"Fixing" our healthcare system...

[Firethorn]

Should the second surgery be done at no charge?  These are not always clear-cut situations.

Given what they charge, how about a surcharge on the first surgury to cover the expected instances of needing to perform a follow up surgery?  They already do it for things like Lasik - where a follow up visit is authorized.

In the spleen case, assuming there's a 20% chance of having to reop, charge each surgury 1/5 the cost of a followup.  Bill it as a complete service, not the split up into 500 parts thing they tend to do now.

[BridgeRunner]

Some complications are unpredictable, some complications are non-negligent error (follow procedures and safeguards and still mess up, perfectly reasonable), but a whole lot of complications may be due to pre-existing problems.  The guy on blood-thinners because of his "lifestyle" induced heart disease is more likely to have post-surgical bleeding.  Someone with poorly controlled diabetes (and many incidences of poorly controlled diabetes are due to not bothering) is gonna take longer to heal, upping the chances of complications.  Out-of-shape and fat people are more likely to have many kinds of complications. 

Why should the healthy and proactive people have a surcharge to cover complications that are far less likely to occur to them? 

[MillCreek]

I forgot to mention in the sponge case cited by Tallpine: during surgery, the surgeon relies on the OR nursing crew to do an accurate count of sponges, needles and instruments to make sure nothing is left behind.  Depending on the surgery, once a sponge (which is simply a piece of gauze) becomes soaked in blood and stuffed into a corner somewhere, it can be very hard to see.  It is not like there is a pristine white piece of material sitting there that is plainly visible.

So who should pay for that second surgery?  The surgeon was relying on the nurse to do her job and make sure nothing was left behind.  Should the nurse pay?  Should we deduct the costs of the second surgery from her paycheck?  Should the nurse lose her license and have to find another line of work?

[Tallpine]

I forgot to mention in the sponge case cited by Tallpine: during surgery, the surgeon relies on the OR nursing crew to do an accurate count of sponges, needles and instruments to make sure nothing is left behind.  Depending on the surgery, once a sponge (which is simply a piece of gauze) becomes soaked in blood and stuffed into a corner somewhere, it can be very hard to see.  It is not like there is a pristine white piece of material sitting there that is plainly visible.

So who should pay for that second surgery?  The surgeon was relying on the nurse to do her job and make sure nothing was left behind.  Should the nurse pay?  Should we deduct the costs of the second surgery from her paycheck?  Should the nurse lose her license and have to find another line of work?

Businesses are normally responsible for the actions of their employees, unless the employee is acting totally outside the line of duty.  If XYZ Moving Co. driver backs a truck into my car, then the company and their insurance company have to pay for it.  The company then either reprimands or fires the driver.

Most medical malpractice suits are probably unwarranted.  But then there are the horrible exceptions.  What I've heard is that when a doctor screws up, the hospital often sends him down the road with a recommendation letter to get rid of him 

[Marvin Dao]

Or how about we don't let any fool with a few thousand dollars be a doctor. Really. I have seen some very incompetent doctors recently. Almost like it has become a good ole boy network instead of a healing profession.

Truth is, the situation is nearly the exact opposite of what you're describing. Entry into medical school is very competitive, especially in the current economy. The good ole boy network has also been taking serious hits with female medical school entrants outnumbering males in some recent years and a strictly enforced minority quota.

Really, the shortage of doctors, lack of competition, and lack of transparency is what drives standards of care down. The shortage is a result of intentional planning to reduce competition in the field. Now, not only are they not training enough physicians to meet demand, the practicing physicians/patient ratio is declining. Part of this is due to the fact that old doctors are retiring earlier and female doctors work significantly less hours and have much shorter careers. As a result, doctors are in high demand, regardless of skill. This allows even the most incompetent doctor to make a pretty damn good living as long as they can still pass their state licensing exams. Not that skill in a doc is an easy thing to evaluate in any case. It's pretty much a crapshoot based on word of mouth and figuring out what the jumble of framed papers on their office walls mean.

[yesitsloaded]

Not that skill in a doc is an easy thing to evaluate in any case.

Usually when they kill patients with stupid mistakes it isn't that hard.

[Marvin Dao]

Not that skill in a doc is an easy thing to evaluate in any case.

Usually when they kill patients with stupid mistakes it isn't that hard.

You'd be surprised at how hard that is to pin on the doc.

[yesitsloaded]

Hard to pin doesn't mean hard to find out. A decent portion of my family is in the medical field. My mother even teaches medicine. Trust me, there are a lot of screwups. Most of it is medication related.

[BridgeRunner]

Most of it is medication related.

Opening up a whole 'nother can of worms.  A great way to cut costs in healthcare would be for doctors to follow protocols for prescribing medications, to do some testing and retesting to determine need for, efficacy of, and continuing need for medications.  Maybe not to automatically go for the latest and greatest (and practically the same as last year's latest and greatest) drug out there that the rep convinced them was just the niftiest thing since sliced bread. 

I like my doctor a whole lot.  But what she doesn't know about the five hundred bucks' worth of medication she has me taking every month could, and does, fill a couple textbooks.  Maybe doctors should work more closely with pharmacists.  Maybe the patent expiration system needs changing so that companies aren't constantly looking for ways to reinvent the wheel in order to stay profitable.

I'm not sure how, but I know that huge part of the problem is expensive drugs and the way they are prescribed: generally with very little regard for side effects and interaction, often several kinds of drugs that may or may not work be necessary or work well together. 

[drewtam]

From an engineers perspective, sounds like we need to do an 8D on this problem. It sounds like we have hazy idea about what the problem is, we don't have good cause and effect analysis, but everyone wants to jump to solutions without looking at the problem statement and cause and effect criteria. A good "fish bone" diagram is a part of the process that will help with the cause and effect analysis as well as identifying root cause(s).