Tag Archives: hospitals

Medical screening, overdiagnosis, and the motives of for-profit hospitals

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Image by @spleenal (Nigel Auchterlounie), who blogs at Spleenal
Image by @spleenal (Nigel Auchterlounie), who blogs at Spleenal

[I don’t seem to be able to display that image anymore, but here’s a link to what I’m talking about.]

This superb graphic was created to dramatize what’s happening these days in the UK, where the National Health Service is being ruthlessly privatized. Here in the US, for-profit medicine is so taken-for-granted that we barely notice it. It’s true, we hear a good deal about conflicts of interest involving pharmaceuticals. Doctors get paid — in one way or another — to increase the profits of Big Pharma, a practice that is detrimental to the financial and/or medical interests of their patients. We hear less about scaring healthy patients into using doctors and services that increase hospital profits (also known as fear mongering). So it was nice to see a recent opinion piece in JAMA that discussed precisely this. Read more

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Drug shortages: “We are talking about people’s lives; this is not a cell phone contract”

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iv-fluidThe shortage of pharmaceutical drugs is a serious problem in the US. The number of drugs in short supply has tripled since 2007. In an article in The New York Times, Sabrina Tavernise reports that the number of drugs in short supply in 2012 was 456.

The types of drugs affected cover a very wide range and include such things as cancer drugs and nitroglycerine used in heart surgeries. The situation is quite disruptive for hospitals, doctors (especially oncologists), and patients.

IV fluid shortage threatens patient care

This year, in addition to drug shortages, there is a nationwide shortage of IV fluid. Intravenous therapy is essential for treating dehydration and electrolyte imbalances, for blood transfusions, and for delivering medications such as those used in chemotherapy. IV fluid is a hospital staple.

A recent JAMA article quotes Erin R. Fox, director of the Drug Information Service at the University of Utah in Salt Lake City: (emphasis added in the following quotations)

“It’s maddeningly frustrating that we don’t have these basics.” … Fox said that although shortages of drugs, particularly sterile injectables, have become common in recent years, it is unheard-of to have a shortage of such a basic supply. …

“Why is the supply chain so fragile that it creates a national crisis? asked Fox. …

“Physicians, nurses, and pharmacists are working together to minimize the harm to patients, but it is really a challenge,” she said.

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Profit-driven medicine: Satisfying patients at the expense of their health

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Why would patients who report greater satisfaction with their health care be worse off medically? This JAMA article, Patient Satisfaction & Patient-Centered Care: Necessary but Not Equal, offers an explanation that makes sense. It points to the commercialization of health care – treating the patient as a consumer – as the villain. (All quotations in what follows are from this article.)

The patient (consumer) satisfaction survey

In the US, many doctors are evaluated and rewarded based on patient satisfaction surveys. Motivated to produce high patient satisfaction scores, doctors are inclined to order more diagnostic tests. Why? It’s more than a simple desire to please the patient.

When physicians’ performance evaluations and incomes are tied to patient satisfaction, the situation becomes ripe for overuse and misuse of diagnostic and therapeutic procedures because it allows the physician to rationalize decision making in terms of patient satisfaction.

Pleasing a patient is a conscious, individualized choice. Rationalized decision making can easily become an automatic habit that requires no additional thought. Read more

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Why don’t hospital workers wash their hands?

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Nurse washing handsHand washing reduces hospital-acquired infections. How do you motivate hospitals to comply with standards? How do you measure compliance? Turns out this is not a simple problem, according to an article in The Journal of the American Medical Association.

Hospitals may have good reasons for selecting an auditing method that will overestimate compliance. For example, audits may be delayed on poorly performing units to allow time to implement quality improvement or auditors may inform health care workers they are being auditing (sic) because they believe it is unethical to monitor covertly. However, as the pressure to perform increases, organizations seeking rapid improvement will be more likely to maintain or substitute methods that overestimate compliance than to use methods that measure true (ie, worse) compliance because doing so would make their hospitals appear to be underperforming relative to their peers. …

Public reporting of hand hygiene compliance places clinicians in a position in which they must choose between protecting patients by striving for real hand-hygiene improvement or protecting their reputations by reporting high rates of hand hygiene compliance. The first path is difficult and often unsuccessful. To encourage progress along this path, it would be better to avoid public reporting before evidence-based improvement strategies are implemented and direct resources toward identifying better ways of measuring and improving hand hygiene. [emphasis added]

Am I missing something here or does this say we shouldn’t publicize information about hospitals with poor hygiene because they’ll just lie about the facts or be otherwise devious and dishonest? Plus, reputation – that is, the financial profits of medicine – is more important than the health and safety of patients? No, it couldn’t be saying that. Or maybe it is, and we should at least be grateful that someone has the courage to speak honestly in public.

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