Friday, September 23, 2016

Health System Harms
First, do no harm.
Hippocratic Oath

When American physicians graduate from medical school, we generally take the Hippocratic Oath to do no harm to patients.
This oath is sometimes hard to achieve since medicine is an imperfect art and often requires invasive care,  toxic medications,   and treatments with unpredictable  and fatal outcomes. Differential diagnosis  may produce the wrong diagnosis,  and the right diagnosis may evolve over time.
What complicates matters are high expectations among patients,   the perception that perfect outcomes are the norm,  the growing belief that  huge amounts of data generated by electronic medical records, and Internet accessible, frequently false, information  promoted by the social media will  improve the quality of care.  
Because of pressures to make the right diagnosis under the pressure of time constraints induced  by federal regulations and  entering  data on EMRs, American physicians feel under siege and are growing  paranoid  for taking the blame for escalating costs and for taking the blame for imperfect results.   Physicians feel like hamsters forced to run faster and faster.  This paranoia, and the demands for  entering more and more patient data and absorbing the cost of more and more federal regulations weighs heavily on the medical profession.
The situation is not helped when the AARP Bulletin , with 50 million readers,  in its 2016 September edit, has this headline emblazoned on its front cover Warning! How the Health System Can Harm You.
In the article, Richard Laliberte, lists these 12 ways the health system can cause harm.
1.       Wrong Diagnosis

2.       Sloppy Practices

3.      Lax Hygien
4. Poor Communication
5. Dismal Discharge Planning
6. Drug Blunders

7. Knowledge Gaps

8. Dangerous Doctors

9. Buried Information

10. Outpatient Black Holes

11. Small Thinking

12.  Physician Burnout

All of these harms can and do occur under time and regulatory and medical legal pressures,  but also may give a false sense of  alarm about their frequency of occurrence  the health system. 
The author concludes:
“Be an assertive patient – but not an obnoxious one.  Don’t act as well-meaning clinicians are deliberately crewing up your care, or threaten to call your lawyers.  Be friendly and respectful, and don’t wastr carrgivers’ time on extraneous complaints they can’t so anything about, such as parking or the cost of medications.”

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