Report Your Doctor! by Val Jones MD
Here is a another great editorial by Val Jones MD at getbetterhealth.com:
In another example of government over-reach, the NYT describes how the Obama administration is enlisting the help of patients to report physicians (whom they believe may have made a medical error), directly to the federal government. While there are systems already in place for such reports at the local hospital level, apparently the “under reporting of medical errors” has triggered AHRQ to pilot a program in which questionnaires are sent to patients to ferret out potential examples of errors caused by the following:
* “A doctor, nurse or other health care provider did not communicate well with the patient or the patient’s family.”
* “A health care provider didn’t respect the patient’s race, language or culture.”
* “A health care provider didn’t seem to care about the patient.”
* “A health care provider was too busy.”
* “A health care provider didn’t spend enough time with the patient.”
* “Health care providers failed to work together.”
* “Health care providers were not aware of care received someplace else.”
So if a patient determines, for example, that a physician did not spend enough time with them, and they believe that resulted in a medical error (whatever that might be), they can/should report the physician to the federal government. Wow. One physician explains the potential hazards of such a process:
Dr. Kevin J. Bozic, the chairman of the Council on Research and Quality at the American Academy of Orthopaedic Surgeons, said it was important to match the patients’ reports with information in medical records.
“Patients’ perceptions and experience of care are very important in assessing the overall success of medical treatments,” Dr. Bozic said. “However, patients may mischaracterize an outcome as an adverse event or complication because they lack specific medical knowledge.
“For instance, a patient may say, ‘I had an infection after surgery’ because the wound was red. But most red wounds are not infected. Or a patient says, ‘My hip dislocated’ because it made a popping sound. But that’s a normal sensation after hip replacement surgery.”
I believe that reporting medical errors is critical in the process of quality improvement, but that is most efficiently handled at the hospital level. There is no need to involve the federal government at the earliest stages of investigation, and the amount of bureaucracy required to support such an effort boggles the mind.
In the past when I encountered medical errors in the hospital setting, I found successful ways to report the incidents to the local administration. The result was a rapid correction of the problems and new processes put in place to ensure that it didn’t happen again. This is how medical errors should be reported and resolved. Soliciting patients for accounts of subtle lapses in social graces by their healthcare providers, and then reporting them to the government for it, is nothing short of Big-Brother creepy.
Change to words “health care provider” to “government”, and the word “patient” to “citizen.” They all seem like violations to me.
Another reason for students to avoid primary care.
Yes, this is not a perfect system. But a patient may well know of an adverse event without access to the background information to be more specific about its cause. The government has done a number of other studies that document the under-reporting of events (identified through chart review) and identified the failure of the healthcare providers to recognize them at the time as the cause of the under-reporting. Perhaps this different viewpoint will help bring things to light.
I have been the one who catches patient concerns for enough years to know that they often have a point.
I would add that 1) if we know of an adverse or undesirable outcome and 2) we talk to the patient about it, honestly sharing what we know and 3) assuring them that the incident has been included in safety efforts, then they will have no reason to report.
Right in line with Medicare “whistleblower” programs. One more way to make a patient the enemy.