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"A hospital is like a war. You should try your best to stay out
of it. And if you get into it you should take along as many allies
as possible and get out as soon as you can. For the amount of money
the average hospital stay costs, you could spend an equal length of
time at just about any resort in the world, transportation included.
And unless your condition required emergency treatment, your health
might be better off if you spent the time and money at the resort,
too. For the hospital is the Temple of the Church of Modern
Medicine, and thus one of the most dangerous places on earth."
-
Robert Mendelsohn, M.D.
Serious traffic accidents, particularly if there is an injury or
loss of life, can paralyze whole freeways for several hours.
Thousands of cars and commercial vehicles sit and wait, spewing
carbon monoxide. People miss appointments, airline flights and
delay-caused business losses accumulate. Hospital, patient, and
doctor schedules fly asunder. Everyone must wait while police,
emergency crews, and expert accident investigators gather the
evidence they need to determine the who, what, why, where, when, and
how of the tragic event. Accuracy is thought to be far more
important than either the cost or inconvenience caused to thousands
of other citizens. It is important to be precise in the assignment
of responsibility and, if facts dictate, blame. In order to do that,
the investigation must take place right away, before evidence
disappears.
In Canada each year, about 3,000 people lose their lives in
highway accidents. Unfortunately, this great toll is a minor
statistic compared to the tragic mistakes made within the health
care system of the country. The "adverse events" study released in
May, 2004, by the Canadian Institutes of Health Research (CIHR) and
the Canadian Institute for Health Information (CIHI) reported that
as many as 23,750 deaths occur each year in Canadian acute care
hospitals due to error, clearly preventable mistakes, most often due
to surgery, infection, and drug reactions.
A truly alarming aspect of these numbers is that all of the data
came from medical charts, and not from any independent assessment of
the circumstances. In other words, those who committed the mistakes
and their associates were the only sources of evidence. A similar
American study stated bluntly, "Only 5-20 percent of iatrogenic
events (medically caused) are ever reported." If all this is not
sufficiently chilling, the Canadian study analyzed only a
representative sample of acute care hospitals, and based its
findings on 2.5 million admissions each year. Of these, 7.5 percent
(185,000 admissions) suffered an adverse event, which extended their
stay in hospital or resulted in death. In addition to the human
carnage, the financial waste is staggering.
Acute care hospitals represent only one slice of the total health
business. Procedures performed in clinics, diagnostic centres,
physicians’ offices, nursing homes, psychiatric institutions, and an
array of other health centres, were not included in the study, and
represent a far bigger area of concern. No one has the slightest
idea how many iatrogenic errors might be uncovered if the entire
field of medicine were to be studied, particularly if the same
forensic intensity were applied that is accorded highway accidents
and crime scenes. A controversial American paper entitled Death by
Medicine (Null et al.) assembled all of the data from respected
research agencies covering the full gamut of health care, including
senior citizens' homes. The paper concluded that adverse events
currently cause 783,000 deaths per year. All official U.S. sources
admit to 100,000 deaths per year as a result of medical mistakes and
over 100,000 as a result of drug interactions.
What is most shocking is that this epidemic surprises no one who
works within the health system. Managers of the best long-term care
facilities now routinely perform thorough examinations of their
residents before they go to acute care hospitals. It is standard
practice to count any bruises, wounds, or abrasions before they
depart. One executive of a multiprovincial long-term care
corporation said in an interview that patients invariably have “more
wounds on their body” after a hospital visit than before they went.
Regular complaints seem to do little to improve the situation. These
minor cuts and bruises may be the result of careless handling in
hospitals or even self-injury as a result of insufficient
monitoring. But they do demonstrate indifference and a system that
too often regards patients as merchandise, something to process and
accommodate.
Following the May release of the Canadian report, media scrambled
to interview doctors and hospital administrators across the country.
The interviewees made all the right noises about it being a "wake up
call," and the "need to be more vigilant," and so on, but there was
not the slightest sense of surprise, shame, or embarrassment. The
indifference was overwhelming: "Germs go with the territory," some
said. "It's because government doesn't provide sufficient funding,"
was heard in some quarters.
It is not unreasonable to estimate that mistakes within the
entire Canadian health system may be inadvertently or negligently
killing 50,000 people a year or more, rivaling heart disease and
cancer as the greatest threats to life. No one knows the exact
number, because the formal adverse events investigation focused only
on a narrow slice of total medical-pharmacological care in the
country. If documented American numbers can be used as a guide,
50,000 may be conservative. This compares to 3,000 deaths due to car
accidents and about 500 as a result of crime. Yet, despite this high
fatality rate, iatrogenic errors receive the least investigative
attention of any other cause death. The reason for this is that the
evidence and motivation required for a thorough investigation must
come from the same culture as the one that made the errors in the
first place.
Only in the relatively rare instances of formal inquests or
malpractice actions is there any independent investigation of cause,
and then only a considerable time after the event. In these
instances, the investigators are dependent upon the formal records
maintained by those who, in all likelihood, were party to the
misadventure.
THEY JUST DON'T GET IT - Gary Bannerman suggests
that none of the American Presidential candidates have the slightest
comprehension about what is necessary to achieve universal health
care
MORE
AMERICAN THINK TANK SLAMS HEALTH SYSTEMS of U.S. and CANADA - A survey of more than 6,000 doctors in seven countries gave Canada poor marks on several aspects of patient care, including wait times for tests, use of electronic medical records, doctors available after hours, multi-discipline teams to treat chronic illness and financial incentives for improving quality of care. The survey suggested Canada has a long way to go on many fronts to catch up with the other countries, which included the United Kingdom, Netherlands, New Zealand, Australia and Germany.
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