When given the information necessary to save the lives of patients, will the care giving community use it to save the lives of patients?
According to the Wall Street Journal, 200,000 patients die each year in hospitals because of blood clots. In 2004, North Mississippi Medical Center in Tupelo, Mississippi, had about 7.6 cases of deep vein blood clots per 1,000 patients. It began assessing a list of risk factors for each patient that prompts each physician to assess when it is appropriate to order anticoagulant therapy and other measures to prevent such blood clots.
A year later they had one case per 1,000 patients. Three years after that, in 2008, they didn't have a single one in a surgical patient, says Michael O'Dell, the hospital's chief quality officer (Wall Street Journal article about it is at this link on their site).
How many years have passed since then? How many patients are dying per year from this in the rest of the country? It has been 160 years since we started trying to get caregivers to just wash their hands enough and they still don't. In the next 160 do you think the same methods of encouragement will get them to start inconveniencing themselves enough to save a couple of hundred thousand lives per year from blood clots?
If you think so, ask yourself this. How does a nation that closes down an industry because a dozen people got sick from broccoli or oysters, accept the carnage in our hospitals? The answer is because they get all their information about medicine from people in medicine and those are among the most self-deluded people on earth. They keep setting up medicine in a way that requires everyone working it it to be saints. (See Saint Theory of Medicine).
It is time to get a grip
It is time for patients to stop having faith in caregivers to be selfless and humble enough to be lucid. If patients have knowledge instead of faith, then medicine can become patient driven instead of provider driven.
Medicine cannot become safe enough without the situation being changed into on in which patients can look out for their own interests, individually as well as in a group, no matter how hard the caregiving community works to prevent that. Any patient safety effort that does not begin with recognition of the fact that the caregiving community looks out for its own well being first is hollow and wastes our time.
In consumer driven industry, when one provider figures out a way to make a product better and cheaper, other industries must find a way to compete with that or go out of business.
But not in medicine.
Compettion in a market economy doesn't mean making everything as cheap as possible. If it did there would be no expensive cars. But it does mean giving people their money's worth, like maybe reducing the odds of making patients worse when they come for treatment so that avoiding treatment is not the best option.
In medicine, there is no market pressure resulting from the awareness of patients because patients don't know anything that their health care professionals don't tell them. If in Tupelo health care providers figure out how to save the lives of patients from blood clots, not only doesn't the rest of the industry need to get on board, but even in Tupelo they don't necessarily get on board with other life saving methods developed in other places. Patients don't even have objective information about the infection rate in Tupelo.
At the moment the press is full of news about infections. More patients die in hospitals from blood clots - twice as many. The news media is not good at keeping more than one issue aloft at a time. We need a better mechanism than headlines for guiding patients.
Good guidance never will come from the caregiving community. It never has and it never will. They probably never will see that. Their subjectivity blinds them to recognition of how their conflict of interest makes them poor guides for patients. Patients must have enough knowledge and resources to find guidance from objective sources, ones that do not have an interest in hiding the truth. Currently there are no such sources. But we can create them.