Last year the New York Times reported that the aviation industry had become so safe that one could fly every day for 123,000 years before dying in an aviation crash.
I wish we could say the same for the US healthcare system. Nationally, problems with healthcare quality (doing too much, doing the wrong things, and doing too little when indicated) are pretty clear. The bigger problem is that the progress has been painfully slow.
I once heard a great lecture given by Dr. Brent James, the renowned healthcare quality expert from Intermountain Healthcare in Utah. In his talk, Dr. James described healthcare’s “dysfunctions,” one of which was a glaring lack of consistency in the practice of medicine. His main point was that healthcare--still today-- remains a “craft” business with little standardization of even basic processes. He reflected on this point in a communication with health writer Paul Levy a few years ago:
Efforts to reduce variation in care and to stop prescribing un-indicated interventions have met a lot of resistance.
Standardized care, even for simple conditions, is “cook book medicine” and that efforts to impose restrictions on medical practice interfere with a sacrosanct “doctor-patient relationship.” This approach partly explains the
. But, it also contributes to a lot of unnecessary and un-indicated medicine, all which is not without harm. There have been efforts to address unnecessary healthcare. “Choosing Wisely” is an initiative sponsored by the American Board of Internal Medicine. The campaign is supposed to reduce unnecessary medical interventions by
, (such as antibiotics for coughs and colds and unneeded x-rays for routine back pain) in nearly every specialty. A lot of the interventions on the list continue to be widely used (to the tune of ~$5 billion per year) even though they have been well studied and found to be pretty
In response, there have been squeals of protest from some physicians. A letter to the editor notes:
There is a critical point to be made about Choosing Wisely and other campaigns such as the World Health Organization’s and the US Centers for Disease Control’s campaigns to improve provider hand washing:
when it comes to ensuring healthcare appropriateness.
Choosing Wisely is promoting itself as a means to “spark conversations between providers and patients.” It has partnered with Consumer Reports to disseminate the list of overused and un-indicated interventions to patients. Clearly it’s hoping that patients will confront doctors about unnecessary procedures and care. The CDC, for its part, is distributing “patient empowerment” materials which ask patients to confront caregivers who don’t wash their hands.
with their healthcare providers to avoid dirty hands and unnecessary care. And there’s the rub: as much as we can argue that patient engagement with their own healthcare decisions is progress, asking patients to keep doctors honest about the most basic medical practices is
(and to an even greater degree
, some who are supposed to supervise their own care on the basis of handouts from the CDC and Choosing Wisely (available here by the way…) Reflecting back on the aviation industry: imagine, for a moment, if we expected passengers to “have a dialog” with airline pilots prior to a flight. Is this something we’d consider admirably “passenger-centered?”
Comments