Friday, December 6, 2013
400,000+ Reasons To Change US Healthcare Culture
I was appalled at the NYT blog http://opinionator.blogs.nytimes.com/2013/12/04/to-make-hospitals-less-deadly-a-dose-of-data/?_r=0. I was deeply sickened.
I just had no idea that it was that bad. 400,000 deaths per year directly attributable to preventable hospital death in the US. Serious, non-lethal harm is estimated at 10 to 20 times higher, 4-8 million per year.
I knew the figures would be worse than in the UK. The figures I have in mind from a decade ago is 6,000 preventable hospital deaths per year. Adjusting that for population size, the US figures are 1000% plus higher. If standards approached UK standards of objective patient care in the 'healthcare' system, a system that has been monitoring and treating this for years, preventable hospital deaths would reduce by 90% or over 350,000 per year.
I am hardly surprised that nobody wants to talk about it. It is an embarrassment. It is shameful. I am not surprised nobody in the medical profession can admit it, even to themselves.
In light of that, perhaps I should not have been surprised to see that this article was old evidence rather than breaking new. It was published 3 months ago in the journal of patient safety.
And it is a gross underestimate of the harm and death that is occurring in the US medical system to patient health. It fails to take into account the human cost of overmedicalisation and overinvestigation that occurs and is seen outside of hospital or that remains unreported, unassociated with the primary cause, the US medical culture. 50% of all radiation exposure in the US is of medical origin, leading to immeasureable cases of cancer and leukaemia a decade or more later.
The numbers engraved in my memory are a 1 in 20,000 risk from a chest X-ray and that CT uses 20x the radiation.
The culture of using the newest and latest drugs and technology is rife and a frequent horror because of a cultural lack of appreciation of the nature of drug licensing, medical licensing and clinical evidence. A drug is licensed by the FDA after alpha testing to prove positive effect. The numbers of patients in the studies are insufficient to predict anything but the most common side-effects. Only the most immediate risks and side-effects are measured even though the patients may be taking these drugs for decades with an accumulative risk. In the alpha trials for licensing purposes, patients are chosen for lack of complexity in their health and medications. The beta-trial commences with licensing and only then do we discover how the drug performs in the complexities of real life and with complex polypharmacy.
And how long did it take for us to discover serious drug interactions with grapefruit?
The evidence of how many problems have arisen in the past during beta testing of licensed drugs produces a very simple rule. Old drugs are tried and tested. New wonder drugs are not. Each carries a significant unknown risk that will only be revealed with time.
These numbers have been excluded from the estimates of 400,000 dead and 4-8 million wounded unnecessarily by US medicine every year.
The scale of this can only be described as a crime against humanity. That such an allegedly noble and caring medical profession is a part of this atrocity, collaborating and participating in it, nauseates me.
I really do feel physically ill. Words fail to express the visceralness of my reaction.
Still, I am incredulous. I cannot believe that this is not at the forefront of every medical mind in the US. I cannot believe that these horrifying numbers are not a constant motivator of dramatic change from inside medicine to restore the honour and reputation of the profession as healers not killers.
But all I hear from many US doctors is about massaging medicine's image, not changing the reality. Claims of compassion and humanity sound good. There is talk of empathy without definition when behind the words it is not empathy but sympathy. Not a mention of the facts or evidence. Nothing said about improving those. Just complaints about EBM from those who have missed its fundamental principles http://clinicalarts.blogspot.mx/2013/12/when-evidence-based-medicine-was-best.html.
I know that there are many, many doctors out there who want to be ethical and save life rather than destroy and take them. I know that they have the highest intentions. The problem is that their strategy is culturally wrong and ineffective. It has been making the problem worse.
Insanity: doing the same thing over and over again and expecting different results.
It is time to identify the problem and resolve it. The first stage of problem solving is to admit the problem. Attempting to solve a problem by continuing the strategy that caused it just makes the problem worse. A change of strategy is needed.
This evidence has brought together the importance of various individual blogs on this site including the use of the dark arts of sales to sell an inferior, non-life enhancing product to an unwitting consumer. It is passive aggressive Win/Lose Lose/Win sales in which everybody will lose in the long term. You should read them all because the individual blogs come together to paint a very different worldview of healthcare in which patient health outcome is prioritised by selfless doctors, doctors who really care about their patients' health.
The US is the birthplace and home of sales. It originated the outdated belief that the customer is always right in early sales psychology. Manipulate the unsuspecting and innocent customer and indoctrinate them into what they expect for your own profit. It is just to sell for your own benefit in the short term. The long term outcome has been that US patients are the least satisfied with the standard and quality of care in the whole world.
This is the darkest art sales strategy and it is still being used in US medicine. It is being sold to med students and doctors too. When I hear words like 'humanity', 'empathy' and 'compassion', I know they are hollow. They are said because they sound good. They will sell. I know they are just sales and a sop to a shallow shell of self-image to prevent insomnia. 400,000+ deaths per year is the proof of the vacuum behind them. It is just a worthless con. It is words without action,
Yes, this lowest common denominator of dark sales has started to be used in the UK by governments hoping to be re-elected health budgets and cutting services at the cost of patient health. It is being used to con voters and hide the truth of what is happening.
Leaving health reform to market forces and patient demand sound good in theory but they are the cause of the problem. That is how the system has got into the mess it is in today. The public has been misinformed, disinformed and uninformed about health and just about everything else in their lives. They don't know what they want and they don't know what they need. The sales and marketing department has decided for them.
The only information on which to base patient choice has been reputation and customer satisfaction. Reputation and satisfaction is bought by spending on dark arts sales and marketing and has nothing to do with the quality of care. Expectation and demand have been manipulated.
As specified in the NYT article, the actual facts and figures have been hidden on which they could have made rational decisions. They objective performance of hospitals in saving lives, or rather killing patients through ineptitute and errors, has been denied to them. It is being blocked by hospital lobbyists.
This is life and death freedom of information that is being denied to the public.
This hard data is the one and only way to change what is happening and stop hundreds of thousands of hospital induced deaths and millions of casualties per year. Some of this life and death information is starting to become available. It is the thin end of the wedge and this is by far the biggest issue in healthcare.
I might even suggest that Obamacare is just a distraction. Or perhaps it is a step in a greater plan to get doctors into centralised groups to make them easily controllable?
So individual American doctors and the US medical profession as a whole are going to have to choose whose side they are on when this blows. Objective health measures will replace customer satisfaction. You really do not want to be on the wrong side of this when it blows. They must choose objective patient health or dark sales strategies. They must choose their individual and professional reputation or a sham that will be shattered by the hard evidence.
You really want to be on the right end of that stick or the consequences will be catastrophic.
So that is the choice. Those are the facts. It does not matter if you Facebook like them or not. It does not change those facts. Face up to them. You can either be behind a cultural medical revolution, leading a revolution for better objective health for your patients and all patients or you can be held accountable and punished.
It is time for doctors to take this into their own hands.