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Don Jacobs
Don Jacobs
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How safe is an emergency room?

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Every year medical errors kill over 98,000 people in the United States. Not injure, kill. That is an alarming number. I wonder how many are just seriously injured instead? Over a million lives have been lost in the past ten years because the U.S. health care system failed to adopt simple reforms recommended in 1999 by the Institute of Medicine. These reforms would have protected patients from deadly mistakes, according to the Consumers Union, publisher of Consumer Reports Magazine. Yet few medical centers implemented the reforms. A July 6th OP-Ed article in the New York Times recently talked about the losses of life in our health care system from failing to control infections or falls in hospitals. The article, written by Paul O’Neill, former Secretary of the Treasury under the Bush Administration, asked same probing questions about the new health care fix currently being pondered by Congress. Which of the reforms will eliminate infections in hospitals? Which will eliminate the 300 million annual medication errors? Eliminate the fractures from falls in the hospital or the cases of pneumonia caused by respirators? Mr. O’Neill’s article answered his own questions – none. He went on to state how the cost of caring for these medical mistakes runs in excess of one trillion dollars yearly. That’s one trillion with a “T”. He explains that fixing these errors, fortunately, isn’t brain surgery. Just enforcing simple procedures like washing your hands would eliminate many hospital caused infections. Low tech improvements like surgical checklists have been shown to drastically reduce surgical errors. Assiduous care and maintenance of central lines and urinary catheters would also drastically reduce infections. Yet hospitals and doctors are reluctant to change. Instead they want to stop patients from suing when they are needlessly injured or made worse because of preventable medical errors. Members of congress parrot the urban myth that defensive medicine is why health care keeps rising. Yet studies by the General Accounting Office and Consumer Reports show defensive medicine has little if any affect on the rising cost of care. Former Secretary O’Neill wants members of Congress to actually understand what’s really driving up health care costs. His idea is to have data assembled by congressional district on hospital-acquired infections, medication errors and other waste indicators. In his view, members of congress are more likely to push for the right sort of change when they realize people they know and represent are being hurt or killed by practices we know how to stop. Former Secretary O’Neill may be on to something. Unfortunately, big insurance and big medicine will spend millions of dollars to prevent any real change. Let’s hope they’re not successful.

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    In general, your info is correct here, and Sec. O’Neill at least has a concept that might make people think.

    As a physician who’s been doing malpractice review for 25 years for both plaintiff and defense, I also agree with your comments on defensive medicine. Patients and medical schools, not lawyers, are the biggest cause of over-utilization of tests. Med schools teach docs to order everything to r/o everything. Patients trust the technology and tests more than they trust their doctor. The patient thinks that the doc who doesn’t order the test or the medicine the pt. thinks he/she needs is just a bad doc. Sometimes a good history and experience is a lot better and cheaper than a test.

    As they say, “The most expensive piece of equipment in the medical armamentarium is a pen in the hands of a physician.”

    Chuck Pilcher MD FACEP
    Kirkland, WA
    BTW, your headline implies the ER is the source of all these deaths. It isn’t. You’re making us “George Clooneys” look bad. :-)