The Health Care Blog post titled “The Empowered Patient” by Maggie Mahar exists, as far as I can tell, because much hospital care has considerable room for improvement and many mistakes are made — for example, patients are given the wrong drug. One commenter (MD as Hell) said he has worked in hospitals more than 30 years and has some advice, including
- Never be alone in a hospital
- Never go to a hospital unless you have no alternative
- Do not let fear motivate you to be a consumer of any part of healthcare
In the comments, several doctors expressed their dislike of the whole idea of “patient participation”. For example,
Patients manage the process. Really? I’m sure your plumber or mechanic love you and this philosophy so much they hug you when you greet them.
Plumber and mechanic errors are not the #3 cause of death in America, as Marty Makary says about medical errors.
Here is another argument against patient participation:
The huge problem that barely anyone wants to talk about is [the assumption] that patient (and family ) participation are always (or even just mostly) beneficial. This is a completely unfounded assumption. Please read Dr. Brawley’s book “How we do harm” to read 2 long and IMHO representative anecdotes of patient/family centeredness resulting in net harm. . . . Lack of patient involvement and medical errors are hardly on top of the list of pressing flaws of the US health care system . . . Profit centeredness resulting in overtreatment of the insured and undertreatment of the underinsured are the main issues.
If medical errors are the #3 cause of death in America, they are one of the most serious flaws of the US health care system. The doctors who dislike patient participation in this comment section do not propose a better way to reduce mistakes, a better way to spend the time and mental energy required by patient participation. Maybe their annoyance is a good thing. Maybe they will be so annoyed they will reduce errors in other ways.
It is bizarre that patient involvement cannot be easily dismissed. I cannot think of another profession (accountants, bus drivers, carpenters, dentists, elementary school teachers, and so on) where anyone says never be alone with them. Sure, hospital patients are highly vulnerable but that vulnerability is no secret. It could have led to a system, similar to flying (airplane passengers are highly vulnerable), with an extremely low rate of fatal error. My own experience supports patient involvement. The biggest motivation for my self-experimentation, at least at first, was my self-experimental discovery that a powerful acne medicine my dermatologist had prescribed (tetracycline, an antibiotic) was no help. My dermatologist had shown no signs of considering this a possibility. When I told him about my experiment (varying the dose of the antibiotic) and the results (no change in acne), he said, “Why did you do that?” Later a surgeon I consulted about a tiny hernia was completely misleading about the evidence for her recommendation that I have surgery for it.
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ok, then how about Never Let Your House Be Alone with a Plumber
When you are very ill/tired/worried, your ability to participate fruitfully may be limited. Still, I wish I had participated more over the years whenever I was well enough to do so. In recent years the probable best thing I did was veto the GP’s recommendation to take statins, a decision made when I was none of ill/tired/worried.
I also now incline to the view that the patient is probably the only actor in the drama who will try to weigh up everything involved – or, at least, everything he (thinks he) understands. The specialists are specialist, the GP can give you only a fraction of his attention – it’s up to you to, at the very least, ask some critical questions.
Taleb brings up the airplane example a lot in his writing. The pilot has as much to lose as you do if the plane goes down so it is in his interest to be vigilant. That is not to say that the doctor is unconcerned for your welfare as a patient but they simply do not have as much to lose as you do if something goes wrong with your treatment. Having “skin in the game” is a great motivator for attention to detail.
As far as advice of what do when you are in hospital I think the post lacks something.
Write down what they are doing with you and when they did it. You are in a bad mental state. You shouldn’t try to rely on your memory.
@Jeff re: “Skin in the game”
Easy solution: Just as the pilot loses his life along with the passenger’s if he crashes, mandate that any surgeon who performs the wrong surgery must have the same surgery performed on themselves. Not that amputating the wrong limb is common (AFAIK), but if the surgeon lost his arm too when he accidentally took little boy Tommy’s, that’d be quite the dis-incentive!
If medical errors are the #3 cause of death, then it it seems that the statistics on those errors, and the doctors/hospitals who made them, should be made public, continually (i.e. online)
Just like it is possible to find out how many cases a lawyer wins/loses, so too with the medical profession. If it is measured *and* publicised, it will get managed.
The trick being to have an objective way of measuring the errors…