tag:blogger.com,1999:blog-10424035.post4802173510884962998..comments2023-09-11T08:58:24.710-06:00Comments on Reach Upward: Deadly DataScott Hinrichshttp://www.blogger.com/profile/11831447472339880148noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-10424035.post-50616479430549321672009-05-06T17:27:00.000-06:002009-05-06T17:27:00.000-06:00A patient advocate needs to have sufficient knowle...A patient advocate needs to have sufficient knowledge and power to properly affect the situation, plus incentives to ensure the patient's best interest. Currently there is hardly ever a single individual that meets all of these criteria in any given medical situation.<br /><br />Another problem not mentioned in this exchange is the practice of defensive medicine -- ordering tests and treatments that have low likelihood of being necessary, just so that all bases can be covered in the event that a patient sues over perceived inadequate care.Scott Hinrichshttps://www.blogger.com/profile/11831447472339880148noreply@blogger.comtag:blogger.com,1999:blog-10424035.post-59434567825593990002009-05-06T13:59:00.000-06:002009-05-06T13:59:00.000-06:00My biggest challenge as a patient advocate is the ...My biggest challenge as a patient advocate is the imbalance in knowledge between me and the doctors. They will direct a course of action that I will think is overkill, but when I try to push back, I'm not really sure how far I should push because I'd hate to have my child skip a treatment that was helpful.<br /><br />I think the primary care physician is supposed to be the person that coordinates all of your care, but I'm not sure how well that works or if PCPs are on board with that strategy. Perhaps improving that patient-advocate role would do more to improve the quality of care than most other innovations, including IT innovations.Bradley Rosshttps://www.blogger.com/profile/06030210881782328907noreply@blogger.comtag:blogger.com,1999:blog-10424035.post-26820108007366085192009-05-04T17:30:00.000-06:002009-05-04T17:30:00.000-06:00While this is a single instance, research shows th...While this is a single instance, research shows that it in fact represents an all-too-common reality. Practitioners are often prisoners of the organizational behavior fostered by the culture in which they work.<br /><br />Most of the practitioners that served my father in his last two years of life were good, caring people trying their best to do a decent job. But there was not, in fact, any competent person that could pull together all of the disparate treatments and effects of such treatments. My Mom was tenacious and did loads of research. Some doctors came to hate seeing her accompany my Dad because she asked pointed and informed questions that they were uncomfortable addressing. The most common refrain was that thus-and-such was outside of their area of expertise, although, treatments they were providing were contributing to an effect.<br /><br />One of the most unfortunate experiences during my father's treatment was when practitioners would refrain from providing the best care possible out of professional courtesy -- being unwilling to step on the toes of a practitioner of a different specialty despite clear indications of what would have been in Dad's best interest.<br /><br />Recent research (see <A HREF="http://reachupward.blogspot.com/2008/11/most-of-our-medicare-money-is-spent-on.html" REL="nofollow">my 11/18/08 post</A>) has found that for patients with complex health conditions, my Dad's experience is not the exception; it is the rule. We do not have a competent approach to treating complex illness.<br /><br />A doctor friend honestly told me that most doctors are painfully aware that "if you are good at using a hammer, every problem looks like a nail to you." Coupled with the heroic medicine culture we have evolved, this leads to sub-optimal treatment, even when doctors believe they are doing their best.<br /><br />I am not comforted by the thought that doctors almost always work to pursue the course the patient wants. Patients ask for drugs by name and doctors prescribe those drugs regardless of whether they are in the patient's best interest or not. Mom's bring their toddlers to the doctor with a cold. Doctors continue to give antibiotics despite oodles of research showing that such broad use of antibiotics is a bad idea. If a patient is better informed than the doctor, then maybe it's good for the doctor to treat per the patient's desires. But this isn't always the case.<br /><br />Patients press for miracle treatments due to broad cultural acceptance of the hero healer myth and due to perverse incentives that reduce motivation to do the macro things that effect better health rather than focusing heavily on the micro things that try to shut the barn door after the horse is already out.Scott Hinrichshttps://www.blogger.com/profile/11831447472339880148noreply@blogger.comtag:blogger.com,1999:blog-10424035.post-39875098233165977272009-05-04T15:37:00.000-06:002009-05-04T15:37:00.000-06:00This is actually related directly to my field (Bio...This is actually related directly to my field (Biomedical Informatics), though not to my area of research interest (for my PhD). While the computer systems surely could have been much better, to me it seems like more of a people issue than a computer issue. That's part of the reason I'm not focusing on this type of research. Not being an MD and not wanting to go into administration, I don't know that I could really make much of a difference in this field. The change has to come from people who can tell the doctors and nurses how to operate. The software developers would like to be able to standardize what they do, but in the end the doctors (who are often hard headed and overworked) do what they want to do, unless their compensation or punishments are directly tied to doing things in a standardized way. And an informatics person (unless they are an MD or administrator) doesn't have the ability to change that very much. At least in my (likely pessimistic) opinion.<br /><br />This is an example of an extremely bad case that illustrates a real problem. However, one case certainly doesn't prove the theory that IT systems are bad for health care (this is a pet peeve when people do this). IT systems can surely help if done well, but that doesn't mean they will be perfect or be able to fix everything. I think Utah (and in particular Intermountain Health Care) has some of the best health care in the world, and part of that (in my opinion) is that they have (relatively) advanced IT systems.Stevehttps://www.blogger.com/profile/06952466893128017717noreply@blogger.comtag:blogger.com,1999:blog-10424035.post-76426575897941638962009-05-04T14:40:00.000-06:002009-05-04T14:40:00.000-06:00Two thoughts:
1) This discussion surrounds a sing...Two thoughts:<br /><br />1) This discussion surrounds a single instance of an unfortunate medical situation and thus it may not balance the various issues according to their real frequency.<br /><br />2) While we do have a hero mentality related to medical practice the reality is that this is not simply an issue with physicians and other medical practitioners. In the end they are tradesmen and 99% of the time they will pursue the course that is desired by the patient. So long as patients press for the miracle treatment the doctors will usually bend over backwards to give that treatment and do whatever is necessary to get paid for it.Anonymousnoreply@blogger.com