The real answer is, of course, you have a responsibility to take some ownership of your own care. Ask questions, don't accept non-answers, make sure the answers are consistent... dr's and specialists, don't always communicate very well with each other or hospital staffs. They may tell a nurse something right when they're going off their shift, and a new nurse comes on.

Either you, or a reliable advocate, needs to keep on top of things and not take things for granted.

Learned before and reinforced by recent experience.

Even BETTER yet, steer clear of undertakers & funeral parlors (not always possible).

Nah, those you just try to put off as long as possible ;-)

After working in US hospitals for the last 25 years, and knowing all the medication errors and neglect wrought by overworked, understaffed, exhausted nurses- all the superbugs like C Diff and MRSA floating around in there, I would just about rather die at home than try to go to one for help

sorta agree........Ive been in the hospital for little surgeries...no infection! what do you do when you need care? Many people leave much better,most do infact!

This will soon be the norm under Obamacare. Count on it. Welcome to European/Canada style socialized, medical care. Poor care for everyone except the politically connected and ultra wealthy.

onthenet .....As a Canadian,aged 47, who has spent the last ten years working in the U.S., I believe I have some perspective on the issue.

In Canada, I received great medical care, whenever I needed it, paid for through my taxes. In the U.S. - I can't afford any type of health care and it's 'no care except for the politically connected or wealthy'.

Wel Hong and Adam44,

Actually everyone fails in avoiding undertakers and funeral parlors once in their 'life'. Fortunately it is always their LAST mistake!

PS : Wel Hong- funny name!

HumanOnAPlanet,

Untrue! Anyone needing emergency treatment can show up at any hospital emergency room and be cared for without regard to money or political butt-buddies. It is the law of the land. Care other than emergencies is your responsibility. Consider the health and dental insurance payments you make here in the US to be the taxes you would have paid for health care in Canada. The same thing under different names and you have to take care of the paperwork.

Different like what, voodoo?

You do realize that if you are in the hospital on a holiday, you have everyone who is lowest on the totem pole taking care of you, don't you?

You will get moonlighters trying to make an extra buck and nursing staff who already worked their shift and can't leave until a replacement arrives.

TheMaineVane is right! It's not like my kids didn't get all their vaccinations, and we all get our physicals, etc., but the medical profession does its best when WE the patient already know what our problem is, and are proactive with our health. Doctors are too eager to foist OUR problem onto somebody else, some drug or whatever.

Of course, if you've got an injury, or are seriously ill, you need our modern medical system to help heal you. But I feel doctors don't know a whole lot more than we do, if we do some research, but they just have better toys, and can get us the medicines we need. But we can do a lot for ourselves by learning about our own bodies, and taking care of them. In Europe, they use more herbal medicines as the first line of prevention and cure, THEN go for the big guns. Also, many of our prescription medicines have their beginnings in plants.

And no, I am not crazy. And yes, my doctor knows how I feel about things. My husband's doctor also knows my (our) feelings about this, since we've been able to wean him off a few prescription medications with some nasty long and short-term side effects using diet, exercise, herbal supplements and teas.

Honey Santana

Of course, if you've got an injury, or are seriously ill, you need our modern medical system to help heal you. But I feel doctors don't know a whole lot more than we do, if we do some research, but they just have better toys, and can get us the medicines we need.

LOL, this is a joke, right? Holy cow are you mis-informed if you believe you can simply "do some research" and come up with the same diagnostic procedures, differentials, and understanding that a board certified physician can.

LOLOL thanks for the laugh this Thursday.

Yeah well, one day when you see your life passing before your eyes we'll see which one you look for first a hospital or a medicine man . . . idiot

And "serious" . . . most of my career (20 years) has been working weekends by choice. You have no idea what you are talking about. The same staff that works during the week rotate through the weekends as well and those "extra buck" people you were talking about are usually the week day people somewhere else. Continuity of care refers to physician-patient-facility relationship while admitted as an inpatient not having the same nurse while the patient is admitted. Would make for some awfully long shifts.

However cape Cod, I have sat in literally hundreds of Patient Safety Committees over my 30+years in health care, and guess where the majority of those medication errors reside? Pharmacy? Physician orders? No. I also live in a state where nurse/patient ratio is mandated by law, and that medication error rate has not dropped. I see the issue more as to the ideology of the people working in healthcare these days as more of an issue than anything else. The biggest catch phrases these days is "it's not my job." "What bonus will I get if I do it?" "I want extra pay for working a weekend."

Here is the main issue on weekends, holidays, nights..... NO ONE wants to work them with our current generation. They come in to an interview and lay out the specific days, hours they will be willing to work, and than ask when they will be making your salary because they want to buy the same things their neighbors have.

What part of this field being a 24/7 operation do these folks not grasp when they decided they wanted to come into this field?

My wife is a professor (tenured, center director in a Tier 1 university) who does research in outcomes. I had a knee replaced on a Monday (never on a Thursday, Friday, or weekend). I would never have surgery or voluntary treatment of any kind during July when all the new interns and residents are being hazed. I chose early December, because the number of patients is low because people hold off elective surgery until mid-January, but the staffing is still good because senior people tend to take off at Christmas and haven't started yet. I used a physician who had great outcomes scores from doing lots of knee replacements in a hospital that is cutting edge in new technologies. So I had good results. But I took precautions.

But you ALWAYS have to be mindful that this country is number one in medical malpractice rates and it is the 5th leading cause of death in this country. It is not even in the top 10 in any other country. You can use common sense and avoid malpractice "traps", check out your hospital, check out your physician, and stay out of emergency rooms if at all possible.

I have been in a Tier 1 medical school hospital (Emory) with a kidney stone and waited over 6 hours in extreme pain until my wife started making calls (she was on faculty there) and magically I was seen. I watched people bleeding and vomiting and passing out, but not being seen for many more hours than me because they did not have "pull" with the hospital. The rule, I later discovered, is that all emergency room visits MUST come in via ambulance or they will have a 60x chance of a "bad" outcome.

So . . . Chris-749391 I wonder what critical patient was shorted on his or her care so you could have your pee pee all better? Your wife may be a bigshot professor but, ethics mandates all patients are treated the same not you before someone else because wifey made a call and dropped a name or two. She should know that and shame to the ER crew. Also you are full of it about the ambulance crap. Did you not know that non-emergent ambulance arrivals go straight back to triage and the waiting room?

It is people like you and your wife that give every hospital a bad name whether they deserve it or not.

Ditto to Jim-935880's reply to Chris-935880's moronic post. Mistakes are made, yes, because healthcare workers are human, but the post confirms the ignorance of many who seek attention in the ER. Contrary to popular belief, patients are prioritized by the acuity of the injury or illness, not the order they checked in. If that were the case, you could just pull a number when you get there. The triage nurse is not saying you do not hurt, it doesn't suck that you feel like crap, etc. If you are waiting, it's because there are people sicker than you. (YES>>>BLOOD AND PAIN AND EVEN VOMITING IS NOT A BIG DEAL WHEN THERE IS SOMEONE ELSE WHO CAN'T BREATHE, IS HAVING A HEART ATTACK...) I feel sorry for the staff who had to deal with you, and shame on your wife for pulling strings so your whiny ass could go before someone who needed care more. Kidney stones hurt like hell and it is terrible that you had to wait for relief, but kidney stones are seldom life-threatening. Ask questions, advocate for yourself by updating the staff on your condition as you wait, but don't judge the nurses and physicians because you think you know better. You have no idea what is in the back already being treated, what has come in through the back doors since you checked in, nor do you know why all those other people have checked in. What you think is sick or gory or emergent, seldom impresses us. And by the way, the ambulance crew and the ER thinks it's funny and a verification of stupidity when people use the waiting room phone to call 911. We are 911 numbnut. FYI..Patients who come in on an ambulance are triaged the same way as if they came by private vehicle...

Why do people continue to insist that malpractice is in the top 5 leading causes of death? It ONLY breaks the top 10 if you count every single case of hospital acquired infections that result in death as malpractice, which it isn't. And of course other countries don't list malpractice in the top 10 because they specifically don't count every case of infection related death as malpractice. Please get your information from someplace other than the legal community.

Also, Jim is correct in his assessment of your ER trip.

Mitchell

Although, an acute kidney stone episode is quite painful and does deserve a trip to the ER, but as was mentioned above, it is seldom acutely life threatening. I say this as someone who passed a few of those and as someone who treated people with them.

Acute, 24 hr triage areas, like ER and L&D are abused by people like you wouldn't believe. Ask any urban ER worker, doc, nurse, tech, clerk, anyone, about their census during and after major sporting events. Somehow a good percentage of the "emergencies" can wait until after the game. What makes people think that it is acceptable to show up to an Emergency Room at 3 am with a complaint of a rash that you had for three weeks, or vaginal discharge. These are not the uninsured people who have nobody else to take care of them. These are the people that are too dumb, or lazy, or both to pick up the phone call their primary care doctor, schedule an appointment, and be seen as outpatient in a day or few. These are the people that by law have to be seen and, eventually, detract from the care of people with real emergencies.

On the other hand, hospital administration, in my experience, will try to cut nursing, lab, tech, and pharmacy staffing whenever they can. This administrative money saving practice often leaves physicians totally helpless in acute care settings, because without appropriate ancillary support even the best physicians are completely handicapped.

The bottom line is, that the responsibility of care for the sick should be shared by the health care providers and by the sick, themselves.

I did not say that I was ever triaged! During my 6-hour wait, I was seen only by an insurance clerk who photocopied my insurance card and drivers' license. There was no other staff in evidence except one very bored Decatur cop. Ahead of me was a kid with a compound fracture of the upper arm. He was bleeding profusely and by the blood on the floor I would say that he had been there a while. The officer got him some towels because there was blood everywhere. During the six hours, there was not a single physician or nurse in evidence as the waiting room slowly filled. I was kinda in the first third of the pack. My wife asked where the ER staff were and the cop just pointed to the cafeteria (which was closed). My wife called my physician who said that he had sent some medical information to the ER, but that the mail had not been opened. So he called and was told that I "had been admitted pending diagnosis." When my wife told him that I had not made it past the insurance desk, be got quite angry and tried to contact the on-call Services Director, but that he wasn't answering his page. He then tried getting hold of the on-call urologist hoping that it might be a kidney stone (he thought it was more likely appendix). The urologist didn't answer his page either. He tried unsuccessfully to get a hold of any of the staff in the ER and, of course, the other departments are closed, but he tried to get in touch with several of the staff that he knew, but was unsuccessful. Finally my wife called the head of the Medical School (which runs the for-profit hospital) who gets the Chief of Services out of bed and sends him to find out what was going on. The Chief of Service storms in and suddenly there is an explosion of scrubs and people trying desperately to find who was the most immediate. I and the kid went pretty much first. He was really shocky, but made it. I turned out to have a kidney stone, but I got that taken care of --- just needed an x-ray and some lab work to see for sure.

But in the ensuing month or so JCAH moved Emory's ER from a Level 1 to a Probationary Level 2. Several of the residents were rotated back without pay. The urologist involved was passed over for promotion from associate professor to assistant professor, essentially ending his career in institutional medicine. The insurance clerk was fire then reinstated in her job. I was not charged for treatment but I signed a paper saying that I would not sue them. I signed it, but I crossed that I would not testify against them in other cases. (I thought I needed to plant that idea in their idiotic little minds.)

But if it had been my position to do so, I would have summarily fired everyone including the insurance clerk and every physician, nurse, tech, and clerk. It would have been easier to have started all over again. That's my whinny story. When I think back, I tend to think --- I should have sued the a-holes.

I am so sorry but that does not explain the nurses that would do nothing except tell me to go home while they talked at the nurses station and talked on their cell phones or texted. Come on, nurses need to have some common sense when it comes to taking care of a patient and they can tell the doctors what is going on. All nurses have to do is open their mouths and speak up to the doctors. They know the difference between a good doctor that wants to help and a lousy one that don't. And, nurses need to keep a patient who can not get out of bed clean. My mother was always dirty and I had to be the one doing their jobs. I uninpacted my mom 3 times because a nurse told me that she was fine and to leave it alone. Once I did it, she was "amazed" at it. I'm sorry, but nurses are after a pay check, not a patients health.

You make a really good point about the types of patients affected by the new MD vortex. At least at my hospital, since I can't comment on the rest of the world, we don't mess up during an emergency. It's only when a chronic CHF or COPD patient comes in for the umteenth time with a severe exacerbation and the new MDs are shaking their heads asking why these people are torturing them with problems they can't figure out how to fix that the patients wait around for their Lasix and Bipap. And once again, they should have an RN that's not waiting around and has already asked for those things.

And FYI for the rest of the world, it's called an Advanced Directive, make one early, make your wishes known to your family and choose a Power of Attorney who has the fortitude to stick to it.

Good post Mike, very informative. p.s. I wasn't trying to be cute with my post. The best course is to take great care of oneself so that one doesn't end up having to rely on others to try fixing difficult conditions that were preventable in the first place. Not always possible of course.

Mike - You make some great points, but on the other hand I have observed the death of a loved one due to stupid medical errors. I don't trust any caretakers anymore and question everything they do. When my husband was in nursing school he observed a fellow patient get reamed out by a physician for questioning a medication error the physician had made. This was a life threatening error. The nursing student was not thanked, but chastised. My husband gave up on the whole profession after that. I used to teach chemistry labs and it was usually not the smartest students that wanted to get into Medical school. It was usually the only moderately intelligent, with huge egos and plenty of greed. Then we have the whole teaching system in Med school that is more like boot camp, and attempts to teach by sleep deprivation and high stress. This leads to lower intelligence and errors. If hospitals were properly staffed we would not need doctors and nurses to be used to working with high stress and no sleep. But the hospital administrators might have to take a pay cut. The whole system is inhumane and we have set ourselves up for the situation we are in. I avoid visiting the doctor unless absolutely necessary, and live a healthy lifestyle instead.

Nurses and their unions are causing most of the problems at these hospitals. The company I own, works very closely with hospitals. Comrade Obama should have concentrated on making hospitals and other healthcare providers more efficient than cramming healtcare insurance down our throats. But of course he did not want to do this because the GOP thought of it first.

C'mon 2012!

But then.... sometimes the doctor or nurse doesn't read the chart. I took my father in because he was having a stroke. They ordered an MRI without looking at his chart. He had a pacemaker which was right there in black and white. If I hadn't been standing there when it was ordered who knows what would have happened.

anonymous,

A couple of points:

1) A Living Will or Advance Directive for Healthcare is only followed by the attending physicians and hospital about 20-25% of the time. They claim that a) this would violate their basic "curative" philosophy, b) that their lawyers taught them not to honor such documents, or c) because end-of-life patients are highly profitable.

2) Much of the problems with new interns and residents are due to hazing. Over 90% of physicians approve of hazing of new interns and residents since they went through it themselves. Make these guys function on no sleep, work hours that make no sense, and expect them to make life and death decisions at the same time. If you look at the rules for new interns and the same rules for new pilots, you will see an incredible difference. There are an increasing number of states that are targeting hazing and we are seeing some small reduction in resulting malpractice as a result.

3) One of the most vital things that can be done right now to reduce medical malpractice is the use of airline-like checklists in both treatment and especially in surgery to prevent malpractice and errors. This is widely opposed by the AMA, JCAH, and other organizations as an infringement on physicians' latitude of treatment. It is being heavily adopted in Europe with huge success. This one thing could save 30k lives a year and prevent another 100k of bad outcomes (such as amputating the wrong leg.)

We really need to take a hard honest look at malpractice in this country. It is waaaaaaay too high and we have a medical malpractice insurance system that serves to protect bad practitioners from criminal, civil, or disciplinary action. This is the only country where a physician can kill someone and be reasonably assured that there will be no negative consequences to his license, his freedom, or his personal income. The modal number of victims for a physician to lose his license is 16 deaths.

This year has been my first in hospitals with unions. Nurses have less patients 2 in ICU as opposed to the 4 to which I am accustomed. Enforced breaks and enough staff. I have seen fewer pressure ulcers and fewer unexpected deaths. Unfortunately, I am seeing patients whose lives are prolonged without chance of recovery. The body does wear out. You don't expect your car to last 80-90 years, but you want your mom to? And you want us in the medical profession to heal her? We DO hurt when our patients die, but for some patients death is a blessing. Just how much pain should a person bear? Life on a ventilator with multiple meds keeping him alive is not pretty.

The luckiest thing that ever happened during a 6-week stay in the hospital for Guillian-Barre Syndrome happened on a weekend. I was into my 4th week paralyzed from the waist down when I had a complete relapse. My neurologist ordered me to start the same course of treatment that had not worked the following week.

The attending neurologist who saw my case that weekend switched me to plasma pheresis and I was walking within three days. My original neurologist simply could not consider the possibility that he might be wrong. So I switched neurologists. All I wanted was to get out of the hospital!

Amen Mike. And still with all the criticism that you in the medical profession must put up with, it is STILL the best medical care in the world. Thank you for what you do Mike.

Amen Mike. And still with all the criticism that you in the medical profession must put up with, it is STILL the best medical care in the world. Thank you for what you do Mike.

"you aren't going to listen to me any more than you've ever listened ."

, what was your point? mine is short, yes people do die but it should not be because of the day of week, time of day or that the Dr. is NEW. (lack of traning)

Chris- depending on what state you are in failure to follow a properly executed living will cannot be attributed to curative philosophy. It comes with criminal penalties if not followed. Yes malpractice is a huge problem, but so is patient families who extend their loved one's life to collect SSI or welfare etc. People haven't any idea about most of what we talk to them about, and there is rarely time to explain it to them in ways they can understand. It is just easier and safer to wait for the family to catch up or for the patient to go to their reward.

You are generalizing alot in this rant my dear nurse. You are using alot of stereotyiping and complain without offering solutions...not helpful. Nurses are guilty of some of the same stuff doctors do that is not nice. Ignoring patient's calls, concern etc. You dont like getting ignored by the doctor but yet you do same to patients. Anyhow... we are all human, and while it seems unreasonable that a doctor will not take you seriously or a nurse not respond right away to a patient...there are reasons and ways to correct the problem.

Often not enought specialists can be found to work in a given area and the ones that you may be hateful against are overworked...and the one night they are with family on a weekend and you call ..yes they may be resistent to respond to your needs. Furthermore...for every valid nursing pager call there are 4 calls for stuff that is irrelevant...cry wolf phenomenon...that desensitizes the MD on call. Again im guily of generalizing as well but just trying to show you that there are 2 sides to every story. In general "Humans" us in the healthfield belong in that category whant to do well, but we are falible like Plumbers, engeneers etc, make mistakes and have different personalities.

docman,

1) Saying that nurses are guilty of some of the same bad behavior physicians are as though that somehow excuses their bad behavior is faulty logic.

2) Blaming nurses for "irrelevant" calls is also specious logic. Physicians are paid the big bucks to make the calls, not the nurses. Perhaps it is their own greed that desensitizes them?

3) Saying that physicians are plumbers, engineers, etc somehow excuses their errors is also specious. Physicians bury their mistakes while plumbers repair theirs. It is a vastly different standard.

Physicians cannot have it every way. Either they are God-like or they are not. (And I will venture an opinion that they are not.) Physicians are a little too taken with themselves. It is especially evident when you consider that the vast majority of physicians do not even have a college degree of any kind --- just a diploma from a school (not a university and usually not a college) and a lot of OJT. They have the same overall qualifications as a lawyer, but insist on being called "doctor". A lawyer is only called "doctor" when testifying in court on a point of law. It's time we started referring to physicians as "Mr." except when engaged in the actual practice of medicine (as etiquette would have it.)

And it's time that physicians stopped complaining about their income as interns (above the national average) and residents (more than three times the national average) and how malpractice insurance is killing them and they are sooooo overworked.

And it is time that people started taking a hard look at easily preventable malpractice --- such as the hazing of interns and residents. Sleep deprivation is a legitimate form of torture and not a medical best practice. Hazing of interns and residents kills patients.

Medical malpractice, in the aggregate, is the fifth leading cause of death in this country and it is not even in the top ten in any other country in the world. Remember the Biblical injunction, "Physician, heal thyself."

I am not sure what you mean by the great majority of physicians do not have a degree. The great majority have a BS/BA and then 4 more years at a college or University it is called med school. The same as "law school" which is only 3 years anyway.

As far as salaries for interns and residents, they make about 40-50,000/yr depending on what year they are. For that they work on avg a 60-80 work week. I can't imagine that the avg American makes three times this working less hours. Assuming a resident makes $50,000 which is high they start lower and a 70 hour workweek avg this is $13 an hour probably less than the unit clerk.

I was an intern in the modern era, once. "Hazing" is long gone. There are fairly strict laws about intern/resident work hours, with serious consequences for violations. Medical training is not easy, and as an intern I did my share of long and exhausting shifts, but patient care comes first. I am now in practice and do not have a luxury of work hour restrictions, and I rely heavily on, not just the medical knowledge, that I acquired in my years of training, but also on the ability to function in high stress situations, the ability to think on my feet no matter what.

On the other hand there are still "old-school" docs out there that abuse interns and residents, but that is usually is in the form of yelling, humiliation, etc. But such practices are becoming less and less acceptable.

I think that people also need to realize that there is a reason we refer to doctors as 'PRACTICING MEDICINE' , in the same way that we refer to lawyers as 'practicing law'. They have a job in which one cannot always guarantee the outcome. Sometimes they do little and their patient recovers nicely. Sometimes they break their backs trying to save someone but the patient dies anyways. Sometimes people just have unrealistic ideas of what the medical profession can accomplish

And for steering clear of hospitals and doctors, that is nonsense. I do believe in living a healthy lifestyle...

That's all I was getting at so relax, ok?

annonymous-2011864

This notion that hospitals are more dangerous on weekends and nights is ridiculous...

You're probably right.

62 million cases analyzed over 27 years doesn't give the researchers enough information to be statistically significant.

We need at least another 50 million cases and another 20 years of statistics before we can draw any realistic conclusions.

This notion that hospitals are more dangerous on weekends and nights is ridiculous. I am an RN in an ICU for a community of roughly 100,000. The BEST nurses I know work on the weekends.

Nurses, yes. Doctors-- not usually. When I had my triplets, we had to wait more than an hour and a half for the surgen to come in to prep for a C-- I was already in hard labor by the time he showed up! They were supposed to be born planned cesarian. When my sister had her daughter, the baby was stuck and she'd been pushing for more than three hours. Why? Because (again) the surgen was not on-call when and where he was supposed to be. Both of them nearly died.

I thank God daily for the nurses I had in the NICU, each of them holds a special place in my heart for caring for my babies. Nurses are the unsung heros of a Hospital!

As an RN, I have way more important things to do than let some obnoxious patient demand I tell them the generic AND trade name of the drugs that they have been ordered. I'd tell you flat out "your NOT my only patient!" I don't know of any nurse that would let a patient pull that b.s. In fact, that kind of ungrateful, sarcastic attitude would put them last on my priority list. Because for every (thank god!) one of you that comes to my unit, there are still hundreds of other patients grateful for my knowledge and skill. And those are the patients I have compassion for! I don't have to prove anything to you. As for expecting a nurse to tell you how long they have been in practice....are you that stupid!

WOW...and all the nurses on this website harp on doctors. Learn to be nice to your patient and treat them like a customer...maybe if you set a good example for the MD's in training and nurses in training they will return the favor and answer patient questions, nurse questions etc. If I had a dime for every "Stupid" question a nurse asked me id be rich. Same for my coleague MD's and Patients. That does not mean I dont take a deep breath and answer the question. We all find moments in life to ask/do stupid things...and the read the arrogant crap posted by matruth and others here is nauseating.

And where are you, Mattruth? I'm asking so I can NEVER be admitted to anyplace you're working. I've known a lot of nurses over the years, and the ones with attitudes like yours are the ones who need to look up the meaning of "nurse."

docman,

Where do you practice? It would be an asset to be able to avoid your services.

why docman Chis, because he is telling the truth?

very scarey night nurses should do what day nurses do. I worked both shifts. That nurse should be reported and fired>How did you know she was watching t.v.? Are you sure you were not on medication ,confused??

Fred,

I'll tell you a true story that illustrates why not:

In 2004 NIH funded a study that would create checklists similar to those required to be used by pilots. These checklists would then be used in 16 different types of surgery to evaluate their impact on undesirable outcomes in a 5-year controlled study. Initially, the study was to be conducted at Emory University Hospital and 3 other locations. Even though fully funded, the study was opposed by the AMA, JCAH and numerous other professional medical organizations. It was the only study ever opposed by an editorial in JAMA (which reasoned that it was an infringement on physicians' treatment prerogatives.)

The checklists involved things like asking each person if they had scrubbed correctly. And asking each person in surgery what their role was. And checking ID bracelets. And verifying that the correct limb was being operated on. And making sure that every one was sober. Little things like that.

Lest you think that it is just something that I read somewhere, I knew the co-PI's (both MD, PhD's) on the study well.

Finally, the PI's gave up --- NIH was starting to get pressure to cancel funding and they were getting pretty desperate since they had so much time invested in the proposal. So they moved the study to one hospital in The Netherlands, and two each in Spain and Italy. They were not happy because the travel was going to screw their budget and none of these three countries has a particular problem with malpractice on a scale that exists in this country. So they were not expecting to see that much of a difference.

But they were astounded. The drop in adverse outcomes --- deaths, hospital-contracted infections, improper procedures, etc. was approximately halved. Even in countries that prided themselves on a high standard of care.

Despite their findings, the official opposition to surgical checklists remains in force. Not a single hospital in the U.S. has adopted them. But on the other hand, Canada, Britain, Holland, Belgium, Germany, Spain and Italy all did confirmatory studies and are in the final implementation stages. Several Scandinavian countries are now doing confirmatory studies.

And we wonder why we have such high rates of malpractice. This is a case where WE invented the model (and this is not a rare occurrence) but other countries have adopted it while we have not.

"Despite their findings, the official opposition to surgical checklists remains in force. Not a single hospital in the U.S. has adopted them."

I work in a 390 bed acute care hospital in Missouri. We have instituted surgical check lists, but also in-room procedural checklists. Additionally, the Joint Commission mandates a time-out for all invasive procedures that requires the types of checks mentioned in the article.

Yeah- every single hospital I have worked at has surgical checklists.

I second that! Surgical check lists are alive and kicking here in US.

Chris, you seem to be just full of misinformation and loathing for healthcare workers. What gives?

Earning a profit for medical services, food, or any other essentials for life should be considered morally wrong. Earning enough to live modestly is not wrong and should be considered acceptable. Hospital administrators, as with most middle and upper management in modern society, earn way more money than they need or deserve. Until we all realize that, the market will continue to favor the rich and gut the poor. According to this poster the poor deserve to die on the street with no medical care. Ask yourselves if you really want to live in a society that embraces that? Remember folks, capitalism does not equal democracy. Look it up.

This article is a report of a RETROSCPECTIVE ANALYSIS of admissions, deaths, etc. It statistically supports common hearsay among medical professionals that adverse outcomes are more common at certain times.

This article has NOTHING to do with health care reform. Please stay on topic. If you are looking for a political fight, at least admit it up front.

Oh, I wasn't aware the topic police were here. my bad. You want to take your analysis of what the topic should stay on to somewhere else that somebody cares?

boxermom, go live in England, Italy, or canada if you think medical care or dental care should be FREE. The care given by social medicine is AWFUL....and you do want to go to school for 4 yrs college, 4 yrs med school, and atleast 3 yrs residency and educational debts...and work for nothing???? get real...socialized medicine countries have private clinics for those who can afford it

So essentially boxermom, you are saying that anyone that takes years of their life to become physicians, clinical scientists, nurses, pharmacists...should look forward to doing that for what a person that didn't graduate high school should expect?? I suppose in your analogy it makes sense that someone that throws a ball through a hoop makes 20 million dollars a year but that brain surgeon should work for minimum wage because it is morally the thing to do?

Fine. But now tell me who is going to pay for that hospital, the millions and millions of dollars it takes annually to run it? The instruments, the reagents, supplies, beds, repairs, maintenance, operating costs like electricity, gas, water, etc. You? The government doesn't want to pay for it. The insurance companies don't want to pay for it. You don't want to pay for it. But magically it is supposed to just exist?

Just one of the products I have to budget for in my hospital is blood products. These save lives obviously. That costs this hospital alone over $50,000 a WEEK. If just once that product was not available, for any reason, and patient care was affected this hospital would be sued for millions. The state and federal agancies would be here in droves to penalize and or shut down this facility. Guess what boxermom, not one of those agencies have stepped forward to provide that product to this hospital free of charge.

It is not morally wrong to make a profit on healthcare services, food, housing or any other essentials for life. It is wrong to make EXCESSIVE profits on them, which is equivalent to price gouging. There needs to be some regulation. That said, healthcare, affordable housing, clothing, and food are not RIGHTS. No one deserves these things without working for them, unless they are disabled. In our constitution we are guaranteed the rights of 'life, liberty, and the pursuit of happiness', not to any material goods or services, of which healthcare is one.

Jon, what about the $1000 a month I pay to the insurance company in order to pay the $20 co-pay?

What you fail to point out Sean are the millions of people that do not pay. Have you ever heard of EMTALA? That specifically states that anyone coming into your health facility has to be treated regardless of their ability to pay. You are mandated by law to not ask any financial questions in an ED setting. So Sean, you pay yours, but millions don't. What do you do for a living may I ask? Ever think that upwards of 40% of what you do should be just provided for free? If not, why not? What makes you think what you provide should be exempt? Think your company could even exist if you did? I'm not "whining" Sean about insurance not paying. What I was pointing out is that what the public sees as what is billed is no where near what is paid, what the public doesn't see is the millions and millions of dollars of service that is provided free. And my biggest point is that every supplier to a hospital, be it the instrument manufacturers, MRI, CT, laboratory instruments, reagents, beds, medicines....on and on are not provided free of charge by ONE of those companies. Why not? Why don't they fit into this categorry of yours of what should be ethical?

I'm not just administrative. I worked the first 20+ years as a microbiologist. I became administrative to run departments and see the costs it takes to run them.

Okay mj, what do you pay in car insurance? House? Do you pay a deductible on any of those if you file a claim? Who do you pay that $1000 a month to? The hospital or an Insurance carrier?

Let me see if I get this right Jon Jones-

are you suggesting that your staff of Doctors and Nurses etc (the highly trained staff people) are the ones who pay for your hospital to run smoothly because they get the big paychecks, which in turn supports the reasons they make insane salaries? I am not saying that they should make a good salary, My Mom is a nurse, I worked in the medical field for over 10 years myself, however now on the patient side of things when I go to a hospital I get the bill for the hospital services and then the bill for the ER docs services, the radiologists services, the labs services and anyone else's services they wish to bill me all from separate places. Now lets say my stay was 6 hours, I think that was the length of my stay 2 years ago in the ER. My the bill for the ER part was well over $2500 billed to insurance my part was $500.00, not a bad deal at all, now the ER doc bill was $1500, billed to insurance my part was $300.00, the radiologists bill was something like $1200 my part was $ 240 after insurance, but that's not including the x-rays and CT-scan so those were priced out as well and sent to insurance and I had my part to pay, see the $1200 radiologists fee was just the charge for the radiologist to look at and read my x-ray and CT-scan films. Which took roughly 2/12 hours. so if we divide $1200 by 2.5 that equals - $480 dollars an hour, that's a sweet payload wage if you ask me. now if we take the ER physicians charge and divide that ($1500+$2500) divided by 6 we get - $666.66 yet another sweet payload wage, even after taxes not a bad wage. Though kind of an ominous number if you ask me. Now, I saw the ER doc for maybe 15 minutes 2 times, because the ER was busy, I highly doubt he was busy working feverishly on my chart or anything to do with me, there were a lot of other patients so understandably he was working with other patients. The nurse however was in my room all the time checking on me, (and no I wasn't calling her). I no for a fact the nursing staff do not get paid near as much as a doctor, but they do a lot of work, sometimes, they even give the doctor ideas, inspiration, I know I know it's hard to believe that an all knowing doctor would need inspiration or idea from a lowly nurse, but it happens.

As for overcharging, price gouging happens in the medical field. One of the other charges on my bill was a charge for $36 dollars, it was for the nurse who brought me a pill that I took myself. I think the charge was actually to pay for the plastic cup and the pill.

Hospitals, as you well know will find a way to charge for everything, including the air the patients breath if possible, one day I think the hospitals will design a way to measure the free floating air in the rooms in liters, or cubic feet , use some little gauge on the wall to calculate respiration's and the exchange of O2 to CO2 to figure out how much of the hospitals free floating room air the patient is breathing and that to will show up on the bill.

Oh and just as an aside, I was diagnosed with an STD, which was odd because my husband and I had been and continue to be in a monogamous marriage, at that time it had been for 5 years, the ER doc prescribed an antibiotic, which I did not take because I did not agree with his diagnonsense. So I got a second opinion as soon as possible because I was bleeding extremely heavily and feeling very weak. Within 3 days I was in surgery, the first ER doc had ping pong balls in his head. Perhaps it's the fact that I enjoy coloring my hair different colors or that I have a mental illness, but one look at me and I am not taken seriously, either way, the stuffy self righteous no-it-all demi-god doctors need to come down a notch before their egos try to kill someone else.

One more thing, when I worked in CSICU (open heart) at a prominent hospital in virginia, we had a head of cardiac surgery felt he was just so wonderfully intelligent (He was a very bright man) unfortunaltely he had a bad temper and a humongous ego to go with it. Throwing charts at nurses, CNA's and other staff was not out of the norm. BUt he was never fired because it was well known that he was part of the good old boys club, that unspoken immunity that many hospitals have, which pretty much only doctors are allowed into.

Our health system is fractured and bleeding, but as long as it bleeds green in the right direction, nobody who can stop the flow wants to.

What you fail to understand corpsman is that 80-90% of patients are paid on a DRG basis. That is Diagnostics Related Groups. That means they give you a set payment for a specific diagnosis. Doesn't matter whether that patient required 10x the treatment of the other patient with the same diagnosis, you get reimbursment of the same $ amount. The other issue as I stated above is in that ER setting 40% of the folks next to you pay zilch. Guess what any industry does if it wants to stay open? Bleeding green is about the furthest from the truth. Look around. Hospitals are closing in record numbers. I really wonder where all these entitled folks are going to go when there are none left in their communities?

Jon,

Okay mj, what do you pay in car insurance? House? Do you pay a deductible on any of those if you file a claim? Who do you pay that $1000 a month to? The hospital or an Insurance carrier?

I pay $500 a YEAR for car insurance with a $500 deductible and $425 a YEAR for home owner's insurance with a $500 deductible..... Healthcare.... $12,000 a YEAR with a $4000 deductible and a co-pay. If you don't like the amount you get paid from the insurance carrier.... drop them!!

Quite a story, corpsman. And Jon, I'm afraid you lose points on your counter. See, thing is, the hospitals may be failing and closing, but the DOCTORS and administrators are not going bankrupt, are they?

mj, how do you drop the only carriers in that field? So, you basically want the hospital providing coverage to your community to drop your insurance carrier so you can't go there. Am I correct in understanding what you want?

Maybe you ought to let your car insurance or homeowners insurance carriers save your life when you have the need. I'll want to come and watch when they do.

And for those who believe that health care is awful in countries with national health care, I have a real suggestion:

Instead of listening to the Limbaugh/Beck garbage, I would suggest that you go straight to the horse's mouth. There are a number of e-mail pen-pal sites on the web. These will hook you up with people in other countries with whom you can correspond via e-mail. This is great if you want to practice another language, but you will find that mostly it is people in other countries who want to practice their English and like many people are more comfortable doing it in writing (where they can take their time and use a dictionary) than face-to-face.

Sign up to be a pen-pal with people in Canada, Britain, Germany, France, Italy, Spain ---where ever. And ask them their opinion of their health care system. It would be good to be a little humble when asking because many of them are quite upset with the amount of misinformation (caused by ignorance) and disinformation (caused by lies) that have been spread in this country. You will find that the French, British, and Canadians are the most touchy since the most lies have been told about their systems.

But it boils down to one question: "Would you swap your system of healthcare for ours?" It is an easy question and many of you will be shocked by the answers you receive.

I always like to tell people where to get accurate information. But I am well aware that you can lead a horse to water, but you can't make him drink.

Yes I have Web as a matter of fact. My urologist said he had to just obtain a $200,000 loan to keep his office open because of lack of reimbursement by Medicare and Cal. Doctors are also leaving the field in early retirement in droves Web. Did you know that Congress has had a bill to reduce reimbursement rates to physicians by 21% that they have to continue to postpone for over two years now? This last one came down to the weekend before it was to go into affect. Have you EVER seen Congress or the Senate vote to decrease their wages by anything? 1% 2% god forbid 21%. They actually just gave themselves a raise by the way.

Chris, than give me a reason so many folks from Canada come down to the US for treatment? Why is that? Tell me their system of treatment. Is it Clinic based? How long are those clinics open? Weekends? Nights? What are your chances of being seen in an actual hospital ER with a non-life threatening emergency during those clinic closure hours? Good? what do they pay a heart surgeon who has put in 10-12 years of his/her life from med school to specialize. In any specialty actually. Give me the incentives to do that, and if you say it is the ideology of medical care, you do know our current generations ideolgy on what they expect, right?

Jon,

Sorry it took so long to reply, been quite busy lately. So, I think I am understanding what you are saying. The DRG, is that pertaining to just the diagnosis criteria or related testing to clump everyone in the same charging scale?

I don't believe that all the hospitals will close, we probably won't be left with no hospitals at all and no medical care at all, there will always be someone willing to do something, won't there. After all, if the medical field was in such peril, why would people stil1 be going to and being accepted into medical schools? It doesn't make sense at all, why continue to fill a dying career field? People will always get sick, always die, always need someone there to "tell them" what to do. That's what doctors seem to do best.

A very enlightened attitude, Geraldine. My sympathies regarding your husband. Would that we all had the same realistic approach to life AND death. More often than not, the aggressive measures are applied to folks who can't say "That's enough, stop, help me be comfortable and let nature take its course."

While it may seem like "old news," there are still many in the medical profession who insist it simply isn't true. Just scan many posts above from those who profess decades of experience in saying that patient care does not vary dependent upon the month of the year, day of the week or time of day.

Everyone on Medicare would be eligible for the same treatment afforded Cheney. No one is ever denied treatment solely because of age under Medicare. In fact, considerable Medicare waste is blamed on providing treatments, such as Aricept (the most common), that do nothing more than delay symptoms, in the aggregate, by around 5 months. At the end of the 5 months the Aricept is usually stopped and the rebound causes a sudden progression of the disease, negating all the benefit and perhaps some more besides.

The only reason that Medicare patients are denied things are, for example, when they are unlikely to survive an operation, or when "special provisions" exist, such as a physician who refuses to provide palliative care, especially pain relief, because of his/her professional "beliefs."

Doctors no longer prescribe the correct care - they only prescribe what the pharmaceutically funded medical schools teach - which is more pharmaceuticals. Doctors are not taught to "cure" disease - they are taught how to suppress symptoms using pharmaceutical medications. They are not taught how to find the cause of anything and they are so specialized and myopic in their approach they no longer see the person - they only see the organ system - not how it connects with the rest of the system.

I am so sorry for the passing of your mother. It should be noted that the $500,000 - $1,000,000 dollar bill to Medicare will be reduced to probably less than $50,000 reimbursement due to contractual agreements. Often times this will not even cover the costs of supplies used. Again, my condolences on your mothers passing

Mike, I'm sorry for the loss of your mother. I also agree with your comments regarding the runaway costs of healthcare. It should be illegal that the medical community gets away with charging whatever ridiculous price they want to charge for patient care. And the prices on medications? Forget it! I wish you and your family all the best, Mike.

And to the person making the snide comment before about people not wanting to pay for their care...you obviously have never been in the position of not being able to pay for it. Wait until you are...you'll sing a different tune...but you're probably better than all of us anyway, right? Jerk.

Mike-2012 I am sorry to hear about your mother, multiple myeloma is a devastating and painful disease I would not want anyone to have to end their life with. But to answer your analogy of what a plumber pays and a hospital, can you tell me the cost of that plumber to run his business? Does he have 100's of nurses on his payroll? Does he have hospital buildings that cost millions to maintain? How about MRI's, CT's, Laboratory instruments, computer systems..on and on that literally cost millions of dollars? I sit on the contracts committee in my hospital. Do you realize that just the maintenance contracts on all the equipment in a hospital costs millions? That is not acquiring them, it is just maintenace. Does a plumber have to do that? Or buy a new wrench?

healtcare pricing is out of sight because of the costs of what is required to run a hospital has gone out of sight. Do you think any supplier of material or product to hospitals has not increased their pricing 10 fold? Why does no one get on the case of these industries? To put it in one frame of perspective ONE unit of packed cells (blood) used to cost $150 each. It now costs $300. The budget for Blood products in this hospital went from $800,000 annually in 2002 to over $2.5 million in 2009 and rising. That is just that ONE cost. Everything else has risen along with it. What does everyone expect the costs of medical treatment to do?

Let me ask you this. If you continued to get raises where you worked on an annual basis you would think you were getting ahead, right? However, if your apartment rent went up annually, or your property tax, cost of food, gas, car...literally everything went up along with it, are you actually seeing any of that income increase? or less?

Mike, I am very sorry for your loss. AsI read I did notice that you truely cared and beyond most people's attention toward their loved one. A long time ago when the t.v. show called Marcus Welby M.D. was shown the doctor would usually mention a patient having something called a "constitution" otherwise known as "a will to live". I think that no matter how many tests that were run. Beyond your awesome intentions to extend her life, your mother gave up her will to live. Her intention probably was stronger to gain entrance into heaven than to continue here on earth. No matter how much everyone loved her. I hope that I have not offened you in any way.

Mike I am so sorry for the loss you and your family have now endured and of little consolation at the moment may well be your mom had a long and I hope wonderful life. I lost my wife of 25 years at her early age of 54 and took care of her in my home until the night she died in my arms. I too felt let down by our medical system and was raped of my life savings as Barb was un insurable and believe me the State (Minnesota) made dam sure I had nothing left in as much as they could find in order to pay with. Our medical system is now designed for the haves and for sure not the have-no-ts. I wish you and your family the very best. David

Hey, Jon! Are you at work now? Are you at your desk, in the hospital? Are you in a Committee meeting right now? Are you "administering" anything except justifications, rationalizations and excuses?

Since you are obviously on the other side of the fence from the vast majority of us who pay, and pay and pay for questionable care, dictated by the insurance companies to protect the doctors from malpractice, seems it'd be a tad difficult for you to see OUR points.

Be talkin' to you.........................Webrydr

You think I don't pay insurance premiums and use healthcare Web? How is that the other side of the fence. You think I like my premiums raised evey year? I just happen to have the advantage you don't, and that is to see it from both sides. Not one. I have no excuses or rationaliztions. I have the experience to see what it costs to run a hospital, and it isn't free. I do know, just like in anything else in american life, that if you are dissatified with anything, you don't have to use it or buy it. Especially if you think it is questionable in the first place. What's the loss?

I have encountered more arrogant doctors than I care to recount. Not only in hospitals, but in clinics as well. During one instance I developed acute abdominal swelling and lower extremity edema, I could barely walk because of my abdominal pain. I had no clue what was wrong but my abdomen was becoming very firm very fast. My husband called the doctors office I had been going to 3 times with no call backs, so we decided to go to U of M in Ann Arbor which was 3 hours away, mainly because the local ERs are untrustworthy worthy in our opinions for reasons that will take to long to explain here. So we get to U of M, get checked in all that and a CT scan is done, mind you I have had a TAH-BSO (which is a total abdominal hysterectomy with both ovaries removed) the CT-scan however showed some kind of mass where my left ovary should be. So the attending tells me "I don't think you're surgeon took your left ovary", since I have a history of PCOS and am on HRT because of my menopause symptoms I asked "what would happen if it is my left ovary in there, it obviously isn't working, I am having menopause symptoms" the doctor gave me this look like I was a complete idiot and said "well, women have ovaries ma'm, it's nothing to worry about" and he turned and left. Meanwhile there was no looking into why I was swelling up or anything, so, now, I have something where my left ovary should be, I'm swelling like a balloon, I'm hurting- bad, and my doctor's a pompous prick, fabulous the perfect recipe for me to go into classic raging b*tch mode and come unglued. After some time the doctor came back and had me sign a release form to get copies of my operative report from my hysterectomy. Within an hour he had them. He looked surprised, he said "well according to your report your surgeon did remove everything and both ovaries so I don't know what we are seeing."

I eventually went home after spending 12 hours in the ER, with no real answers. I then called my GP the following day, and explained to the nurse what happened, she said she would have my doctor call me back. About 45 minutes the secretary caled me back indicating I was being discharged from the clinic entirely, apparently the doctor didn't like the factr that I went over his head to U of M to get cared for, and I did not get a chance to say "well we paged the on call for the clinic 3 damn times with no call back" because the secretary was very abrupt and rude and hung up pretty fast.

So, suffice to say, in my lifetime, I have been brushed off my doctors so many times, I don't trust most of them, most of them have big fragile egos and the only way to get anything done is to kiss their butts and make them feel good about themselves and even then it doesn't guarantee they'll make the right diagnosis because they might just as well be to busy thinking about what a doctor they are mentally reciting their private mantra of " I am so awesome!"

Very simple corpsman, don't go to them. You do have that choice.

Jon Jones >>> Your arrogant no it all replies do not go unnoticed by us. Telling people they have a choice is an oxymoron. To compare a car or home costs to medicall expenses is stupid at best. Try comparing to the corporate profit margin of then and now of the suppliers ie: drug companies, Doctors, Hospitals etc. This should help inlighten you as to where much of this patient cost is incurred. Please do your home work before you sit to type and really get a life and try to find a heart. This is not OZ!!!! David

I appreciate very much the fact you realize this is not OZ David, so that means all of this healthcare does not magically appear in a poof by a guy behind a curtain. I'm still waiting for folks like you to tell me who is going to pay for the cost of this care when your federal government doesn't want to pay it, your private insurance carriers don't want to pay it, and obviously people like you don't want to pay it. You are very correct david, this is not OZ.

Give me your best plan on how to provide it than.

Jon Jones>>> Have to actually go to work for a little while and make sure my employees are making enough to cover their share of medical insurance and that my profit can still match theirs. But I will be happy to reply further if possible later on. Dialog is always a good start. David

And that profit is required to keep your business afloat and to put back into your business to maintain and improve it I am sure. Anyone that thinks hospitals are not also a business have not met the folks that work in hospitals and expect to make a living doing what they do just like anyone else. What might amaze folks is that hospitals have to make a profit so that they can cover their employees medical insurance, match retirement, etc. and they have hundreds to cover. Best of luck with your business.

OMG! Thank God you're okay!

Ah - we've now hit on the inherent problem in the US. We are no longer happy with a house, a car and a toy - we now have to have bigger houses, nicer cars and better toys.

I dont' know - my grand parents and even parents - had nice small homes, cars that always ran, vacations once or twice a year, clothes on their back and food on their table. To expect more than that - or worse yet - to assume you have a right to more than that is just plain arrogant.

Boxerman never once said that health care providers couldn't earn a descent living. But one does not need a 4,000 square foot home - that is waste and excess and if we've learned anything in the past couple of years in this country it's that waste and excess always come with a cost down the line.

If we'd remove the insurance industry from the supply chain in medicine - the actual providers could earn more while costing the patient less.

Kent 1984 said: "If we'd remove the insurance industry from the supply chain in medicine - the actual providers could earn more while costing the patient less."

Thank you, Kent 1984. I am not so young that I can't remember what medicine was like before health insurance: it was a direct exchange between a doctor and a patient where you got a service and paid at the desk when you left. (or was billed) Fees were affordable. Drugs were often dispensed from the office. Doctors lived in the communities they served, not in gated mansion developments at the edge of town like they do today, and had an incentive to do a good job and keep their patients happy otherwise they'd lose business and suffer the natural consequences for failure to do right. When an actual mistake was made we were more forgiving because we understood it for what it was based on known history; we did not have to wonder, like we do now, if care is being deliberately withheld because the insurer does not want to pay or we got the cheapest care over the most appropriate care or our care was "capitated" and the doctor was financially incentivized to offer nothing at all and wantonly let us go without. Old school medicine placed the individual first; "New Medicine" chants "the good of the whole herd over the individual cow" and truly believes "it is okay to sacrifice a few to benefit many."

Now, the insurance company acts as middleman and dictates to both sides, has wrangled control of the money exchanging hands and vacuums up the lion's share, has corrupted the doctor-patient relationship into what it has become today. Feeding that monster has driven costs up past what most people can afford. Doctors do not work for patients anymore, they work for the ones who pay their bills and who/what they have signed contracts with. "He who pays the piper calls the tune". In the medical industry's own trade publications concern has been raised about the infiltration of organized crime into the health insurance business; organized crime naturally gravitates toward money and there is big money in medicine and in controlling both sides of medical care. We can trust and depend on people who get to keep what they don't spend on someone else? Has that ever worked? As long as we keep feeding that monster, it is going to grow until it consumes us. It is almost there now. With the government overstepping its place and dictating we buy health insurance we've been committed to do business with organized crime and follow its agenda. We will all get to find out, in time, where this path leads us.

I have insurance and have always gotten the best care, and I bet Dick Cheney does not have any better than me. My best friend has no insurance and has gotten the best care also...he just signed up as a hardship case at a nearby teaching hospital. Please find out your your facts before making ludicrous and angry statements. Maybe you live somewhere that does not have many decent medical facilities.