From an article sent to me written by Sanjay Gupta in the New Yorker:
Why have [mistakes by the health care system] been so hard to prevent?Here’s one theory. It is a given that American doctors perform a staggering number of tests and procedures, far more than in other industrialized nations, and far more than we used to. Since 1996, the percentage of doctor visits leading to at least five drugs’ being prescribed has nearly tripled, and the number of M.R.I. scans quadrupled.”
“What may be even more important is remembering the limits of our power. More — more procedures, more testing, more treatment — is not always better. In 1979, Stephen Bergman, under the pen name Dr. Samuel Shem, published rules for hospitals in his caustically humorous novel, “The House of God.” Rule No. 13 reads: “The delivery of medical care is to do as much nothing as possible.” First, do no harm.”
I got a patient mad at me yesterday when I questioned her judgement. Our team and the specialists in the hospital spent hours going over a patients records, analyzing and reanalyzing existing tests this women had for her complaints and determined that no further testing was necessary, that the complaint was with certainty not caused by organic disease. She then left immediately after discharge (probably with her bracelet still on) and went to the next nearest hospital where she was admitted for the same symptoms and, rather than making a phone call to me or the doctors on call for me, her “admitting physician” proceeded to to the expensive and invasive test we chose to avoid and send her back to me for follow-up. She saw going to the other hospital as being “extra careful.” Had she died as a consequence of the procedure (which revealed no disease per her report as we knew it would), I’m sure we would have taken the blame somehow. Instead, she was befuddled at why I would accuse her of not having trust in me by not following my care plan. “I like you Dr Perkins, I just wanted to get my pains checked out.”
The hospital, which made a lot more on the expensive test than we did by doing the right thing, has yet to send me records.
We have gone from Munchhausen the disease to a Munchhausen the business model.
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