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Thursday, April 22, 2010

Long, full and joyous: Don Berwick and the pursuit of health

On Monday, Pres. Obama formally nominated Dr. Donald Berwick to be the Administrator of the Centers for Medicare and Medicaid Services.

At a recent conference of the Institute for Healthcare Improvement, Don described health care as a means to an end. "Health care has no intrinsic value, none," he said. "Health does. Joy does. Peace does….The best health care is the very least health care we need to gain the long, full and joyous lives that we really want. The best hospital bed is empty, not full. The best CT scan is the one we don't need to take. The best doctor visit is the one we don't need to have."

This was a tough message to hear for the hospital leaders who comprised most of his audience. But Don has never shied away from delivering tough messages clearly. That quality makes him a good choice for this impossible job. Perhaps Don's greatest virtue in this context, however, is his single-minded focus on a single vital aim.

Health in its fullest sense is our goal. Health is far from the absence of disease, which is usually the way it has been defined in medical care settings.

Even early detection isn't good enough. Better is the prevention of conditions that leaves us whole, without the need for medical procedures like biopsies. That will take an enormous transformation of our healthcare system. Don, I salute you, and I'm reporting for duty!

Thanks to Robert Pear for the source story in the April 20 issue of the New York Times.

Thursday, April 15, 2010

If you have a family member in the hospital: Rapid Response methods

Our Rapid Response Work Group of the Consumer Health Quality Council of Health Care for All will encourage insurers in Massachusetts to publicize an important message to their members throughout Massachusetts. We hope they'll tell people how they can call for a Rapid Response method or team in the hospital, if needed, to rescue a family member whose health is suddenly deteriorating in the hospital. We hope they'll include it in their print and e-newsletters and emails to their members.

The announcement will alert people that certain warning signs often precede, by several hours, a usually fatal heart attack or respiratory arrest in the hospital. "Failure to rescue" is one of the most common causes of in-hospital deaths, so this could save many people's lives.

The announcement reads like this:

Have a Family Member in the Hospital?

Be aware that certain signs can warn that a heart attack or respiratory arrest can occur in the next few hours:

A sustained noticeable change, either an increase or decrease, in their:

Breathing rate;

Heart rate or Pulse; or

Blood pressure;

Or if they experience Confusion.

You can ask the nurse about the specific criteria your hospital uses.

If you see that your loved one is experiencing one or more of these signs while in the hospital, you can insist that the hospital respond promptly with a "Rapid Response Method" or a "Rapid Response Team." That's a new state law (Chapter 305 of Massachusetts General Laws), and is required by the hospital's accrediting body, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

Non-Massachusetts residents should realize that you, too, can call for a Rapid Response, per the JCAHO regulations, even if you don't have a state law requiring it.

Read another story about rapid response teams.

Wednesday, April 7, 2010

The paternalism is a little more kind-hearted now: Patient's participation in medical decision-making

David Leonhardt tells this story in his column today:
Dr. Dale Collins Vidal, a reconstructive breast surgeon at the Dartmouth-Hitchcock Medical Center, told me a story about a patient's husband who asked to sit in on the medical team's discussion of his wife's case. The doctors said no, because they were uncomfortable with him knowing about the uncertainty surrounding the case. "The paternalism is a little more kind-hearted than it was in the past," Dr. Collins Vidal says, "but it's still paternalism."

As a rule of thumb, Don Berwick suggests "nothing about me without me." This fails the test.

Advice: Patients and their spouses need to learn about the uncertainty that usually accompanies the decision the doctor is making. If this is impossible during a hectic, scary time in the hospital, get a professional patient advocate to help you understand your choices. The alternative is to leave key decisions to well-meaning strangers who don't know your loved one's values and preferences.

Thanks to David Leonhardt for the source story in today's New York Times.