New Yorker magazine has an interesting article based on a question and answer session, supposedly by a group of doctors in New York, on how they deal with patient, malpractice, surgery, second opinions and many other issues. A good read, but the critical patients wonders if this is another fictional work. Follow this link: http://nymag.com/bestdoctors/ and then click on the "Whats up docs," tag.
What do you think?
Foster.
Sunday, June 17, 2007
Wednesday, May 30, 2007
A book about healthcare that IS worth reading
I recently had the pleasure of reading Mountains beyond Mountains by Tracy Kidder, (also a Harvard alum!), and highly recommend it to anyone interested in health care.
It is almost a narrative of Kidder's relationship with Dr. Paul Farmer, founder of Partners in Health which is based in Boston with a mission to provide community based healthcare in the developing world. Kidder takes a dramatic journey through Dr. Farmer's life, (personal and professional), and the journey gives an insight into how to make things happen. Not all of it is complimentary to Dr. Farmer, and a friend who had also read the book did not like him as a result. She felt that he had dumped his co-founder, (and close friend), Ophelia Dahl, but the evidence does not support that, so I disagreed. (It is co-incidental that Ophelia Dahl had a baby last week, so congratulations to her and her family.) Whatever you think about this book, you will almost certainly have an opinion on the participants in it.
Don't expect this book to be an, "easy," read, because it is not, although it only took me two days to read it all because I could not leave it down. That is a testament to Tracy Kidder's writing style, as much as to the story, but the point is that the reader with a conscience should not expect to leave this book untouched. The disparity in treatment is incredible, and the various contributing factors are equally important highlights.
It is also interesting in that it discusses the politics of the WHO attitude to TB treatment, and the value of taking a sceptical view on, "gold standard," treatments, which were shown to have contributed to people's ill-health, not to their health. This is particularly timely given the case of the now CDC imprisoned irresponsible U.S. patient who has XDR TB and took a flight from Europe to Canada, (don't they worry about security screening for people who are on the no-fly list or is that just an American constraint?) because he did not want to spend time in an Italian hospital. The fact that he risked infecting others with not alone TB, but the XDR version, whilst on board, makes him one of the worst public enemies around.
Having recently condemned a book about how doctors think as a waste of time, and as strongly as I reviewed that book negatively, this one is equally positive because Tracy Kidder talks about real medical decisions with an honesty and detail sadly lacking in Dr. Groopman's book. Whilst Kidder obviously had a politico/medical agenda influenced by Dr. Farmer, what a wonderful agenda he laid out. The challenge is for those of us interested in patient care to pay attention and take action.
Thanks for the refreshing blast of reality Tracy.
Stay healthy, and ask your physician to tell you what is really wrong with you.
It is almost a narrative of Kidder's relationship with Dr. Paul Farmer, founder of Partners in Health which is based in Boston with a mission to provide community based healthcare in the developing world. Kidder takes a dramatic journey through Dr. Farmer's life, (personal and professional), and the journey gives an insight into how to make things happen. Not all of it is complimentary to Dr. Farmer, and a friend who had also read the book did not like him as a result. She felt that he had dumped his co-founder, (and close friend), Ophelia Dahl, but the evidence does not support that, so I disagreed. (It is co-incidental that Ophelia Dahl had a baby last week, so congratulations to her and her family.) Whatever you think about this book, you will almost certainly have an opinion on the participants in it.
Don't expect this book to be an, "easy," read, because it is not, although it only took me two days to read it all because I could not leave it down. That is a testament to Tracy Kidder's writing style, as much as to the story, but the point is that the reader with a conscience should not expect to leave this book untouched. The disparity in treatment is incredible, and the various contributing factors are equally important highlights.
It is also interesting in that it discusses the politics of the WHO attitude to TB treatment, and the value of taking a sceptical view on, "gold standard," treatments, which were shown to have contributed to people's ill-health, not to their health. This is particularly timely given the case of the now CDC imprisoned irresponsible U.S. patient who has XDR TB and took a flight from Europe to Canada, (don't they worry about security screening for people who are on the no-fly list or is that just an American constraint?) because he did not want to spend time in an Italian hospital. The fact that he risked infecting others with not alone TB, but the XDR version, whilst on board, makes him one of the worst public enemies around.
Having recently condemned a book about how doctors think as a waste of time, and as strongly as I reviewed that book negatively, this one is equally positive because Tracy Kidder talks about real medical decisions with an honesty and detail sadly lacking in Dr. Groopman's book. Whilst Kidder obviously had a politico/medical agenda influenced by Dr. Farmer, what a wonderful agenda he laid out. The challenge is for those of us interested in patient care to pay attention and take action.
Thanks for the refreshing blast of reality Tracy.
Stay healthy, and ask your physician to tell you what is really wrong with you.
Tuesday, April 17, 2007
Ground Zero
I went to see Ground Zero in New York City last week. It was a profound experience, and one that I would recommend to everyone.
You have to peer through wire fences to see what is in effect a building site, but a building site with a real sense of history. I thought that it was more like a monument.
There is a timeline, and several pictures of the aftermath which accurately capture the fear on the day and regret for those who died. There is no special lighting or any featuring, but none is needed, just standing there is enough if you remember the day. It is akin to remembering where you were when you heard that John F. Kennedy had died, (if you are my age!), an unforgettable moment in one's life.
Remembering the men, and women, who gave their lives that day in the line of duty makes one realise that life is precious and those who care for it, (whether firemen, doctors, nurses, or others), are what makes a natural society work. Without them, there could be no life saving. Think about it!
My thoughts were of the terror that people who were there must have experienced. To be high up in that building and not know if you would ever get down had to engender fear at a level that most humans would never experience. What of the people who jumped, what must they have felt that jumping from the 95th floor was better than waiting? The terror of those on the street when the building came down must have been equally horrendous.
I prayed for all those whose lives were lost that day, and that we may see peace. Justice with peace; is it too much to ask of humankind?
Peace,
Foster.
You have to peer through wire fences to see what is in effect a building site, but a building site with a real sense of history. I thought that it was more like a monument.
There is a timeline, and several pictures of the aftermath which accurately capture the fear on the day and regret for those who died. There is no special lighting or any featuring, but none is needed, just standing there is enough if you remember the day. It is akin to remembering where you were when you heard that John F. Kennedy had died, (if you are my age!), an unforgettable moment in one's life.
Remembering the men, and women, who gave their lives that day in the line of duty makes one realise that life is precious and those who care for it, (whether firemen, doctors, nurses, or others), are what makes a natural society work. Without them, there could be no life saving. Think about it!
My thoughts were of the terror that people who were there must have experienced. To be high up in that building and not know if you would ever get down had to engender fear at a level that most humans would never experience. What of the people who jumped, what must they have felt that jumping from the 95th floor was better than waiting? The terror of those on the street when the building came down must have been equally horrendous.
I prayed for all those whose lives were lost that day, and that we may see peace. Justice with peace; is it too much to ask of humankind?
Peace,
Foster.
Saturday, April 14, 2007
How Doctors Think; a book review
I have just finished reading Dr. Jerome Groopman's book, titled, "How Doctors Think," (2007, Houghton Mifflin).
I was dissapointed with the book, which started well, but turned into a parade of name dropping anecdotes by Dr. Groopman, such as, "We met some thirty years ago when she was a student and I was a resident," (referring to Dr. JudyAnn Bigby, now Secretary of Health and Human Services in Massachusetts). Apart from the possibility that Dr. Bigby might not appreciate the apparent age disclosure, his inclusion of her story was really about how she sees the practice of medicine today, supported by a couple of anecdotes.
The slip cover offers this tantalising promise, "How Doctors think offers, direct, intelligent questions patients can ask their doctors to help them get back on track." Personally, I did not agree that it delivered these questions to help patients. If the emphasis was meant to be on, "intelligent," rather than, "patients," (who tend to be average, because the law of large numbers applies to them), then his promise is open to interpretation, and is possibly misleading.
He included a chapter entitled, "Epilogue: A patient's questions," (why as an epilogue? I thought this book was to provide advice to patients!). In it he offers patients this advice, "If, after a while, you are not getting better, the discomfort persists or has worsened, then it is time to rethink the diagnosis." Interesting advice, eh?
He goes on, "How to make the correct diagnosis? There is no single script that every doctor or patient should follow," (Since when did patients start making diagnoses?). He then offers this insight, "So a thinking doctor returns to language..." (remember, this is the only chapter dedicated to the patient!), and proceeds to imply that misdiagnoses are really caused by patients not properly including all the clinical clues doctors need, when originally describing their symptoms. That was a lot of sour medicine for the critical patient to swallow in one go!
Dr. Groopman dealt with a number of contentious and contemporary issues, particularly around the problem of medical error, and his general thesis was that errors occur, and the way doctors approach patient care has a significant impact on the outcome. (Now that was a surprise!). He claims that doctors follow specific patterns because they were trained to do so by their instructors, and that some of these approaches have no scientific bases. (Not very comforting news to patients!) Whilst he dealt with a number of issues, he relied heavily on a limited number of sources, and I was surprised that there was such limited evidence.
He contends that medicine is an uncertain science and advised patients to challenge doctors' diagnosis, particularly if those patients are regarded as cranks. He failed to deal with how to ascertain that professionally, and still keep a relationship with your medical provider. In fact, he suggests, (at the end of his 26 page introduction), that patients who are not getting a straight answer should, "freely broach the issue with their doctor, 'I sense that we may not be communicating well,' a patient can say. This signals the physician that there is a problem in compatability." Does this sound like a typical patient:doctor exchange to you? Me neither.
I felt that this was more a book for medical professionals in mid career, than a book for patients. In fact I felt that it was a, "filler," book which took advantage of the interest in patient informatics. I suspect that Dr. Groopman, (whom I don't know), is an intelligent and articulate man who decided to follow a pet project, but, on this occasion at least, failed to contribute much to the understanding of patient:doctor relationships.
As a health literacy proponent, I felt that the writing style adopted, (although possibly appropriate for the New Yorker, where the author is a regular contributor), was completely inappropriate for an average patient in the US, (on whom many literacy studies exist, and whose range of reading skills are well known).
So, I would recommend this book to; people who work at Beth Israel Deaconess Hospital in Boston, Mass. USA, and want to get promoted; to mid career medical professionals who wonder why their patients seem so cranky these days; to literary buffs who want to know how to write for the New Yorker; to socialites in Boston who want stories about medical practitioners, and pretty much no one else.
If it is not clear by now, I did not enjoy this book, and did not think that it added anything to the body of important work in understanding medical cognition such as that by Patel et al., (1). Sorry for the sarcasm in this review, but some of the contents deserved it.
I have to be fair, and say that the book has been on the New York Times hardcover nonfiction best seller list for 4 weeks, (rising to number 4), and that my review is distinctly different to the New York Times literary reviews by William Grimes, (2), and Michael Crichton, (3), who commended it.
Stay healthy, and read good books that can help patients,
Foster
1. Patel, V. L., J. F. Arocha, et al. (2001). "A primer on aspects of cognition for medical informatics." J Am Med Inform Assoc 8(4): 324-43.
2. http://www.nytimes.com/2007/03/23/books/23book.html?ex=1176696000&en=25aa21b2e8452099&ei=5070 accessed April 14, 2007 (registration required).
3. http://www.nytimes.com/2007/04/01/books/review/Crichton.t.html?pagewanted=1&ei=5070&en=d63b39649668eb0c&ex=1176696000 accessed April 14, 2007 (registration required).
I was dissapointed with the book, which started well, but turned into a parade of name dropping anecdotes by Dr. Groopman, such as, "We met some thirty years ago when she was a student and I was a resident," (referring to Dr. JudyAnn Bigby, now Secretary of Health and Human Services in Massachusetts). Apart from the possibility that Dr. Bigby might not appreciate the apparent age disclosure, his inclusion of her story was really about how she sees the practice of medicine today, supported by a couple of anecdotes.
The slip cover offers this tantalising promise, "How Doctors think offers, direct, intelligent questions patients can ask their doctors to help them get back on track." Personally, I did not agree that it delivered these questions to help patients. If the emphasis was meant to be on, "intelligent," rather than, "patients," (who tend to be average, because the law of large numbers applies to them), then his promise is open to interpretation, and is possibly misleading.
He included a chapter entitled, "Epilogue: A patient's questions," (why as an epilogue? I thought this book was to provide advice to patients!). In it he offers patients this advice, "If, after a while, you are not getting better, the discomfort persists or has worsened, then it is time to rethink the diagnosis." Interesting advice, eh?
He goes on, "How to make the correct diagnosis? There is no single script that every doctor or patient should follow," (Since when did patients start making diagnoses?). He then offers this insight, "So a thinking doctor returns to language..." (remember, this is the only chapter dedicated to the patient!), and proceeds to imply that misdiagnoses are really caused by patients not properly including all the clinical clues doctors need, when originally describing their symptoms. That was a lot of sour medicine for the critical patient to swallow in one go!
Dr. Groopman dealt with a number of contentious and contemporary issues, particularly around the problem of medical error, and his general thesis was that errors occur, and the way doctors approach patient care has a significant impact on the outcome. (Now that was a surprise!). He claims that doctors follow specific patterns because they were trained to do so by their instructors, and that some of these approaches have no scientific bases. (Not very comforting news to patients!) Whilst he dealt with a number of issues, he relied heavily on a limited number of sources, and I was surprised that there was such limited evidence.
He contends that medicine is an uncertain science and advised patients to challenge doctors' diagnosis, particularly if those patients are regarded as cranks. He failed to deal with how to ascertain that professionally, and still keep a relationship with your medical provider. In fact, he suggests, (at the end of his 26 page introduction), that patients who are not getting a straight answer should, "freely broach the issue with their doctor, 'I sense that we may not be communicating well,' a patient can say. This signals the physician that there is a problem in compatability." Does this sound like a typical patient:doctor exchange to you? Me neither.
I felt that this was more a book for medical professionals in mid career, than a book for patients. In fact I felt that it was a, "filler," book which took advantage of the interest in patient informatics. I suspect that Dr. Groopman, (whom I don't know), is an intelligent and articulate man who decided to follow a pet project, but, on this occasion at least, failed to contribute much to the understanding of patient:doctor relationships.
As a health literacy proponent, I felt that the writing style adopted, (although possibly appropriate for the New Yorker, where the author is a regular contributor), was completely inappropriate for an average patient in the US, (on whom many literacy studies exist, and whose range of reading skills are well known).
So, I would recommend this book to; people who work at Beth Israel Deaconess Hospital in Boston, Mass. USA, and want to get promoted; to mid career medical professionals who wonder why their patients seem so cranky these days; to literary buffs who want to know how to write for the New Yorker; to socialites in Boston who want stories about medical practitioners, and pretty much no one else.
If it is not clear by now, I did not enjoy this book, and did not think that it added anything to the body of important work in understanding medical cognition such as that by Patel et al., (1). Sorry for the sarcasm in this review, but some of the contents deserved it.
I have to be fair, and say that the book has been on the New York Times hardcover nonfiction best seller list for 4 weeks, (rising to number 4), and that my review is distinctly different to the New York Times literary reviews by William Grimes, (2), and Michael Crichton, (3), who commended it.
Stay healthy, and read good books that can help patients,
Foster
1. Patel, V. L., J. F. Arocha, et al. (2001). "A primer on aspects of cognition for medical informatics." J Am Med Inform Assoc 8(4): 324-43.
2. http://www.nytimes.com/2007/03/23/books/23book.html?ex=1176696000&en=25aa21b2e8452099&ei=5070 accessed April 14, 2007 (registration required).
3. http://www.nytimes.com/2007/04/01/books/review/Crichton.t.html?pagewanted=1&ei=5070&en=d63b39649668eb0c&ex=1176696000 accessed April 14, 2007 (registration required).
Wednesday, March 21, 2007
Getting to the decision point
I am interested in shared medical decision making, and its value to patients. In an excellent paper on the subject, Charles et al. (Soc Sci Med 1997 Mar;44(5):681-692) identified the critical features of shared decision making in a healthcare context as follows:
That at least two participants, (physician and patient), are involved,
That both parties share information,
That both parties take steps to build a consensus about the preferred treatment,
That an agreement is reached on the treatment to implement.
I think this is a really useful framework for those who think about this issue.
I like to characterise the agreement of both parties as concordance, (a phrase originally applied in a medical context by the Royal Pharmaceutical Society of Great Britain), by which I mean, mutual agreement. If there is mutual agreement to proceed along a specific course, based on full participation by both parties, and an exchange between them, then I think there is concordance.
The agreement, however, leads to another element, and that is an expectation. Because the critical patient is interested in patient informatics, I think that it is important to be clear that the patient has an expectation of the outcome of the agreed course of action.
I think that many health care professionals overlook this aspect, and proceed on the basis of their expectation, rather than the patient's. So what can a patient do?
The key is for both parties to be upfront about their expectations.
Here are some ideas as to how to make that happen:
Inform the doctor about the patient’s problem, including the effect on them personally,
Specify how involved the patient wants to be in making the decision,
Facilitate the inclusion of the patient and doctor's personal values, fears and aspirations,
Inform the patient about their diagnosis, and treatment options,
Identify the specific decision that needs to be made, (including the option of no treatment),
Clarify and illustrate the risk associated with each treatment option,
Identify the patient’s lack of specific knowledge about this condition,
Identify other decisional conflicts [1] [2] that the patient may have,
Identify high quality evidence based information resources,
Identify a set of decision aids [3] [4] to improve knowledge and recall,
Outline a plan and timeframe for the process.
With this list, both parties can look at the process, and make a rational and shared decision as to whether the treatment is appropriate, and in line with good medical practice and the what the patient expects to happen.
Try it out next time you have a medical decision to make. I think it will give you a greater sense of participation and ultimately satisfaction with the outcome, even if the outcome did not meet original expectations due to complications that were considered in the decision making process.
Stay healthy,
Foster
[1] O’Connor A, Rostom A, Fiset V, Tetroe J, Entwhistle V, Llewellyn_Thomas H, Holmes_Rovner M, Barry M, Jones J Decision aids for patients facing health treatment or screening decisions:systematic review 1999 BMJ 319:731-734
[2] Murray E, Davis h, Tai SS, Coulter A, Gray A, Haines A Ransomised controlled trial of an interactive multimedia decision aid on hormone repleacement therapy in primary care 2001 BMJ 323:490
[3] O’Connor a, Rostrom A, Tetroe J, Fiset V, Entwhistle V, Llewellyn-Thomas H, Holmes-Rovner M, Barry M, Jones J Effectiveness of decision aids for people facing health treatment of screening decisions 1999 Best Evid. Health Care Cochrane Colloq. http://www.cochrane.org/reviews/en/ab001431.html
[4] http://decisionaid.ohri.ca/docs/Cochrane_Summary.pdf accessed September 12,2006
That at least two participants, (physician and patient), are involved,
That both parties share information,
That both parties take steps to build a consensus about the preferred treatment,
That an agreement is reached on the treatment to implement.
I think this is a really useful framework for those who think about this issue.
I like to characterise the agreement of both parties as concordance, (a phrase originally applied in a medical context by the Royal Pharmaceutical Society of Great Britain), by which I mean, mutual agreement. If there is mutual agreement to proceed along a specific course, based on full participation by both parties, and an exchange between them, then I think there is concordance.
The agreement, however, leads to another element, and that is an expectation. Because the critical patient is interested in patient informatics, I think that it is important to be clear that the patient has an expectation of the outcome of the agreed course of action.
I think that many health care professionals overlook this aspect, and proceed on the basis of their expectation, rather than the patient's. So what can a patient do?
The key is for both parties to be upfront about their expectations.
Here are some ideas as to how to make that happen:
Inform the doctor about the patient’s problem, including the effect on them personally,
Specify how involved the patient wants to be in making the decision,
Facilitate the inclusion of the patient and doctor's personal values, fears and aspirations,
Inform the patient about their diagnosis, and treatment options,
Identify the specific decision that needs to be made, (including the option of no treatment),
Clarify and illustrate the risk associated with each treatment option,
Identify the patient’s lack of specific knowledge about this condition,
Identify other decisional conflicts [1] [2] that the patient may have,
Identify high quality evidence based information resources,
Identify a set of decision aids [3] [4] to improve knowledge and recall,
Outline a plan and timeframe for the process.
With this list, both parties can look at the process, and make a rational and shared decision as to whether the treatment is appropriate, and in line with good medical practice and the what the patient expects to happen.
Try it out next time you have a medical decision to make. I think it will give you a greater sense of participation and ultimately satisfaction with the outcome, even if the outcome did not meet original expectations due to complications that were considered in the decision making process.
Stay healthy,
Foster
[1] O’Connor A, Rostom A, Fiset V, Tetroe J, Entwhistle V, Llewellyn_Thomas H, Holmes_Rovner M, Barry M, Jones J Decision aids for patients facing health treatment or screening decisions:systematic review 1999 BMJ 319:731-734
[2] Murray E, Davis h, Tai SS, Coulter A, Gray A, Haines A Ransomised controlled trial of an interactive multimedia decision aid on hormone repleacement therapy in primary care 2001 BMJ 323:490
[3] O’Connor a, Rostrom A, Tetroe J, Fiset V, Entwhistle V, Llewellyn-Thomas H, Holmes-Rovner M, Barry M, Jones J Effectiveness of decision aids for people facing health treatment of screening decisions 1999 Best Evid. Health Care Cochrane Colloq. http://www.cochrane.org/reviews/en/ab001431.html
[4] http://decisionaid.ohri.ca/docs/Cochrane_Summary.pdf accessed September 12,2006
Tuesday, March 13, 2007
A question of information
The Boston Globe carried my letter yesterday, (March 12th), about the need for high quality patient oriented information on costs, efficacy, outcomes and so on.
I think that this is a serious debate, particularly in the US, because of the increasing pressure on patients to absorb more and more of their own healthcare costs.
As an example, I needed a blood glucose test recently for insurance, and I called my local hospital to know how much it would cost because I was paying for it myself. I have insurance, but this was not a medical treatment, and not medically necessary. After being passed around for a while, they told me that it would cost $41, so I went ahead and set it up.
A week later I got the bill. The charge? $156, almost four times the original, "quote." I am, "in discussion," with the hospital as to the reason. Initially they denied that they would provide any quotes for blood testing, but eventually conceded that it may have happened, "in error!"
My point, and the point of my letter, is that how can the system expect patients to undertake preventative medical procedures, such as a colonoscopy or a blood test, if you cannot get an accurate quote from the hospital. Many health plans are now requiring that the patient pick up several thousand dollars in deductibles, (mine does), and so I want to get the best value for my money. The hospital system does not seem to recognize that, but I suspect that in time they will be forced to change. At least I hope so, and I will be the first to commend those that offer their costs up front.
The one state in the union to encourage and participate in this is New Hampshire, which recently introduced a new system to allow patients to input their insurance information and gives a range of prices based on a select number of procedures. Check it out at: http://www.nhhealthcost.org/
This is a good first step, and the Department of Health and Human Services are to be commended.
The link to my own correspondence is: http://www.boston.com/news/globe/editorial_opinion/letters/articles/2007/03/12/just_tell_us_what_healthcare_costs/
Take care!
Foster
I think that this is a serious debate, particularly in the US, because of the increasing pressure on patients to absorb more and more of their own healthcare costs.
As an example, I needed a blood glucose test recently for insurance, and I called my local hospital to know how much it would cost because I was paying for it myself. I have insurance, but this was not a medical treatment, and not medically necessary. After being passed around for a while, they told me that it would cost $41, so I went ahead and set it up.
A week later I got the bill. The charge? $156, almost four times the original, "quote." I am, "in discussion," with the hospital as to the reason. Initially they denied that they would provide any quotes for blood testing, but eventually conceded that it may have happened, "in error!"
My point, and the point of my letter, is that how can the system expect patients to undertake preventative medical procedures, such as a colonoscopy or a blood test, if you cannot get an accurate quote from the hospital. Many health plans are now requiring that the patient pick up several thousand dollars in deductibles, (mine does), and so I want to get the best value for my money. The hospital system does not seem to recognize that, but I suspect that in time they will be forced to change. At least I hope so, and I will be the first to commend those that offer their costs up front.
The one state in the union to encourage and participate in this is New Hampshire, which recently introduced a new system to allow patients to input their insurance information and gives a range of prices based on a select number of procedures. Check it out at: http://www.nhhealthcost.org/
This is a good first step, and the Department of Health and Human Services are to be commended.
The link to my own correspondence is: http://www.boston.com/news/globe/editorial_opinion/letters/articles/2007/03/12/just_tell_us_what_healthcare_costs/
Take care!
Foster
Friday, March 9, 2007
So how are you doing Doc?
There have been a couple of examples of patient care information that has been made available recently. Paul Levy of Beth Israel Deaconess hospital in
Now patients in Pennsylvania can go look up which hospital has the best or worst infection rates as they make decisions, (at least I hope they take this information into account), about where to have elective surgery undertaken. The critical patient hopes to see many more states and hospitals promote the publication of these important barometers of patient health.
A good framework for this was provided by the
What is interesting, and often overlooked, is that this figure is derived from two studies in Colorado/Utah and
That data should include not just the infection rates, but also the adverse drug events, incorrect procedures, and error rates related to individual procedures or diagnosis.
Most patients want to get better, and by tracking resolutions by diagnosis rates by individual hospitals, patients can potentially see where the hospital with the best outcomes for their condition is. That should not be confused with the number of procedures that hospitals undertake, which is never a barometer of successful outcomes.
The IOM made several recommendations, of which one is that health organizations should be setting up safety programs within their own organizations, and reporting the outcomes of those programs to patients and other interested parties.
The critical patient completely agrees with this recommendation, but sees limited evidence that this is happening. Do you know if it is happening, and we are just not seeing it in the information overload?
Foster
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