Warning!
Accessing health care may cause the following:
- Death - Medical mistakes are the fifth leading cause of death in the US
- Harm - As many as 25% of all patients are harmed by medical mistakes
- Injury - 3-17% of patients will experience an injury as a result of their care
- Unnecessary Procedures - Approximately one quarter of all medications and medical procedures may not be necessary
- Unnecessary Risk - Many patients who are candidates for minimally invasive surgery are never told of their options and instead have more extensive surgery with greater risks
According to
two highly regarded health care experts in the United States, we should all be
better informed advocates for our health care.
In fact, an empowered patient is seen by both learned professionals as a
key driver to improving quality and avoiding being one of the statistics above.
Wouldn't it be great if we could research the quality of our hospital before we go in for elective surgery, in the same way we check out a hotel or restaurant before we go there. What about a ‘star-system’ for hospitals? Secret shoppers/patients? Anonymous critics?
In his book, Unaccountable, Marty Makary, MD chronicles what hospitals won’t tell you and how
transparency can revolutionize health care.
He shares a great deal of
frightening anecdotal evidence from his years as a resident and is a vocal
advocate for ‘sunlight being
the best disinfectant’.
Dr. Makary
makes a compelling argument for hospitals publishing a range of quality
indicators including:
- Bouncebacks (readmissions to hospital)
- Complication rates (e.g. what is the post-surgical infection rate)
- Never events (e.g. having surgical equipment left inside of you or operations done on the wrong part of your body – should NEVER happen)
- Safety culture scores (% of hospital staff who would want to have surgery at the hospital they work at – yes there are surveys out there that capture that) and;
- Hospital volumes (how many surgeries does the hospital do in a year – practice makes perfect).
Dr. Makary promotes
‘open notes’ as one solution to the quality crisis in health care. “Being
able to review your doctor’s notes in writing might be even better,
particularly if you could add your own comments, perhaps via the web. Transparency plus collaboration puts patient
and doctor literally on the same page so people no longer have to wonder what
their doctor is thinking or whether it radically diverges from what they
understood.”
Donald
Berwick played the role of critic in his book, Promising Care How We Can Rescue Health Care by Improving It. Donald is
past president and CEO of the Institute for Healthcare Improvement (IHI) and is
a well-recognized expert on healthcare quality internationally (currently running for Governor of Massachusetts). In his recent book in the chapter ‘My Right
Knee’, he tells the story of his own experience with the healthcare system when
he required knee surgery. If you only
read one chapter of this book, read that one (although the entire book is
excellent).
Donald puts
into print what all of us would like when we are faced with surgery, an
agreement with the surgeon on what he/she will/will not do.
This was what Donald (international expert on health care quality) wanted
from his surgeon:
-
No needless death – don’t kill me
-
No needless pain – don’t hurt me
o
Don’t do stuff that won’t help me
o
Don’t repeat things that have already been done
o
Don’t leave me worse off than when I arrived
-
No helplessness – don’t make me more vulnerable
-
No unwanted waiting – my time is as important as
yours
-
No waste – give me effective, efficient,
necessary care
In one of
his IHI keynote addresses published in his book, Donald spoke of his personal experience
as a patient and in so, provided a solution to reducing health care quality risks. “The two most important ways to prevent
helplessness are to share information with me and to give me choices. First, keep me posted. That’ll begin with my medical record. No one can touch my knee who won’t give me my
medical record to read anytime I want it, no questions asked, and no
delays. Better yet, let me keep my
record with me, and I’ll let you use it anytime you want.”
These are
two great books that everyone should read.
I accidentally read them back to back and was impressed by the common
elements that these two experts shared.
While they often present polar opposite perspectives of the same problem,
(one glass half full, one glass half empty) both are right. After reading Makary’s book I would be afraid
to enter a US hospital but after reading Berwick’s book, I’m reassured that
quality abounds in the system. One
shining a spotlight on the problems one focusing on the solutions, both
recognizing the importance of patients advocating for quality health care.
Your Health. Your Health Information. Manage it Well.
