I Might Have Been Wrong About Obesity…

I frequently make a big deal about obesity – how it’s probably one of the primary reasons Americans have comparatively low life expectancies, and how it contributes largely (no-pun intended) to our skyrocketing health care costs.  My generalizations are imprecise at best…just plain wrong at worst. 

Check out this Q and A with health economist Eric Finkelstein, author of The Fattening of America, on my favorite blog – the Freakonomics blog.  The Freakonomics “movement,” led by Steven Levitt and Stephen Dubner, is great at finding the unintended economic consequences of certain endeavors.  Some of the major points from the interview:

• Yes, obesity does cost us money – about $93 billion per year…not a drop in the bucket.  But obesity is “cheaper” than it has ever been, and it continues to become less costly.  Compare this number to the $350 billion cited by McKinsey (previous blog posting) for collection and billing costs in health care, and you start to see that the creative thinking needs to be focused on health care markets and administration, rather than keeping people thin.  
• Obesity is not a sign of market failure, but a sign of market success.  We are incentivised to be fat.  Food is relatively cheap and getting more so.  Innovations as benign as power windows in automobiles are too numerous to account for, and incrimentally reduce the number of calories Americans must burn to produce the same economic output.  30 years ago, power windows were an expensive optional extra.  Today, even the cheapest cars have them.  Same with microwaves –faster food preparation means more time for work with less energy (calories) exerted.  Additionally, we have such fantastic pharmaceuticals and medical procedures that obesity (to an extent – BMI lower than 35) doesn’t lower life expectancy significantly.   Why? Today’s obese people have better lipid profiles and lower blood pressure than skinny people 40 years ago. 
• Perhaps the most interesting point made by Finkelstein was this:  it isn’t economically viable to spend money to prevent obesity.   As discussed above, obesity is partially an outcome of market success – meaning the best way to fight obesity is to make life harder.  We could all live like Amish people but it would cost trillions in lost productivity…we would be skinnier, but have similar or shorter life expectancies.  Plus it presents interesting philosophical issues.  What is our purpose?  It seems to be to survive, reproduce and make life easier and more rewarding for ourselves.  Maslow’s pyramid.  We would never back-out all the efficiencies American’s have integrated into their lives – it wouldn’t be worth it.  Obesity is a sign of economic success – this is why it correlates very closely with an industrialized country’s wealth.  So why institute expensive, paternalistic government programs to prevent obesity if everything else we are doing as a society, consistent with generalized notions of “progress,” is contributing to it?  
• Comparing obese people with smokers is not fair economically.  Obesity does exhibit a cost on America – the $93 billion mentioned above accounts the extra food, pills, medical procedures an obese person will consume while having the same length of life as a skinny person.  The most interesting fact here is that smokers only exhibit a cost on society because of the collateral damage of second hand smoke. But they may pay for it themselves.  Smokers pay billions in cigarette taxes and die before they collect much of their social security.  This is one of the few cases I can think of where a tax has been implimented efficiently…that is, it ends up costing the country less overall – it saves money.  Finkelstein mentions that if the government were truly dedicated to reducing health care costs – the easiest way would be to hand out free cigarettes.  People would die long before they would have to be treated for the chronic diseases associated with old age – the most expensive segment of health care. 
• Obese people who work extremely hard, create a lot of value, and don’t have time to exercise are an interesting bunch given these statistics.  Reducing their labor productivity by 1.5 hours per day (they start going to the gym) would have a dramatic negative effect on their overall lifetime productivity – but yield little positive benefit: they pay for their own health insurance, and they live nearly as long.  

Yes, obesity does exert a cost on society…but it’s an incrementally shrinking cost.  The key to reducing health care costs lies in the efficiencies in the system itself.  And let’s not forget – America is one of wealthiest nations in the world.  This is why we have the highest health care cost per person, we are willing to pay for it…never mind that many of the expensive bells and whistles don’t necessarily help us.

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Health Care Coverage for 40 Million Uninsured Without Raising Taxes

A solution for America’s uninsured always seems financially unsustainable.  Sure, other countries have it, but they don’t have 300 million people, vast disparities in household incomes and general wealth, a third-world country next-door neighbor with a broken fence latch, and a military.

Well, thanks to the embarassing inefficiencies present in our current health care system, the solution to most of its problems lies in wringing a bit of extra water out of an absolutely saturated sponge.  The difficulty doesn’t lie in the amount of water in the sponge, it’s getting a proper grip…which is particularly tricky.  Enough with the ill-conceived metaphors.

Cheryl Hall‘s business column in the Dallas Morning News discusses MedSynergies, a company capitalizing on the collection side of medicine.   J. R. Thomas, the CEO of the company, cites a McKinsey & Co. study that has found what could be the single biggest problem with American health care – the billing and collections process.  The study finds that 15-20% of the cost of health care goes towards billing and collections – that’s $350 billion per year as bills needlessly bounce between patients, doctors, hospitals, and insurers.  This would be enough to cover 40 million uninsured Americans.  Most businesses cannot survive with a 20% cost of collections.  Perhaps businesses with significant barriers to entry, like bounty hunting…

Here’s some stupefying excerpts: for every 100 bills a typical private-practice doctor sends to insurance companies, 30 are kicked back because the forms were filled out wrong, the procedures weren’t covered or the rules were so incomprehensible that the doctor’s office couldn’t follow them.  Emergency room bills often have a 40-plus percent initial rejection rate.  MedSynergies is able to reduce this to 10% and 20%, respectively.    Typically, a medical provider has to send out bills – to the patient, the government or the insurance company – four times to get fully paid, Thomas says. But it often takes six or seven bills, and it’s not uncommon for it to take a dozen attempts to “zero out” the balance.

So, is the only solution to this problem for hospitals and private-practice physicians to hire MedSynergies? Well no, there’s a much simpler solution.  It involves changing the way providers do business.  With the advent of Health Savings Accounts, there’s a growing population of people who are paying cash for much of their medical expenses.  The problem is, there is no transparent pricing for patients to use as a benchmark.  That’s all changing.  Doctorpricing.com is a physician cash network that is slowly filling in the missing pieces by creating a true market for health care.  Thousands of doctors are tired of the expenses associated with the billing process, and the time value of money issues of having accounts receivable for 3-6 months in some cases.  Doctors who create a profile on Doctorpricing.com can offer point-of-service, cash pricing for consultations and medical procedures — eliminating much of their overhead.

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Hospitals Will Have to Pay for Mistakes

Vanessa Fuhrmans of the Wall Street Journal reports that insurance companies are probably going to stop paying for medical treatments made necessary by “never-events,” (list from the National Quality Forum) those major screw-ups you pray a hospital never commits.  Examples include leaving a sponge in a surgery patient, amputating the wrong limb, transfusing the wrong blood type, etc.  Participating insurers are following Medicare’s lead, and not allowing themselves, or patients to be billed for errors that should, under no circumstances, occur.  Some of these insurers are WellPoint, Aetna, Cigna, UnitedHealthcare, and Humana.

The purpose is to incent hospitals to prevent these mistakes in the first place, which cost billions a year to insurers, hospitals and patients alike.  Laissezfairehealthcare is in favor of this.  Eventually more preventable errors that aren’t necessarily never-events, will become never-events as hospitals become safer and less accident-prone.  While hospitals could spend money trying to skirt around these new restrictions, or attempt to pass the cost through to the insurers and patients another way, many will discover simple updates in policies and procedures, personel changes, or technological investments will more than pay for themselves in improved patient outcomes.

Smart hospital administrators are already seeing the light: “[t]o lower its rate of infection…Pitt County Memorial Hospital in Greenville, N.C., in February expanded its screening for methicillin-resistant staph infections to all patients coming into the hospital. By identifying and isolating those with the strain early, it lowered the number of MRSA pneumonia cases related to ventilator use by 67% and MRSA urinary-tract infections by 60% within eight months. In all, the expanded screening has cost nearly $1 million, $800,000 picked up by private and public insurers.  Steve Lawler, the hospital’s president, says it has more than recouped its $200,000 investment. Moreover, spending the money to make the hospital safer is a “better return on investment…than some billboard campaign,” he says.”

For another viewpoint – visit to the Verden Group’s blog.

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Primary Care Physicians: An Endangered Species

A recent Health Care Blog Post explains the looming crisis in primary care. Some background: great health care systems are anchored by primary care physicians (PCPs), the generalist doctor whom your family depends upon for standard medical care. The PCP must have a workable basic knowledge of nearly all medical specialties and be able to diagnose and treat most illnesses. It is the PCPs job to refer patients with more complex medical issues to specialists. Specialists are experts on specific areas of medicine.

Data shows that higher percentages of PCPs are associated with healthier, lower-cost populations. In most developed countries with healthier populations than ours, PCPs (generalists) represent 70-80% of total doctors – while the remaining 20-30% are specialists. In the U.S., not only are the numbers reversed, the trend is getting worse. As PCPs dwindle in this country, wait times for medical attention will increase, quality of talent will drop, and quality of care will continue to drop. What’s causing the change? Well, in a word….money.

I’m not accusing doctors of being greedy – I’m accusing them of being human. Compensation drives behavior. If you don’t believe me, read Freakonomics. Specialists earn, on average, well over twice as much as PCPs. And with the increased risk of socialized medical systems, I don’t know a single medical student or resident who isn’t going to be a specialist of some kind (and I know a lot of them). Many of them simply cannot afford to be a PCP – with hundreds of thousands of dollars of loans to pay off, they stand little chance of ever building any real wealth if they become a PCP. To quote the blog post: “Between 2000 and 2005, the percentage of medical school graduates choosing Family Medicine dropped from a low 14% to an abysmal 8%. Among Internal Medicine residents, an astonishing 75% now end up as hospitalists or sub-specialists rather than office-based general internists.”

So if primary care is so critical to our nation’s health care (outcomes and costs), why doesn’t the market respond by paying PCPs more? The answer is simple: we don’t have a free market in American health care. What we have is Medicare’s Resource-based Relative Value Scale (RBRVS). Originally conceived in the 1980’s by Harvard Economist William Hsiao, the system was originally designed to calculate an accurate way to reimburse physicians for their time spent on medical procedures — and to reduce disparities in the medical specialities. The problem is the reimbursement formularies reward complex medical procedures over pro-active health care management (preventative care), and after 20 years of budget problems, Medicare continues across-the-board cuts to its doctor and hospital reimbursement levels…which penalizes PCPs more than specialists because of lower reimbursement levels to being with. In fact, in January of 2008, an inefficient Medicare will enact a 10.1% cut in physician reimbursement rates. (Medicare’s costs are skyrocketing – at current trend levels they will account for 20% of our nation’s GDP by 2050).

So why a reimbursement system that favors specialists to generalists? Well, apparently Congress approves 90% of the legislation recommended by the American Medical Association(AMA). The AMA represents a surprisingly small percentage of American physicians. This is reflected in its 30-member committee (called the RUC), comprised mostly of specialists, whose job it is to lobby Congress. “In other words – and it is important to be clear about this – the premeditated actions of the specialist-dominated RUC, operating under the auspices of the AMA and in alliance with [Medicare], appear to have played a direct role in the current primary care crisis by driving policy that financially favored specialty care at the expense of primary care. Equally important, this relationship has been key in establishing drivers of our health systems relentlessly explosive cost growth with its attendant impacts on the larger US economy.”

Two things will help solve the problem. Better representation of primary care physicians on the RUC, and a transparent, non-Medicare-dependent free market for health care.

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You Get What You Pay For…

As predicted, the “universal” health plan introduced by the Commonwealth of Massachusetts is more expensive than the politicians thought it would be.  The tab could run $619mm for the state’s fiscal year, $147mm or 20% over-budget – according to this health blog post on the Wall Street Journal’s website.

What’s the answer to this problem?  Well, when a business’ expenses are over-budget (20% is laughable…but not unusual with inefficiently planned for and poorly conceived government welfare programs), you have two choices, increase revenues or decrease expenses.  And because policymakers wouldn’t dare charge citizens higher premiums so soon after introducing the program that got them elected, they’ve predictably opted to decrease expenses.

How?  You guessed it, they are cutting payments to health care provides such as doctors and hospitals.  You can bet the program, comprised of forced medical insurance, will see continued budgetary problems.  You simply cannot provide 100% coverage, 100% access, and any reasonable level of health care for cheaper than programs that don’t make those promises.

If the program continues in its current form, I predict there will be a shortage of primary care physicians in Massachusetts.  Everyone loses…   except for the political careers of people who couldn’t care less about public health.

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Let’s Pick on Canada Now…

In September 2003, Harvard Medical Professor Dr. Steffie Woolhandler had this to say in the New England Journal of Medicine: “A large sum might be saved in the United States if administrative costs could be trimmed by implementing a Canadian-style health care system.”

While I’m sure Dr. Woolhandler is a brilliant clinician and activist, I firmly believe that most of the economic data will show that a single-payer health system (which resembles Canada more than the U.S.) cannot provide access to all, or perhaps even most… and would cost this country more in lost lives and productivity, not to mention, increased taxes.

The Frasier Institute, a non-partisan, Canadian research organization recently released some scary data: wait times for Canadians needing surgery or other therapeutic treatment hit an all time high of 18 weeks in 2007.  That’s over 4 months.  “Despite government promises and the billions of dollars funneled into the Canadian health care system, the average patient waited more than 18 weeks in 2007 between seeing their family doctor and receiving the surgery or treatment they required,” said Nadeem Esmail, Director of Health System Performance Studies.

This is an increase from 2006 (18.3 vs. 17.8 weeks).  Some provinces are worse than others, like Saskatchewan (27.2 weeks), New Brunswick (25.2 weeks) and Nova Scotia (24.8 weeks).  The wait time is roughly equal parts waiting to see a specialist (once you’ve seen a primary care physician and gotten your required referral) and waiting to receive treatment once you’ve seen a specialist.  Given the growing shortage of primary care physicians in Canada, these numbers don’t even factor in the time it takes to get an appointment to see the primary care doc.  

Diagnostic technology suffers from similar exaggerated wait times in Canada.  Average queues for a CT scan are 4.8 weeks.  For an MRI, 10.1 weeks.  Oftentimes these types of diagnostics are needed to check for imminent, if not emergency medical problems.  A close friend recently spent a week in the hospital with multiple pulmonary embolisms.  This was a life threatening condition that was detected literally just in the nick of time with a CT scan..which was administered within an hour of arriving at his doctor’s office.  If he had been in Toronto, he would likely have died.  Blood clots don’t patiently wait 4 weeks…

In Canada, people are waiting for 827,429 surgical procedures.  This is a 7.8% increase from last year…and it’s getting worse.  And with data showing that famous and politically-connected people routinely jump the queues, it’s difficult to even make the argument that everyone is given the same level of access.

Esmail concludes by saying: “This grim portrait is the legacy of a medical system offering low expectations cloaked in lofty rhetoric. It’s one defended by special interest groups with a stake in maintaining the status quo. The only way to solve the system’s most curable disease – lengthy wait times that are consistently and significantly longer than physicians feel is clinically reasonable – is for  substantial reform of the Canadian health care system.” (emphasis mine).

Lofty rhetoric is what gets votes…

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Our Dependence on Government-Payor Medical Care May Kill Us…

Just about anyone who doesn’t work directly for the U.S. Department of Health and Human Services, and has experience in health care, could not argue that Medicare’s reimbursement formularies adequately reimburse hospitals and doctors – AND keep a straight face.  Medicare reimbursement, the bane of many hospitals’ existence, began, like many government programs, with a benevolent purpose and a seemingly meaningful methodology.  And, like many government programs, has been so re-written, picked, prodded, subject to compromise, restricted by budgetary constraints, and sterilized by bureaucratic red tape and competing political interests…that the “well-meaningness” and logic are as endangered as the cancer patients I’m about to discuss.  To give you an idea of what government is capable of, just look at the present U.S. Tax Code.  Congress has created the necessity for an industry that costs this country upwards of $265 billion annually, just to comply with it.

The latest casualty in Medicare’s inconsistent, non-hippocratic formulary, may be 60,000 people per year with Non-Hodgkin Lymphoma.  A NY Times article says that Medicare may arbitrarily cut its reimbursement for a new class of promising cancer drugs…the only treatment option for many disease sufferers.  The drugs, Bexxar (GlaxoSmithKline) and Zevalin (Biogen Idec.) , part of a group called radioimmunotherapies, will be critical, life-saving drugs, if hospitals can afford to offer them as treatment options.

Marion Swan, a spokeswoman for the Lymphoma Research Foundation, says the drugs are the only option for some patients. “Our number one concern is that patients have access to all viable treatment options,” she said, “and it looks like this might be denying access.”

The worst part is that the Federal rules prevent hospitals from offering drugs to non-Medicare patients, if they cannot offer them to Medicare patients.  This means anyone with regular insurance or the ability to pay for potentially the only drug that will save them, will be denied access.

This is where socialized medicine fails us…

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The Great Compromise

A laissezfairehealthcare blog comment turns the raging American health care debate on its head by posing the question: what are Americans willing to do without.  In a country where food, shelter and entertainment are readily accessible to an overwhelming majority of the population (relative to other countries with our size and immigration levels), most American children are taught they can be anything and have anything.

This is a fantastic framework to create for children — build imaginations that can craft all the possible joys of life to come.  But there’s a caveat.  Perhaps the biggest lesson I learned once the my rose-colored glasses were removed…when I entered the real world…was the notion of compromise.  In this country, happiness, fulfillment and self-actualization aren’t promised and certainly aren’t guaranteed.  It’s the opportunity to pursue these things that we value.  This is a critical distinction that a surprisingly small number of people have made.  If you work hard and create opportunities for yourself to be lucky – you can have it all.  But don’t expect anyone to give it to you.  But…in order to take a specific path, you have to give up the opportunity to take other paths.  You have to make compromises…and without the benefit of hindsight.  This is the notion of risk and reward.

The comment on this blog discusses health care as a compromise, where we can’t have all of the following:

(1) quality health care that is affordable

(2) health care that is accessible to all

(3) health care which is unlimited

Read each of these as if they exclude the others.  E.g.  (1) is basic, non-comprehensive health care for most; (2) is low-quality health care for everyone; and (3) is comprehensive health care which isn’t necessarily accessible or affordable.  I would argue that “quality” is a very relative term.  We’ll assume for the sake of argument that “quality” means basic, preventative health coverage without resources for catastrophic health events.  “Unlimited” means coverage for everything.

Hillary Clinton and Barack Obama probably opt for (1) and (2).  This is where the “socialized medicine” argument comes into play.  Would Americans be willing to choose this path at the exclusion of others?  It’s difficult to analyze the argument in a vacuum…that is…a priori, without consideration of empirical data.  If we were to engage in the academic exercise…it would seem like a reasonable choice.  Everyone gets basic health care, without the bells and whistles.  And this is the card politicians play.  It’s a brilliant play, really.  The notion of “universal health care” sounds fantastic — I’m willing to bet it is great for a presidential candidate’s poll numbers.  But if we accept the notion of the exercise…that is…compromise, we need to look at what we would have to give up – and we can only do this with real world data.  Providing basic, quality health care to every person that resides within our borders…which is affordable, would take away so many bells and whistles that we could arguably acheive the same patient outcomes by distributing pamphlets about the dangers of smoking and obesity, and spend hundreds of billions less.  To make it affordable for everyone and maintain some semblance of quality and accessibility – the economics dictate that you strip it down to such a bare-bones affair – that a flu shot may not be covered.  Even with conservative estimates of illegal immigrants and low-wage workers, the endeavour would represent a tremendous transfer of wealth from the productive to the non-productive.  There are plenty of legitimate arguments for a “Robin Hood” approach in other scenarios…if it’s economically viable.  In this case, I can’t see how it is.  With the federal government acting as single payer and health care indemnity monopoly – all possible efficiencies are worked out and resources are wasted.  The second act of my economic argument is motivation.  It’s the classic confusion of the American Dream – guaranteeing the pursuit of happiness vs. guaranteeing happiness itself.  If you allow people to think that the government will always bail them out – they have no motivation to take reasonable, calculated risks.  They are working less efficiently.  Hillary Clinton is arguing for a 90-day moratorium on home foreclosures — obviously for political reasons.  If the government bails out Americans who borrowed more than they could afford to pay, it trains everyone to be wasteful and reckless.  If America chooses (1) and (2), resources will be transferred from the responsible to the irresponsible, and those who can truly afford (3), will create a second, private tier of health care anyway.  And the irresponsible have no incentive to become responsible.  But everyone is paying more of their income for a system that necessarily, empirically, gets less efficient and sustainable over time…until we’ve trained ourselves into a welfare state.

This is why a truly efficient market always wins.  As an American and an advocate for some form of consumer-directed health care, I believe picking (1) and (3) at the exclusion of (2), in a real-world, non-academic sense – is the appropriate compromise…because over time the economic incentives are in place to increase efficiencies, rather than reduce them…meaning if people learn to take enough responsiblity, we might get (2) as well.  The notion of investing your health care dollars into people with a reasonable chance to recover is unfair.  Many people with resources and no reasonable chance to recover will invest in hope…and choose to spend their resources however they see fit.  And if everyone in this country is responsible for some of their own health care risk…they will train themselves to either make more money or reduce their cost of care through healthier choices.  If Americans had an incentive to be just a bit more disciplined, we wouldn’t see skyrocketing cases of type-II diabetes.

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A Simple Way to Save Billions in Health Care Expense

Exercise between Thanksgiving and New Year’s.  That’s it.  If every sedentary American exercised 30 minutes per day, 5 days per week during the holiday season, we could probably reduce health care expense in this country by 15%, maybe more.  A brisk walk is all it would take.

Where am I getting this?  An article by Kevin Hassett of Bloomberg news.  On average, Americans gain 1.0-1.4 pounds between Thanksgiving and New Year’s that they don’t lose.  This is primarily because most Americans consume considerably more calories during the holidays, but burn the same number of calories they normally burn.  If the average American gains 1.2 pounds per holiday season, a slim 25 year old will have added nearly 50 pounds of excess weight by the time he is 67.  Data seems to confirm this.  The average 20-something male weighed 164 lbs in the 1960s.  40 years later those same average men weighed 192 lbs.  The outlook was similar for women.

What’s interesting is that these are the same trends in mean weight gain that define America’s growing obesity problem (no pun intended).  Annual medical costs for obese individuals are, on average, $1000 more than those for non-obese people. Hassett cites a 2004 study by the Centers for Disease Control and Prevention –  almost half of all Medicaid and Medicare costs are now obesity-related…and climbing.  “This health burden is paid for by everyone.  Society is engaging in a large transfer of resources from individuals who exercise and watch what they eat to those who, in many cases, do not.”

A simple solution to this problem?  Exercise during the holidays.  That’s it.  You don’t even have to make it a year-round thing.  Burn enough extra calories during the holidays to cancel out the extra 2400 or so you consume.  Obesity will drop, people will have more energy, life expectancies will increase, and billions will be saved.

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Quaid Twins Needed a Less Human Solution…

According to planecrashinfo.com, the largest single cause of airline fatalities is “pilot error,” at 45%.  Studies by Boeing have pegged the number as high as 70%.  All other causes make up slivers of the remaining proverbial pie chart.  The conclusion to be drawn is that the single weakest link in any complex system we rely on daily, is the human link.  Dennis Quaid recently experienced human error at the renowned Cedars-Sinai Medical Center, when his newborn twins were accidentally given 1000x more Heparin, a blood-thinner, than they were supposed to receive.  The Health Populi blog shows a picture of Heparin vials with varying concentrations — they are color-coded by dose concentration and clearly marked, however medical staff at Cedars-Sinai somehow grabbed the wrong vials.

The Quaid twins are going to be fine (although they could have bled to death)…and the purpose of this post isn’t to point the finger at Cedars-Sinai Hospital.  As hospitals go, Cedars-Sinai is probably a pretty good place to get sick – it was ranked “best of the best” by U.S. News & World Report, and all those Hollywood types seem to like to die there.  The purpose is to use the Quaid twins to talk about something I’m willing to bet happens all the time.

After all, we’re human.  The person that grabbed the Heparin vial may have misread the label, or perhaps Heparin changed its color-coding system.  More likely a 10,000 U/ml vial found its way onto the same shelf as a 10 U/ml vial…and the label never even came into play.  Perhaps a new person was stocking the cabinet and didn’t think to sort the Heparin by color — having no idea the person retrieving the vials would assume the dosage by location.

Chaos Theory states that non-linear systems appear to produce random results, but actually are predetermined entirely by their initial conditions.  Put another way, if you subject the exact same inputs to a system, you will get the exact same result.  But a tiny variation on any of the inputs could produce dramatically different results.  It might be safe to say that the farther away the input is, temporally, from the end of the system, the more dramatic the change in output.  And its not arithmetic, it’s logarithmic.  The conclusion, if you buy this chaos theory crap, is that you want as little variability in input as possible in a critical system in which lives are dependant.  And because the least precise input is most assuredly a human one, you probably want to reduce human intervention as much as possible — especially if your job is running a hospital.

Sitting here typing this post, my spell-check is telling me I’ve made at least half a dozen spelling errors, and I’ve made countless grammatical errors…I’m sure.  I’ll try to proofread it, and maybe I’ll eliminate 80% of the errors, but my fallible eyes will inevitably miss a few things.  If I was a doctor writing down consultation notes, writing down a prescription…anything where I could misplace a decimal, I’d be acutely aware of the possibility of making errors (and the certainty of many errors throughout my career), but unaware of where many of my errors would be.  And maybe my office has a system of checks and balances built in to catch these errors…and for the most part it works, except when my “checker” misses one of my errors, or more likely, catches my error but assumes a la Authority Bias (I’m the one in the white coat and the letters “MD” after my name) that I meant to do it.

A close friend of mine was a recent near-casualty of such an error.  He had a prescription filled at a new pharmacy, and was given a generic form of (coincidentally enough) an anti-coagulant in a different dose, but same size pill.  Nobody informed him that the new pills, while looking exactly the same, were twice as potent.  Like the Quaid twins, he was fortunate to get medical treatment, just as his kidneys started to bleed.  He could have died.  And if he had, a single break in the chain of communication somewhere between doctor, nurse, pharmacist, and patient would’ve been to blame.
We learn new things everyday about how to improve human perception and attention, how to minimize human err…but the human mind will always have biases that will cause us to make mistakes.  One of the keys to reducing patient deaths is to reduce or eliminate human control…when practical, of course.  A study was done recently (I can’t find a citation) where ER doctors were more accurately able to diagnose heart attack patients by asking three fixed questions and plugging the results into a research-developed computer program, then they were using their own judgement.  Even experienced doctors that used their own instincts were significantly less accurate.

We need more innovations in health care administration to reduce “preventable errors.”  With increasingly complex health systems (literally dozens of parties touching every health insurance claim), we need increasingly simple ways for humans to interact with those systems.  Let’s start small – how about Google or Cerner developing standardized electronic medical record keeping systems EVERYONE can use.

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