Monday, September 19, 2005

The Pile of Babble

Once, a few years ago, after college and before medical school, I worked as a reporter at a daily newspaper in the Northeast. My career plans were well-known to my editors, and they gave me the paper's health beat. I had some good scoops -- tainted food, a pertussis outbreak -- and got my share of the general news beat -- hostage takings, vineyard openings. But my favorite thing was to write feature stories.

While I was working at the paper, the Institute of Medicine released one of the most quoted analyses of modern medicine in modern history. Called "To Err is Human," it laid out how up to 100,000 people each year are killed by medical errors. Now, notwithstanding the purists who say, that everyone who dies is killed by a medical error, that's a big number. And the reality, if you read the text closely, is that it's probably inflated from what any reasonable standard of error-related, or iatrogenic, death actually is -- many of the patients in question would almost certainly have died quickly no matter what modern medicine had done to help or harm them.

But one thing that was clear was that there were some serious problems with the way medicine was practiced. One of these was the way that much of medicine was still dependent on hand-written notes and prescriptions, which were immensely prone to error. Likewise, there was no standardized way to make sure that patients with certain diagnoses were getting standardized, well-established care -- things like making sure that patients who had heart attacks got aspirins and beta blockers. I wrote an article about doctor's handwriting and the trouble that pharmacists had deciphering it. That was about 6 years ago. Today's New York Times reminds us all that this problem still hasn't been effectively tackled.

I work at one of the finest medical centers in the world. We regularly approach the top of any given ranking system. We are surrounded on all sides by high-tech industry and information services corporations that sell the computing age around the globe. And yet when I write notes on my patients, I scrawl them on pieces of paper and stick them in a binder. When I write an order, I press firmly so as to make it through all three pieces of carbon paper, the least legible of which will be sent to the pharmacy. It's like stepping back in time, and I think it's criminal. Especially when some places have been working with paperless, or near paperless, systems for almost 20 years. How this level of disparity can exist at the highest levels of medicine, when its clear that the way we do business is actively harming our patients, astounds me...and doesn't surprise me at all. Medicine is among the world's oldest industries, and its momentum and trajectory are all but unalterable. And most doctors are totally uninterested in deviating from the path of the way things have always been done. They applaud one another for creating variations on a theme, but are not, as a type, likely to ever look anywhere but straight behind themselves.

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