T Nation

Healthcare Reform


I have mentioned in past post about the work my father does in a hospital in upstate NY. His job is to make the processes as close to perfect as possible and to eliminate as many mistakes and simply bad practices as humanly possible. Based on the following article, it seems his services are badly needed everywhere in the US.

Healthcare: America's Leading Cause of Death

(originally published on 10/11/04)

In 1999, the Institute of Medicine released a groundbreaking report on a largely unrecognized affliction amongst hospital patients: Doctors. The study estimated that between 44,000 and 98,000 hospitalized Americans die every year as a result of errors made by treating physicians--including improper drug administration, surgery conducted on the wrong part of the body, and even mistaken patient identities. Addressing the current state of medical treatment, the investigators wrote: "The status quo is not acceptable and cannot be tolerated anymore."

They had no idea.

It turns out that the study's estimate of yearly casualties from medical errors--numbers already higher than those for annual deaths from car accidents, breast cancer, or AIDS--may only be the tip of iceberg. A report last year from the non-profit Nutrition Institute of America estimated that conventional medicine in fact kills over 780,000 Americans per year. That makes healthcare the #1 cause of death in our country.

How do doctors' errors add up to such staggering numbers? One major factor is misuse of drugs, including cases where meds are given in the wrong amounts, at the wrong times, or in lethal combination with each other. One study in 2002 found that hospitals average 40 drug-dosing errors per day. The Nutrition Institute study estimates annual deaths from these mix-ups at 106,000. Another 88,000 fatalities are thought to be caused by treatment-resistant bacteria that result from the over-prescription of antibiotics, another common form of drug misuse.

Surgery is also an area where mistakes regularly kill. To begin with, the Nutrition Institute says, about 17% of surgical procedures are unnecessary, which translates to 7.5 million Americans going under the knife without good reason, and over 37,000 of such patients dying from complications. One Spanish study pegged the percentage of unnecessary surgeries even higher-- about 20 to 25%. Surgeries conducted on the wrong part of the body are not uncommon, a high-profile example being Willie King, a Florida diabetic who had the wrong leg amputated. Even after surgery, patients aren't safe: the Center for Disease Control and Prevention (CDC) estimates that 500,000 surgical wounds become infected. And a report in the Chicago Tribune showed that in 2000, 103,000 patients died from infections they contracted while in the hospital.

More stunning, however, was the observation that nearly 75% of these fatalities could have been prevented, in many cases by measures as simple as doctors washing their hands and instruments. The Tribune uncovered thousands of cases where surgeons were observed operating without scrubbing up or wearing masks, sometimes in dusty, fly-infested operating rooms. Indeed, a recent, much-publicized New Scientist article noted that even doctors' ties can cause infection, with a survey of ties from medical staffers at a New York hospital finding potentially deadly bacteria in almost half.

Even the above numbers, which are chilling, may not fully capture the amount of people dying needlessly. Numerous studies have estimated that only 5 to 20% of medical mistakes are ever reported, the rest simply being ignored or even covered up. The Institute of Medicine recognized this as one of the biggest barriers to making healthcare safer. Simply put, doctors are scared to admit they made an error, correctly fearing hefty malpractice suits. The Institute recommended creating confidentiality safeguards that would allow physicians to come forward when things go wrong, and work with healthcare officials in trying to make operations safer.

Most parties involved in these studies blame the entire medical system, rather than just "bad apple" doctors. Indeed, the Institute of Medicine report--tellingly titled "To Err is Human"--said, "Research reveals systematic, predictable organizational factors at work, not simply erratic individuals." Many hospitals, it was noted, resist even basic attempts to safety-proof their operations. One article observed, for example, that numerous hospitals store drugs in concentrated form, meaning that they must be diluted prior to administration to prevent a lethal overdose. Heading off multiple fatalities would be as simple as diluting the drugs before they are stored, rather than waiting for this task to be done by a bleary-eyed doc or nurse at the end of their 12-hour shift.

What can you do to improve your personal odds of surviving medical treatment? The Agency for Healthcare Research and Quality has produced a booklet of tips that, while largely common sense, are well worth reading, printing out and saving for a rainy day. Read it here: http://www.ahrq.gov/consumer/20tips.htm.

Bottom line: studies have shown that people attribute a high level of trust to anyone wearing a doctor's or nurse uniform. This attribution can lead to blind faith in a flawed system. As with so many things, you--or your family--need to be more forceful as advocates for your own healthcare. Your life may literally depend on it.


As the article clearly shows, what many of us have already come to know... many many many doctors don't know WTF they are doing or sometimes why they are doing it. Everyone wants the answer to the healthcare problem and all our stupid politicians are looking at what government plan they can come up with to fix it. IT HAS NOTHING TO DO WITH A GAVERNMENT PLAN!!!!! many of our problems these days come from our waste as a society. Americans waste so much it's not even funny, and it transfers to all aspects of our lives. You cant be a doctor and at home, waste as much as you want with little regard to the consequences, and then come to work, do a 180 and do things efficiently and perfect. Learning how to be efficient and not waste, should be a core class in schools from kindergaten till 12th grade. pound it into our younger generations so that when they take over perhaps they will finally be able to do it right.



I'd start with reforming the practice of having interns work absolutely frickin' ridiculous shifts -- I really don't care what the concept behind it is, unless it balances out against the probability that someone who's been working constantly for 36 hours won't make a simple mental mistake that will kill a patient.

Another easy fix: Make doctors or nurses type prescriptions so they're legible and people aren't getting the wrong medication (and kept in a computer that could keep track of what the person is taking would be even better...).


AMA seems to cover for bad doctors too.

Lots of problems with this industry.

The health insurance companies appear to pocket too much of the money.

Trial lawyers are making a fortune off of the industry.

AMA covers for bad doctors.

Real reform is required throughout.


780,000 deaths a year by medical error. Thats potentially 780,000 lawsuits that healthcare insurance companies have to defend, and then most likely pay out on. thats not even taking into consideration all the normal things healthcare insurance companies have to pay for like the millions who get treated annually with no problems. Healthcare insurance companies are not getting rich, they are barely breaking even.

That is definately one area that would be handled immediately at any reputable orginazation or one seeking ISO certification. The problem is that the big wigs there are making people unhappy, hurting people, and actually wasting money not saving it. Thats how stupid these people are, they try to squeeze a nickle out by making thier employees work longer hours, then the employee screws up and the hospital get sued, then they lose money, the employee is unhappy, the patient is unhappy or dead and the hospital is out money. Again, internal reform is the way to go, so much progress could be made, and when people start getting treated efficiently, people stay in the hospital for less time, the cost goes down, the staff is under less pressure and enjoy thier jobs, the hospital is making more money, healthcare premiums go down, the government heathcare programs start working better (though they eventually need work too) and everyone is happy, at least with regard to healthcare.



The insurance companies are making a fortune, don't kid yourself.

We have a couple health insurance companies with big headquarters in town. The places are like the Taj Mahal.

There are a bunch of insurance executives living in million dollar homes right down the street. The kids drive BMW's to high school.

Too much money is going in the insurance companies pockets.


Zap buddy, any CEO is making big dough and any big companies headquarters is gonna be huge and extravagent, i.e. waste, but that stuff is not even .0001 of the companies revenues or expenditures. If they did things right, they would be far far richer than what you are seeing today.



I agree. Forcing hospital professionals to work long, crazy hours and shifts with little or no breaks/sleep/decent meals or exercise breaks I believe is a huge contributor. That kind of labor practice was supposed to have gone out with Sweatshops. Many hospitals have huge staffing shortages; hence, the good workers who are there are forced into these crazy working conditions, creating the potential for mistakes.

There is a healthcare crisis currently where there are not enough doctors for certain specialties, and not enough nurses. Not enough nurses means the nurses are similarly overloaded, and there are even less checks and balances for the already overloaded physicians.

Some schools have resorted to lowering their standards for admissions, which I can attest, is a big mistake. Other good members of the healthcare team, and most importantly the patient, ultimately suffer for this.

I also believe that lowering the standards is a recipe for more disaster in that it scares away many strong nurses and doctors from the field, because of patient safety and liability issues, and leads to quicker burnout of existing healthcare providers. The solution should not be focused on lowering standards but upon creating better solutions. For example, reforming health insurers' practices so that physicians are properly reimbursed for their services and hence attract better candidates to schools and to the field. Also, better working conditions would help to retain and recruit good candidates to the field.

Currently, many good people are leaving the field, having been burned out working long shifts, not sleeping and eating out of vending and coffee machines, and not seeing their families or being able to have a personal life. Sure, it seems MD's and RN's earn a decent living, but if you look at the personal costs, it really isn't as much as it seems at first glance. So there are many other dynamics that play into the healthcare staffing crisis that is a large contributor to the incidence of healthcare errors.

Automation and Technology I believe is the wave of the future in healthcare. I belive that all orders should be transcribed onto automated means of communication. This will prevent errors related to handwriting. Currently, many hospitals are converting to or already using computerized charting, but more can and will be done. For example, pharmacies order IV or IM medications in vials that hold only one dose rather than multiple doses, decrease the chances of, say, a tenfold dose ot the medication being given, and high risk medications, such as IV potassium not being stored at nursing stations but rather in the pharmacy, thereby creating better checks and balances.


Not true.

This is the biggest falsehood.

My firm's insurance industry analysts laugh about this myth all the time.

If this was true then torte reform would cause insurance companies to immediately lower premiums.

Not gonna happen. Who is going to make a publically traded company reduced their profits? No one.

The costs associated with lawsuit in the medical industy accounts for less than 0.5% of all claims.

Cananda will continue to get more auto manufacturing plants as the labor is better educated there and their national healthcare system is funded though taxes which is cheaper than Americas busted private healthcare system.

My employees premiums have doubled in the last 6 years. Covering healthcare cost at this rate is not sustainable.

We have an ER based healthcare system in the U.S. and it does not work.

I do not know what the answer is?


What about the lack of adequate healthcare staff? I see this as the larger issue. Minnesota hospitals are so understaffed that many bring in health care professionals from overseas (as I'm sure many other states do). This is a much deeper issue than just doctor error. When you have interns working "crazy" hours it's because there is a lack of staffing. If you were to graduate from a university with a degree in nursing today you could walk into any hospital and get a job--that's how understaffed they are.

This is not to say there aren't other issues like negligence prevalent in the system. Lukily, I've never had to witness it.


when three minutes of a nurse's time and a band aid costs 800 dollars and 40 dollars respectively, there is something fundamentally wrong with the system. I hate emergency rooms.

preventative medicine is the key! fewer patients relieves strain on physicians/nurses, and in turn would help get rid of 80 hour work weeks. The world needs to eat better and exercise more.


You do realize you have answered your own question, right? :slight_smile:

Now seriously, that's why I frown upon the neo-con philosophy that privatization is the cure for all evils. It is the cure for many problems that come with "Big Government", but time and again -- both here and in Europe -- privatization in key areas -- like healthcare and public transit -- has made things worse, not better.

What people need to realize is that people are as incompetent in private companies as they are in government. They're the same species, who tends to be driven by all the wrong principles. Privatization creates an incentive, but it's the wrong one for fundamental things like healthcare: making money quickly. Bottom line is that hospitals being run by people motivated by making money in the SHORT term are even worse than hospitals being run by unmotivated people. Hence, as sucky as healthcare is in Canada and in Europe, ours is worse.

Of course, in theory, smart capitalists should realize making money in the long term is the way to become rich, and being competent is usually the key to that. But in practice few people are smart enough to be good capitalists -- as they were not smart enough to do well in a Government-run environment. The problem is not the philosophy, it's the people. The vast majority of the population is just a bunch of greedy, lazy bastards who couldn't care less about anything except their own ass.

So, unfortunately, I've grown cynical enough to realize there isn't enough people with the right principles in this World to make healthcare really work ANYWHERE, with any system. There are simply too many sick people and too little people with the right motivation to help them. So few, in fact, that they are tired and overworked -- and eventually they will give up too.

Most ER doctors don't get paid at all for their work, even though they're saving lives. Some of my best friends work at the ER and the trauma center here at Stanford (one of the 3 that serves a population of close to 2 Million people in the SW Bay Area -- that's a ratio of around 600,000 people per trauma center), and, quite honestly, I don't know how they survive. My wife and I do whatever I can to help them out -- including getting them healthy stuff they can eat while on shift -- but I am amazed how they continue. These guys should get a medal for putting up with this. Yes, they make mistakes, but how many of you would be clear-headed after working for 48 hours straight, with little or no time to even eat something decent?

The health insurance companies milk the doctors to the bone -- they only pay them outrageously small rates, while, at the same time, paying outrageous amounts of money to the pharmaceutical Cartel.

This is also going to get much, much worse before it gets better -- a whole generation of Baby-Boomer nurses and doctors is going to retire soon and be replaced by people that are only going into healthcare because there's demand for it -- not because they are motivated to help people. I lost count of how many people I know that were in IT but are moving to healthcare because their job went to India. I feel for them, but it's definitely the wrong motivation.

So, guys, the bottom line is: take care of yourselves and do NOT get sick. And if you do, move to Canada... :slight_smile:


You guys, Dave Chapelle already solved our looming health care crisis:

"Fake Canadian IDs for all Americans"

This is not such a big problem. :slight_smile:

Seriously though, from the front lines I can tell y'all that many of you guys make excellent points regarding the structure, et al, of our system as the problem. I will divulge to y'all now that in order to fix this, something is going to have to break. Something big. We will continue to ride on this track until the wheels fall off, and only then will something be done to change things. The reason for this is not stupidity or incompetence as some of you might think, but it is simply the existence of evil.

There are many very powerful and influential people in our country who have a LOT to lose if things change for the better. Veg, your father is going to encounter a great deal of resistance is he wishes to spead his business in a fair manner. A great deal of the people who serve on medical boards and committees are complete scum (trust me on this), and he will have to beat the sharks at their own game if this ISO thing is going to see a green light. I'm talking about kickbacks, fraud and outright bribery here. And that goes double for any politicians who have any say in this.

Do not despair, people. Yes, the coming years are going to be tough on us medical folks, but we are bad-ass, and we will continue to help you as best as we can.

PS If you want to do your part to help me, stop drinking non-diet sodas and eating at Mickey D's. And more importantly, get a friend to do the same.

Thank you in advance.
Your servant, lothario


Swiperfox makes good points. I'm not directing this toward you personally, swiperfox, but I work as a nurse in an ER, and if a person utilizes the ER for non-emergent complaints that only require a band-aid, then they are misusing the Emergency Department. This is a common problem in ED's around the country that are driving up the costs of healthcare for everyone. I can attest that a large amount of people presenting to the Emergency Department have minor complaints, including splinters, broken fingernails, sinusitis, etc.... For obvious reasons, ED's are set up with the best emergent care supplies, equipment and personnel whose job it is to be ready at all times for emergent arrivals. So yes, if someone uses these resources for a superficial abrasion, they are utilizing premium healthcare services that come with them premium price tags. It makes no sense to buy a plain old hamburger for $30.00 at an expensive french restaurant when jack in the box sells them for 99 cents...but it's ideal to go to that french restaurant for the foie gras.

Emergent care is costly because it IS EMERGENT care- traumas, hypovolemic shock secondary to bleeds, acute cardiac problems, acute strokes. These complaints require trememdous amounts of resources, and the doctors and nurses are well-trained.

Swiperfox has it going on, with suggesting the great diet, exercise and health conscious lifestyle. I agree that the best medicine is prevention. The person who eats poorly, doesn't exercise and smokes like a chimney for decades can't do so expecting to be cured of their acute heart attack by a three hour ER visit. Sure, we can intervene with all the best possible technology, but it is really up to the person to make appropriate lifestyle changes. All too commonly, people do not, and then require repeated interventions over and over again, and this also is driving up the costs of healthcare.


Good points!!!!!

-Yes, most ER doctors don't get reimbursed the way private practice physicians do. Usually, they are salaried or hourly employees. And the pay is not much more than nurses', as many people erroneously believe. I don't know a single ER staff doctor who became wealthy or could retire early because of his/her salaries. And yes, they work very very hard. Most of the ER docs I know are in it because they want to help people. I went into ER nursing because I love the community and caring for the community.

-hspder, people like you really are our angels, bringing the docs and staff food. I'm glad that there are people who know that doctors are human beings too, with the same biological requirements for rest, nourishment, support.

-For physicians of other specialties, the Insurance companies give them the run around, causing great difficulty in obtaining reimbursements, and this has to change. We as consumers of medical insurance and services need to demand that the Insurance companies are reformed, otherwise suffer consequences. This would help alleviate the strain on the system and help to attract and retain doctors into the healthcare industry.


I just wanted to see this posted again, chinadoll. My guess is that our fellow T-nationers don't realize that our ER's double as 24 hour health clinics/cafeterias/hotels.

"It hurts to pee..." so she calls 911.

"My temperature I took at home is 99 degrees" so he comes in to the ER in the middle of the night for some Tylenol.

"I'm drunk." so he comes in for "treatment" which consists of a cheeseburger, a soda, and a nap.

The really fun part about this is that I know some of you might be thinking "why put up with people like that? Just kick that drunk bum out into the street! Tell that guy to call his doctor in the morning, or go to Eckerd's for some Tylenol, and tell the girl who has trouble peeing to stop calling EMS and maybe keep her ankles together every once in a while..." but you guys don't realize that we just simply can't. We're not allowed to. If that drunk who says he has "chest pain" actually had a coronary, we are liable for all kinds of hell. We know that he knows that we know he's full of shizzle, but he knows that we know that he knows that there ain't shit we can do about it. So those guys come in all the time.

Nice to see you posting, china... I haven't seen you around for a while. :slight_smile:


Thanks, L!!

Hey, friend, nice to see you here too!!! I've been busy working a lot!!! Hehe, how coincidental, eh??

EMTALA is a law that governs all ED's that states that every patient who presents to the Emergency Department must have be triaged and also have a medical screening exam. It's illegal to turn anyone away, even the person who calls 911 for a sore toe secondary to wearing too tight shoes all day, or the chronic drunk who just wants a hot meal....and unfortunately, the honest taxpayers and healthcare consumers ultimately foot the bill, and not the abusers.

L~ You're right, most people don't know how the system is being abused, and this drives up the costs of healthcare and burdens the system tremendously. More people should know of the abuses so that more minds and support are garnered for real solutions.


Yes, but you know what they say...common sense in not very common.


I agree completely -- and it's at least partly the result of the AMA playing the role of "doctors' union" and keeping the supply of doctors low.

Allow me to explain.

The number of medical schools accredited by the AMA has remained static while the demand for doctors has skyrocketed. There are currently (well, I shouldn't say "currently" as my stats are from back when I worked at The Princeton Review, so they're a bit dated) around 3 applicants for each opening in medical school. There are a whole lot of smart, well qualified people who don't get in to med school (based on some ridiculous reasons, I might add, as the schools have all the power in this situation and they are basically looking for reasons to reject applicants).

If you don't go to an AMA accredited medical school, it's a lot harder (though not impossible) to practice -- and basically there are no non-AMA accredited medical schools in the U.S. (not counting territories here).

Contrast this to law school -- if you really want to go to law school, you can go. Not that you'll get a job, and there are definitely some bad schools, but you can go. Same for business school. But not for med schools, largely due to the AMA's refusal to accredit new schools that could create doctors who could fill the ever-increasing (at least while the Baby Boomers are around) demand.

The AMA can argue all it wants about only letting the best, most qualified people in, but they've moved well beyond the point of "protecting" the public from the possibility of bad doctors -- especially when this protection leads to an artificial shortage that makes good doctors practice poorly.


I understand, having worked a summer as an EMT I came across MANY situations in which the 911 call was unnecessary. The situation I was reffering to was an incident in which, while attempting to chip tile off my bathroom, I missed a hammer strike and caught my finger on the head of a chisel. I struck hard enough to have my finger explode out the side, opening a large gaping wound and turning it completely purple. I could have well bandaged it by myself, but was unsure if it would even close without stitches and thus I was brought to the ER (it was ~11pm on a saturday, so I'd have had to wait a day to see anyone otherwise). Ironically, the only concern I drew was due not to my injury, but a resting heart rate of 32 :slight_smile: (and that only lasted for about a minute)

I also think that often times patients are unaware of how critical or not their situation is, and fearing the worst head straight to the ER. Stomach pain was probably my most common ambulance call.


This is the case in just about every hospital that I've set foot in. Unfortunately, the admins at all of the hospitals TRY to run them as short-staffed as possible (as do Execs of all big companies) to keep overhead costs low. It's not that there aren't enough good techs/nurses/etc out there, it's that the hospitals won't pony up the money to create new hire positions for them.