The Arrogant Doctor
Second, Dr Makary works for a major teaching institution. In other words, a teaching hospital. Using his arguments, we should ban all teaching facilities. Teaching hospital allow residents (physicians who are being trained) and nursing students to actually treat patients. These residents actually operate on patients. It does not matter how much supervision he or she may have. Using a scalpel or cutting near the aorta has risks. By Dr Makary’s argument, this should not be allowed. Let me go further. Teaching institutions will have complications, I can guarantee that almost any surgery will be safer in the hands of a board certified surgeon than a 1st year resident. If we follow Dr Makary, there will never be any well trained surgeon. Ever hear the old adage, never go to a teaching hospital in July. That’s because all the new interns start July 1st!
OK, lets go a little deeper. Most hospitals now have extensive precautions to minimize any of those horrible complications he sites. St. John’s Health Center and Cedars Sinai here in Los Angeles, and all other good hospitals, institute double and triple check systems before any surgery. We have what we call time outs, where everyone in the operating room must stop what they are doing and either the surgeon or the nurse will do a sort of pre-flight check. ALL must be in order.
The first paragraph of the WSJ article claims that American medicine is more deadly than the airline industry. I love a smart guy who can mix and match whatever he likes. Reminds me of the silly joke that went around when I was a kid, but makes sense now: “Do you walk to school, or carry a lunch?” One has nothing to do with the other. Except if you believe in yellow journalism.
His solutions are interesting and I’m not opposed to them in principle, but I reject his claim that this will remove all medical errors. He is trying to quantify what he considers being a good doctor. Dr Makary, that can not be done. That’s like trying to quantify and qualify what makes a good person. It’s a bell shaped curve.We can give general guidelines, but that’s about it. Government intervention can not make a good doctor, nor can it prevent a bad one. Just like voting for a President doesn’t make him a good one, no matter how much hope is promised.
His first solutions:
Let’s see the numbers, Dr Weiss. Otherwise, your article is a waste of our time.
Inquiry 1999;36:255-264
New England Journal of Medicine 1991;324:370-376
American Journal of Public Health. 2007;97:1945-1951
Clinical Infectious Diseases.2004;39:1668-1673
Journal of American Medical Association 2000;284:2187
New England Journal of Medicine 2000;342:1123-1125
Journal of American Medical Association 200;286:415-421
The above will give you all the numbers you need.
The point of the article is NOT to defend any medical error, but to demand honesty.
To paraphrase Winston Churchill…..history is just one persons point of view…or was that said by OJ?
yes. let them record *everything.* the statists forced that against police officers for all stops and it backfired on them, supporting police accounts in the vast majority of encounters.
and, God help us, government mandated healthcare will needlessly kill far more patients than any suggestion by this leftist dr makary will “save.” Lord save us from doctors like him.
doctors, really need to take re-take control of healthcare and tell these government masterminds and unelected desk jockeys to butt out.
I think thou dost protest too much.
The “practice” of medicine is stuck in the 1800s even as the technology advances, that’s really what it’s all about.
And doctors remain happy to bury their mistakes, and blame it all on mother nature.
The older I get, and I have gotten reasonably old, the more I dislike doctors.
My job, which involves a lot of computer programming and database systems design, is not entirely unlike a doctor’s, in that I have to diagnose problems in complex systems every day. The slightest miscalculation or miscue can cause a system to come crashing down — or worse, give plausible but incorrect results — due to factors that were perhaps obscure and unforeseen (but not necessarily unforeseeable). There is too much to know. Computer systems design and maintenance is a humbling profession. You would think that being a doctor would be, too, in that human bodies are far more complicated than the most complex computer systems ever designed. But I have seen little evidence that this is so.
It’s like the old joke about two men arguing about whether they could run from a bear. One says, we can’t outrun a bear; the other says, I don’t have to outrun a bear, I just have to outrun you. It’s like doctors figure they don’t have to know everything to cop an attitude, just more than you.
About fifteen years ago, I went to my doctor to seek help because I was packing on the pounds at a rate of about ten pounds a year. Already about forty pounds overweight, I explained to the doctor (a skinny little guy about my age at the time) that I was eating a low-fat diet (as the wisdom of the day suggested), yet pounds were still accumulating. He said, what about execise? I responded that, you know, I used to run six miles a day when I was in my twenties, and I still couldn’t seem to lose weight even with that regimen.
So he pointed at my midsection and said sarcastically, “When you were running six miles a day, were you carrying *that*?”
What I needed was someone to go over the various diet options with me and help me figure out an approach that worked. But what I got was an arrogant little twerp who would rather insult a patient than help him.
And then there are the doctors who schedule you for an appointment and make you sit in their waiting rooms for two hours. Like your time isn’t important, only theirs. If you have to cancel an appointment, you might wind up paying anyway, as their time is valuable. But they take hours of your time unnecessarily and nobody cuts you a check.
It doesn’t surprise me that this attitude permeates their written wisdom.
@ Reformed Trombonist:
I am sorry about your experience with this particular physician. I think you need a different doctor.
Fifty percent of all physicians finished in the bottom half of their class.
@ Zopilote: Fifty percent of all physicians finished in the bottom half of their class.
Yet, all of them finished in the top of their undergraduate classes.
There’s the old joke about the new arrival to Heaven. He says to
St Peter, ” Who’s that walking around wearing a lab coat and
carrying a stethoscope.” “That’s God, he thinks he’s a doctor.”
Clearly, this guy just wants to sell his book.
The progress in quality of care since that NIH study has been truly astounding. Maybe it’s a question of who sucks less, but I notice Dr. Makary failed to mention that the US has the safest hospitals in the world. Although Medicare now has benchmark quality indicators for all kinds of common procedures and conditions, I would credit not the government, but private companies for the initial progress- truly the market doing what the government is too heavy-handed to do.
The dashboard is also an old idea. When that study came out, big corporations were truly shocked at the fact that they were not getting the quality care they were paying for, and formed the LeapFrog Group http://leapfroggroup.org/ (this is not the only one, but certainly was at the cutting edge of assessing quality of care). I remember listening to presentations about dashboards from LeapFrog, and feeling a little indignant at the time- but one good thing you can say about doctors is that they’re reasonably good at math, and it was obvious that something was terribly wrong with the system. It was like we couldn’t see the forest for the trees- there was an astonishing lack of data then.
And it was the good doctors like Dr. Makary, the ones who were at the vaunted research hospitals, who should have had that data, but didn’t. Talk about the pot calling the kettle black.
Another good thing about us is that we’re terribly competitive, and simply doing things like internally publishing complication rates caused them to plummet. Around this time there was a push for evidenced-based medicine, which kind of ticked off the old-timers but now is standard across the board.
The camera idea isn’t even new. They recorded every major trauma case back in the day when I was at UCSD- don’t know if they still do. And then the attending doctors would go over everything in painstaking detail. That was always a learning experience- often a very humbling one- for the residents involved. It was the only way to learn anything given the chaos of a major trauma case.
I dont know where Dr. Makary has been hiding, but evidently not in the quality of care department. Which twenty years ago were rare, and now every hospital has one.
And now, there are “dummy” patients that are fully computerized to practice many emergency drills and test one’s skills at thinking quickly in a situation that is rapidly deteriorating. Started with the anesthesiologists.
i did an intense study of all the major patient safety studies, care in 1974 in California studied by don harper mills published in the western medical journal(21,000 cases), care in New York in 1984 studied by the harvard group published in 1991 in the new england journal of medicine, and again the harvard group studied care in utah and colorado from 1992 published in various journals in 2000.
the Institute of Medicine Monograph to err is human was released in 1999, published in 2000.
i looked and found the studies showed a steady rate of “events to study” which means untoward events that required evaluation–4%, a 1% rate of negligence or avoidable events, and a less than 0.25% rate of negligence producing injury or death.
The head researcher for the Harvard group cautioned that their methods were unreliable, in an article in the New England Journal of Medicine after the big noise was made by the media on the release of the IOM monograph.
There is no patient safety crisis or epidemic.
There are always critics who pick.
There are times when there are screw ups. the chatterers who commented here that teh negligence is deplorable or whatever, would be satisfied with nothing but perfection, and are always looking for an excuse for some more of that perfect government intervention.
consider that even the best trap shooters miss one or two out of a hundred.
and don’t talk to me about how safe commercial aviation is–they land healthy planes with redundant systems at a well graded place with lights under guidance, in a place that is well prepared with support systems and backup. Practicing medicine on a sick patient or injured patient is like landing a plane in the dark that is not functioning well, while some people turned off the lights and the glide slope on the carrier and the weather ain’t so good with 20 foot swells.
my comparison study of 318,000 cases with the three studies in CA NY and Utah adn Colorado is discussed at
https://heartland.org/sites/all/modules/custom/heartland_migration/files/pdfs/23751.pdf
In all four studies mentioned the negligence with injury rate was less than 0.5%.
Critics would say that’s too much–but recall that Brennan of the Harvard group said about the New York study.
–”I have cautioned against drawing conclusions about the numbers of deaths in these studies.”
–”The ability of identifying errors is methodologically suspect.”
Stand down all your professional critiques, the estimates of deaths are based on weak and unreliable research. Brennan admits it.
The judgement of negligence in the New York Study was tested with a Kappa of 0.4 which is worse that a coin toss.
and the rate of finding of negligence on the deaths in the New York study was above 50 % even though many of the deaths were in people who were terminally ill.
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