Saturday, August 7, 2010

Calling out incompetence

Disclaimer: I am no expert on health care. While I've studied data on health care systems in the more global sense (to keep up with last summer's health care debate), I know next to nothing about day-to-day care. This post is entirely from personal experience and a few data searches.

Today I came to the conclusion that hospitals deliberately screw old people in order to make them more enthusiastic about dying.

My grandfather fell and broke his hip two weeks ago. After contracting pneumonia in the hospital (this is so typical we even have jokes about it), the hospital staff finally figured out they weren't giving him the correct antibiotics. Then they decided that since he needed his daily medication (that he took prior to being admitted to the hospital), but couldn't swallow the pills, they would shove a tube down his throat so they could administer the pills that way. That was a perfectly fine idea, except that they decided they couldn't give him ANY sedation because of his condition (later we found out this was not true, but that's the conclusion they came to at the time). So, for an extended period of time, they attempted to ram this tube down his throat while he choked and struggled. After some time, they gave up. This experience proved so traumatic for my grandfather, that he wouldn't allow hospital staff near him for the rest of the day.

Unfortunately this is not the end of the story. After almost a week, they decided to try again. This time they gave him sedation (thank goodness) and were able to get the tube to his stomach. A subsequent x-ray showed that they had put too much down his throat and that it was coiled up in his stomach. So they pulled about 10 inches out. Another x-ray showed the problem remained, so they pulled another 12 inches out.

Now, I'm fairly good at math, especially arithmetic. My special math powers tell me that these trained professionals shoved almost two feet of excess tubing down my grandfather's throat. How complicated can this be? Look at the distance between your mouth and your stomach. I just measured mine and it's less than two feet. So, what happened here is these people put twice the necessary amount of tubing down into my grandfather's stomach. Wow.

Again, I'd like to stress that I really don't know much about this procedure, but is it really that complicated?

Medical error is frighteningly common. According to an Institute for Medicine report published in 2000, medical errors account for anywhere from 44,000 to 98,000 deaths in the United States every year. That makes medical errors either the 9th or 5th leading cause of death among Americans.

This article from ABC News reported in 2007 that doctors at Rhode Island Hospital performed brain surgery on the wrong side of a patient's head on three separate occasions in the space of a single year. Consequently, the Department of Health finally had to fine the hospital $50,000.

This report from the Commonwealth Fund reports that in July of 2005 improvements to the medical system have taken place since the original report. These improvements included, "the development of performance standards, an increase in error reporting, integration of information technology, and improved safety systems." Personally, while these "improvements" sound overdue, I'm not too optimistic about the effects of these measures in hospitals.

An even more underlying problem is the attitude of some doctors and nurses. Often, health care professionals are trained to be aloof. I understand the need to be emotionally separated from patients, but this attitude can't be helpful in treating a patient's needs especially when most patients need more than just physical care (see post on palliative care and my extension of it below). Nor is being aloof helpful when medical errors are so widespread. Complacency is the last thing we need in a system that needs such fundamental change. 

Proposed solutions vary, but it seems that we ought to be looking at what other countries are doing in order to address such a systemic problems. Subsequent posts on health care will focus on some of the debate that took place last summer over the health care bill as well as more personal information from my friends who are currently being trained to be health care professionals. 

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