Wednesday, October 09, 2013

Millenson reminds us that we are behind

If the effectiveness of a prophet is measured by the degree to which s/he makes people uncomfortable with the status quo, we have to give Michael Millenson top honors.  In 1997, he wrote Demanding Medical Excellence and gave widespread attention to the safety and quality problems in hospitals.  He wrote:

From ulcers to urinary tract infections, tonsils to organ transplants, back pain to breast cancer, asthma to arteriosclerosis, the evidence is irrefutable. Tens of thousands of patients have died or been injured year after year because readily available information was not used ­– and is not being used today – to guide their care. If one counts the lives lost to preventable medical mistakes, the toll reaches the hundreds of thousands.

The only barrier to saving these lives is the willingness of doctors and hospital administrators to change.

What was shocking back then is now accepted as accurate--or even understated--but it is time to evaluate what has changed.  Michael's recent blog post on The Health Care Blog does this.  While he points to some progress, the same passion is evident, as is the impatience--and rightfully so:

Put it all together and this is what you’ve got: for the past decade (or, maybe, for several decades), 100,000 Americans (or maybe upwards of 200,000 Americans) have lost their lives each year in hospitals through preventable medical mistakes. Add it up: a million preventable deaths? Two million? Plus preventable injuries? Pick your time frame and your toll.

Now, consider that 15 years after the IOM error report there is no reliable estimate at all of the death and injury toll in the outpatient environment. Why? And why no outrage?

Indeed. We still find hospital administrators more interested in market dynamics, mergers, and the like than improving the quality and safety of care.  We still find doctors untrained in the use of the scientific method to achieve clinical processes.  We still see medical schools and residency training programs as woefully deficient in such matters.

Captain Sullenberger said it well:

"I wish we were less patient. We are choosing every day we go to work how many lives should be lost in this country."

"We have islands of excellence in a sea of systemic failures. We need to teach all practitioners the science of safety."

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