Harvard: surgical complications = 330% more profit

[Carol]

Actually I have had a blood draw messed up because I didn't fast. I remember it distinctly because I got a diabetes scare out of the whole mess (and also meant additional blood work such as A1C test on top of the draw being done). All was well (I am not diabetic) but it sure gave me a bit of a fright since my grandmother developed Type 2 herself.

I don't exactly know how the chain of communication got broken. I may have been told but forgot. I don't have to fast for my routine blood work that I have done every 3-6 months.

As a contrast, I just saw my primary care doc this week and she decided to order a few other tests (cholesterol etc) along with my routine stuff, and she made it very clear to me that I needed to fast.

Did she do so because she is better than my previous doc? Or did she do so because the routine of a doc in a small primary care office in rural New Hampshire is a bit less hectic and more personal than a routine of a doc at a big hospital in a busy Boston suburb? Did I understand the instructions better because I knew that once our appointment is over I would not have to fight crazy traffic to get back to a busy office....I would simply need to get home and log on from my living room?




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[Steve]

Spinal surgery. Neither I nor the hospital have any interest in MRSA or other infections in my spine... For other surgeries with my wife, the protocol wasn't so extensive.

But I also get the idea it's not a universal practice.

I hope it was clear that I don't think you look unclean. It makes sense that they would be very cautious for spinal surgery.

 

[DennisBreene]

So... just to put it in concrete terms... My overnight stay on what was scheduled as outpatient surgery was a complication, right?

I have to note: the hospital did ask extensively about sleep apnea pre-surgery. And, while it was left in my hands, the did a lot to prevent infection, giving me a detailed protocol for bathing the night before and morning of my surgery, using special soap and sleeping on clean sheets. From the nurses's comments -- I suspect they don't get great compliance on that...

Technically yes, it was a complication. Knowing about your history of sleep apnea may have allowed the anesthesia team to alter your medications and reduce the seriousness of the complication but your response still required a longer level of post op observation and that would be considered a complication. Compliance is spotty, and honesty about compliance is even less reliable. There were patients who's hygiene was so obviously sub par that I would order a pre-op shower in the hospital just to be sure that there was compliance. Infection control is one of those areas where a great deal can be accomplished if you can get the staff to wash their hands between patients (especially the doctors; they can be the worst offenders).

 

[DennisBreene]

Actually I have had a blood draw messed up because I didn't fast. I remember it distinctly because I got a diabetes scare out of the whole mess (and also meant additional blood work such as A1C test on top of the draw being done). All was well (I am not diabetic) but it sure gave me a bit of a fright since my grandmother developed Type 2 herself.

I don't exactly know how the chain of communication got broken. I may have been told but forgot. I don't have to fast for my routine blood work that I have done every 3-6 months.

As a contrast, I just saw my primary care doc this week and she decided to order a few other tests (cholesterol etc) along with my routine stuff, and she made it very clear to me that I needed to fast.

Did she do so because she is better than my previous doc? Or did she do so because the routine of a doc in a small primary care office in rural New Hampshire is a bit less hectic and more personal than a routine of a doc at a big hospital in a busy Boston suburb? Did I understand the instructions better because I knew that once our appointment is over I would not have to fight crazy traffic to get back to a busy office....I would simply need to get home and log on from my living room?




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People, being imperfect, retain a fraction of what they are told during a medical visit, and often that is inaccurate. It is a real challenge to learn how to communicate with your patients, and what supplemental material to provide, to increase the likelihood that important info will be understood and retained.

 

[jks9199]

Technically yes, it was a complication. Knowing about your history of sleep apnea may have allowed the anesthesia team to alter your medications and reduce the seriousness of the complication but your response still required a longer level of post op observation and that would be considered a complication. Compliance is spotty, and honesty about compliance is even less reliable. There were patients who's hygiene was so obviously sub par that I would order a pre-op shower in the hospital just to be sure that there was compliance. Infection control is one of those areas where a great deal can be accomplished if you can get the staff to wash their hands between patients (especially the doctors; they can be the worst offenders).

I remember reading about a study where they discovered that one of the greatest sources of contamination across patients was the doctor's tie...

 

[ballen0351]

I just can't see the risk of messing up on purpose to charge more outweighing the chance you will loose your job or worse. I also just can't see a doc deliberately causing harm to someone just to make more money. Sure like any profession there are bad one but its not the norm which is the tone I get from this thread.

 

[arnisador]

I agree they wouldn't be committing harm. But if causing harm cost the hospital money, they'd be more motivated to try to make changes rather than believing "it has to be that way/we just can't change the fact that accidents happen". Some years back anesthesiologists cut way back on their accidental death rate by developing a series of checks and perhaps more importantly pilot-style checklists. Hand-washing is strictly enforced at some institutions. If it costs them money, the higher-ups will make changes. If it doesn't, then they're mor elikely to be complacent--not malicious, just complacent.

 

[K-man]

I needed some abdominal surgery last year. I had just one question for my GP. "If you had to have this procedure, who would you use?"

I had just one question for my surgeon. "Of the hospitals you visit, which one has the lowest risk of infection?"

A lot of complications can be avoided if you ask the right questions.
:asian:

 

[DennisBreene]

I agree they wouldn't be committing harm. But if causing harm cost the hospital money, they'd be more motivated to try to make changes rather than believing "it has to be that way/we just can't change the fact that accidents happen". Some years back anesthesiologists cut way back on their accidental death rate by developing a series of checks and perhaps more importantly pilot-style checklists. Hand-washing is strictly enforced at some institutions. If it costs them money, the higher-ups will make changes. If it doesn't, then they're mor elikely to be complacent--not malicious, just complacent.

The trend is absolutely toward identifying factors that can be changed to reduce any number of complications; from strict hand washing, to checklists and timeouts (the entire surgical team stops and goes over the plan, operative permit, and the identified part to be operated on), to patients personally marking the part to be operated on. My reading of the level of commitment is that those who don't wish to comply are generally pressured to change their ways or find some other place to practice. I think that it is effective and reassuring and needs to continue. As to other issues, I can't recall a physician that I have known who proposed surgery or treatment that was not considered indicated by the physician. In fact, Washington State had preoperative approval across the state for cataract surgery at one time. They abandoned it when they discovered that the program cost far more than the miniscule numbers of cases they turned down, and the reviewing doctors were often not in a position to adequately judge the indications because they had never seen the patient. I had one patient who had legally blind vision, a cataract and macular degeneration. The reviewing doctor refused the surgery but reversed himself (reluctantly) after a call from me. I was able to report back to the reviewer that the patient had 20/40 vision (legal to drive without glasses) after surgery. The point being that there is no substitute for knowing your patient and your judgment based on a through examination.