Thursday, August 18, 2011

The Best of the Best

This caught my eye. I remembered seeing it before, but this time the words whacked me in the face. A quite disconcerting discourse, to say the least, took place between my unimaginative self as it wrestled with its true opposite. What? My mind cried out in despair and disbelief. What can come of this?

For those still in limbo and distracted by the mental image of my minds utter chaos, let me lay the scene.

It was a quiet Sunday afternoon covered by a canopy of cloudy skies heralding a most inopportune thunderstorm -on the moisture indulged earth, brewing nearby.

Metaphorically it seemed appropriate for what was to come.

A liar begins with making falsehood appear like truth, and ends with making truth itself appear like falsehood. ~William Shakespeare

The headline simply read, “93,000 medical error related deaths.” There were many exclamation marks in that article. They were provocative and suggestive of a mishandled, mistreated population suffering from the inadequacy; inefficiency, malpractice and sloppiness of the medical care provided in these the United States. Really? I thought are we that bad? Do we lack the scientific rigor and knowledge? Do we lack empathy? Do we lack the “substance” that makes this noble profession, noble? Are we slackers worried about enrichment, as the article seemed to imply, with no care for the patients? Are we callous? Are we the epitome of irrational, inconsiderate and selfish human beings?  Well if you read that article you would be vaccinated too against the real facts that I am about to explore.

The answers that arrived via the slow methodical train from reality were: No! We are none of these. As physicians and nurses we are the best of the best. We are the paragon of humanity, immersing ourselves in the service of humanity. We, the physicians, dentists, nurses, psychologists, pharmacists, clinical researchers and others that deal with providing health care in the United States, have warded off more diseases and rendered more scourges and plagues to the isolated cells of “once what was,” then any other in the human race. We continue to kick the rouge expressed, human body related, sentiments of nature’s fury into the casket of oblivion. We help people survive longer and slowly –albeit agonizingly slow, we are forcing the learning of the art of healthy living, although that still only addresses one side of the equation.

So what was this 93,000 number floating in front of my eyes?

Let me take this slowly and one by one. This is not meant to be paternalistic nor derogatory by any means. It is meant to educate those “media journalists” who learn slowly but yield a broad demonic vilifying brush of ignorance to paint their, innocent or otherwise, version of the reality. There is simplicity and a great argument to be found in the numbers that this very elite group of “know-it-all” seems to not want to adhere to. Just so they can sell their news wares!

In the United States, there are approximately 956,000,000 (956 million!) visits to the physician offices and a total of 1,200,000,000 (1.2 Billion) ambulatory care visits to the physician offices, emergency room and ambulatory care centers within and out of the hospitals per year. Now let us grapple with the enormity of this statement, provided by the CDC. One can parse this information in many different ways, but what remains constant is the absolute number of health-visits. This data is based on insurance claims filed.

Of these 1.2 billion visits 132,000,000 (132 million) visits were to the Emergency Department of a hospital. 42,400,000 (42.4 million) visits were injury-relief seeking related. Additional data gleaned from the sources indicate that there were 3,200,000,000 (3.2 Billion) prescriptions written during that time and a total of 7,000 errors related to “handwriting skills” which by the way remains constant even with the electronic prescription filings (recent published annual data).

The total number of physicians in the United Sates is around 550,000, (0.5 million) serving a population of 308 million, both in the rural and urban areas. Majority of them however are located in the urban, suburban and near-reaches of the large towns where hospitals exist and large populace reside.

Having those facts at hand, let us dissect the error rates for those easily convinced with what is broadcast on television and by the provocateurs in the news media.

Based on the total healthcare visits, the error rate of 93,000 medical errors translates to a 0.00775% error rate per visit!

And to tackle the error related to handwritten or electronically transmitted prescriptions. Of 3.2 Billion prescriptions per year and 7,000 errors translates to 0.000021%. The magic of hard numbers is, that you cannot hide from their truth.

Now if you will indulge in some comparisons, as the media is wont to comparing medicine and Airline Transportation: The fatality rate for Airline Transport is 0.43/100,000 hours of flying. In General Aviation the fatality rate is 2.3/100,000 hours of fight time. Now let us compare that with driving where the fatality rate is 35-40/100,000 hours of driving. (NTSB Data) So car wrecks are almost 20 to 1 compared to plane wrecks, yet an occasional plane wreck wreaks havoc on the news circuits. They seem to flash the photo of twisted metal on the screen ad-nauseum. Why is that? Why not bring the gory, grimy, bloody and heart-wrenching detail of every car accident to the forefront? The answer is simple; because the element of fatigue would set in and that is not “sexy” or another way to put it is, it is not “newsworthy.” Similarly on a slow media day when no guns are going off and the markets are not crashing, the media decides to pull out from its hat something derogatory related to medicine and parade it before the eager eyes. Let us not be fooled by such insipid and irrational comparisons made by “well-meaning” pundits. Know the facts!
Based on just the numbers quoted above, those that try to equate aviation accidents or anything to medical errors are surely misinformed, uneducated or both! But they do!

What is not mentioned here and which, is very telling: Of the 202,400 patients diagnosed with Breast Cancer each year  (2010), 160,000 survive the disease from therapy! So we are comparing "apples and oranges" as one would say in kindergarten between a "naturally acquired" disease entity treated successfully with a 80% success rate and a 0.00775% error rate when treating a large population with multiple encounters!

Let me offer another opinion as to why this, the media blitz, happens? Maybe I have grown cynical over time, but there is always a benefit to someone or some organization when such peddling of unrelated facts are brought to the fore in our consciousness with pseudo-statistical fiat. It might be a company advocating a new piece of software for the electronic prescription transmittal? It might be the desire of the legal industry to legislate and thus by virtue of that regulate and mandate, failing which criminalize the innocent offender.  It might be an industry marketing a competitive product. Or it might be a politician wanting some much needed time before the camera to garner attention. Whatever it is, there is disservice to the many.

There is another little inconvenient fact about malpractice not well advertised: More than 80% of the Malpractice Claims are settled in the medical community’s favor. As one lawyer put it, “That’s because the doctors have good lawyers defending them.” Really? Or may be it is that the litigation machine enriches the legal side and puts an inordinate and unnecessary stress on the medical side. May be that is why tort reform and capped rewards are so angrily prosecuted by the attorneys and the politicians. Or maybe as I have been told many times, “You just don’t see the big picture!” I guess, I don’t.

Is it no wonder that 400 physicians commit suicide because they are under extreme stress, working long hours, spending less time to decompress from the vicissitudes of disease, having less time with their family, which ultimately leads to depression and faced with a constant microscopic scrutiny it turns their world upside down. They are after all humans! Or did we forget that? Physician suicide rate is twice that of the lay population and metes both males and females equally. Related to physician suicides rate, several psychological undertakings have emerged; finding faults with the persona of the physician, the environment where they work and even the families and heritage they were born to. All are conjectures of idle minds mostly trying to hide behind the “compassionate euphemisms” of the day. Only those in the trenches of this modern medical warfare know what it is to face the music.

Case in point (And I bring this in for the simple act of understanding), a legislation proposed in Sacramento, California mandates the use of “fitted-sheets” to be used in all hotel beddings through out the state. (SPF432) Now any logical individual would ask the question, “Why?” No one knows except the legislator. But carrying this thought experiment further indicates that now a State engulfed with over $140 billion in debt, when adding such legislation is seeking to be punitive with the “gotcha” factor and trying to recover money from private enterprise. Stupid! And wildly idiotic, but that is the compulsion of a mind-set steeped deep in “Gotcha!” So of necessity a common-sense question would be what would this piece of legislation do to the small hotels and motels in that state. Answer is simple, run them out of business with the added expense. Shooting oneself in the foot is a mark of supreme something! Some might label it as “bravery” but only in a fool’s paradise. The sinister encroachment in the name of “doing good” can bite an entire industry in the rear and lay waste overall societal benefit. The regulatory burden on medical care has increased significantly making it impossible for private practitioners to render care. More and more physicians cowed by the fears and the burdens of today are resorting to belong to a hospital under the umbrella of “safety.” The chapter of individual thought is rapidly coming to an end. Maybe it is for the better, or then again maybe it is not. Time will tell.

Have we made progress in medicine? Yes, certainly! That is an undisputed fact. Will we make further progress in the medical field; ridding cancer, heart disease, lung disease, kidney disease, diabetes etc.? That remains to be seen on how we as a nation approach freedom of thought and action.

So, is my premise that these medical errors are acceptable? No definitely not! We must try to limit harm to any and all patients as much as humanly possible. That is the Hippocratic oath. But to demonize the entire medical industry of physicians, nurses and pharmacists alike, is akin to pointing fingers at mirages. There are simple solutions that are in effect at the hospitals and pharmacies for diminishing medication errors, but they do inspire into play the patient’s own sense of safety and cognizance. Several well-constructed algorithms are already in place in hospitals to limit any oversight that might endanger the patient. These constructs did not arise from the media induced fervor, but through the thoughtful reconstruction of the facts and a constructive methodology to prevent furtherance of the previous errors. Unfortunately, whatever new method is undertaken to rectify previous error, the searchlights are focused upon the errors and not on the new-found religion of safety. Physicians by and large reflect on their own methods and that of their peers to cajole and mold the process of helping patients achieve health and better life through rigors of science and facts. And it is the managing physician who sleeps on a wink and rides the rollercoaster of his life, constantly harangued with images and dreams of preserving the life of another human being. We must remember the frailty of human survival, the limits of human intelligence and the infinite and rapidly expanding horizons of the misinformed “word,” that shape our world. I offer no excuses only that baked into these facts but not visible, one must not forget that “to err is human.”



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