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Patient Driven Medicine

Eat, think, and be wary

by Joel Selmeier

Abigail Zuger, M.D. in the New York Times said: "That is the fatal flaw in market-based medicinal care: Patients and their relatives simply cannot be savy shoppers. Their attentions are elsewhere."

What is the most fundamental information a savy shopper needs? Success rates. Has any patient ever had objective information about that?

Never

4.8% of the physicians injure so many patients each year that they are responsible for over half of the medical malpractice lawsuits filed. Can any patient figure out who they are? No. And it is a federal offense for anyone to tell them. That is how much health care professionals want patients to be savy shoppers.

The most fundamental flaw of market-based care is that the only information to which patients have access comes from the people who don't want them to have it. There is no market-based medical care without objective information on success rates.

As things stand now the well-being of patients depends more on the beliefs and interests of health care workers than on knowledge of their own. That is more than just unacceptable. That is outrageous. And it is the only way it ever has been.

Enough

It doesn't have to be that way anymore. It now is possible for the patient community to gather the information necessary to know better than to let doctors send them into death traps. As yet no one is gathering that information. Everyone continues to let health care professionals be the only source for information about health care. That is why things are as bad as they are without anyone being able to do anything about it. Enough.

Medicine won't protect patients until patients know when they don'tIt is time for a paradigm shift in how we think about medicine. It is time to stop imagining that patients can or should trust health care to guide them to safey and affordability. And it is time to stop trying to get them to by micromanaging them and "fixing" medicine like we have been trying to do for at least 160 years.

If it were possible to "fix" medicine, we would have gotten them to start washing their hands enough more than a century ago. No one ever has managed to get them to comply with mere hand hygiene requirements. It has been 160 years since we started trying to. Enough. It is time to make it so that patients know when they don't wash their hands so that patients can go elsewhere. When that patient community collects its own information about where health care professionals are infecting them, the well-being of patients finally will depend not on health care workers doing what they never have done, but instead will depend on the patient community finding out where patients are safe and well and solvent and where they are not.

Most of this site covers the problems. The rest is about how to accomplish the solutions. I wish that solutions were the only thing posted here, but insight does not spring merely from new thoughts. It requires understanding what the problems are as well as what old ideas and assumptions are holding us back. Otherwise we keep believing in them and they defeat us.

Max Planck, a famous scientist, said that new ideas succeed not because people see the light and change their minds, but because people die and new people grow up with the new ideas being what they take for granted. I don't believe there is a point in trying to convince health care professionals or patients in general of any of this. Fortunately, we do not have to. All we need is about six of the right people to get on board and set up, in one limited place, an initial implementation of the solutions. Once it has been shown to work in one place, others will copy it.

That could be franchised.

Solutions ..........|.......... Problems
|
......................... | ............ Myth #1
|
Patient Agency... | .........................
|
Nequamitis ....... | ........................
|
......................... | Conflict/Interest
|
........................ | ............. Loyalty
|
......................... | ..Wall of Silence
|
.................. ...... | .......Blacklisting
|
........................ | ....Psych of Care
|
........................ | ... Transparency
|
........................ | .. Charles Cullen
|
........................ | Orville L Majors
|
........................ | ......... Kayshyap
|
........................ | .............. OSMB
|
........................ | ..... Semmelweis
|
........................ | . Benjamin Rush
|
Patients Boards. | ........................
|
Campaign ... | ..................

"If we can get just 10% of people to be smart patients, it will change the system." - Mehmet Oz, surgery professor. The only way to do that is with information that comes from someplace other than the vested interests in medicine.

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Patient Driven Medicine Versus
The Benevolent Overlord Model

Put ten doctors in a room to talk about patient safety and what do they come up with? In the last couple of decades they came up with the liability limitations for themselves that increase their position as the overlords of powerless patients.

Is anyone working on a plan that does not further entrench us in that paradigm? All of the talk about Patient Centered Medicine amounts only to trying to get overlords to think more about patients. The chief thing that does is further entrench us in the model that cannot even get them to sterilize their hands enough.

Like with Transparency, the thing benevolent overlords are supposed to provide in spite of their conflicts of interest and the self serving lens through which they see the world. It still leaves all of the information collection in their hands.

When medicine makes patients better it is advertised. When it makes them worse 93% of the time no record is made of it at all. That is what overlords do when they are not benevolent.

Neither providers nor patients can make informed decisions without knowing what providers never have and never will report.

Ludwik Fleck, a physician, said that "to see" means to recreate a picture created by the mental collective to which one belongs. This is true of the medical community. For instance, it sees itself surrounded by frivolous suits rather than by the patients it has injured. And it sees as good for patients treatments that are good for itself no matter how bad they may be for patients (examples are on this site).

For patients to survive in spite of this requires information about medicine that has not been filtered through the self-interested mind-set of the medical community.

Objective information is the foundation for reducing the unacceptable rates at which medicine bankrupts, injures and kills patients. Patients must be able to learn where safety, efficacy and affordability lie. Doctors do not steer the patient community around even untrustworthy health care professionals and facilities, let alone around the incompetent and/or outrageously expensive. They never will. This is a job the patient community will have to do by collecting information that has not been filtered by the medical community.

Neither providers nor patients can make informed decisions without knowing what providers never have and never will report. Health Care Professionals do not have the objectivity necessary even to recognize such information. The information necessary to make safe decisions can be collected only by people who are not in the employ of medicine.

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Loyalty is the core operating ethic of medicine - not integrity, and not safety. When things go wrong, disloyalty is what ends careers. Failing or refusing to report problems does not end careers. Failing or refusing to help patients does not end careers. But being disloyal to colleagues does. And loyalty is maintained through self-serving delusion, denial and silence about the people and problems harming patients.