By Evan Falchuk
Media reports on misdiagnosis continue to mount.
A recent study on patients with Alzheimer’s found that half had been misdiagnosed. Half.
Another headline blared “4 out of 10 patients being misdiagnosed.” The article encouraged patients to “see another doctor” if they are worried about their diagnosis.
You know what it makes me think about?
Starbucks.
By Evan Falchuk
Dr. Wes connects the news of the Wikileaks document dump to the privacy of health care data:
While a single individual’s private health care information may not carry the gravitas of wartime communiqués, each of us deals with famous patients who might not want their diagnosis, HIV status, or drinking history spread far and wide. For them, this private information might be just as personally damaging as anything disclosed by WikiLeaks.
Wes raises a good point. To which I would add a bigger point.
All of the laws and security systems and everything else don’t mean your health information will remain private. No, the extent to which your health information stays private depends on the honor, reliability and trustworthiness of the people who have it.
Almost everyone who touches health information has those morals. But not everyone. And for them, there is no law, no security system that can stop dishonor. What we can do is call this kind of behavior what it is, and root it out. Leaking confidential health information is despicable.
Good on Wes for taking this opportunity to remind us of that.
By Evan Falchuk
The government is remaking the health care system in order to pull money out of it.
So what do Americans do?
Look for ways to make money.
By Evan Falchuk
Here are some interesting things you may have missed this week:
1. Can CAT Scans Prevent Lung Cancer? Smoke and Mirrors. The always-interesting Michael Kirsch, MD calls BS on the news that CT scans can prevent lung cancer. Read the whole thing.
2. Paging Dr. Luddite. Megan McCardle at The Atlantic is a terrific economics writer – but falls for some very strange ideas about why health care is so far behind in adoption of information technology:
Fighting disease is relatively simple. Fighting patients, doctors, and all the other stakeholders in the current system may be beyond the powers of even the most advanced computing system.
Really? There’s persistent magical thinking around health care IT. Yes, more technology will make things better, but it’s not the fundamental issue in health care. The problem is a continuing failure to recognize that fighting disease is incredibly hard. The most powerful tools available to do that are doctors’ insights, judgment and time, and patients’ engagement in that process. Ever-more clever ways of failing to take this into account are the real culprits here, not doctors and patients.
3. Businesses Not Going to Drop Health Plans Because of Reform. At the New Health Dialogue, they report on a study by the benefits consulting giant Mercer. They found that few, if any, employers plan on dropping their coverage in order to push their employees onto government-run exchanges in 2014. If the government’s success in attracting people to its new plan for people with pre-existing conditions is any preview of how well that will go, this shouldn’t be a surprise.
4. MetLife Stopping New Sales of LTC Coverage. Earlier this week I advised that buying long-term care coverage was a cornerstone of being a health care survivalist. This news underscores two points. First, that the coverage is too cheap right now so you should buy it before rates go up. Second, as the linked NYT blog post points out, not enough people understand how important it is to own this kind of coverage. Medicare isn’t going to cover you for long term care.
5. Knights of the Executive Roundtable. More on this later, but I had the privilege on being a member of this terrific panel in Las Vegas on Thursday. Risk and Insurance said it brought some “well-received frankness” into one of my favorite topics – how to produce good medical outcomes and how to measure them. If you know me, you know my answer: did the person get the right care?
By Evan Falchuk
You want to see a doctor?
You’re going to have to wait. And I don’t mean like an hour in the office.
I mean like 53 days.
By Evan Falchuk
The American Cancer Society says that men over 50 need to seriously consider whether they really ought to get screened for prostate cancer. According to them, the risks of getting tested may outweigh the benefits of detecting the cancer, especially for younger men. They say it’s a “complex issue,” but they understate how complicated it really is.
Like the recent controversy over breast cancer screening, the new recommendations add to the swirling morass of conflicting messages and priorities around health care in America.
By Evan Falchuk
A new study out of Israel (h/t Robin Grantham via twitter) says that the kind of mood your doctor is in may significantly impact the quality of care you get.
On days the doctors felt positive moods, they spoke more to patients, wrote fewer prescriptions, ordered fewer tests and issued fewer referrals. However, when doctors were in a bad mood, they did the opposite.
Now, I bet this is true in any line of work. If you’re in a bad mood one day you probably aren’t as good at your job as on days you are in a good mood. Ok, well maybe not every line of work.
Still, if being in a bad mood leads to lower quality, higher cost medicine, let’s think about what the work life of a doctor typically looks like.
For starters, they often have to see 30 or 40 patients a day, and spend maybe 20 minutes with each. Private insurers and the government impose on them an increasing amount of administrative work. They’re also increasingly involved in the medical decisions the doctor works so hard to make. Doctors’ incomes aren’t going up, but the cost of their malpractice coverage is. Meanwhile, patients are increasingly demanding and sophisticated, the pace of change in diagnosis and treatment is accelerating.
It’s a set-up that seems exquisitely designed to create high levels of stress, anxiety, fatigue and burn-out, doesn’t it?
Of course, these were precisely the things the Israeli researchers said led to lower quality, higher-cost medicine.
The stress, anxiety, fatigue and burn-out we see, though, are just symptoms of a larger problem. Our system too often deprives doctors of the time and space they need to get to know a patient, think about their problem, consult with colleagues, and offer sound advice. These are the things patients want from their doctors. What’s more, doing these things are a big part of why people become doctors in the first place. Unfortunately, there isn’t much of anything in the health care reform proposals that addresses this deeply fundamental problem, and so it will continue, or get worse.
Which ought to create bit more stress and anxiety for the rest of us.
By Evan Falchuk
Dr. Toni Brayer asks – is it dangerous for doctors to say “sorry?”
In the past, physicians were advised to never admit to a problem or to apologize for clinical errors with the thought that it would lead to more lawsuits. Saying “I’m sorry” might be taken by a lawyer as an admission of guilt and malpractice. Attorneys advised, “Say nothing” but that left patients with unanswered questions and often the feeling that the doctor just didn’t care.
She points out that some 35 states have passed laws that prevent a doctor’s apology from being used against him or her in proving a malpractice claim.
I understand why these kinds of laws may be needed. If you say you’re sorry for something, you are implicitly taking some degree of responsibility for whatever has happened. Plaintiff’s lawyers will use a doctor’s apology to the maximum extent possible to show the doctor knew what they did was wrong.
“Sorry” is, as wise people have observed, the hardest word in the English language. But why is this?
I think people like to think of themselves not as infallible in their actions but as infallible in their intentions. By this I mean, whatever I do, it will be with the right intentions. Even if something goes wrong, it will not be so much my fault so much as a bad twist of fate. Apologizing is, in this sense, a very un-natural thing to do. You haven’t done anything wrong.
But think of it from the perspective of the person who has been harmed by your actions. If you’ve hurt me in some way, I may conclude that the reason it happened wasn’t dumb luck but rather that you were careless, or at the least not concerned enough with my well-being. Your failure to apologize will look to me like my conclusions are right. You can’t even say you’re sorry? You must not care much about me at all.
It’s enough to make someone very angry. And it’s awfully easy for an angry person to find a lawyer who will listen to them. At that point, it’s too late for sorry.
Saying you’re sorry is so hard because it takes so much humility. We have to be willing to accept that not only are we imperfect in our actions, but we can also be imperfect in our intentions. Or at least that others may believe we are imperfect in our intentions. You have to be able to admit that, yes, it’s true, I wasn’t as attentive as I could have been. Or you know, you’re right, I can see why you would think I was being careless, I’m sorry for what I did.
So long as your apology is genuine, timely, and based on a true understanding of the problem you have caused, you will defuse the problem. But your work isn’t done. Apologizing doesn’t fix everything, it just gives you the opportunity to repair your relationship. So, saying sorry is not a cure for problems of medical malpractice, but it might prevent more cases than you think.
Still, there is something very wrong with the notion that we need to pass laws to make it so that an apology isn’t a legally dangerous thing to do. We should not look upon a doctor’s apology as something to be used against him, but rather as a sign of his humility and his caring for his fellow man.
If he has committed malpractice, there will be plenty of facts that can demonstrate it. Whether he acted as a good and caring person in dealing with the aftermath of a bad event ought not be one of them.
By Evan Falchuk
As I’ve blogged about before (here, here, here and here), a big reason reform is going so badly is this: Reformers don’t understand how people react when you try to make changes to their health benefits.
Companies across America have been making changes to health benefits for years.
Reformers seem to have ignored the lessons of their experience.
By Evan Falchuk
The 5th edition of the health blogosphere’s most interesting new carnival, Patients for a Moment, is up at Adventures of a Funky Heart.
If you don’t know, Patients for a Moment is the brain child of blogger Duncan Cross, and is the blog carnival “for, by and about” patients.
This week’s edition has a slew of great posts, go on over and check them out.
