Is Medicine As Bad As My Surgeon Says It Is?

During my last appointment with one of the surgeons who operated on me following my auto accident, after discussing my latest injury and path forward, she changed the subject and threw me a curve ball: She turned the subject to my emergency care in the hours following my accident and offered her opinion that the hospital to which I was taken by ambulance had committed malpractice.

Now, malpractice isn’t a work doctors use lightly. In my experience as a lawyer, I find that most doctors are protective of their medical colleagues and their profession. Many dislike lawyers because they second-guess doctors’ decisions. And seek monetary damages for their clients. Frankly, I never thought I’d hear a doctor go out of her way to offer an unsolicited opinion that her distant colleagues screwed up.

I wasn’t surprised by the opinion, however. Indeed, I had reached the same conclusion on my own, although I hadn’t intended to do anything about it other than to call the hospital and share my concerns. I certainly had no intention of suing, and I still don’t have any such intention.

My doctor didn’t stop there. She began talking about the state of hospitals in general. She criticized what had become of most of the teaching hospitals, including some well-known ones. She opined that, outside of a few institutions like the Cleveland Clinic and MD Anderson, most have seen their quality erode. Finally, she said she would avoid most hospitals, including a well known one right here in Indy.

She offered quite a few specifics to back up her claim, but I’m not going to get into it here. Nor am I going to explain the basis for her and my opinion that the hospital to which I was taken had committed malpractice. I’m not going to get into it because, by and large, most of us have no choice in the matter. Or very little choice.

We will go to the nearest hospital to which the ambulance takes us or our GP or specialist sends us. Moreover, we lack the time and sophistication to research the quality issues adequately. Or at least we lack the commitment to take the time. That said, there is more we can do.

I have a friend who thinks you always need an advocate to help look after your interests if you find yourself hospitalized. I have another former friend who can recite the times her presence at the hospital (one of the top-ranked hospitals in the country) helped save her husband’s life. I have another friend who took her mother from Pittsburgh to Texas for an operation because that’s where the best care could be secured. In other words, there is something we can do; we’re not as helpless as we often act.

When I look back to my relatively brief hospital stay, I can see where an advocate would have helped. I had suffered a concussion that had rendered me unconscious for a considerable period of time — an injury to the brain. I was hardly in position to make important decisions or to question decisions being made by doctors.

I was fortunate though; the negative consequences of their mistakes may have been relatively minor. But others haven’t been so fortunate. Some mistakes have been costly. Some have been deadly.

There always will be mistakes, of course. We’re human. We’re imperfect. Mistakes are part of our makeup. But there are mistakes, and there are mistakes.

I’d argue that many of the mistakes today are the foreseeable product of a corrupt incentive system. My surgeon would argue — and I tend to agree — that most hospitals are being run by the finance department these days, which is a fancy way of saying that money rules. It’s not surprising. We see it everywhere, not only in medicine.

We see it in the fields of research (pharmaceutical and others), government (corporate special interests calling the shots), education (the atrocious quality of the student educational experience at most of our colleges and the abysmal results achieved by many K-12 schools), religion (despite Jesus overturning the tables, it appears the money changers won), and elsewhere.

But medicine is arguably different. Lives are at stake. But is it different? Why would we think it would be?

I’m grateful for the skill and expertise of some of the doctors, nurses and other medical professionals who worked on me and my case in the aftermath of the accident. But I’m also disappointed in the performance of some of the doctors and others.

I’m not going to forget what my surgeon told me. The next time (if there is a next time), I’ll be less deferential and more skeptical, especially concerning the judgment calls the doctors make. And I will ask for help from someone who isn’t in the middle of the crisis.

I know that money corrupts. History teaches few lessons that are as clear as that one. Is money corrupting our health care system? Or perhaps the better way of asking it is, Is medicine immune from the corrupting influences of money?

How could it be?

It’s a New World (i.e., I’m a Dinosaur)

The internet has dramatically changed — and will continue to change — the world. At times, it makes me feel like a dinosaur. I’m not alone, but that doesn’t make it any better.

Two systems that are replete with dinosaurs are health care and education, although the former is well ahead of the latter in catching up to the 21st century (mainly because there is more money to be made in health care).

If you want to get a flavor for what I’m talking about, take a half hour and watch this presentation on internet trends by Mary Meeker.

Keeping up or, in my case, catching up, seems like an impossible task. My generation didn’t grow up with the internet. Yours will, Vera. Your parents’ generation was the trailblazing generation. I expect much more to come from that generation. I don’t have such high expectations from mine. I can’t begin to imagine what yours may deliver.

One disservice my generation and the Xers provide to younger folks is interpreting the world, and guiding kids, with a 20th-century mindset based on 20th-century experiences. In short, many of us fail to appreciate how the world has changed and is changing. Consequently, we’re preparing many of our children and grandchildren for a world that no longer exists. Fortunately, it’s hard to keep young people down. Many see what’s happening and are responding.

I came to believe that I’m not technologically savvy enough to do my students justice in the classroom. Few professors and teachers are. But that will change as the dinosaurs retire or expire. Until then, most of our schools and colleges will remain behind the curve. This is one of the most critical reasons no millennial should outsource his or her education to our formal education system.

Enough said! Watch Mary’s presentation and, if you’re really enticed, read her slides.

The Joy of Paying for Health Care

Two weeks ago I had an appointment with a health care provider. I didn’t actually need to see a doctor or other provider. But my insurance company requires an annual visit whether I need it or not. If I don’t comply, I don’t receive coverage for my sleep apnea treatment. Next year I’ll probably forgo the visit since it appears the cost of the annual visit exceeds the savings I derive from having coverage.

Such are the calculations one must make in America today. We have a truly screwed up health care system, which is essentially dominated by private insurance and pharmaceutical companies. So we end up paying more than any other people in the world, yet we die sooner and are generally unhealthier than our counterparts in other developed western countries.

The health care provider I saw says the system will change. He, too, is frustrated by our system, and in particular with insurance companies. I asked when. He said probably in 12 to 15 years, but he wasn’t sure meaningful change would come about in his lifetime.

I thought he was unduly optimistic. I reminded him of the extreme passivity of the American public. We are very tolerant of high-cost, underperforming systems. You see it in health care. You see it in education. We’re so convinced we have the best of everything (we’re #1, of course), we’re blinded to reality.

But I’m not complaining (even though it may seem like it). To the contrary, I’m sincerely grateful and delighted.

The scene when I checked out out of the doctor’s office makes my point. Continue reading