Tuesday, June 9, 2009

Decision Makers Differ on How to Reshape Nation's Medical Services

Nowhere else in the world is so much money spent with such poor results.
On that point there is rare unanimity among Washington decision makers: The U.S. health system needs a major overhaul.

For more than a decade, researchers have documented the inequities, shortcomings, waste and even dangers in the hodgepodge of uncoordinated medical services that consume nearly one-fifth of the nation's economy.

Pockets of medical excellence dot the landscape, but at least 100,000 people die each year from infections they acquired in the hospital, while 1.5 million are harmed by medication errors. Of 37 industrialized nations, the United States ranks 29th in infant mortality and among the world's worst on measures such as obesity, heart disease and preventable deaths.

The Institute of Medicine estimates that one-third of all medical care is pure waste

They envision a health-care system that guarantees a basic level of care for everyone, shifts the emphasis to wellness and prevention, minimizes errors, and reduces unnecessary and unproved treatment.

On average, Americans receive the recommended, proven care 55 percent of the time, according to Rand studies. Sometimes, doctors or nurses overlook a basic but critical step

Ten years ago, in its landmark report "To Err is Human," the Institute of Medicine estimated that 44,000 to 98,000 people die each year from medical mistakes, highlighting the need for improvement. Since then, the tally has risen, said Janet Corrigan, president of the National Quality Forum, a nonprofit membership organization that promotes quality standards.

"We now know estimates of those who die from hospital-acquired infections is upwards of 100,000," she said. "Many of those, if not most, are avoidable and preventable."

In today's system, "we don't ration care, we ration people," said Donald M. Berwick, president of the independent Massachusetts-based Institute for Healthcare Improvement. "We know that if you are black and poor or a woman, there are all sorts of effective interventions you are not going to get."

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And if you're a woman with CFS, you almost certainly will not get effective interventions, because the doctors will ascribe all your problems to psych/emotional reasons and simply refuse to do any of the tests that would prove there's a biological reason for your symptoms.

In 1987-88, my boss and I had similar symptoms; mine were much worse.  He was put on a plane and flown to the far end of the state for more tests.  I was told to "tell your husband you want to quit your job and be a housewife"; there was no need for more tests, I was a woman and women don't want to work. 

They can tell you all they want that men and women get the same medical care, but when it comes down to it, we don't.  My boss could not believe that they had not tested me for the same things he was tested for.  He especially couldn't believe that I was told I was a hypochondriac and simply too lazy to work.

Don't believe me that it's still the same story 20 years later?  Google up the statistics about how many women die of their first heart attack because ER doctors brush them off, attribute their symptoms to anxiety or digestive issues, and prescribe entirely wrong medication.  Most men survive their first heart attack, because they're taken seriously and treated promptly.

My now-permanent disability was ENTIRELY preventable if I'd gotten the right pills in the critical early months, instead of having to prove that every one of the zillion brands of anti-depressants didn't work for me before anyone would believe that my real problem was that pain was keeping me awake, and the lack of sleep had reduced my immune system to non-functional.

But I was a divorced woman, so there was no need to x-ray to find a source of the pain, there was no need to do a cortisol test or test the status of my immune system or a sleep study, because the only thing that could possibly be wrong with me was depression over being divorced.  Never mind that I kept reminding them that the same symptoms were there when I was married, and had started months before the wedding.  This had nothing to do with my marital status.

Eventually, x-rays were done and found three previously-unknown fractured vertebrae.  A C-Reactive Protein test was done and was "off the charts".  Someone asked me to keep a sleep diary and decreed that I had "severe" sleep problems, for which I was given strong sleeping pills that knocked me out despite the intense pain.  But the problem was the years it took to find a doctor who would actually listen to my symptoms/history, rather than diagnosing me in the first few seconds with "divorce".  It was fast and easy to diagnose, but it didn't help me because it was the wrong diagnosis and the prescriptions were the wrong pills for what was actually wrong.

I very easily could have been one of the nearly 100,000 people a year who die from medical mistakes.  I was actually given a prescription that could have killed me; when I told a pharmacist my past experience with a related drug, he refused to fill the prescription, and another doctor warned me that if I had any intention of trying it, I needed to demand that I be admitted to a hospital first so that life-saving personnel and equipment would be immediately at hand when the inevitable bad reaction occurred.



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