Let it burn!!

[sylvanthus]

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Question for you all, if you were to say to hell with medicine, drop a NYT article, national interview, etc on the bull**** that goes on in medicine that the public would be appalled at, What would you say? This is, of course, assuming the public was intelligent, well informed, and gave a ****. Ive got a couple.

1) When DOH JCAHO, WTFBBQ, comes for a site visit, they inform people well ahead of time, tell them what they will be judged on, the hospital of course cleans up their act for the brief moment they are here, and then its back to business as usual when the inspection is over. Clearly these visits are BS.

2) After a central line is placed, if the patient spikes a fever, we don't check blood cultures for X amount of hours because we don't want to get dinged with a central line infection. If somehow a BC is drawn and is positive, they make up some nonsense about how they did an US of the lungs, maybe there was a consolidation, so its likely the bacteremia is due to a pneumonia.

3) When foleys are DC, it is hospital policy to only remove them at a set hour, clearly to avoid CAUTIs.

4) EDs fudge their numbers by tossing patients back in "rooms" quickly to make their door to room times/door to provider times look good. But, patients wait just as long, just in a different room. Makes the ED look good though! We once had a "holding" area opened up to move patients to so admission to room times looked good. Patient was basically placed in a break room. Of course, coded, no meds were closeby, the oxygen on the cart ran out, we didnt have suction to intubate, and the kicker? We couldnt get the bed out the doorway to move them to the ED where we had appropriate equipment. The apparently had to lift up a side of the bed to fit it in there in the first place.

Specific to residency...

1) ACGME surveys are fudged by programs, program directors feed correct answers to avoid "confusion" and they are done as a group.

2) Work hours are obviously recorded incorrectly. We are told to input the hours "scheduled" not actually worked.


Those are the ones I can think of off the top of my head. I am sure there is way worse **** going on that I don't know about. Feel free to jump in.

 

[gro2001]

1) When DOH JCAHO, WTFBBQ, comes for a site visit, they inform people well ahead of time, tell them what they will be judged on, the hospital of course cleans up their act for the brief moment they are here, and then its back to business as usual when the inspection is over. Clearly these visits are BS.

I believe the Joint Commission occasionally does surprise visits, partly for this reason. While I agree that there is a performative aspect to inspections, I've also seen a hospital outside the US go through the JCI process for the first time (the international version of JCAHO) and while some of it was as you described, it was overall a transformative process for the better. I think a lot of people who practice primarily in the west don't quite appreciate the huge amount of input these kinds of institutions (as annoying as they can be) bring to making hospitals more functional.

2) After a central line is placed, if the patient spikes a fever, we don't check blood cultures for X amount of hours because we don't want to get dinged with a central line infection. If somehow a BC is drawn and is positive, they make up some nonsense about how they did an US of the lungs, maybe there was a consolidation, so its likely the bacteremia is due to a pneumonia.

Wow, haven't seen this. It has been suggested to me that maybe I shouldn't send a line tip for culture once. Never been told I should delay drawing blood cultures or noticed this practice by others.

3) When foleys are DC, it is hospital policy to only remove them at a set hour, clearly to avoid CAUTIs.

I haven't seen this either.

4) EDs fudge their numbers by tossing patients back in "rooms" quickly to make their door to room times/door to provider times look good. But, patients wait just as long, just in a different room. Makes the ED look good though! We once had a "holding" area opened up to move patients to so admission to room times looked good. Patient was basically placed in a break room. Of course, coded, no meds were closeby, the oxygen on the cart ran out, we didnt have suction to intubate, and the kicker? We couldnt get the bed out the doorway to move them to the ED where we had appropriate equipment. The apparently had to lift up a side of the bed to fit it in there in the first place.

The biggest ED shenanigans I've seen are related to the door-to-doc times. I know of many EDs who place a doc in triage so the patients have technically been seen by an MD immediately on arrival, even though the real history taking, thinking, etc will happen later. I've wondered if it would make even more sense to put the MD just outside the front door and start recording negative door-to-doc times.

1) ACGME surveys are fudged by programs, program directors feed correct answers to avoid "confusion" and they are done as a group.

Our PD does clarify every year that we are never scheduled for "home call". That is true, we never were in residency. Every year some people misunderstand and think that the month they are on tox when they get called in to do a shift if someone calls out sick (what some programs call 'jeopardy') is them being on home call and put down that they've do a month of home call. I don't feel that's dishonest, it's genuinely clarifying as the term can be confusing and some people don't read. What kind of answers do you feel were fed to you at your program?

2) Work hours are obviously recorded incorrectly. We are told to input the hours "scheduled" not actually worked.

I was encouraged to record everything accurately, and I did. I've heard this being more of a problem at some other programs though.

 

[TooMuchResearch]

I believe the Joint Commission occasionally does surprise visits, partly for this reason. While I agree that there is a performative aspect to inspections, I've also seen a hospital outside the US go through the JCI process for the first time (the international version of JCAHO) and while some of it was as you described, it was overall a transformative process for the better. I think a lot of people who practice primarily in the west don't quite appreciate the huge amount of input these kinds of institutions (as annoying as they can be) bring to making hospitals more functional.



Wow, haven't seen this. It has been suggested to me that maybe I shouldn't send a line tip for culture once. Never been told I should delay drawing blood cultures or noticed this practice by others.



I haven't seen this either.



The biggest ED shenanigans I've seen are related to the door-to-doc times. I know of many EDs who place a doc in triage so the patients have technically been seen by an MD immediately on arrival, even though the real history taking, thinking, etc will happen later. I've wondered if it would make even more sense to put the MD just outside the front door and start recording negative door-to-doc times.




Our PD does clarify every year that we are never scheduled for "home call". That is true, we never were in residency. Every year some people misunderstand and think that the month they are on tox when they get called in to do a shift if someone calls out sick (what some programs call 'jeopardy') is them being on home call and put down that they've do a month of home call. I don't feel that's dishonest, it's genuinely clarifying as the term can be confusing and some people don't read. What kind of answers do you feel were fed to you at your program?



I was encouraged to record everything accurately, and I did. I've heard this being more of a problem at some other programs though.

Yeah, we were given some info to clarify ACGME questions people sometimes misinterpret, but always took the survey on our own time and were told to answer honestly because it helps them change the program if needed.

Were also always told to log all hours, including additional documentation time. I didn't necessarily do it (because it was too much work), but that was what we were told to do.


In the ICUs, we did what was right for the patient, CLABSI and CAUTI be damned.

 

[GonnaBeADoc2222]

The metrics scamming is a good one.

Would like to see one about PG and pressuring of physicians to become concierge doctors in the ED.

 

[citymd1234]

This has been written about extensively in the NYT. Ultimately changed nothing. No one cares.

 

[Birdstrike]

Question for you all, if you were to say to hell with medicine, drop a NYT article, national interview, etc on the bull**** that goes on in medicine that the public would be appalled at, What would you say? This is, of course, assuming the public was intelligent, well informed, and gave a ****. Ive got a couple.

1) When DOH JCAHO, WTFBBQ, comes for a site visit, they inform people well ahead of time, tell them what they will be judged on, the hospital of course cleans up their act for the brief moment they are here, and then its back to business as usual when the inspection is over. Clearly these visits are BS.

2) After a central line is placed, if the patient spikes a fever, we don't check blood cultures for X amount of hours because we don't want to get dinged with a central line infection. If somehow a BC is drawn and is positive, they make up some nonsense about how they did an US of the lungs, maybe there was a consolidation, so its likely the bacteremia is due to a pneumonia.

3) When foleys are DC, it is hospital policy to only remove them at a set hour, clearly to avoid CAUTIs.

4) EDs fudge their numbers by tossing patients back in "rooms" quickly to make their door to room times/door to provider times look good. But, patients wait just as long, just in a different room. Makes the ED look good though! We once had a "holding" area opened up to move patients to so admission to room times looked good. Patient was basically placed in a break room. Of course, coded, no meds were closeby, the oxygen on the cart ran out, we didnt have suction to intubate, and the kicker? We couldnt get the bed out the doorway to move them to the ED where we had appropriate equipment. The apparently had to lift up a side of the bed to fit it in there in the first place.

Specific to residency...

1) ACGME surveys are fudged by programs, program directors feed correct answers to avoid "confusion" and they are done as a group.

2) Work hours are obviously recorded incorrectly. We are told to input the hours "scheduled" not actually worked.


Those are the ones I can think of off the top of my head. I am sure there is way worse **** going on that I don't know about. Feel free to jump in.

We work in an increasingly highly regulated profession, with our medical decisions determined by government and quasi-government, non-medical bureaucrats along with insurance workers with no medical training, that act like blindfolded dictators. Everything they do makes our jobs harder, worsens care and increases waste and cost. And it's frustrating as hell. I'm 100% certain it's the right thing to do to blow the whistle on all of this insanity. And we need to keep blowing it, until things change. Whether that will happen during my lifetime, or before a crisis point is reached, remains to be seen.

 

[southerndoc]

This has been written about extensively in the NYT. Ultimately changed nothing. No one cares.

I agree. Nobody is going to side with the ER doc who they view as part of the problem why they waited so long. They also could care less with the amount of money we make.

The public views our whining much like a major league baseball players whining. Our salaries justify putting up with so much, and the public will never link our complaining with actual bad outcomes.

 

[RustedFox]

I agree. Nobody is going to side with the ER doc who they view as part of the problem why they waited so long. They also could care less with the amount of money we make.

The public views our whining much like a major league baseball players whining. Our salaries justify putting up with so much, and the public will never link our complaining with actual bad outcomes.

Reason number 562 why it's okay to hate the muggles.

 

[DrGasPasser]

We work in an increasingly highly regulated profession, with our medical decisions determined by government and quasi-government, non-medical bureaucrats along with insurance workers with no medical training, that act like blindfolded dictators. Everything they do makes our jobs harder, worsens care and increases waste and cost. And it's frustrating as hell. I'm 100% certain it's the right thing to do to blow the whistle on all of this insanity. And we need to keep blowing it, until things change. Whether that will happen during my lifetime, or before a crisis point is reached, remains to be seen.

Let me play Devil’s advocate. What other high-risk industry exists free of government micromanagement? My wife is a banker, and 70% of what she does is compliance that does not generate revenue. My uncle was an airline pilot - Uncle Sam’s hand was so far up his ass that it tickled the tonsils. If it’s not the EPA, then it’s OSHA, the FAA, FCC, or some other 3-letter agency breathing down your neck.

Stated another way, what has the House of Medicine done recently to make the public think that we need less regulations? Keep in mind that we kill about 250,000 people a year with preventable medical errors, and our hands are all over the opioid crisis that culls another 60,000 per year. Making matters worse, many of us were coming up in the age of rampant over-testing and exorbitant utilization in the 80s and 90s that gave birth to HMOs and eventually today’s notion of “value based care” because our colleagues would do stupid crap like stress test 90-year olds or order head CTs for every headache. That’s right - you get to spend hours on the phone justifying a test to someone with a HS education because too many of our colleagues with a decade of post-graduate education can’t seem to properly conserve healthcare resources.

BTW, trying to deny our culpability in the opioid crisis or those preventable errors only solidifies the public perception that we are collectively detached from reality and can’t be trusted to regulate ourselves.

 

[GonnaBeADoc2222]

Let me play Devil’s advocate. What other high-risk industry exists free of government micromanagement? My wife is a banker, and 70% of what she does is compliance that does not generate revenue. My uncle was an airline pilot - Uncle Sam’s hand was so far up his ass that it tickled the tonsils. If it’s not the EPA, then it’s OSHA, the FAA, FCC, or some other 3-letter agency breathing down your neck.

Stated another way, what has the House of Medicine done recently to make the public think that we need less regulations? Keep in mind that we kill about 250,000 people a year with preventable medical errors, and our hands are all over the opioid crisis that culls another 60,000 per year. Making matters worse, many of us were coming up in the age of rampant over-testing and exorbitant utilization in the 80s and 90s that gave birth to HMOs and eventually today’s notion of “value based care” because our colleagues would do stupid crap like stress test 90-year olds or order head CTs for every headache. That’s right - you get to spend hours on the phone justifying a test to someone with a HS education because too many of our colleagues with a decade of post-graduate education can’t seem to properly conserve healthcare resources.

BTW, trying to deny our culpability in the opioid crisis or those preventable errors only solidifies the public perception that we are collectively detached from reality and can’t be trusted to regulate ourselves.

If the government cared about the opiate crisis / overuse, they would not tie MIPS ratings to PG results.

It's a nice self fulfilling feed back loop you've described: patient demands xyz, we say no, this results in poor PG score and MIPS hit. Other alternative: patient demands xyz, we say yes, we are now "bad doctors" in need of "regulation".

 

[deleted547339]

Let me play Devil’s advocate. What other high-risk industry exists free of government micromanagement? My wife is a banker, and 70% of what she does is compliance that does not generate revenue. My uncle was an airline pilot - Uncle Sam’s hand was so far up his ass that it tickled the tonsils. If it’s not the EPA, then it’s OSHA, the FAA, FCC, or some other 3-letter agency breathing down your neck.

Stated another way, what has the House of Medicine done recently to make the public think that we need less regulations? Keep in mind that we kill about 250,000 people a year with preventable medical errors, and our hands are all over the opioid crisis that culls another 60,000 per year. Making matters worse, many of us were coming up in the age of rampant over-testing and exorbitant utilization in the 80s and 90s that gave birth to HMOs and eventually today’s notion of “value based care” because our colleagues would do stupid crap like stress test 90-year olds or order head CTs for every headache. That’s right - you get to spend hours on the phone justifying a test to someone with a HS education because too many of our colleagues with a decade of post-graduate education can’t seem to properly conserve healthcare resources.

BTW, trying to deny our culpability in the opioid crisis or those preventable errors only solidifies the public perception that we are collectively detached from reality and can’t be trusted to regulate ourselves.

Get out of here with that noise. The preventable death numbers are such nonsense, I think every time it gets quoted, whoever said it should get slapped. The actual number is probably 1% of that.

Edited for typo

 

[Birdstrike]

Let me play Devil’s advocate....My uncle was an airline pilot - Uncle Sam’s hand was so far up his ass that it tickled the tonsils.

I knew someone would eventually stand up in favor of free, plentiful and non-consensual prostate exams by Uncle Sam.

 

[DrGasPasser]

@GonnaBeADoc2222, The opioid crisis began in the late 80s/early 90s and gained steam in the early parts of the 2000s - long before patient satisfaction scores were influencing our pay check. While I fundamentally disagree with the concept of trying to measure the satisfaction of rampant healthcare consumers who have little or no financial stake in the game as if they were customers, blaming it all on patient satisfaction is crap.

@Birdstrike, I prefaced my post as a Devil’s Advocate argument. I’m actually pretty conservative/libertarian in my leanings. I’d loving nothing more than to get Uncle Sam out of the healthcare delivery business which would shift oversight from central planners at HHS/CMS to state and local health departments.

@TimesNewRoman, Good luck with that arguement. Those numbers come out of our own industry and were published in the BMJ. The lead author, Martin Makary, is not an idiot. I’m all ears if you’ve got some other numbers. Study Suggests Medical Errors Now Third Leading Cause of Death in the U.S. - 05/03/2016

 

[Birdstrike]

@GonnaBeADoc2222, The opioid crisis began in the late 80s/early 90s and gained steam in the early parts of the 2000s - long before patient satisfaction scores were influencing our pay check. While I fundamentally disagree with the concept of trying to measure the satisfaction of rampant healthcare consumers who have little or no financial stake in the game as if they were customers, blaming it all on patient satisfaction is crap.

@Birdstrike, I prefaced my post as a Devil’s Advocate argument. I’m actually pretty conservative/libertarian in my leanings. I’d loving nothing more than to get Uncle Sam out of the healthcare delivery business which would shift oversight from central planners at HHS/CMS to state and local health departments.

@TimesNewRoman, Good luck with that arguement. Those numbers come out of our own industry and were published in the BMJ. The lead author, Martin Makary, is not an idiot. I’m all ears if you’ve got some other numbers. Study Suggests Medical Errors Now Third Leading Cause of Death in the U.S. - 05/03/2016

-The opiate crisis did not begin in the 1980's. It began in 3400 B.C. or earlier and although it's waxed and waned, it hasn't stopped ever since opium was discovered and cultivated.
-If you're a libertarian, I'm not sure why you'd spend time justify an opposite view, with the underpinnings of your argument being, "It sucks for everyone else, so it should suck for us, too."
-The "Medical errors are 3rd leading cause of US deaths" statistic has been debunked and is clearly inflated. I'm surprised you'd accept such conclusions so unquestioningly. There are people with political aspirations who have a bias towards never ending regulations and government oversight. Medical errors researchers are not immune to bias, error or political motivations.

 

[dadaddadaBATMAN]

@GonnaBeADoc2222, The opioid crisis began in the late 80s/early 90s and gained steam in the early parts of the 2000s - long before patient satisfaction scores were influencing our pay check. While I fundamentally disagree with the concept of trying to measure the satisfaction of rampant healthcare consumers who have little or no financial stake in the game as if they were customers, blaming it all on patient satisfaction is crap.

@Birdstrike, I prefaced my post as a Devil’s Advocate argument. I’m actually pretty conservative/libertarian in my leanings. I’d loving nothing more than to get Uncle Sam out of the healthcare delivery business which would shift oversight from central planners at HHS/CMS to state and local health departments.

@TimesNewRoman, Good luck with that arguement. Those numbers come out of our own industry and were published in the BMJ. The lead author, Martin Makary, is not an idiot. I’m all ears if you’ve got some other numbers. Study Suggests Medical Errors Now Third Leading Cause of Death in the U.S. - 05/03/The numbers from those studies never seem to clearly spell out how we're executing

That article is poorly hidden marketing for further funding to study preventable death. They basically make the argument that there is no way to study how much preventable death is occurring because it isn't' recorded, then make a completely irresponsible conclusion based on extrapolation of data from small studies with poor methods to the entire U.S. population.

The article itself states that review by experienced clinicians has poor inter-rater reliability when deciding if a death is due to medical error. They then say that another study had concluded that 0.6% of hospital admissions end in lethal events, and say that 2/3 of those are due to medical error based on a prior study which is linked but not defined. For reasons which they don't explain, they claim that is likely conservative. Then they turn around and say that if 0.4% of hospital admissions in the united states is used as the going rate for medical error, then it's the third leading cause of death.

It makes the assumption that the deaths are preventable if only we had made a correct diagnosis, not given a certain treatment, etc etc. It's little better than reading tea leaves. Misdiagnosis is not a cause of death. Miscommunication is not a cause of death. They can both absolutely lead to lethal events, but if you want to quantify medical error as a cause of death you would have to show what would have happened without the medical error, which is impossible.

I agree it needs more study, and I admire that they are attempting to tackle a difficult topic. But the article was written to create click bait for more funding and further study. The numbers can't be taken as gospel, and probably were not intended to be.

 

[GonnaBeADoc2222]

@GonnaBeADoc2222, The opioid crisis began in the late 80s/early 90s and gained steam in the early parts of the 2000s - long before patient satisfaction scores were influencing our pay check. While I fundamentally disagree with the concept of trying to measure the satisfaction of rampant healthcare consumers who have little or no financial stake in the game as if they were customers, blaming it all on patient satisfaction is crap.

@Birdstrike, I prefaced my post as a Devil’s Advocate argument. I’m actually pretty conservative/libertarian in my leanings. I’d loving nothing more than to get Uncle Sam out of the healthcare delivery business which would shift oversight from central planners at HHS/CMS to state and local health departments.

@TimesNewRoman, Good luck with that arguement. Those numbers come out of our own industry and were published in the BMJ. The lead author, Martin Makary, is not an idiot. I’m all ears if you’ve got some other numbers. Study Suggests Medical Errors Now Third Leading Cause of Death in the U.S. - 05/03/2016

Yah blame physicians, not purdue pharma

 

[Birdstrike]

Yah blame physicians, not purdue pharma

And why is no blaming the countless thousands of people who lied to their doctors to get pills to inject or sell?

Oh, I forgot, "The customer is always right."

Sorry, my bad.

 

[Birdstrike]

Most published research is wrong. Don't ever forget that.

 

[deleted547339]

@GonnaBeADoc2222, The opioid crisis began in the late 80s/early 90s and gained steam in the early parts of the 2000s - long before patient satisfaction scores were influencing our pay check. While I fundamentally disagree with the concept of trying to measure the satisfaction of rampant healthcare consumers who have little or no financial stake in the game as if they were customers, blaming it all on patient satisfaction is crap.

@Birdstrike, I prefaced my post as a Devil’s Advocate argument. I’m actually pretty conservative/libertarian in my leanings. I’d loving nothing more than to get Uncle Sam out of the healthcare delivery business which would shift oversight from central planners at HHS/CMS to state and local health departments.

@TimesNewRoman, Good luck with that arguement. Those numbers come out of our own industry and were published in the BMJ. The lead author, Martin Makary, is not an idiot. I’m all ears if you’ve got some other numbers. Study Suggests Medical Errors Now Third Leading Cause of Death in the U.S. - 05/03/2016

You, sir, are an idiot if you believe that.

Let’s say there are a million physicians in the US. Presumably nearly all of these hospital deaths are occurring in house. A good percentage of doctors practice outpatient medicine, or path, or Peds, or psych, or palliative care where they are obviously not causing deaths. A good bit practice super low risk medicine, like derm, cosmetic plastics, etc. How an endocrinologist or rheumatologist could feasibly kill a patient outside of wonton neglect is beyond me. Your basically looking at only adults and only inpatient. Your EM, hospitalists, cardiologists, surgeons and anesthesiologist. Let’s say for round numbers, that’s 25% of docs.

So you are telling me that year after year, decade after decade, every single adult doctor kills a patient. Every year. You practice 35 years as an anesthesiologist and you kill 35 people???? Let’s say your special and have never killed someone and neither have a handful of other people in your group. That means there are outliers killing someone every month. Are you kidding me? That crazy coked up neurosurgeon botched a few procedures and got convinced of felonies and they made a blockbuster podcast about it. And that was only a couple dozen patients, a couple of which died.

Those numbers are insane. They count basically any error that occurs on any patient that dies. The study lacks face validity.

If you can’t see the obvious bias in that, I have some swamp land to sell you.

 

[BoardingDoc]

@GonnaBeADoc2222
@TimesNewRoman, Good luck with that arguement. Those numbers come out of our own industry and were published in the BMJ. The lead author, Martin Makary, is not an idiot. I’m all ears if you’ve got some other numbers. Study Suggests Medical Errors Now Third Leading Cause of Death in the U.S. - 05/03/2016

Did you even read the study that you posted, or the reference that they use to derive their numbers?
The study you posted states: "A literature review by James estimated preventable adverse events using a weighted analysis and described an incidence range of 210 000-400 000 deaths a year associated with medical errors among hospital patients.16"

I decided to look up footnote 16. It's this: James JTA. A new, evidence-based estimate of patient harms associated with hospital care. J Patient Saf 2013;9:122-8. doi:10.1097/PTS.0b013e3182948a69 pmid:23860193. 17 Ghaferi AA, Birkmeyer JD, Dimick JB. Complications, failure to rescue, and mortality with major inpatient surgery in Medicare patients. Ann Surg 2009;250:1029-34. doi:10.1097/ SLA.0b013e3181bef697 pmid:19953723.

In that article it stipulates that premature death caused by medical harm is as high as 400k/yr. However, it also states the following: "Premature deaths as a result of medical errors may occur many years after the hospital stay because the patient’s care was not optimal or did not follow guidelines."

Looking into exactly who they quote as "premature death due to a medical error" they give examples further down.

One of their typical examples is the early death of heart failure patients in the 90s who weren't prescribed beta blockers. Yes, it is clearly an error to not prescribe beta blockers, however, the tone of your post and of the first paper is that doctors are making mistakes and killing patients. The reality is that doctors are making mistakes and patients are no worse off than they were before, they just aren't as improved as they could be in a perfect situation. There are obviously real medical errors which result in a patient's death, but implying that those events are as widespread as 210k-400k/yr is clickbait, not science.

 

[TooMuchResearch]

Did you even read the study that you posted, or the reference that they use to derive their numbers?
The study you posted states: "A literature review by James estimated preventable adverse events using a weighted analysis and described an incidence range of 210 000-400 000 deaths a year associated with medical errors among hospital patients.16"

I decided to look up footnote 16. It's this: James JTA. A new, evidence-based estimate of patient harms associated with hospital care. J Patient Saf 2013;9:122-8. doi:10.1097/PTS.0b013e3182948a69 pmid:23860193. 17 Ghaferi AA, Birkmeyer JD, Dimick JB. Complications, failure to rescue, and mortality with major inpatient surgery in Medicare patients. Ann Surg 2009;250:1029-34. doi:10.1097/ SLA.0b013e3181bef697 pmid:19953723.

In that article it stipulates that premature death caused by medical harm is as high as 400k/yr. However, it also states the following: "Premature deaths as a result of medical errors may occur many years after the hospital stay because the patient’s care was not optimal or did not follow guidelines."

Looking into exactly who they quote as "premature death due to a medical error" they give examples further down.

One of their typical examples is the early death of heart failure patients in the 90s who weren't prescribed beta blockers. Yes, it is clearly an error to not prescribe beta blockers, however, the tone of your post and of the first paper is that doctors are making mistakes and killing patients. The reality is that doctors are making mistakes and patients are no worse off than they were before, they just aren't as improved as they could be in a perfect situation. There are obviously real medical errors which result in a patient's death, but implying that those events are as widespread as 210k-400k/yr is clickbait, not science.

I prescribed steroids to a morbidly obese man today for an asthma exacerbation. Now they'll probably get diabetes and eventually die of complications from that.

Or to phrase it differently: I killed him.

 

[DrGasPasser]

You, sir, are an idiot if you believe that.

Let’s say there are a million physicians in the US. Presumably nearly all of these hospital deaths are occurring in house. A good percentage of doctors practice outpatient medicine, or path, or Peds, or psych, or palliative care where they are obviously not causing deaths. A good bit practice super low risk medicine, like derm, cosmetic plastics, etc. How an endocrinologist or rheumatologist could feasibly kill a patient outside of wonton neglect is beyond me. Your basically looking at only adults and only inpatient. Your EM, hospitalists, cardiologists, surgeons and anesthesiologist. Let’s say for round numbers, that’s 25% of docs.

So you are telling me that year after year, decade after decade, every single adult doctor kills a patient. Every year. You practice 35 years as an anesthesiologist and you kill 35 people???? Let’s say your special and have never killed someone and neither have a handful of other people in your group. That means there are outliers killing someone every month. Are you kidding me? That crazy coked up neurosurgeon botched a few procedures and got convinced of felonies and they made a blockbuster podcast about it. And that was only a couple dozen patients, a couple of which died.

Those numbers are insane. They count basically any error that occurs on any patient that dies. The study lacks face validity.

If you can’t see the obvious bias in that, I have some swamp land to sell you.

Again, it’s not a matter of what I believe (in this case I happen to think that our preventable medical errors are probably a lot higher than we like to believe for a lot of reasons). It’s a matter of perception. The public and policy makers have a perception that you are not delivering adequate value, and your own industry is fueling that perception with papers like the one I provided. People talking about what happened in 3400 BC Mesopotamia while referencing the current overdose epidemic in America are not helping the perception.

Basically, you are buried in paperwork and regulations, in part, because the medical community has done a piss poor job communicating that fewer regulations will benefit patient centered outcomes. The other big reason being that these regulations serve as a source of price controls, but that’s another topic for another thread. Simply put, we have not led from the front on major issues of the day, instead pointing fingers at other industries. Our messaging and performance at delivering better quality at lower cost (i.e. value) has been horrible.

BTW, you are free call me an idiot, but there is no need to address me as Sir. Only my wife does that.