Friday, May 18, 2007

Reducing Medical Errors

While I am on the topic of medicine, I want to mention an interesting take on medical mistakes. Harvard School of Medicine’s Dr. Jerome Groopman has written a book entitled How Doctors Think. His book is intended to wake up the medical community to thinking errors that harm patients. He believes that medical schools should begin teaching courses in logic as applied to diagnosing patients. Groopman is considered to be one of the best in his field, but some of the stories of his own thinking errors leave one with perhaps reduced confidence in doctors.

Groopman says that doctors too often hit on the first possible diagnosis that comes to mind and then stick with that diagnosis. They look only for factors that might confirm their initial diagnosis while ignoring factors that might suggest something else.

For example, Groopman related the story of consulting with another doctor while preparing for surgery. He had a series of procedures lined up. He planned to try one after the other until he found the root problem. The other doctor listened and then said, “Maybe he has gout.” At first it seemed preposterous, but after thinking about it, Groopman realized that he had ignored some symptoms and tests. The patient was then treated effectively without having to endure extensive exploratory surgery.

Groopman says that it is important for patients receiving a diagnosis to ask three questions:

1) Is there anything else this could be?

2) Could there be other issues in addition to the main diagnosis?

3) Is there anything in your examination or tests that might be counter indicative of this diagnosis?

Groopman says that this approach will help the doctor think in ways that will produce the best possible outcome. He says that many doctors will not welcome the questions, but that your health is more any doctor’s ego.


Anonymous said...

Okay, to a certain extent, yes we should take some responsibility for own health, but if I am going to pay someone because they are an "expert" I would think that he would have the expertise to realize that his first assumption isn't always right.

I would also add one more question: "What does this medicine do? and do I really need it?" Too many times doctors prescribe because people expect a solution to their problem, when the best bet is that they can do fine without the medication.

Think of it this way. "Take these meds and you will be fine in two weeks. Don't take these meds, and you will be fine in two weeks."

Richard D. said...

Wait a minute. Hold on there. How far do you wanna go with this whole "teaching logic" thing? Next thing you know, people will be deducing that there is no god or something. I say we keep things the way they are. Go on believing what we were taught to believe. What we don't know won't hurt us.

Democracy Lover said...

One possible cause of medical errors are the economic and other pressures we put on doctors in our system. A recent comparison of health care systems in the 30 most developed nations (OECD) showed that the US had the highest rate (0.7) of deaths per 100,000 population. The median was 0.4, and all the other nations in the group have some form of national health insurance.


Reach Upward said...

DL, almost all of the health care comparisons between the U.S. and other nations suffer from serious problems with differences of definitions and data collection methods. Even the producers of these studies say in their official literature that few definitive conclusions can be drawn except to say that more studies must be done with better data and better methodologies.

The press loves to draw conclusions. Heck, study authors love to make allusions to conclusions not supported in their official literature when talking to the press.

The U.S. health care system has some serious problems, to be sure. But having lived under a nationalized health system in Europe, I do not see such a program as a solution for the woes of the U.S. system. It would simply be an exchange of problems. Some problems would be reduced, while others would be amplified.

I have yet to see any proposal that would truly address our system's problems without causing other unacceptable problems.

Democracy Lover said...

Given the high cost of our system (the study I mentioned shows that the US even spends more on government funded health care than nations that cover everyone!) and the poor results (the US has relatively health care outcome statistics), something must be done. I have yet to hear a complaint about a national health care system that could not be overcome with good legislation. I have yet to see a way to cure our current system's ills without removing profit from the system.

Casey said...

DL, I think that there isn't enough competition in the medical industry. Doctors get paid the same amount by insurance providers whether they solve the problem or not. In fact, a second visit to the office allows for the biller to file another claim. If the medical industry were nationalized it seems to me that there would be less incentive to solve a patients problem. If I were a doctor, I would be incentivized to run the patients through as quickly as possible in order to turn a profit. (I already feel like a sheep being herded through the office when I go to the doctor. In and out, no time for questions, here is your prescription.)

So what's my solution? It seems to me that if everyone (or a great percentage of everyone) had high deductible insurance to cover only the most serious injuries or illnesses that we as consumers would shop around for better doctors. In other cases we would skip the doctor and become educated about our health because it affects our pocket book. When we did spend our hard-earned money, we are going to find a doctor who will address the issue. None of this hit-and-miss diagnoses stuff. Getting good health advice goes back to the incentives. Is the Doc incentivized to solve my health problem? I don't think he or she is today with the proliferation of employee-sponsored health plans or under a nationalized health plan.