How to stop hospitals from killing us

http://online.wsj.com/article/SB10000872396390444620104578008263334441352.html?mod=googlenews_wsj

by bmahmood • 14 years ago

153 96 14 years ago

online.wsj.com

nancyhua• 14 years ago

I feel sorry for everyone involved in this complex industry, no arena of which is aligned with the goal of people's long term health.

The common sense suggestions in this article are a good step towards improving things by increasing transparency and accountability via documentation but may not address the root problems.

greenyoda• 14 years ago

"A few years ago, Long Island's North Shore University Hospital had a dismal compliance rate with hand washing—under 10%. After installing cameras at hand-washing stations, compliance rose to over 90% and stayed there."

There's something seriously wrong with the medical profession if doctors only wash their hands 90% of the time, even if they know they're being watched. The words "reckless disregard for human life" spring to mind. How many deaths from infections per year could be prevented if hospitals just fired any doctors who didn't wash their hands? (Hospitals are a breeding ground for antibiotic-resistant pathogens like MRSA.)

Another interesting article is Atul Gawande's "The Checklist" [1] (later expanded into a book), which describes how the use of simple checklists, similar to those that pilots use, can prevent medical errors like operating on the wrong body part.

[1] http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_...

7952• 14 years ago

Great read, thanks.

"The tasks of medical science fall into three buckets. One is understanding disease biology. One is finding effective therapies. And one is insuring those therapies are delivered effectively. That third bucket has been almost totally ignored by research funders, government, and academia."

HarryHirsch• 14 years ago

Bucket 3 actually conflates public health and industrial safety. But one wonders where he got that idea from. There is ample research in public health, although perhaps not so much in the US, as a hospital or pharmco you cannot make money from it, and there is ample research on industrial safety as well. Airlines know a hell of the last thing - cockpit management, checklists, the works. I seem to remember Atul Gawande discussing this last item.

bryanlarsen• 14 years ago

"There's something seriously wrong with the medical profession if doctors only wash their hands 90% of the time"

It's not that they're failing to wash their hands 10% of the time, it's that they're not washing their hands properly 10% of the time. We don't know if the incompleteness is significant or insignificant.

InclinedPlane• 14 years ago

Exactly. And the previous problem wasn't that doctors and nurses weren't washing their hands, it was that they weren't washing them well enough. A quick wash as one might do before eating a meal is not the same level of washing as required for someone who has had their hands exposed to, say, MRSA or who is about to interact with a sick patient.

konstruktor2• 14 years ago

If that's what they actually checked, I can see doctors avoiding washing at the washing stations to not get caught with errors, which is even worse than getting it wrong. Talk about bad incentives...

However, I would consider bad hand washing almost as neglegient. It's really not rocket science

Alex391717• 14 years ago

Actually there is some (possibly) good news on this. The CDC guestimates that central-line associated blood stream infections (CLABSIs) declined by 58% in ICUs, from 43,000 to 18,000. While this is only a rough estimate (not a measurement) based on poor data, Provnost (the guy in the New Yorker article) did refer to the results as "the first national success we have for patient safety in this country." (So this is positive, but note the implication.)

The bad news is that the majority of CLABSIs happen outside of the ICU where there is no previous data. For these non-ICU settings, the CDC writes, "efforts to improve central line insertion might have limited impact." ("In 2009, an estimated 23,000 CLABSIs occurred among patients in inpatient wards and, in 2008, an estimated 37,000 CLABSIs occurred among patients receiving outpatient hemodialysis.")

Also, CLABSIs account for only a very small percentage of all hospital acquired infections.

Sources: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6008a4.htm/

http://www.ama-assn.org/amednews/2011/03/14/prl20314.htm

mcmatterson3• 14 years ago

I've worked in the healthcare field for many years, and have written protocols and supporting applications to measure practise standards around central line procedures (both in and out of ICU environments), and I can say quite definitively that while CLI infections as a result of procedural mistakes happen, they are not the low hanging fruit you think they are.

If I had to nominate three low hanging fruits with respect to medical errors, they would be:

- Hand washing. Colleagues of mine have researched and written extensively about this issue; study after study bears out the numbers people are quoting here. I'll source some references and reply with them.

- Positive patient ID. The high flying stories about operating on the wrong patient, or on the wrong limb are one thing, but much more sinister is the issue of mislabeled blood work, specialist reports that are delayed due to mismatched paperwork, and medication mis-administration (more on this later). The degree to which healthcare professionals operate in an environment of mislabeled, misattributed, and simply missing documentation is astounding.

- Medication Administration. A close colleague of mine has made a career around studying the practice of chemotherapy administration and the reduction of errors therein. The feedback she gets when presenting to practitioners is both very encouraging (they, of course, genuinely want to improve their practice), and also disheartening (very simple changes to process have simply never occurred to many front-line staff. They're consistently amazed that the idea of process improvement is even a thing).

If you've ever been in the unfortunate position of having to see chemo being (properly) administered, you get to see firsthand how rigorous process controls are supposed to work. Every bag that gets hung is triple checked via different calculation paths, every patient's identity is re-confirmed every time (even patients that have been on the ward for months), and every interaction with infusion pumps is double checked by at least two nurses after every action. It's a great thing to witness; it's just sad that it isn't the norm everywhere in healthcare.

firefoxman1• 14 years ago

Things like "Jiro Dreams of Sushi" make you realise how few people treat their job as a "craft" let alone a profession. I can't remember a single time in school being taught that what I should be striving for in a "career" is mastery, excellence, or to even take pride in my work.

When you don't care about your craft, stuff like this happens.

marshallp2• 14 years ago

The only real solution to healthcare is to reduce costs by eliminating hospitals/doctors altogether using big data/telerobotics/smartphones. Sadly, because of the AMA and FDA this innovation will have to occur offshore first.

daeken• 14 years ago

This seems deeply, deeply misguided. Let's say you eliminate hospitals -- where are you going to get surgery? Even if it's done by remotely controlled robots, it's not exactly going to happen in your house, since it's not a sterile environment. What about when you break your leg; do you expect a robot ambulance to drive up an treat you in your driveway?

Hospitals and doctors alike have to change to make things better -- more advanced technology, different business models, etc -- but throwing them away entirely is just downright silly.

marshallp2• 14 years ago

Yes, the robots should drive to your driveway in a bubble of sterility.

I'm not suggesting this happen by tommorrow, just that it is technically possible with the enough investment.

I'm just suggesting that when it comes to medical matters innovation is happening at a snails pace.

The aerospace industry manages to lose almost no lives, while the medical industry loses people left and right. There's something deeply wrong there.

Recently, Vinod Khosla suggested 80 percent of doctors are superfluous and medicine still operates in a voodoo magic kind of way for the most part.

anigbrowl2• 14 years ago

The US is rated worst among developed nations for this sort of thing: http://www.commonwealthfund.org/News/News-Releases/2005/Nov/...

I was in hospital following an accident last year. When I was discharged from the ICU the following day, the nurse gave me the paperwork for the patient in the next room. I didn't notice, being still rather beaten up by the whole episode - it was my wife who spotted it. For a 12 hour stay I ended up paying over $15,000, and then I hard to fork over an extra $90 to get copies of the medical record. On paper.

I'll take socialized medicine any day of the week. the private sector does a terrible job of healthcare.

Alex391717• 14 years ago

"I'll take socialized medicine any day of the week. the private sector does a terrible job of healthcare."

This. The average hospital patient is the victim of 1 medical error per day, and ~10% of those lead to death or permanent disability. So you could literally go into the hospital being perfectly healthy, and odds are that you'd be dead or disabled in little over a week.

edit: Ignore this, I was mixing two different statistics that, while both accurate, don't seem to be compatible. There is better data below.

shasta• 14 years ago

Are you serious?

javert• 14 years ago

But we already have socialized medicine. It's just that you have to pay for it.

anigbrowl2• 14 years ago

I would vastly rather pay through somewhat higher taxes. I was able to absorb the financial hit in this case, but was lucky that my injuries were relatively mild. But besides the financial side of it, the amount of administration the patient has to go through is absurd, not to mention the ethically dubious gathering of financial information and legal agreements from patients who are in shock or heavily medicated.

In countries where the government runs public health (in which I have worked as a medical aide, have a parent who has been a CEO of a national health organization, and have a sibling in medical practice - so I'm not pulling stuff out of thin air), hospitals typically seek to minimize the number of different doctors and nurses that interact with the patient, so as to minimize confusion, miscommunication, and of course cost. Here the opposite seems to be true, as if every doctor on duty felt obliged to provide (and bill for) their medical opinion. Now, I don't want to make a case on a few anecdotal data points, but my personal observations of my own and family members' treatment experiences over the last 10 years, supplemented with observations from friends who are paramedics, nurses and doctors, are that American healthcare is really wasteful and inefficient.

larrywright2• 14 years ago

"I'll take socialized medicine any day of the week. the private sector does a terrible job of healthcare."

Go find the nearest veteran and ask them about their experience with government-provided healthcare.

EDIT: I don't mean to say that this is true everywhere, but in the US it definitely seems to be the case.

zach2• 14 years ago

Uh, okay. My dad has been delighted with his VHA healthcare, if you demand anecdotal evidence. Statistically speaking, the Veterans' Health Administration routinely outscores private hospitals for satisfaction and is more cost-effective as well.

http://www.biomoda.com/presidents-column/june-presidents-col...

Certainly, the Department of Veterans Affairs itself is poor, and the facilities are dealing with a massive influx of new veterans, but the quality of healthcare in the VHA remains quite good.

_delirium• 14 years ago

I moved to Denmark about 1 1/2 years ago, and my experience has greatly improved over my American experience. Strangely, given the fears that government=bureaucracy, one of the #1 improvements has been that bureaucracy is much reduced. In the United States, even though I was covered under a group healthcare plan, it was much worse. Rules on in/out-of-network doctors were byzantine, rules on referrals were opaque, and billing was a goddamn mess: one hospital visit means dozens of separate bills from every specialist, which are often miscoded and require time on the phone to sort out (turns out anaesthesiologists don't know shit about medical billing).

In Denmark, it Just Works™: I got a health card on my 4th day after being in the country, and it covers everything. No anesthesiologist sending me a surprise $5,000 bill for something that should've been covered; no arguing over preexisting conditions; just professionals actually trying to do their jobs correctly, instead of trying to figure out how to screw me over or pass the buck to someone else.

krickle• 14 years ago

The US has basically the worst cost of healthcare to life expectancy rate out of all the first world countries. They're going to have to improve either of those statistics to even contend with socialized medicine.

tayl0r• 14 years ago

Anecdotal evidence ahead:

German hospitals make mistakes too, it's not just in the US.

My premature daughter was born in Berlin and she had club feet (which was already known since you can detect it from the sonogram).

Because our daughter was premature and had to stay in the hospital for 6 weeks, we couldn't go to the professional orthopedic doctor (who has treated hundreds of babies with club feet) since he was off-site. We had to let the on-site orthopedic doctor treat her.

Everyone at the hospital said, "He [the on-site doctor] is great, he has treated club feet before, he knows what he is doing." etc.

So, we let him treat our daughter for 6 weeks while she was the hospital. Every 3 or 4 days she got new casts on her feet.

When our daughter was finally released we took her to the real orthopedic doctor and he took one look at the casts and just laughed. "These casts look like they are from treatments from the 60s, this is not how anyone has treated club feet in decades." He put new casts on her and it was like night and day watching him work- he was a master at putting the casts on compared to the previous doctor.

The good doctor also said he has seen this happen many times before with babies from our hospital. They do the club feet casts wrong all the time and yet nothing ever happens. They don't improve, they don't get trained in how to do it, they don't even get told "DON'T DO IT" when no treatment would have been better than bad treatment. It's infuriating to know that these bad doctors can just keep being bad and no one does anything about it.

Our daughter also had to stay in the hospital for an extra day because they "forgot" to tell us we could take her home.

And these are just the mistakes we know about.

At least the whole experience was 100% free. No copays, no deductibles, nothing. I can't imagine how much all this would cost in the US.

tisme• 14 years ago

If the hospital has a feedback process you might want to make use of it to get them out of the 'he knows what he's doing' rut.

If nobody tells them they might continue to believe it. Likely they have your daughters case chalked up as a success.

Alex391717• 14 years ago

"If medical errors were a disease, they would be the sixth leading cause of death in America—just behind accidents and ahead of Alzheimer's."

This is wrong, it's at least the third leading cause of death. And realistically if you don't smoke and you exercise once in a while, medical 'oopsy daisies' are probably your #1 risk of death:

C.f. The IOM's report To Err is Human: http://wps.pearsoneducation.nl/wps/media/objects/13902/14236...

And then also read Lucian Leape's commentary in JAMA on why it is probably a huge underestimate: http://jama.jamanetwork.com/article.aspx?articleid=192842

(Leape is one of the authors of the original IOM report, and the report cites a lot of his own research, including his study estimating that only 5% of medical errors are ever discovered.)

C.f. also Barbara Starfield's estimate in JAMA: http://jama.jamanetwork.com/article.aspx?articleid=192908#RE...

Realistically, all of these estimates are at the low end. In fact most of them only count deaths in hospitals (and severely undercount them), when at least half of all medical errors are thought to happen at local doctors offices, plastic surgery clinics, nursing homes, etc.

C.f. also the CDC figures for Hospital Acquired Infections, which IIRC the IOM report doesn't count as being medical errors:

http://www.cdc.gov/HAI/pdfs/hai/infections_deaths.pdf

My personal rule of thumb is to avoid taking any drugs or getting any non-trivial medical procedure unless I've read at least three books about it. The problem is that all the papers published in medical journals are basically complete bullshit (except the occasional well-done NIH ones), which means if you want real information about a given drug then the only way to get it is to subpoena the FDA, or read a book written by someone who has.

The way drug approval works is that you need 2 tests demonstrating that the drug is better than a placebo, but you're allowed infinite tries to get there. So often a drug will be better than a placebo in only 2 out of 10 trials, but it will still get approved and only those two trials will get published in medical journals. And then those journal articles will have very little in common with the actual data from the FDA trials because the pharma companies completely spin it, which is why the vast majority of the most popularly prescribed drugs are not only no more effective than placebos, but in fact significantly worse when you look at the total quality/length of life.

grueful3• 14 years ago

I think one of the major turning points in the future will be to trigger a "space race" which makes a grand project of developing substantive improvements to medical care and quality of life.

There have been significant improvements here motivated by e.g. battlefield medicine, and great results out of academic or humanitarian labs, but much of our current work is stuck in a loop between patents and the FDA approval process. Good intentions aside, the system acts to motivate certain patterns of action in order to stay profitable and continue growing year-to-year which aren't optimal for our long-range interests.

How one would go about motivating such a grand project - I have no idea. Perhaps it's a matter of continuing to make such small improvements as we can until the system is primed for one giant leap. The road of progress was never a well-paved or straight one except in hindsight.

I think that small teams and open sharing of knowledge are both key ingredients. The amount of resources currently in play in medicine is staggering, but social systems tend to lose efficiency very quickly as they scale. Perhaps startup culture will be a key piece in making this happen, but the timescales involved in speculative medical research tend to be beyond the scope of the typical VC-backed endeavor.

derleth7• 14 years ago

> a "space race" which makes a grand project of developing substantive improvements to medical care and quality of life.

How about a "space race" to destroy destructive nonsense like homeopathy, anti-vaccine idiocy, reiki, and all of the other non-scientific crap people try to use instead of real medicine.

Getting rid of quackademic medicine would be a good first step.

http://en.wikipedia.org/wiki/Quackademic_medicine

http://www.sciencebasedmedicine.org/index.php/quackademic-me...

ippisl2• 14 years ago

At the academic level , there seems to be a "space race". Maybe it could be improved by making the NIH invest in more radical high risk stuff.

But the commercialization process sure sucks. Testing and verifying a drug is expensive, long and complex. But there seem to be some work going to improve that:

1. The FDA is becoming a bit more friendly[1]. 2. There are some new innovations in how to run clinical trials. One example is [2].They claim they might bring drugs 1-3 years faster to market. 3. Organs on a chip are starting to become available and this might be more accurate than the mouse models used today.

Since some of the new innovations in clinical trials do use web/mobile technology, i wonder what role startups can take in this area.

[1]http://www.xconomy.com/national/2012/09/10/the-fda-turns-fri... [2]http://disruptiveinnovationsinclinicaltrials.blogspot.co.il/...

agumonkey• 14 years ago

I was just wondering if there was or were companies like google or spacex/tesla for medicine. One that do away with the status quo. Things like chuck pell opener http://www.youtube.com/watch?v=txVM07D4bbA . And aiming at a smaller 'time to market', practical effects.

gizmo686• 14 years ago

When you say subpoena the FDA, do you mean that you need to get a court order compelling the FDA to show you the results?

Alex391717• 14 years ago

I meant filing an FOIA request, my bad. From what I hear the FDA is usually pretty good about complying with requests for basic results, so a court order shouldn't be needed most of the time.

jonchang5• 14 years ago

> The way drug approval works is that you need 2 tests demonstrating that the drug is better than a placebo, but you're allowed infinite tries to get there. So often a drug will be better than a placebo in only 2 out of 10 trials, but it will still get approved and only those two trials will get published in medical journals.

This is incorrect. All clinical studies must be registered before they are started, precisely so that negative results are reported.

Alex391717• 14 years ago

That's wrong. They are registered so that they can't hide the data from the FDA. But once the FDA has the data the drug companies aren't required to publish it anywhere, nor does the FDA publish it themselves.

gruseom3• 14 years ago

You say "reported", but that's ambiguous. The question is, are all registered clinical studies published? If they are, why did Kirsch and Sapirstein have to sue under the Freedom of Information Act (and wait years) to see the unpublished studies of antidepressants?

http://www.thedailybeast.com/newsweek/2010/01/28/the-depress...

ivix• 14 years ago

The NHS already provides this data:

https://indicators.ic.nhs.uk/webview/

The spreadsheet:

http://indicators.ic.nhs.uk/download/SHMI/July_2012/Data/SHM...

Sadly, you can pretty much guess the results. Poorer areas = higher death rates.

w1ntermute• 14 years ago

In an industry as tightly regulated as medicine, it's not surprising that such enormous inaccuracies have not been worked out. No matter what medical professionals might say about wanting to save people's lives, the ubiquitous motivator of economics is a much more powerful incentive. Unfortunately, since the industry is not open to being influenced by the free market, it will be very difficult to break into the industry and jump start that innovation.

It will be very interesting to see if developing countries manage to leapfrog our current system and establish a medical industry that is less dependent on people.

rayiner• 14 years ago

But the malpractice lawyers are terrible! Tort reform!

mkopinsky• 14 years ago

You joke (I think), but tort reform actually has the potential to enable/encourage some of what is mentioned in this article - when mistakes are something that we can't even talk about for fear of gazillion dollar repercussions, it's hard to do anything to fix the problem.

lostlogin2• 14 years ago

It would be interesting to see stats compared between 'socialized' systems (we call it the public system) and private systems. When everyone has the same boss (Minister of Health) and is working within the same rules and guidelines it must do something to the stats. We do have a private healthcare service, but its basically restricted to simpler day stay (or slightly longer stays) surgery and less complex procedures. There are no private emergency healthcare hospitals here that I know of. New Zealand is the country. The system is far from perfect here, but I'm yet to learn of a system I'd prefer.

bryans• 14 years ago

It's amazing how easy it is for tiny mistakes to result in serious consequences.

I have a medical condition that took over two years to officially diagnose. During one of my hospital stays toward the beginning of that ordeal, a doctor had decided that my issue required major surgery involving the removal of an organ. Less than one day before the scheduled surgery, the doctor decided to do "one more test" for an easily treatable condition. As it turned out, he had misread a previous doctor's note suggesting a possible diagnosis, as a dismissal of the diagnosis.

I'll never know whether the confusion was due to poor handwriting or poor attention to detail, but I feel lucky that the error was caught in time. I met multiple people during my numerous, lengthy visits whom I suspect were not as lucky.

tokenadult• 14 years ago

From the submitted article:

"Nothing makes hospitals shape up more quickly than this kind of public reporting. In 1989, the first year that New York's hospitals were required to report heart-surgery death rates, the death rate by hospital ranged from 1% to 18%—a huge gap. Consumers were finally armed with useful data. They could ask: "Why have a coronary artery bypass graft operation at a place where you have a 1-in-6 chance of dying compared with a hospital with a 1-in-100 chance of dying?"

"Instantly, New York heart hospitals with high mortality rates scrambled to improve; death rates declined by 83% in six years. Management at these hospitals finally asked staff what they had to do to make care safer. At some hospitals, the surgeons said they needed anesthesiologists who specialized in heart surgery; at others, nurse practitioners were brought in. At one hospital, the staff reported that a particular surgeon simply wasn't fit to be operating. His mortality rate was so high that it was skewing the hospital's average. Administrators ordered him to stop doing heart surgery. Goodbye, Dr. Hodad."

So we have a known model that improves results. Let the patients who decide which hospitals to visit know beforehand how hospitals compare in getting good results for patients. Give patients power to shop. That provides incentives for hospitals to do better, and nudges hospital managers to do what is necessary to win the trust of informed patients.

This kind of reform would be very good to apply to schools as well. Already, one state in the United States that is conspicuous among all fifty states in educational achievement (the state I live in) allows all residents of the state to enroll in the public schools of ANY school district anywhere in the state. (The school district I live in has inbound open-enrollment students from the geographical territories of forty-one other school districts.) In general, the power to shop is the incentive factor to bolster by government regulation, letting each consumer decide what trade-offs are important. That works considerably better in driving improvement than regulating outcome goals, and better still than regulating inputs into the provision of the important service being regulated.

jonah2• 14 years ago

Real data and informed consumers are a very valid way to promote improvement through "competition".

Often times though, that's not enough as is the case in LA right now where patients are being prevented from using the best doctors:

Two of the most prestigious names in Southern California healthcare — Cedars-Sinai and UCLA — are getting shut out of a major insurance plan for being too expensive.

In a bold cost-cutting move, Anthem Blue Cross has eliminated doctors affiliated with the hospitals from a health plan offered to about 60,000 employees and dependents at the cash-strapped city of Los Angeles.

The city opted for Anthem's plan because it will save $7.6 million in annual premiums next year by excluding physicians from the two institutions known for tending to the Southland's rich and famous. About 2,200 city workers and family members are expected to lose access to their doctors under the plan.

This dramatic step shows that even some of the most-respected names in medicine can't get by on reputation alone at a time when the U.S. is grappling with a $2.6-trillion healthcare bill annually. Major hospitals and medical groups face growing pressure to justify their charges. And employers increasingly are willing to risk the ire of workers by cutting popular providers to clamp down on costs.

- http://www.latimes.com/business/la-fi-hospital-costs-2012092...

makomk• 14 years ago

Reporting death rates does give hospitals an opportunity to reduce them, yes, and one way they might that is to get rid of unsafe surgeons and fix unsafe practices. Unfortunately that can only reduce death rates so far - they're also affected by the number of high-risk cases the hospital takes on. So it turns out that reporting these statistics gives hospitals a financial incentive to turn down, drive away, or otherwise prevent and discourage high-risk patients from obtaining medical help.

konstruktor2• 14 years ago

That's how home births get their low mortality rate: Midwives (luckily) just send all the high risk cases to hospital, and even a cancelled home birth where the actual birthing happens in the hospital would count towards the hospital's mortality rate.

adrianbye• 14 years ago

the problem is this method encourages hospitals and doctors to avoid taking the difficult cases.

lets say you have a complicated problem which only has a 25% success rate. but due to these statistical models, nobody will do the procedure for you, since it will skew their results. what do you do?

Ntrails• 14 years ago

Can you not simply modify the way in which you calculate the statistics?

Since doctors tend, as I understand it, to state the expected success rate to patients before surgery - this could be used as a factor in the reporting.

A more confident surgeon might be willing to quote a higher success rate, which would attract more patients (or patients willing to pay more) but would be more punishing were he shown to be incorrect.

Obviously this is very vague, and whilst I work with statistics I don't deal in medicine. But the difference between a surgeon/hospitals success rate and the expected success rate seems like a good measure of competence?

Riesling• 14 years ago

The current state of medicine is extremely frightening.

Note 1: My comments here relate to the German health system, with which I am most familiar with, but I assume that other systems work similar, if not less efficiently.

In my opinion, there are many other problems in the broad field of medicine, but the following two points could be resolved with the support of IT, so I will confine my remarks to those.

1. Plausibility checks

Virtually no plausibility checks will be carried out in todays hospitals. Often conflicting drugs are prescribed, which produce uncomfortable side effects. One should start to make all medications and treatment measures subject to automatic (computer based) plausibility checks. This would also lead to a cognitive relief of the clinical staff.

2. Statistical evaluations (data mining)

The lack of inadequate statistical analysis is another concern. Germany has begun to build a national cancer database only this year. One can only imagine what valuable information is hidden in those statistics and have been missed up to this day. Imagine an international database in which all patients who are admitted as an emergency to the hospital are captured statistically. This data could be stored completely anonymous. The only thing of importance would be the provision of relevant laboratory values and the patient's symptoms described in the context of the (verified) final diagnosis. Such a system could support the finding of completely new knowledge (data mining) and support the doctor in finding the right diagnosis.

And of course the hospitals need strong incentives to implement these measures. Which is why I support the author's call for absolute transparency.

How to stop hospitals from killing us

Related Stories