Hospitals Are Killing Us

Or so says Dr. Marty Makary in a recent Wall Street Journal Review article (Sept. 22-23, 2012). Here are some excerpts:

When there is a plane crash in the US, even a minor one, it makes headlines. there is a thorough federal investigation, and the tragedy often yields important lessons for the aviation industry. Pilots and airlines thus learn how to do their jobs more safely.

The world of American medicine is far deadlier: Medical mistakes kill enough people each week to fill four jumbo jets. But these mistakes go largely unnoticed by the world at large, and the medical community rarely learns from them. The same preventable mistakes are made over and over agina, and patients are left in the dark about which hospitals have significantly better (or worse) safety records than their peers.

As doctors, we swear to do no harm. But on the job we soon absorb another unspoken rule: to overlook the mistakes of our colleagues. The problem is vast. US surgeons operate on the wrong body part as often as 40 times a week. Roughly a quarter of all hospitalized patients will be harmed by a medical error of some kind. 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. The human toll aside, medical errors cost the US healthcare system tens of billions a year.

I encountered the disturbing closed-door culture of American medicine on my very first day as a student at one of Harvard Medical School's prestigious affiliated teaching hospitals. Wearing a new white medical coat that was still creased from its packaging, I walked the halls marveling at the portraits of doctors past and present. On rounds that day, members of my resident team repeatedly referred to one well-known surgeon as "Dr. Hodad". I hadn't heard of a surgeon by that name. Finally, I inquired. "Hodad,"it turned out, was a nickname. A fellow student whispered: "It stands for Hands of Death and Destruction."

Stunned, I soon saw just how scary the works of his hands were. His operating skills were hasty and slipshod, and his patients frequently suffered complications. This was a man who simply should not have been allowed to touch patients. But his bedside manner was impeccable. He was charming. His patients worshiped him. When faced with excessive surgery time and extended hospitalizations, they just chalked up their misfortunes to fate.

Hospitals as a whole also tend to escape accountability, with excessive complication rates even at institutions that the public trusts as top-notch. Very few hospitals publish statistics on their performance, so how do patients pick one? As an informal exercise throughout my career, I've asked patients how they decided to come to the hospital where I was working. Among their answers: "because you're close to home"; "You guys treated my dad when he died";"I figured it must be good because you have a helicopter." You wouldn't believe the number of patients who have told me that the deciding factor for them was parking.

Dr. Makary's Five Crucial Reforms for Transparency

1) Online dashboards (which means publicly available rates for infection, readmission, surgical complications, and "never event" errors. Also annual volume of each type of surgery and patient satisfaction)
2) Safety Culture Scores (rates of good teamwork)
3) Cameras (video recording of all procedures)
4) Open Notes (online access to the patient record for the patient)
5) No more Gagging (open dialogue, no restrictions on patient comments

Political partisans can debate the role of government in fixing health care, but for either public or private approaches to work, transparency is the crucial prerequisite. To make transparency effective, government must play a role in making fair and accurate reports available to the public.

My comment:

First, Dr. Makary is correct, we have a massive patient safety problem in the US. The Institute of Medicine has documented nearly 100,000 deaths per year due to preventable medical error. It's probably much higher. And, as Dr. Makary notes, if this poor safety record were superimposed on the airline industry, planeloads full of passengers would crash each week.

Second, we don't have that abysmal safety record in the airline industry because we have GOVERNMENT oversight for safety in airline travel. Yes, fellow Americans, we have a government program which actually keeps us safe while traveling by air. Rather than bellowing about 'death panels', we should be pushing our governments (state government would be a better place in the supervision of patient safety) to adopt an aggressive approach to reducing preventable medical errors.

Third, every doctor can tell stories about the Drs. HODAD he/she has known. Patients do not know the difference between Dr. HODAD and a really good surgeon. Just like patients make decisions concerning which hospital to use based upon parking structures. No amount of really good data available to the public will make most patients good 'shoppers' for best quality health care, both because patients are usually too sick or injured to shop and because patients don't know what to make of medical data anyway. Markets will never solve our patient safety problems. Public health departments, however, can make a difference.

The Utah Healthcare Initiative has been on the record for more than three years arguing exactly these points, now being discussed in the pages of the Wall Street Journal. Isn't it time that you joined us and began working to make these needed changes happen?

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Dr. Joe Jarvis