Doctor K's Healthcare Safety Blog

MOORE is Not Better!

Have you seen Michael Moore’s movie “SiCKO” yet?  I recently did.  Mr. Moore must be congratulated for his newsreel expose of two important issues in modern healthcare: universal coverage and access to care.  It is particularly important for patients and the public in the United States to understand at a “gut level” the differences and similarities between our healthcare system and that available in other developed countries in the world.  The issue will clearly be on the national stage during the next year, as the presidential campaigns and election processes unfold.

With tongue-in-cheek Mr. Moore leaves the viewer with a lasting impression of the serious deficiencies in US healthcare delivery, as well as the conflicts of interests and agendas between pharmaceutical companies, health insurance companies and the federal government’s regulatory agencies.  One is led to believe that such may not be the case in other countries of the world.  That may not necessarily be so.

My own quibble with this movie is that there is no effort to document the overall quality and safety of the healthcare delivered in other parts of the world.  That is not to say that the US system is the gold standard.  Instead, our results in such areas as perinatal care, infant mortality, immunizations and infectious disease rank us way down the list.  The movie does touch on these points.

My point is that it is one thing to gain access to care.  It is quite another to appreciate that once that care is received, it will be of consistent, appropriate, and high quality, and that it will be safe.  The movie leaves one with the impression that healthcare in Canada, Great Britain, France and even Cuba is in some ways superior to that here in the United States.  The point could be debated at many levels, but the key will be to assess overall quality and safety.  In my opinion, appropriate metrics do not exist as yet to do so.  Universal access to poor quality care or unsafe care does not promote health.  Pardon the pun, but “Moore is not better”.

Irvin B. Krukenkamp, MD
www.DoctorK.org

Paradigm Shift in Patient Safety

You know, our healthcare system in the United States is a hot topic of conversation amongst patients, politicians and pundits right now.  This increasing scrutiny is driving a real transformation – some would say a true revolution – to reinvent patient care that is focused on safety, quality, accountability, and transparency!   

I am personally distressed to hear of a woman dying on the floor in a Los Angeles Hospital Emergency Room while on-lookers desperately tried to gain the attention of the hospital staff to help her, and even called 911 not once, but twice in desperation for assistance.  What is even more disturbing is that no one at the hospital – no doctor, no nurse, no administrator - had reached out to this poor woman’s family to console them, or to admit that a serious error had been made, or to engage the family in the processes of analysis to understand the root causes that allowed this tragedy to occur.

This is a particularly shocking example of what I believe is wrong with our healthcare system as it exists today!  Hospitals, medical plans, doctors and nurses fear retaliation, fear retribution, fear that lawsuits may be filed against them, and even fear that they will be fired, when errors occur. Those fears promote a culture of “cover up” in our healthcare system that thwarts any meaningful discussion that could lead to productive changes in the organization of healthcare delivery.  Those fears prevent a transparent and honest conversation with the grieving families so that they may gain closure in the understanding of what happened to their loved one.

I have spoken to literally dozens of families who have fallen victim to medical errors and they all express one common theme. And that is their sincere wish that someone in authority, their doctor, or a hospital administrator, or even the nurse at the bedside, would simply meet with them, and speak honestly and openly about what happened to their loved one.

I have spoken to countless doctors, nurses and hospital administrators who themselves also grieve over a medical error, but are forced to remain silent in the fear that any admission of wrong-doing may result in a grave outcome for their own livelihood or future.

This apparent stalemate must be broken if we are to promote a future healthcare system that is safe, that is high quality, and that can be transformed from its mistakes.  I believe that we must regain focus upon the patient in healthcare, and push aside so many other conflicting interests that may influence medical decision-making. I believe that doctors, hospitals and medical plans should make their outcomes transparent, and should be accountable to their patients, and the families, that they serve.

These are but a few of the new ideas that will lead healthcare into a new era. I have devoted my own career to promoting safety and quality in healthcare, and it is my sincere hope that through education, on-going discussions, and yes, maybe even legislation, that we can reap the rewards of safe healthcare, and prevent such tragedies as a woman dying on the floor in an American hospital emergency room.

Thank your for your attention. I hope that the information on this blog may be of some help to you!

Irvin B. Krukenkamp, MD
www.DoctorK.org