Sickness in Health Care

When you read a lot of health care news (as I do) there are times you run across really sickening stories. Today I read about a study published in the New England Journal of Medicine done with Harvard University and Dartmouth Medical School researchers about dementia patient care. It seems that almost 20% of hospitalizations by nursing homes may have been motivated not by their concerns over patient health but simply by money.

It seems Medicare pays three times more for nursing homes to care for patients after brief hospitalizations. The transfer rate varied from just 2% in Alaska to 37% in Louisiana. In McAllen, Texas 26% of the study participants had multiple trips to the hospital for conditions that can easily be treated in a nursing home like urinary infections, pneumonia and dehydration. Only 1% of the patients in Grand Junction, Colorado were transferred to hospitals for the same conditions.

For some nursing homes to take advantage of the weakest and sickest in our society speaks volumes about the state of our health care system. Too often it's all about the money, not the people.

Health Care Reform Benefit

One of the overlooked features of the current health care reform effort is the initiative to boost the quality of care, hopefully while reducing the cost. The 10-year, $10 billion program hasn't attracted a lot of attention, perhaps because of its growing support across a wide spectrum. This seems to be something almost everyone can agree on.

Improving the quality of health care is important not only because it will save thousands of lives each year but also because poor quality care costs more. Dr. Donald Berwick, head of the Medicare and Medicaid programs, was quoted recently as saying that 1 of every 7 Medicare patients who is hospitalized suffers harm from a medical error. That's TERRIBLE!

A new Center for Medicare and Medicaid Innovation plans to work with physicians in 8 states to better coordinate care. (Too bad Texas isn't one of them.) At least it's a start.

Superbugs

The inevitable is happening. A new gene coming from India makes common germs into superbugs, or germs that are immune to antibiotics. Called NDM-1, the new gene has already shown up in three states and in Canada involving three different types of bacteria. In every case the patient has either received surgery or visited India.

After decades of overuse of antibiotics it's not a surprise that Mother Nature would find a way to adapt. The surprise is that this new gene seems capable of using different mechanisms to enable a bacteria to use it to deflect all types of antibiotics.

It would make sense to boost your natural immune system instead of relying strictly on antibiotics.

Surgery Center Infections

A new study published in the Journal of the American Medical Association finds that surgery centers have serious problems with infection control. The study was done in response to an outbreak in Nevada of hepatitis C where 63,000 surgery center patients had to be notified.

The new study found 67% of the centers studied had at least one lapse in infection control and 57% were cited for deficiencies. Some of the centers in the study hadn't been inspected 12 years.

There are more than 5,000 outpatient surgery centers in the U.S. today performing more than 6 million procedures annually.

Failing Health Care for Mothers

I've often written how the U.S. spends more on health care than an other nation on earth with poor results. It is especially clear on maternal mortality where we spend more per birth than any other nation yet we rank #41 in the world. For all of the money we spend there are 40 other industrialized countries that have better survival rates. This includes countries like Croatia, Hungary and Macedonia. Our rate is double that of Canada and most of Western Europe!

Deaths from obstetrical causes within one year of giving birth rose nationally from 7.6 per 100,000 births to 13.3 from 1996 to 2006. In California the rate tripled from 5.6 deaths to 16.9. How can so many American women die from childbirth when we spend more money per birth than anyone else on the planet?

Some people within the medical community point the finger at the increase in the number of cesarean sections which now account for 1/3 of all births, an increase from 20% of births in 1997. But there may are other possible causes.

During the recent health care debate it was often heard that America has the best health care system in the world. Try explaining that to all of the women who died from childbirth. Something is wrong in our health care system and it needs to be changed.

Growing Radiation Risk

The growth in diagnostic imaging tests in America has exploded in recent years. It's estimated that our radiation exposure has increased more than 600% since 1980. According to the National Council on Radiation Protection and Measurements increased exposure leads to increased cancer risk. Since many imaging centers are owned by doctors it's become a lucrative opportunity resulting in a wild west environment, a dangerous place for patients.

Isn't it amazing that occupational radiation exposure is regulated by the federal government but there is no federal oversight when radiation is used for medical purposes? Doesn't this seem like upside-down priorities considering the number of people at risk?

Today even some doctors are beginning to suggest that tracking a patient's cumulative radiation dose in their medical record is necessary. Such a record could help prevent unnecessary radiation exposure.

Medical Cost Conundrum

I've been to the Mayo Clinic in Rochester, Minnesota and I would be the first to say that it is the finest medical facility in America, possibly the world. How does it provide such outstanding service at such reasonable costs? That's the basic question in health care reform today and one of the best articles I've read on the subject came out a couple of weeks ago in the New Yorker magazine.

The Cost Conundrum by Atul Gawande is an outstanding article about what's really involved in health care reform today. Who pays is only part of the puzzle. I've said for a long time that what we're paying for also has to be part of the discussion because complementary and alternative medicine has a lot to offer, that's why more than 1/3 of Americans already use it. What's really at stake in health care reform is the heart and soul of medicine in America today. President Obama recently was raving about the article at a Cabinet meeting and it's been circulating around Washington at the highest levels.

To learn even more about this issue you should read Shannon Brownlee's award-winning book OVERTREATED: Why Too Much Medicine Is Making Us Sicker & Poorer. It will open your eyes and you'll never look at your doctor quite the same way again.

Hospital Errors

A World Health Organization study shows that hospitals can reduce the number of deaths from surgery by more than 40% simply by using a checklist according to a report in the New England Journal of Medicine. The 19-point checklist has nothing to do with high-tech but focuses on human error and basic medical procedures.

The study shows that hospitals using the checklist reduced their rate of death after surgery from 1.5% to 0.8% and reduced the number of complications following surgery from 11% to 7%.

It usually takes 17 years for a medical advance to become standard practice but the Institute for Healthcare Improvement is pushing for faster adoption. According to vice president Joe McCannon "Patients deserve it, and they deserve it now."