours early and check in to an eight bed pre-procedure “suite” that is equipped better than the original Soviet’s Mir space station.
What is in the suite?
Eight high-tech Hill-Rom hospital beds (prepared to turn you upside-down and resuscitate you if an “error” happens) that cost $8-12,000 each.

After you are changed into a gown and lying in your $10,000 bed you’ll be attached to one of eight high-end blood pressure and oxygen saturation machines which, @ $3,400.00 each makes sure that you -- a normal walking, talking outpatient -- do not suffer from a significant lack of oxygen or blood pressure.

And who hooks you up to this apparatus? An RN of course. An RN who is exclusively assigned to this “pre-procedure” suite with a salary of $70K per year.

This RN will push up to you in an ergonomically appropriate Herman Miller Aeron work chair ($1,300.00 each) while she asks you almost identical questions (“are you allergic to peanuts; do you have headaches when you orgasm; do you tend to react violently in adverse situations…”) which she will type into a Dell laptop ($800.00) before she shuffles off to call the PA.

The PA is another nurse, the “physicians assistant” ($80K/ year) who is permanently assigned to the department and who roves in place of an M.D. in case there are complexities that might bridge the gap between RN and MD in a situation that used to need nothing more than a secretary…

Then they will ask you more questions.

And after the basic, simple, minimally invasive, without-risk procedure, you will be monitored like a baby mouse in a hawk’s nest for any little indication that you might “win the lottery” and suffer some infinitesimally statistically small complication of this essentially safe procedure; and... God help you if you do.

If your heart beat should accelerate or your blood pressure rise (even at the sight of a pretty girl) you will be immediately assaulted by a playbook of scenarios memorized by the RN and PA and meant to replace all simulacra of judgments so that nothing is left to chance.

And, four hours later your test will be done. The system will be $10,000 poorer; and, no man in his right mind will be able to accuse the system of a medical error.

Will it have been worth it?

Well, I guess if 98,000 people a year were actually really dying from medical errors, then any change – no matter how expensive—will have been worth it. However, nothing has changed. As two of the IOM researchers reported six years after the egregious “landmark” IOM report To Err is Human:

Despite finding small improvements at the margins—fewer patients dying from
accidental injection of potassium chloride, reduced infections in hospitals due
to tightened infection control procedures—it is harder to see the overall,
national impact…the groundwork for improving safety has been laid in these past
five years but progress is frustratingly slow...

Why is that? Why haven't the monitors and the questions about peanut allergies and the inclusion of thousands of paraprofessionals and doctor-substitutes and myriad technological advances improved the “error” rate?

Because it was bogus to begin with.
That next in BS in Healthcare.

Wednesday, September 17, 2008

Error in your Local Hospital? There are More Errors in Today's NY Times

Fit To Stink

The New York Times (the power of CHRIST compels you!) adds to the unending procreation concerning MEDICAL ERRORS.

As we all know--nowadays better than Grimm's Fairy Tales--medical errors are commonplace, and seemingly not fixable.
As quoted by The Times impeccable government worker bee, Dr. Peter Angood (chief patient safety officer of the Joint Commission, an independent hospital accreditation agency— Whoo-ah!)

An Institute of Medicine report nearly a decade ago highlighted the prevalence of medical errors, and they are still a major problem. There’s been slow progress in the
decline of these errors

Frequent, deleterious medical errors are a given. There is no debate about it (there never has been). It’s always been completely and totally accepted since day one of the IOM report . And why is that? Because it is intuitive to most Americans. The press and the lawyers constantly beat it into our heads that the medical system SUCKS and is always making ERRORS.

The Trains Need To Run On Time
Politicians reinforce the belief in an unendingly error-prone system by claiming a Health Care Crisis (which is what again?) that needs to be attacked, fought, and conquered, like Mussolini’s railway’s system.

Politicos want to help you FIGHT the big drug and insurance companies in addition to the well-lobbied, wealthy physicians – all of whom are obviously conspiring to keep the error-prone system extant and unchanged for their own benefit and to your detriment.

According to Luke

Because the IOM report said it was true (don’t forget, venerable scientific institutions used to say that cigarette smoking was good for you), the fact of rampant medical errors has become GOSPEL. And that without my ever having found one single doctor, politician, scientist, air-head or mother of invention who has read the IOM report or has any friggin’ idea of what is in that report or what they based their completely unchallenged conclusions upon.

What if I told you that the IOM report was WRONG.
That errors here, in the U.S. health care system are less than everywhere else in the world? That, actually, we commit relatively few errors?
Would you believe me?
In the Next Issue of BS in Health Care You will Learn How the IOM got it wrong, and why errors in health care are, statistically, less connected to bad health care than earwigs are a cause of deafness.

Tuesday, September 16, 2008

BS in Health Care

This is not an error.

This is a new medical blog.

A new dog, with old tricks.

What will you learn here? Inside stuff from the medical wold. Stuff you never heard before. Original material born from the wound of 30 years in health care; from the pen of a primary survivor and someone who knows it all.

I almost certainly don't care what you think, so don't respond. Don't write me idiot screeds; I'm not listening--because I don't care. Why?

Maybe I'm just writing to hear myself think. Maybe I don't want to have to scratch to get you off my neck -- maybe because the opponents of my views have long had their own outlets, all of which are slave-savants to the accepted creed of HEALTH CARE CRISIS: the uninterrupted voicing of which has finally achieved self-fulfillment; because, I'll tell you now, we've got a full-fuelin' HCC raging on the rails of a California train line, right through a red light.

Anyway, you can't know more about what it is I write; and, if you do? You know it wrong. So, you can tune in just to hear a different view or see a new slant...because I have a BS in Health Care.