Fixing Healthcare at U.S. Hospitals

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The data say that it's in crisis, the data say that we have 50 million uninsured people, that the quality of care is irregular, sometimes it's spectacular, but often it's not it's sporadic. That we harm and kill way too many people in the course of getting care, we know that a jumbo jet worth of patients die every day in American hospitals because of medical mistakes.

And the cost of care is bankrupting our country, and so Herbert Stein once said in famously Stein's law that if something can't go on, it won't and this can't go on and so it wont and yet we don't exactly know how to remake the system. I think the cost challenge is probably going to be the dominant challenge for the next 5 or 10 years.

We know that about 30% of what we spend on healthcare adds no or little value to patients but that's a huge chunk of change, that's nearly a trillion dollars and there are a lot of people who believe those expenditures are adding something. Providers believe that, sometimes patients sometimes believe that, so trying to figure out a way of extracting that wasteful non-value added expenditure out of the system in a way that is politically feasible, I think that's the hardest thing we have to do.

At the same time we have to figure out a way of providing high quality, reliable, safe satisfying care to patients. Medicine is both too reliant on technology and not reliant enough, and so one of the challenges we have is to find a sweet spot, where we're using technology appropriately in the right way for the magical things that it can do and yet not reflexively relying on it when there are other things that can work as well or better and are certainly far cheaper.

Where it's not reliant enough is computerized, order entry, bar-coding, there should be in our healthcare system a single medical record that knows everything about me and it doesn't matter whether I'm going to my local hospital across town or I'm in a car accident 3,000 miles away, that the technology has the information that a doctor and there's needs to have to take care of me effectively.

The problem today is we're going through this really, kind of gangly adolescent phase, where the agenda has grown massively. We have the beginnings of some new tools largely information technology but the tools have become a master in many ways, you should be in the hospital if you need to be in the hospital.

I think when you don't need to be there, you're safer out of there and it's not just because of the errors but because the bacteria that we have in hospitals are less safe or scarier than the ones that float around in the community. The number of errors that are reported every year is a small subset of the number of errors that occur every year.

In the average mid sized hospital there will be 10-20,000 reports through their incident reporting system, not all of them are full fledged errors some of them are near misses, some of them are just unsafe conditions. But it's remarkable the number of errors that take place in the life of an American hospital or unfortunately befall an American patient.

I think what concerns me the most is the aging of the population which is a good thing, because I have moved into that age bracket, but I think reckon complete inability to understand how we're going to effectively take care of boatloads of 80 and 90 and 100 year old patients and provide them with quality of life that they want and deserve and figure out how we afford to pay for it.