Free Healthcare IT Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Get all the latest Health IT updates from Neil Versel for FREE!

Medical harm explained, in graphics and Farzad style

INDIAN WELLS, Calif.—Still think the United States has the “best healthcare in the world?” You clearly haven’t been paying attention.

Last month, the Wall Street Journal ran this excellent commentary from Johns Hopkins surgeon Dr. Marty Makary about how the broken culture of medicine is harming people. An excerpt:

I encountered the disturbing closed-door culture of American medicine on my very first day as a student at one of Harvard Medical School’s prestigious affiliated teaching hospitals. Wearing a new white medical coat that was still creased from its packaging, I walked the halls marveling at the portraits of doctors past and present. On rounds that day, members of my resident team repeatedly referred to one well-known surgeon as “Dr. Hodad.” I hadn’t heard of a surgeon by that name. Finally, I inquired. “Hodad,” it turned out, was a nickname. A fellow student whispered: “It stands for Hands of Death and Destruction.”

Makary went into a discussion of checklists, à la Gawande, and reporting of adverse events. “Nothing makes hospitals shape up more quickly than this kind of public reporting,” he said. Yep, a little shaming can be good for consumers. And shocking.

Now playing in a fairly small number of theaters and available on DVD, on demand and through iTunes is a new movie called “Escape Fire,” which takes its title from the Don Berwick book of the same name. I have not been to see it yet — soon — but the trailer is compelling. So is this graphic, which the movie’s producers are circulating on social media:

 

Still think we don’t have a problem with patient safety in this country? Not only haven’t you been paying attention, you also haven’t heard Dr. Farzad Mostashari tell the heart-wrenching story of accompanying his mother to an emergency department shortly after he joined the Office of the National Coordinator for Health Information Technology in 2009.

He couldn’t get answers about his mother’s condition from anywhere in the department, and not because the doctors and nurses didn’t want to do the right thing. “The systems are failing them,” Mostashari said Wednesday at the College of Healthcare Information Management Executives (CHIME) CIO Forum, where I am now.

Even as a physician, he felt like he would be imposing on the doctors and nurses on duty if he requested to look at his mother’s paper medical record to see what might be wrong. “There was something rude about trying to save my mom’s life by asking to see the chart. That’s messed up,” Mostashari said.

Yes, yes it is. And Mostashari later told me he shared that story for me, because I had told him right before he went on stage about the suffering my dad needlessly suffered in a poorly managed hospital in my dad’s last month of life. Journalists don’t often say this, but thank you, Farzad.

As it turns out, the CIO of the health system that owns the hospital that mistreated my dad is here. I introduced myself and gave a brief synopsis of what happened, in a non-confrontational way. I intend to follow up. The hurt of losing my dad is still fresh, but I feel inspired by the media soapbox I have.

I want to honor my dad’s legacy in a positive way. I want to help this hospital fix its terrible processes and toxic culture so others won’t have to suffer the way he did.

October 18, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Not so elementary, my dear Watson

In just the last few hours, I’ve seen a huge wave of pushback and doubt about Watson, the IBM supercomputer, being used for clinical decision support.

Yesterday, I covered a “healthcare leadership exchange” at IBM’s new Healthcare Innovation Lab in downtown Chicago. I posted some of my observations on the EMR and HIPAA blog, and made the case for diagnostic decision support.

I also wrote a story for InformationWeek, but that hasn’t run. Instead of posting my story, InformationWeek healthcare editor Paul Cerrato wrote a column about Watson already being “beaten in the medical diagnostics race” by Isabel Healthcare, a diagnostic decision support tool that’s been available for years. I have to admit, he’s right. I first interviewed Isabel founder Jason Maude probably in 2002 or so, and I first blogged about the company in 2005. I mentioned Isabel in a 2007 post that, interestingly, also alluded to the work of Don Berwick and Larry Weed.

Cerrato mentioned Jerome Groopman’s 2007 book, “How Doctors Think,” which discussed, in part, how IT could help doctors avoid many types of cognitive errors. “[D]octors tend to lean toward diagnoses that are most available to them in their day-to-day routine,” Cerrato wrote (emphasis in original). That’s exactly what Weed has said for decades, and exactly what Atul Gawande talked about in his groundbreaking book, “Complications.” Computers should not make decisions for physicians, but rather should help them reach the right conclusions, particularly when they see rare cases.

Wouldn’t you know, “e-Patient” Dave deBronkart commented on my EMR and HIPAA post to say he just finished reading Groopman’s book. He tweeted a link to my post, which a few of his 6,500 other Twitter followers noticed. They also noticed EMR and HIPAA grand poobah John Lynn’s comment that the example in yesterday’s Watson demo, a 29-year-old pregnant woman being prescribed doxycyline was “pretty weak.” (He’s right, by the way.) Aurelia Cotta, who blogs about issues such as infertility and adoption, started this thread that also got South Carolina nurse Sunny Perkins Stokes interested:

@ @ @ I can see great uses for this, but I find it funny the example they give of doxy in pg is wrong.
@AureliaCotta
Aurelia Cotta
@ @ @ because it's still using the FDA's pg categories, which are 30 years out of date. GIGO anyone. Heh
@AureliaCotta
Aurelia Cotta
RT @: @ @ @ find it funny the example they give of doxy in pg is wrong.| How so?
@sunnystill
Sunny Perkins Stokes
@ @ @ sorry to reply late--but FDA is binary, and Motherisk is risk vs reward ratio. Critical difference
@AureliaCotta
Aurelia Cotta
@ @ @ doxy is an excellent drug, and cheap. Lyme disease can cause m/c + stillbirth. What if pt needs it?
@AureliaCotta
Aurelia Cotta
@ @ @ baby teeth that have a line on them as a remote chance, might be worth the risk to a pt with no $
@AureliaCotta
Aurelia Cotta
RT @: @ @ @ baby teeth might be worth the risk to a pt with no $ ?Amoxicillin not just as good?
@sunnystill
Sunny Perkins Stokes
@ @ @ maybe to you, but what if the pt is allergic? Or they've already tried amoxicillin, and it didn't work?
@AureliaCotta
Aurelia Cotta
@ @ @ context matters is all, and I just think any sources used should be good, not "lawyer endorsed"
@AureliaCotta
Aurelia Cotta

 

Well, there’s a reason why I call myself a “healthcare” reporter and not a “medical” reporter. I don’t know the science, and I do occasionally get myself in trouble when I start talking about things like whether doxycycline is contraindicated during pregnancy. (To my credit, I did attribute the statement to IBM’s chief medical scientist, Dr. Marty Kohn.)

As I was reading the above tweets and contemplating this blog post, I came across a link to some tongue-in-cheek pushback against Watson in healthcare. An anonymous radiologist who blogs about PACS as “Dr. Dalai” compared Watson to HAL, the diabolical mainframe in “2001: A Space Odyssey.” Dr. Dalai wrote: “Watch out, boys and girls, Watson is headed to a hospital near you, and he (it?) may challenge you as much as he did Ken Jennings.” Jennings, of course, is the Jeopardy! champion whom Watson beat earlier this year.

At first glance, I thought Dr. Dalai was yet another whiny physician clinging to the status quo. But he hit on the real issue: application of knowledge. Quoting from an interview with one of Watson’s programmers, Dr. Dalai noted that the supercomputer is being loaded with all kinds of medical reference material in preparation for “learning” human physiology and ultimately gathering experience in medicine. “This isn’t fair!  If I could just take a text book, stick it up my, ummmm, brain, and have it instantly memorized, I would be whiz, too!” he wrote.

Yeah, isn’t that the whole point of clinical decision support?

June 3, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Slams on Berwick are getting pathetic

The slams on Dr. Donald Berwick, frankly, are getting pathetic.

Today, Fox News medical contributor Dr. Marc Siegel dismissed Berwick as a “basically a policy wonk” who “hasn’t really practiced since 1989.” Siegel tried to score points with sound bites. “This guy has more quotes than Yogi Berra, and let me tell you something, these quotes are an indictment on people that want clinicians to make decisions,” Siegel said on Fox this afternoon.

According to Siegel, comparative effectiveness “doesn’t work in the real world.” Well, sure, that’s the point of clinical decision support. Best practices are for common conditions, and clinical decision support is to help physicians either follow best practices in the case of common conditions or, just as importantly, diagnose and treat ailments that they don’t often see. (Read Dr. Atul Gawande’s best seller,  “Complications,” for a description of the chaos that ensues when physicians see rare cases.)

Fox News anchor Megyn Kelly tried to feign fairness by saying of President Obama’s recess appointment that installed Berwick as CMS administrator last year, “lots of presidents do it.” But she later said that that Berwick “loves” the British National Health System, trying to paint Berwick as a socialist. Once again, this isn’t about socialism or capitalism or any other ism that has unfortunately been the focus of “health reform” in this country. It’s about trying to improve the quality of care. (It’s not about insurance, no matter how many politicians or pundits say so.)

Defending Berwick was Dr. Cathleen London, a family practitioner at the Weill Cornell Iris Cantor Women’s Health Center in New York City. London took issue with Berwick’s opponents relying on sound bites to make their thin arguments. (Siegel smugly laughed this off.)

When Kelly again tried to tie Berwick to the NHS, London said, “He likes that we do evidence-based medicine, that the British have NICE that actually oversees what the NHS should cover and shouldn’t.” Yes, the British National Institute for Health and Clinical Excellence (NICE) is an independent advisory board that helps the NHS make coverage decisions. You know, the same way any insurance system, public or private, has to decide what and what not to cover.

To his credit, Siegel praised Berwick’s work at the Institute for Healthcare Improvement for helping to reduce deaths in hospitals. “He’s apparently very well liked among patient safety advocates,” Kelly added.

London noted that former CMS Administrator Tom Scully, a George W. Bush appointee, is a fan of Berwick. Still, Siegel continued on his argument that comparative effectiveness is restributive in that it takes healthcare away from some people. “You’re not going to be able to pay for very expensive care,” Siegel said.

Why exactly would we want very expensive care in cases where less expensive but equally effective treatments are available? Is it because of the public perception that more expensive care automatically means better care? It sounds like Siegel is either trying to perpetuate that myth or protect the profits of pharmaceutical and device manufacturers. But then he made the salient point that “insurance is overused” and that healthcare reform, which he derides as “ObamaCare,” did little to address that problem.

All that says is that both sides of the political debate are wrong, and the Senate Democrats are cowards for not standing up for better care.

March 23, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.