quote:Originally posted by paddletothesea:
Gotta wonder about those "medical association". The AMA (AMerican Medical Assoication) is responsible for over 85,00 deaths due to false diagnosis, improper diagonsis, screw ups by doctors etc etc EACH YEAR. Now if it was any other business...say General Motots Corp and they lost 85,000 employees a year you better believe there would be an investigaion. But NOOOOOO not the AMA!
Sigh ... I guess I'll have to weigh in here.
First, in defense of the AMA (I cannot believe they need my help, but what the hell) - it's an ASSOCIATION, not a cabal. It is not some monolith; you would not believe how contentious any given group of physicians can be among themselves. The AMA as a group is no more "responsible" for individual deaths than the National Rifle Association is for all those gun deaths (29000) every year - and I am *NOT* a gun owner or NRA supporter, but that's another soapbox. Their mission (the AMA, that is) is to promote health, not knock off their livelihood through ignorance, carelessness or indifference, much less actual malpractice. What so many people do not 'get' is that a doctor or hospital staff can do everything right, by the book, and the patient can still have a bad outcome. That's not malpractice, folks. Malpractice involves actively doing something you KNOW is not standard of care for that particular patient in that particular situation.
Your basic newborn is far more complex than the most advanced computer ever devised. Medicine is as much art as science, imperfect on both counts. Add to this the human factor on the part of both physicians or nurses (fatigue, miscommunications) and patients, who often are less than forthcoming about the drugs (legal or over-the-counter or alternative herbals) they're taking, their health practices (e.g. sexual) that doctors have to guess at, but which can significantly affect treatment and outcome - and you have a great recipe for disaster. Healthcare is NOT cars, attempts to the contrary over the decades to run it that way. People aren't widgets - hence the lack of cookie-cutter treatments. Once size does NOT fit all, or even many.
Back to iatrogenic deaths, to which you are referring. The original Harvard study most often cited (in the Journal of the American Medical Association, BTW) was based on "the medical charts of 30,121 patients admitted to 51 acute care hospitals in New York state in 1984. They reported that adverse events/injuries caused by medical management that prolonged admission or produced disability at the time of discharge occurred in 3.7% of admissions." See
http://bmj.bmjjournals.com/cgi/conte...l/320/7237/774
for more.
That's one study, more than 20 years ago, of hospitals in 1 state. Correlation is not causation. It does NOT necessarily mean that every institution will have the same rate nationwide; some will be worse, others better. I remember when the government was first tracking death rates nationwide, there was considerable alarm over a few institutions where the mortality rate was nearly 100%!! Turns out they were including hospices in the survey (duh!). Where you have an older population or sicker patient load (i.e. oncology) you will have a higher mortality rate that has nothing to do with error.
I would add that most errors, medical or otherwise, should be attributed to poor processes, not careless people. These are called latent errors. See
http://pediatrics.aappublications.or...ull/111/5/1108
for examples.
Having once served on a committee charged with streamlining the admissions process from ER to patient floor, I can tell you there is no system as complicated as a hospital. The above process involved ER doctors and nurses (intake/H&P/initial diagnosis and treatment/decision to admit), physician offices (for existing patient records), laboratory and radiology (for ordered diagnostic tests), medical records (for previous admissions), admissions and central registration (to check insurance coverage AND to see if there's a room available - often not, and they have to be held in the ER for hours until there's a bed available) housekeeping and laundry (to clean the room and provide fresh linens), transport (who delivers the patient from the ER to the floor), floor clerks and nurses (who take the patient's ER records and start a floor chart, and accompany the patient to the room), volunteers (to provide the patient and family with basic hospital information, Patient Bill of Rights, etc.), pharmacy (for medications ordered), social services (if the patient will require post-discharge assistance like home care), utilization review (to examine the intake chart and check the treatment plan for appropriateness and medical necessity.) Also, on occasion Security or the Chaplain may be required if family members are very distraught. I'm sure I've left a few departments out. You can imagine trying to make a flow chart involving so many services, to get the patient the most efficient - and safe - care.
Finally, there are any number of factors beyond our control. For example, some of the most serious bacteria have become resistant to the strongest antibiotics we have (methicillin and vancomycin resistant bacteria are rare but increasing.) Bacteria are smart; they mutate when they come up against antimicrobials.
Are there way too many deaths and injuries? Absolutely! Can we do better? Hell, yes. Will we ever get it down to none? Never, not even close, for reasons cited above.
[This message has been edited by Auburn Annie (edited February 01, 2005).]