Managing Medical Care
This Gina Kolata article is a must-read for anyone concerned about the quality of health care. Medicine does, of course, entail many judgment calls. But so do most occupations. That doesn't mean the concept of "best practices" can't apply in medicine, just as it does in other fields. Certain very basic practices save lots of lives if they're made routine. Yet doctors, like every other sort of worker, sometimes need to be reminded to do things they know they should do.
Using incentives like bonus pay and deterrents like public humiliation, it is a bold new effort by the federal government, along with organizations of hospitals, doctors, nurses, and health researchers, to push providers to use proven remedies for common ailments.
And it is a response to a sobering reality: lifesaving treatments often are forgotten while doctors and hospitals lavish patients with an abundance of care, which can involve expensive procedures of questionable value. The results are high costs, unnecessary medicine and wasted opportunities to save lives and improve health.
Simple things can fall through the cracks....
At Duke University's hospital, for example, when patients arrived short of breath, feverish and suffering from pneumonia, their doctors monitored their blood oxygen levels and put them on ventilators, if necessary, to help them breathe.
But they forgot something: patients who were elderly or had a chronic illness like emphysema or heart disease should have been given a pneumonia vaccine to protect them against future bouts with bacterial pneumonia, a major killer. None were.
All bacterial pneumonia patients should also get antibiotics within four hours of admission. But at Duke, fewer than half did....
"Medical care is one of those very strange parts of the economy where you get paid no matter what the quality of the service you provide," Dr. Asch said. "It is like you went to a car dealership and your Mercedes is going to cost you the same as your Yugo."
Read the article, check out the charts, and look up your own local hospitals' performance here.