In another example of government over-reach, the NYT describes how the Obama administration is enlisting the help of patients to report physicians (whom they believe may have made a medical error), directly to the federal government. While there are systems already in place for such reports at the local hospital level, apparently the “under reporting of medical errors” has triggered AHRQ to pilot a program in which questionnaires are sent to patients to ferret out potential examples of errors caused by the following:
* “A doctor, nurse or other health care provider did not communicate well with the patient or the patient’s family.”
* “A health care provider didn’t respect the patient’s race, language or culture.”
* “A health care provider didn’t seem to care about the patient.”
* “A health care provider was too busy.”
* “A health care provider didn’t spend enough time with the patient.”
* “Health care providers failed to work together.”
* “Health care providers were not aware of care received someplace else.”
So if a patient determines, for example, that a physician did not spend enough time with them, and they believe that resulted in a medical error (whatever that might be), they can/should report the physician to the federal government. Wow. One physician explains the potential hazards of such a process:
Dr. Kevin J. Bozic, the chairman of the Council on Research and Quality at the American Academy of Orthopaedic Surgeons, said it was important to match the patients’ reports with information in medical records.
“Patients’ perceptions and experience of care are very important in assessing the overall success of medical treatments,” Dr. Bozic said. “However, patients may mischaracterize an outcome as an adverse event or complication because they lack specific medical knowledge.
“For instance, a patient may say, ‘I had an infection after surgery’ because the wound was red. But most red wounds are not infected. Or a patient says, ‘My hip dislocated’ because it made a popping sound. But that’s a normal sensation after hip replacement surgery.”
I believe that reporting medical errors is critical in the process of quality improvement, but that is most efficiently handled at the hospital level. There is no need to involve the federal government at the earliest stages of investigation, and the amount of bureaucracy required to support such an effort boggles the mind.
In the past when I encountered medical errors in the hospital setting, I found successful ways to report the incidents to the local administration. The result was a rapid correction of the problems and new processes put in place to ensure that it didn’t happen again. This is how medical errors should be reported and resolved. Soliciting patients for accounts of subtle lapses in social graces by their healthcare providers, and then reporting them to the government for it, is nothing short of Big-Brother creepy.
There is a romantic view of America as a homogeneous nation – a nation that is flat. But the real America has high peaks of affluence and deep valleys of poverty and a varied landscape of health care spending. It is a hilly terrain of income inequality.
The Affordable Care Act was based on homogeneity. Not only would its provisions be disseminated equally, but smoothing the peaks and valleys of health care utilization would liberate the funds necessary to finance it. Under reform, Newark would come to resemble Grand Junction CO, and Mayo would be the model for Manhattan. No longer would Los Angeles, home to the nation’s largest concentration of poverty, consume more resources than Green Bay, WI, where poverty is infrequent. Regional variation in income and poverty could be ignored all together. The problem is “practice variation,” and health care reform will fix that.
Of course, the US is not homogeneous, and poverty cannot be ignored. In fact, Read more »
*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*
It’s more than just a few flecks. President Barack Obama, who turned 50 in August, is definitely going gray. He’s said the color change runs in his family and has mentioned a grandfather who turned gray at 29.
But others see it as a sign that the presidency is taking a toll on Obama, as it has other on presidents. Dr. Michael Roizen, of RealAge.com fame, says presidents age twice as fast as normal when they’re in office. The main cause, he says, is “unrequited stress—they don’t have enough friends to mitigate the stress,” which brings to mind the line commonly attributed to Harry Truman: if you want a friend in Washington, get a dog.
Accelerated presidential aging? Not so.
The only problem with this notion of accelerated presidential aging is that it just ain’t so, according to S. Jay Olshansky, a professor at theUniversity ofIllinois at Chicago and a longevity expert. Read more »
*This blog post was originally published at Harvard Health Blog*
A New York Times Magazine story published on the newspaper’s website on Wednesday details the complicated history of screening for prostate cancer in the U.S. and revisits the related story of the U.S. Preventive Services Task Force meeting that was abruptly cancelled for political reasons on November 1, 2010, the day before the midterm Congressional elections. I was interviewed several times for this story, starting shortly after my resignation from my position at the Agency for Healthcare Research and Quality, where for 4 years I had supported the USPSTF’s scientific activities on a wide range of topics.
I commend science journalists Shannon Brownlee and Jeanne Lenzer for their tireless reporting efforts and dogged persistence in pursuing the real reason for the meeting’s cancellation, despite repeated and vigorous denials of senior government officials. Former USPSTF Chairman Ned Calonge confirms in the Times story that politics played a role: “In November 2010, just before midterm elections, the task force was again set to review its [prostate screening] recommendation when Calonge canceled the meeting. He says that word leaked out that if the November meeting was held, it could jeopardize the task force’s financing.” It’s true that several members of Congress had threatened to cut off funding for the Task Force after it recommended against routine mammography for women in their 40s. To the best of my knowledge, however, the order to cancel the meeting came directly from the White House, not Congress. And according to my superiors at the time, Dr. Calonge had no choice in the matter. Read more »
*This blog post was originally published at Common Sense Family Doctor*
This underestimates the increased cost by a huge factor…
Remember how Obama recently waived new ozone regulations at the EPA because they were too costly? Well, it seems that the Obama administration would rather make people with Asthma cough up money than let them make a surely inconsequential contribution to depleting the ozone layer:
Asthma patients who rely on over-the-counter inhalers will need to switch to prescription-only alternatives as part of the federal government’s latest attempt to protect the Earth’s atmosphere.
…But the switch to a greener inhaler will cost consumers more. Epinephrine inhalers are available via online retailers for Read more »
*This blog post was originally published at GruntDoc*