At the risk of sounding arrogant, most physicians are arrogant. Some are so downright arrogant that they make Obama look humble.
The Wall Street Journal recently had a two-page article from a Dr. Marty Makary (“How to Stop Hospitals from Killing us.”) This self-righteous yellow journalism article went on to regurgitate the Institute of Medicine’s 20 year old review paper claiming that there were 98,000 deaths a year from medical errors. Before I respond to Dr Makary, I need to repeat what I wrote here on PJ and elsewhere a short time ago:
We hear much about the number of deaths from “medical errors.” This narrative began when an Institute of Medicine article stated that medical errors cause up to 98,000 deaths a year in U.S. hospitals. This received huge play in the mainstream media. While any medical error is bad — and sometimes tragic — they do not occur to the extent reported. The original report relied on a study from 1991. Only a small subset (27%) referred to negligent or substandard care. That still leaves the number of medical error deaths at a staggering 27,000, but the remainder of these adverse events were normal complications of medical and surgical care, such as infection and post-surgical bleeding. There we go again with “complications” equaling malpractice.
The other neglected point: how many “complications” were due to care in a teaching institution or training program? This study also failed to consider the quality of outpatient facilities or private medicine.
The problem with yellow journalism is that it is based on a little truth, and then it runs wild with speculation. Dr Makary does just that.
First, he makes the assumption that no other doctor but himself was capable of improving health care outcomes. Thank you Dr Makary. The Institute of Medicine paper is more than 20 years old. He assumes that we physicians have stood still for 20 years. There have been incredible advances in the treatments of cancers, spinal cord injuries and more. Umbilical cord blood stem cell therapies are about to revolutionize medical therapies.There has also been tremendous strides to improve and limit any complications from surgeries, re-admissions and the like. While any complication is a horrible occurrence, it does not happen anywhere near the rate that Dr Makary claims. He should know better than that. He is using 20 year old data — and faulty data at that.
I devour good books, and have no problem putting down a bad one after 30 pages and never picking it up again. If it’s not good, why waste my time? If it’s good, I don’t want to stop. This one is a hell of a read! So was the The Andromeda Strain.
I read Moises Velasquez-Manoff’s An Epidemic of Absence in one sitting. This was Michael Crichton with Hookworms. The premise is fascinating, although heavy with anecdote and less on peer reviewed clinical data, even with his 307 footnotes. Definitive science should never get in the way of a good read.
I was hooked, pun intended. Remember, I am Western-trained but still consider myself very open minded.
What Velasquez-Mannoff suggests is that maybe we are a little carried away with the pure benefits of hygiene. Does using Purell at every turn really benefit us in the long run, or will we end up dying from a dirty finger nail because of it? This puts credence in what I always believed…”The 10 second rule”. You know, if it’s on the floor less than 10 seconds you can still eat it.
His adventure begins with searching to cure his premature baldness. Okay, I’m a little hard on him here. He’s really looking into an area of medicine that has not been brought to light until now, and he was really looking for a treatment for Irritable Bowel disease and MS. Every action in medicine and in life has an unintended side reaction. We are all intertwined. We, meaning every organism that is in touch within our body. We don’t need to treat everything! Not all bacteria are bad. Our intestines, mouth, and nose are lined with millions of organisms that actually are our allies in keeping us healthy. I think we all know that.
The problem as I see it, which he does not address is deeper. I’ll explain in a moment.
First, physicians have 2 main edicts that we should follow
1) Above all, physician do no harm
2) Alleviate pain and suffering
Our job is not to make people live longer. That’s just a by product of the 2 edicts.
Have you ever had a headache? Have you ever had diarrhea? Have you ever taken aspirin?
If so, you may be entitled to compensation for complications from taking aspirin. Call us now. We don’t get paid until you do, and then we take 40%. Why risk your hard-earned money on work? Come roll the dice. It’s free. It’s America.
Okay, maybe I got a little carried away there, but not by much. Late night TV ads now solicit “clients” who have had “complications” from some sort of medical treatment. Never mind that “complications” does not equal malpractice. Life is a complication. Malpractice is supposed to be just that, not maloccurrence.
This problematic scenario forces physicians to practice defensive medicine. This has nothing to do with what’s the best medicine, only with what trial lawyers have forced us to do. Defensive medicine has become “standard of care.”
The true cost of defensive medicine is hard to pinpoint. Estimates range from between 10% and 25% of every health care dollar spent. Many of us believe it may even be higher.
Defensive medicine not only costs us a hell of a lot of money, it may also kill us! Doctors call for more than 62 million CAT scans annually in the USA. According to a 2007 New England Journal of Medicine article, one-third were probably unnecessary. Again, many physicians feel that may be an underestimate.
Here comes the real kicker. The radiation dose from a single CAT scan is 500 times that of a plain chest X-ray.