5 ms·

If you spend anytime with the medical industry you soon realize the issue. I helped launched (the now deadpooled) Theil backed MetaMed a few years -- essential

by ada1981 10y ago

If you spend anytime with the medical industry you soon realize the issue. I helped launched (the now deadpooled) Theil backed MetaMed a few years -- essentially a private research team for medicine, and what the founders taught me was astounding. That things like amputating the wrong limbs, doctors not washing their hands and killing you by infection and a horror of other preventable errors are shocking common. This didn't even take into consideration that things discovered in labs that might cure you take at least 30 years to reach the doctors who might implement them, if they ever do. The distortion of hubris from doctors, economic incentives and other systemic issues results in a "health care system" that doesn't realily seem to do what it sets out to do -- we spend 10x what some developing countries do per year per person with no better outcomes. Accute care seems to be reasonably good, fixing a broken arm, etc. (assuming they don't accidentally remove it); but chronic care is often just a pipeline for the recurring revenue model of big pharma (at best). The examples are never ending but for fun, take a google to discover how many pap smears are performed annually on women who have already had their uterus removed - then consider the cost to insurance and tax payers.

icegreentea 10y ago
It's worth noting that many developed world's medical systems have a problem with the acute-chronic gap. Remember that pretty much all systems grew out of acute care - as a result, nearly all of them are quite good at it. But one of the problems with increasingly good acute care, as well as general increase in public health is the rise of chronic care issues. The sheer inefficiency and ineffectiveness of America's chronic care is not alone. Here in Canada, it's pretty clear that our system strains when put up against chronic care. There's certainly a lot to fix, but as you've pointed out, doctors are a huge component in the current system that has the change. This points to the fact that somehow we need to engage and get buy in from them. One of the things that I'm always wary about when reports like this come out is that while they present a wonderful opening into engaging with current stakeholders, it's also very easy to put current stakeholders on the defensive, and have them quickly adopt a us-vs-them mentality, something that certainly is not conducive to change.
DanBC 10y ago
> That things like amputating the wrong limbs Wrong site surgery is a "never event" in the English NHS. That means that there's never any excuse for it to happen, and it should not ever happen. https://www.england.nhs.uk/patientsafety/never-events/ https://www.england.nhs.uk/patientsafety/never-events/ Indeed, it's the first one on the list: https://www.england.nhs.uk/wp-content/uploads/2015/03/never-evnts-list-15-16.pdf https://www.england.nhs.uk/wp-content/uploads/2015/03/never-... In 2012 / 2013 there were 83 wrong site surgeries. That's way too many, but for context: http://www.nhsconfed.org/resources/key-statistics-on-the-nhs http://www.nhsconfed.org/resources/key-statistics-on-the-nhs > There were 15.892m total hospital admissions in 2014/15, 31 per cent more than a decade earlier (12.102m). (Not all of those will be surgeries) and: > In 2015, across Hospital and Community Healthcare Services (HCHS) and GP practices, the NHS employed 149,808 doctors, 314,966 qualified nursing staff and health visitors (HCHS), 25,418 midwives, 23,066 GP practice nurses, 146,792 qualified scientific, therapeutic and technical staff, 18,862 qualified ambulance staff and 30,952 managers.
- kleinishere 10y ago
  tl;dr - The US has similar "sentinel events" that are decided upon by a not for profit Joint Commission organization that accredits health facilities across the US. Failure to "respond" to a sentinel event and make meaningful attempts to prevent future occurrences can jeopardize a hospital's accreditation. Hospitals voluntarily report "most" sentinel events to the Joint Commission so their data is explicitly not usable for frequency/trending over time. To add additional info on the subject, the US employs a similar concept (and name) to "sentinel events." Relevant to surgery, this includes: "Invasive procedure, including surgery, on the wrong patient, at the wrong site, or that is the wrong (unintended) procedure" "Unintended retention of a foreign object in a patient after an invasive procedure, including surgery" More broadly, sentinel events are generally defined as: "a patient safety event...[that] results in any of the following: Death Permanent harm Severe temporary harm" (1) Outside of surgery, there are around a dozen additional, specific events that are always deemed to be "sentinel events." This includes forms of assault, abduction, unauthorized departure (i.e. the medical team has not yet discharged the patient) leading to patient death/harm, and specific, highly avoidable outcomes due to standardized procedures such as blood transfusions, too much bilirubin in newborns, and prolonged radiation. (1) These sentinel events policies are guided by the Joint Commission in the US, a not for profit organization that guides many patient safety initiatives and accredits health facilities in the US. At least for hospitals, site visits are unannounced around every 3 years. (2) Failure to gain/maintain accreditation, among many outcomes, threatens a hospital's ability to participate in Medicare/Medicaid as the Centers for Medicare & Medicaid Services (CMS) considers the Joint Commission a national accrediting organization. (3) Revenues from Medicare + Medicaid are generally essential for the solvency of a high majority of hospitals in the US - in 2013, the national average was ~58% of hospital revenues (4). Hospitals are "strongly encouraged" to report sentinel events to the Joint Commission but it remains voluntarily. Thus, the Joint Commission's data is available but explicitly not "an epidemiologic data set and no conclusions should be drawn about the actual relative frequency of events or trends in events over time" (5) However, hospitals are "required" to respond to a sentinel event through a comprehensive analysis and planning to prevent future occurrences. If the Joint Commission becomes aware of an event during a site review or other means that was not addressed in compliance with the lengthy review policy required, then the facility will risk its accreditation status. (1) (Post often references "hospitals" but applies to many health facility types.) (1) [PDF] https://www.jointcommission.org/assets/1/6/SE_CAMOBS_2016Upd1.pdf https://www.jointcommission.org/assets/1/6/SE_CAMOBS_2016Upd..., from http://www.jointcommission.org/sentinel_event_policy_and_procedures/ http://www.jointcommission.org/sentinel_event_policy_and_pro... (2) http://www.jointcommission.org/mobile/faq.aspx http://www.jointcommission.org/mobile/faq.aspx (3) http://www.jointcommission.org/faqs_ccn/ http://www.jointcommission.org/faqs_ccn/ (4) [Point 27] http://www.beckershospitalreview.com/hospital-management-administration/50-things-to-know-about-the-hospital-industry.html http://www.beckershospitalreview.com/hospital-management-adm... (5) http://www.jointcommission.org/sentinel_event_data_general/ http://www.jointcommission.org/sentinel_event_data_general/
agumonkey 10y ago
I often think that the medical industry enjoys (or suffers) from some sort of a given god complex. They can do what they want as soon as they reach a certain threshold of saving. Nobody will debate them (most of us don't have the articulate knowledge anyway) and will morally and existentially satisfy from still being alive. I just went through 4 doctors (gen. and specs.) about deep yet diffuse cardio vascular problems (life altering if not threatening). Their diagnosis was "nothing to see you are depressed". Since my problems started I can't sleep on my right side (causes heart race, pain and suffocation), and have now back pain; in order to sleep without pain I tried on my stomach. This configuration changed something, I felt stings around my heart, and a sudden relaxation, warm blood reaching my fingers and feets (something I didn't feel for a year). Stings moved along, hurting at finger and toe tips. I felt sweetly alive, jumped out of my bed (because now I can). Even cleand my browser tabs. So much for depression. I tried discussing with doctors calmly. Accepting the data, their knowledge. Yet not backing down if I felt they weren't really solving my problems. But it's impossible. One doctor even dared me to reproduce transient symptoms with an annoyed tone. You start considering being hypercondriac, a crybaby. Deep down all I want is a way to monitor myself deeply so I can take care of myself but I'm facing this paywall.
- iradik 10y ago
  Don't give up! I was told the same thing you are depressed. Doc even wanted to push meds on me. Took months of seeing specialists but ended up getting a real diagnosis which required a major surgery. Now I'm finally better but you have to work within the system which means finding a good doctor.
  - agumonkey 10y ago
    May I ask what happened.
  - selestify 10y ago
    What was the diagnosis, if you don't mind me asking?
- deleted 10y ago
  [deleted]
nradov 10y ago
Pro tip: if you're going to have surgery, especially to have part of your body removed, use an indelible marker to write clearly on the operating site as well as the opposite side. Something like "remove this kidney" and "do NOT remove this kidney".
- JshWright 10y ago
  The surgeon should do this themselves during their preop consult with you. If they don't, ask them...
  - JshWright 10y ago
    They even make a special pen for it: http://www.alimed.com/viscot-pre-surgical-mini-skin-markers.html http://www.alimed.com/viscot-pre-surgical-mini-skin-markers....
pjc50 10y ago
> "health care system" that doesn't readily seem to do what it sets out to do -- we spend 10x what some developing countries do per year per person with no better outcomes. It's a for-profit healthcare system. It does exactly what it sets out to do. Spending 10x more without having to deliver better outcomes is a success. If it could get 20x more cost for half as good outcomes that would be even more of a success. Healthcare can never really be a consumer market without an acceptable, nearly-free-at-point-of-use baseline alternative or very heavy government intervention in its operation. (The NHS is arguably at the other end of the scale, since it manages demand with triage and queuing. If your condition is merely uncomfortable and not life-threatening you'll have a long wait. It is, however, very cheap.)
- tomcam 10y ago
  Healthcare could easily get costs controlled precisely by being a consumer market. If we wrote the checks for our health care ourselves, and if there weren't laws against publishing prices for procedures, and insurance companies could operate in all states, then there would be tremendous lowering of costs in a very short time.
  - pjc50 10y ago
    > If we wrote the checks for our health care ourselves .. then most people wouldn't be able to afford it. Also doesn't work for emergency care: you can't shop around while unconscious.

by ada1981 10y ago

icegreentea 10y ago

It's worth noting that many developed world's medical systems have a problem with the acute-chronic gap. Remember that pretty much all systems grew out of acute care - as a result, nearly all of them are quite good at it. But one of the problems with increasingly good acute care, as well as general increase in public health is the rise of chronic care issues. The sheer inefficiency and ineffectiveness of America's chronic care is not alone. Here in Canada, it's pretty clear that our system strains when put up against chronic care. There's certainly a lot to fix, but as you've pointed out, doctors are a huge component in the current system that has the change. This points to the fact that somehow we need to engage and get buy in from them. One of the things that I'm always wary about when reports like this come out is that while they present a wonderful opening into engaging with current stakeholders, it's also very easy to put current stakeholders on the defensive, and have them quickly adopt a us-vs-them mentality, something that certainly is not conducive to change.

DanBC 10y ago

> That things like amputating the wrong limbs Wrong site surgery is a "never event" in the English NHS. That means that there's never any excuse for it to happen, and it should not ever happen. https://www.england.nhs.uk/patientsafety/never-events/ https://www.england.nhs.uk/patientsafety/never-events/ Indeed, it's the first one on the list: https://www.england.nhs.uk/wp-content/uploads/2015/03/never-evnts-list-15-16.pdf https://www.england.nhs.uk/wp-content/uploads/2015/03/never-... In 2012 / 2013 there were 83 wrong site surgeries. That's way too many, but for context: http://www.nhsconfed.org/resources/key-statistics-on-the-nhs http://www.nhsconfed.org/resources/key-statistics-on-the-nhs > There were 15.892m total hospital admissions in 2014/15, 31 per cent more than a decade earlier (12.102m). (Not all of those will be surgeries) and: > In 2015, across Hospital and Community Healthcare Services (HCHS) and GP practices, the NHS employed 149,808 doctors, 314,966 qualified nursing staff and health visitors (HCHS), 25,418 midwives, 23,066 GP practice nurses, 146,792 qualified scientific, therapeutic and technical staff, 18,862 qualified ambulance staff and 30,952 managers.

kleinishere 10y ago
tl;dr - The US has similar "sentinel events" that are decided upon by a not for profit Joint Commission organization that accredits health facilities across the US. Failure to "respond" to a sentinel event and make meaningful attempts to prevent future occurrences can jeopardize a hospital's accreditation. Hospitals voluntarily report "most" sentinel events to the Joint Commission so their data is explicitly not usable for frequency/trending over time. To add additional info on the subject, the US employs a similar concept (and name) to "sentinel events." Relevant to surgery, this includes: "Invasive procedure, including surgery, on the wrong patient, at the wrong site, or that is the wrong (unintended) procedure" "Unintended retention of a foreign object in a patient after an invasive procedure, including surgery" More broadly, sentinel events are generally defined as: "a patient safety event...[that] results in any of the following: Death Permanent harm Severe temporary harm" (1) Outside of surgery, there are around a dozen additional, specific events that are always deemed to be "sentinel events." This includes forms of assault, abduction, unauthorized departure (i.e. the medical team has not yet discharged the patient) leading to patient death/harm, and specific, highly avoidable outcomes due to standardized procedures such as blood transfusions, too much bilirubin in newborns, and prolonged radiation. (1) These sentinel events policies are guided by the Joint Commission in the US, a not for profit organization that guides many patient safety initiatives and accredits health facilities in the US. At least for hospitals, site visits are unannounced around every 3 years. (2) Failure to gain/maintain accreditation, among many outcomes, threatens a hospital's ability to participate in Medicare/Medicaid as the Centers for Medicare & Medicaid Services (CMS) considers the Joint Commission a national accrediting organization. (3) Revenues from Medicare + Medicaid are generally essential for the solvency of a high majority of hospitals in the US - in 2013, the national average was ~58% of hospital revenues (4). Hospitals are "strongly encouraged" to report sentinel events to the Joint Commission but it remains voluntarily. Thus, the Joint Commission's data is available but explicitly not "an epidemiologic data set and no conclusions should be drawn about the actual relative frequency of events or trends in events over time" (5) However, hospitals are "required" to respond to a sentinel event through a comprehensive analysis and planning to prevent future occurrences. If the Joint Commission becomes aware of an event during a site review or other means that was not addressed in compliance with the lengthy review policy required, then the facility will risk its accreditation status. (1) (Post often references "hospitals" but applies to many health facility types.) (1) [PDF] https://www.jointcommission.org/assets/1/6/SE_CAMOBS_2016Upd1.pdf https://www.jointcommission.org/assets/1/6/SE_CAMOBS_2016Upd..., from http://www.jointcommission.org/sentinel_event_policy_and_procedures/ http://www.jointcommission.org/sentinel_event_policy_and_pro... (2) http://www.jointcommission.org/mobile/faq.aspx http://www.jointcommission.org/mobile/faq.aspx (3) http://www.jointcommission.org/faqs_ccn/ http://www.jointcommission.org/faqs_ccn/ (4) [Point 27] http://www.beckershospitalreview.com/hospital-management-administration/50-things-to-know-about-the-hospital-industry.html http://www.beckershospitalreview.com/hospital-management-adm... (5) http://www.jointcommission.org/sentinel_event_data_general/ http://www.jointcommission.org/sentinel_event_data_general/

agumonkey 10y ago

I often think that the medical industry enjoys (or suffers) from some sort of a given god complex. They can do what they want as soon as they reach a certain threshold of saving. Nobody will debate them (most of us don't have the articulate knowledge anyway) and will morally and existentially satisfy from still being alive. I just went through 4 doctors (gen. and specs.) about deep yet diffuse cardio vascular problems (life altering if not threatening). Their diagnosis was "nothing to see you are depressed". Since my problems started I can't sleep on my right side (causes heart race, pain and suffocation), and have now back pain; in order to sleep without pain I tried on my stomach. This configuration changed something, I felt stings around my heart, and a sudden relaxation, warm blood reaching my fingers and feets (something I didn't feel for a year). Stings moved along, hurting at finger and toe tips. I felt sweetly alive, jumped out of my bed (because now I can). Even cleand my browser tabs. So much for depression. I tried discussing with doctors calmly. Accepting the data, their knowledge. Yet not backing down if I felt they weren't really solving my problems. But it's impossible. One doctor even dared me to reproduce transient symptoms with an annoyed tone. You start considering being hypercondriac, a crybaby. Deep down all I want is a way to monitor myself deeply so I can take care of myself but I'm facing this paywall.

iradik 10y ago
Don't give up! I was told the same thing you are depressed. Doc even wanted to push meds on me. Took months of seeing specialists but ended up getting a real diagnosis which required a major surgery. Now I'm finally better but you have to work within the system which means finding a good doctor.
- agumonkey 10y ago
  May I ask what happened.
- selestify 10y ago
  What was the diagnosis, if you don't mind me asking?
deleted 10y ago
[deleted]

nradov 10y ago

Pro tip: if you're going to have surgery, especially to have part of your body removed, use an indelible marker to write clearly on the operating site as well as the opposite side. Something like "remove this kidney" and "do NOT remove this kidney".

JshWright 10y ago
The surgeon should do this themselves during their preop consult with you. If they don't, ask them...
- JshWright 10y ago
  They even make a special pen for it: http://www.alimed.com/viscot-pre-surgical-mini-skin-markers.html http://www.alimed.com/viscot-pre-surgical-mini-skin-markers....

pjc50 10y ago

> "health care system" that doesn't readily seem to do what it sets out to do -- we spend 10x what some developing countries do per year per person with no better outcomes. It's a for-profit healthcare system. It does exactly what it sets out to do. Spending 10x more without having to deliver better outcomes is a success. If it could get 20x more cost for half as good outcomes that would be even more of a success. Healthcare can never really be a consumer market without an acceptable, nearly-free-at-point-of-use baseline alternative or very heavy government intervention in its operation. (The NHS is arguably at the other end of the scale, since it manages demand with triage and queuing. If your condition is merely uncomfortable and not life-threatening you'll have a long wait. It is, however, very cheap.)

tomcam 10y ago
Healthcare could easily get costs controlled precisely by being a consumer market. If we wrote the checks for our health care ourselves, and if there weren't laws against publishing prices for procedures, and insurance companies could operate in all states, then there would be tremendous lowering of costs in a very short time.
- pjc50 10y ago
  > If we wrote the checks for our health care ourselves .. then most people wouldn't be able to afford it. Also doesn't work for emergency care: you can't shop around while unconscious.