The incredible explosion of biomedical knowledge over the past decade means that schools ask each successive class of students to absorb more knowledge. They ask us to accomplish more with less, and to do it in less time.
There is a little-appreciated issue that I see brewing: doctors (and maybe even patients) are quietly being buried by electronic information overload. As a result, I believe doctors are being placed at an increased liability risk.
I agree with those who say there are “never” events that are totally preventable and should never happen. But I want to set the record straight. Listen to me. Surgeons are not the cause of sponges being left in patients. I’ll explain.
Within the past 20 years, there were close to 10,000 reported instances when a foreign object was left in a patient, the wrong surgery was performed, or the surgery was performed on the wrong patient or wrong part of the body.
I think there are two reasons for such seemingly epic failure. First, how we interface with an EMR. Second, how the EMR tries to impose its will on to us, instead of the other way around.
Regardless of the type of pain, acute or chronic, patients seek relief. Anesthesiologists are committed to relieving pain for patients before, during and after surgery. In addition, anesthesiologists treat chronic pain unrelated to surgery. These physicians have the additional education and training to accurately evaluate, diagnose and treat patients with chronic pain through a comprehensive medical approach.
One thing about operating on the hypercritically ill: when you start from zero, there’s no downside: clearly, she’s going to die unless I can do something. No decision there; and, at some level, no pressure, in a perverse sort of way. Which is not to say I’m cavalier about it: I know that I’m the only hope she has. But unless I make a horrible judgment, or a monster technical error, a bad outcome is the default situation: I can’t make it worse. I think.
Knowing that our system safely trains young surgeons is comforting. Someday in the not too distant future, the odds are that I will probably need surgery myself. It is great to know that the students and residents training today will be ready to safely help me when that day arrives.
It is not an easy time to be a physician in the United States. Attempt to order an expensive test for a patient and an insurance company is likely to second guess your decision. Try upholding the bottom line for your medical practice and the government will probably start questioning whether you are overcharging for your services. To make matters worse, even patients are getting into the act.
I recently said I would describe the essential elements of “true reform.” I realize others might add or subtract from my list, but here it is – at least for today: Payment reform, electronic records, comparability data, and primary care.
An OR nurse with 40 years of experience told me that she thinks robotic surgery might go the way of the laser. Similar to the unusual complications seen with the laser, when robotic surgery goes bad, it really goes bad.
Healthcare should become more about data-driven deduction and less about trial-and-error. That's hard to pull off without technology, because of the increasing amount of data and research available. Next-generation medicine will utilize more complex models of physiology, and more sensor data than a human MD could comprehend, to suggest personalized diagnosis.
Physicians often find themselves in the difficult situation of effectively communicating important information to their patients in a finite period of time without seeming terse or abrupt. This challenge is further complicated by an evolving framework of reimbursement that is focused on rewarding doctors for both quality and performance.
Extensive preoperative testing of ambulatory patients continues at the discretion of the surgeon, anesthesiologist, and probably the patient’s primary care doctor too. And the tab mounts.
Improvement in documented actual patient safety has lagged grotesquely. Part of that retardation can be blamed upon a continuing culture of cover-up.