Health care in critical condition
Kim Laviere says a surgeon mistakenly cut a key artery during an operation to repair a varicose vein, which led to the amputation of one foot.
By Robert Bazell
NBC NEWS BOSTON, May 7 Ñ A new report from the prestigious RAND Corporation says the quality of health care for most Americans is surprisingly poor: The group ranked the U. S. medical establishment 37th in overall performance worldwide. But some hospitals, like BostonÕs MassachusettsGeneral, are taking much-needed steps to fix this broken system.
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KIM LAVIERE says she understands bad health care. She says a surgeon mistakenly cut a key artery during an operation to repair a varicose vein. Now she is severely disabled, with one foot amputated. ÒBefore it happened I was a very independent woman,Ó Laviere said. ÒI came and went as I pleased.Ó She sued the surgeon and hospital; both deny the charges. Experts say such frightening stories are far too common. ÒWe get undressed, we disclose our innermost thoughts,Ó said Dr. Robert Brook, vice president of RAND Health, a think-tank organization. ÒItÕs hard to believe that we do this in front of a system that is providing mediocre results at best, and is disorganized and using ancient technology.Ó The report points out that half of Americans do not get needed preventive care: 40
percent of those with chronic conditions like diabetes and high blood pressure do not get proper treatment and 98,000 die a year from medical mistakes. Yet few seem to care. ÒThere is no public constituency,Ó Brook said. ÒThereÕs no walk for quality of care. ThereÕs no march to improve quality of care.Ó
What should be done? The biggest problem is that while we have amazing new medical machines and drugs, much of health care relies on ancient technology Ñ often illegible notes in medical records that get lost.
ÒWhat needs to happen is that there needs to be the kinds of checklists and systems that are built into every other industry to make sure that the work gets done and people donÕt forget what theyÕre doing,Ó Brook said.
REDUCING HUMAN ERROR
Some hospitals like Massachusetts General are bringing in large-scale computerization. Every doctor and nurse sees the entire patient history at once Ñ and bad handwriting and poor memory do not lead to mistakes with orders for drugs and tests.
ÒIn a place like the Massachusetts General Hospital, there are 3,000 medications you can prescribe, 1,100 lab tests, 300 radiology procedures,Ó said Dr. Joseph Glaser of Partners HealthCare System. ÒAnd they have to master that. And itÕs inconceivable that any human being masters that.Ó
[Image] Study finds many nurses dissatisfied
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The computer asks questions to ensure the dose of a drug is correct and it does not interact with other medications.
ÒYou cannot even write the order before you answer these questions,Ó said Dr. Charles Boucher, a cardiologist. Every day in response to questions from the computer, doctors or nurses change 4 percent of the order Ñ avoiding potential mistakes.
But even at this Harvard teaching hospital, officials say, many doctors and nurses initially resisted the new computer system.
And across the country, most hospitals say they are so strapped for cash that they canÕt even consider computerizing medical records Ñ no matter how many lives might be saved.
The new report says changes arenecessary throughout AmericaÕs health-care
system, to prevent problems that create potentially deadly consequences for millions every year.
Avoiding medical mistakes
¥ Become an expert on what ails you. Ask
your doctor all about it and do your
own research.
¥ Know all about your medications.
Thousands die each year from medication
errors. Know what you're taking, what
the name is, what the strength is and
what it's for.
¥ After taking new medications, watch for
new symptoms that could be side
effects.
¥ Bring all of your medicines to the
doctor with you -- even
over-the-counter drugs and herbal
remedies -- so your doctor can see
everything you are taking.
¥ Know your lab results. Call your doctor
if you don't receive notification after
lab tests.
¥ Be on guard, even in the hospital.
Every time a drug is about to be
administered, even intravenously, ask
what it is.
Source: NBC News
Robert Bazell is chief science
correspondent for NBC News.