“Pennsylvania announced Tuesday it would no longer make Medicaid payments to hospitals for serious, preventable medical errors.” Pennsylvania House Bill #489 (2007) presumably would penalize surgeons and hospitals for operating on the wrong limb or leaving instruments in the abdomen. Anyone who might oppose this Bill risks being called a monster who likes seeing people maimed or murdered. Nonetheless, I must speak out.
• Should there be checklists and automatic feedback systems to protect patients? Of course!
• Should there be standardized, proven clinical pathways for common ailments? That is in process.
• Should we punish a doctor who operates while intoxicated? Obviously, but we already do.
• Should we punish a surgeon or nurse who accidentally leaves a gauze pad in the belly after surgery?…
• What should we do to the doctor after a patient has a bad, but known side effect from a drug?…
• What should be done about an obese patient who remains obese after a stomach stapling?…
Where do you draw the line and who draws it? Will punishing the “bad apples” eliminate errors and bad outcomes from medicine and assure high quality? (That was, I hope, a rhetorical question.)
Think about it from the providers’ perspective. They go to the racetrack every time they take care of a patient. If the patient does well, the provider wins by getting his or her money back. If the patient does not do well, the provider loses: money, face, even licensure. Heads they stay even; tails they lose. Why would a provider ever bet? Why even become a care provider? If you are one, why take any risk, even if the approach with risk has the potential to make the patient better than the standard, safe approach?
In a subsequent Post (after the lawsuit is resolved), I will share with you a case where chosing the safest course caused the patient to lost his leg.
Imagine a patient with a life-threatening medical problem called “X.” One drug makes 99% of pts with “X” temporarily feel better and does nothing for one in a hundred (1%). A different drug cures 99% of pts with “X,” but harms 1%. Which drug would you want if you had “X?” Which drug will a doctor prescribe who works in Pennsylvania?
Under the increasingly punitive rules that govern healthcare, patients are going to get health care that is the safest short-term option: safest both for the patient and for the doctor’s license. Such options are often dangerous for the patient in the long term. Even worse, quality of care will never get better. Taking the safest approach, we will never see cures for breast cancer, diabetes or arthritis.
Risk-free medicine is dangerous to our health.
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