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Full Table of Contents
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Abbreviated
Table of Contents
Home Page
Patient Safety
Silence vs
Safety
Silenced
White wall
of Silence
Silencing
Conflict Of
Interest
Psychology of
Providers
Subjectivity
Blacklisting
Nurse survey
Loyalty
Mobbing and
bullying
Trust Us
Defensive
documenting
Report Rate
Risk
managemnt
SOAP
Management
Hospitals
Crime in
medicine
Sexual Abuse
Liability
Limitations
Free Speech
for Patients
Exploitation
OSMB Medical
Boards
Mammography
solutions
Medical errors
Medical Complaints
One number
Links
Injured patients who want to help and be heard,
click here.
Thomas Jefferson said that given the choice between
government without newspapers and newspapers without government, he would choose
newspapers.
In medicine we have government without newspapers. Patients
cannot find out what they need to know to make informed choices. No one in
medicine records or reports the information patients need to know the most. So
patients will have to do it.
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MammoSite
Is it better for patients than other treatments?
That's not the kind of thing medicine is interested in learning.
That is why patient safety is the problem that it is.
The Food and Drug Administration cleared MammoSite for use on
breast cancer patients in 2002 making it one of the thousands of devices the FDA
lets onto the market each year after only cursory review and with no clear
evidence that they help patients. By 2008 MammoSite had been performed on about
45,000 breast cancer patients in the USA. But even after treating 45,000
patients with it, there still had been no collection of information on those
patients that would enable the health care system to learn whether MammoSite is
better or worse than other treatments available for the same condition.
Diane C. Robertson, an executive with the ECRI Institute, a nonprofit group in
Plymouth Meeting, Pennsylvania that evaluates new devices for insurers and
hospitals, said “Nobody is looking to see whether they help patients," and
“We’re never going to wisely allocate resources in health care unless we start
to focus on what’s best for patients.” (New York Times, October 27, 2008)
You can be sure that the people providing the treatment learned how to make a
profit with it. And you can be sure that they learned what is necessary to limit
their liability for treating patients with it. But the well-being of these
providers does not
depend on whether the treatment actually is the best one for patients. So they
don't know.
It is the same with the mammography
that is used to determine whether the patients need treatment in the first
place.
Devices
It is the same throughout medicine, for instance, devices
like artificial knees or hips, a 6.7 billion dollar per year business in the
USA. There are no independent referees or sources of information about them. No
one tracks the long-term performance of them. The Food and Drug Administration
clears them for sale without their being tested in patients, and then after they
are installed in patients, no one looks to see how they are doing.
One patient, Lise Markham, had to replace a flawed hip two
years after it was implanted. The experience awakened her to how little patients
know. "My doctor knew everything about me . . . but what did I know about the
other side?" she said.
Dr. Richard A Berger received over $8 million over a decade
for consulting and training other surgeons in how to implant artificial knees
and other medical devices. Finally he began to notice how often patients were
having problems with them. He did his own study and found that half of all
patients had problems with the artificial knees. As a result he no longer gets
to be a consultant or a trainer of surgeons. Someone else is training surgeons
in how to install devices that have problems half of the time without anyone
monitoring that or enabling patients to shop around to see if other devices
might be a safer option.
MSRA Study
In response to years of heavy lobbying and politicking by a victim of MRSA,
The Illinois Hospital Association finally conducted research on
patient-discharge data ― the same kind of analysis that previously had been
done by The Seattle Times in Washington state, which one might think should
have been a harbinger to which someone in medicine should have been paying
attention ― and was stunned at how many MRSA cases it found. Medicine keeps
telling us that our well-being is their foremost concern. If it actually
were, would they not care about it enough to check to see how they were
doing in achieving it? The health care industry is not
interested in knowing their own success rates. And they don't want patients
to know it either. So safety is the issue that it is (see
Conflict of Interest). The Centers for
Disease Control and Prevention found that MRSA now kills more people than
AIDS. A medical panel said that screening all patients for MRSA would be
"impractical or extreme ... with little added value." According to the CDC, 99,000 patients die from MRSA each year.
A couple of versions of the accident pyramid say that for every fatality in a community 300,000 unsafe
acts were committed and 29 other people were injured. In other words, for
each of those 99,000 who died there are 29 who got sick and lived. That is
2,871,000 patients some of whom were disabled, and others of whom are
functional but miserable for the rest of their lives. Including the ones who
died, it is close to 3 million people who were made sick unnecessarily by
unsafe acts committed by caregivers. Saving them would create little added
value to whom?
What makes it impractical and "with little added value" is that
caregivers don't make money by saving lives. Just as they don't make more
money by checking to see if half of artificial knees fail. They make more
money when artificial knees fail and patients come back to get another knee.
They make more money when time isn't wasted on extreme measures like washing
hands and taking other safety precautions to avoid infecting patients. They
make more money treating the infections they give patients than they would
if they protected the patients from getting infected in the first place.
They make more money when they make patients sicker.
That could change if patients were able to learn what people,
institutions and practices cause the most infections. Then patients could go
someplace safer and the more dangerous practitioners would have to stop
infecting patients in order to win business back. Diabetes Study
We know a woman whose dissertation for her Masters of Public
Health was a study on a diabetes clinic. She was looking to see how much good
the clinic did for the patients. Unfortunately, in the end all that could be
said was that the results were inconclusive. It was said that the
patient-information collected at the clinic was good, but not was good enough
for a research project.
I'm not sure why, at every level, we give them so much credit
for being selfless and well-meaning and objective and knowledgeable about their
patients. No attention is paid to the strength of the need of caregivers to believe that
they are doing good for their patients. If they had as strong a need to do good
as they have to believe that they do good, they already would know what the
long-term consequences were for the patients. But they don't. They don't collect
the data that would enable them or anyone else to make an honest evaluation of
the long-term results for the patients. Anecdotal evidence remembered by people
with a strong self-interest why healthcare
professionals running state medical boards are a problem. It is why healthcare
professionals imagine they are helping patients when they put risk management in
charge of patient safety. It is why patients continue to die
unnecessarily at an alarming rate in medicine without anyone in medicine being
particularly concerned about it.
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