Much Ado
Yes, John, we do miss some errors, but that will always be true. The important point is that we haven’t done much to reduce the error rate, and the results are not impressive. And yes, Nikki, education will be an essential ingredient if patients ever get the power to make their own healthcare decisions. They will need to know how to make good decisions. There are no magic pills for the most important determinants of health today--tobacco, obesity, and inactivity. These personal choices are, however, amenable to education.
An article in the Public Library of Science (and abstracted in the Washington Post) reported wide gaps in mortality between groups defined by race and geography. Asian women live longest, and urban black shortest. Although not surprising, there are several interesting conclusions from this article: The disparities were minimal in infants--a tribute to federal programs directed at that age group. Disparities were greatest in young and middle age adults, and the chief factors cited were tobacco and obesity, neither of which is related to healthcare. The authors noted that there was little difference in health insurance, and access to healthcare was not a factor. These conclusions highlight again the differences between health and healthcare. As noted, health is related to genetic factors, personal choices, and environmental factors (clean air, water). Healthcare is what you need when health fails. The important point is that health can be measured by infant mortality, longevity, disease prevalence, etc. These factors have little or nothing to do with healthcare. It is thus unfair to criticize the healthcare system by citing infant mortality or life expectancy. In fact, it may be argued that better healthcare actually negatively impacts health by preserving sick individuals in the population.
So, what does the article have to do with healthcare efficiency? Nothing. And that’s the point.
Comments
Bob,
Your point is well taken. The advances in healthcare can, and probably will, in the long run increase the cost of healthcare as it will be necessary to utilize the system more as people live longer that, in the past, would have died. It is a real ironic "Catch 22".
Being a former military nurse, I feel safe in comparing the technological advances of battlefield medicine. The use of the helicopter and MASH units during the Korean War greatly reduced the number of soldiers that were killed because the "technology" was there to save them. Now advance to today's battlefield medicine - the same is true to a greater degree. The result is more money is being spent on long term rehab or just long term care for some of the injured soldiers that in the past would have died. We are going to have more VA hospitals and services in the future. I do not wish that we were not so "effective" by any measure, but the cost of our effectiveness is paid in veterans with more significant life long significant injuries and need for on-going care. Each individual case, the person involved must make the value judgment if that is a good thing or not.
When I was in the military and working in an ICU, we had a patient, who did not have any family to speak for him, whose disease required him to have both his legs amputated at the hip, then it required both his arms amputated at the shoulder. Then they wanted to remove half his bowels and the nurses almost revolted. They decided to let him go.
Just because we can, does not mean that we should. We are at a point in our technology were we need to become more realistic as to the consequences of our technology.
Posted by: John Harrison, RN, MHSA | September 18, 2006 10:55 AM