Monday, July 6, 2009

Profoundly Ignorant

Former Treasury Secretary Paul O'Neill (no, not the unlikable retired New York Yankee outfielder, although both have about the same credibility when it comes to health care reform opinions) has a curious op-ed in the NY Times today. According to Mr. O'Neill, we don't need more entitlements to fund health care reform. The financing solution is simple; just make those damned doctors eliminate all hospital related infections and errors, the bastards!

The president says he likes audacious goals. Here is one: ask medical providers to eliminate all hospital-acquired infections within two years. This is hardly pie in the sky: doctors and administrators already know how to do it. It requires scrupulous adherence to simple but profoundly important practices like hand-washing, proper preparation of surgical sites and assiduous care and maintenance of central lines and urinary catheters. With these small steps, we would no longer have the suffering and death associated with infections acquired in hospitals and we would save tens of billions of dollars every year — money we should have in hand before new health-care entitlements are enacted.


These are the shark-infested waters we swim in these days. We're either greedy or careless. Either way, kill all the doctors (in the revisionist, postmodern Shakespearean rewrite).

23 comments:

Anonymous said...

...starting with replacing white coats with scrubs.

Brits are already implementing the protocols. Americans bitch on.

The Happy Hospitalist said...

If you can tell me how to eliminate out of hospital infections, I'll tell you how to eliminate in hospital infections. I'm thinking John Travolta and the bubble boy need to make a tour across the US explaining how easy it is to avoid infections.

Buckeye Surgeon said...

Anon-
Being an advocate for implementing practices that decrease infections is one thing. Pompously declaring that doctors and hospitals need to eliminate all infections within 2 years is quite another. It's so laughable and uninformed, it's almost shocking. Scary that O'Neill is able to spout such nonsense from the NY Times platform...

HHo- As long as Travolta doesn't bring his buddy tommy cruise...

Anonymous said...

Some of us are borderline paranoiacally anti-Fed. That's understandable, but is it reasonable?

Credit to whom credit is due.

platensimycin said...

If you really need to find someone to blame, blame industry.

"What one person calls waste, another calls income" (article)

rlbates said...

Happy, I agree!

Frank Drackman said...

It's like the Mice trying to put the bell on the Cat... How are you gonna make the Bacteria wash their hands???? Even if you put in really tiny soap dispensers... Idiots...

Anonymous said...

O'Neil's claim to fame was perfecting the business practice of rolling aluminum from giant ingots into product ordered by Boeing and Renold's Aluminum Foil.

This process is done on a massive scale on the banks of the Mississippi River in Iowa. The only casualties are the River Eco-System and the massive air pollution. There are legends describing the catfish near the warm water outlets of the Alcoa
water disposal sewer outlets.

O'Neil was fired from the Bush Administration for being a loose canon. He was not a good fit for a political position, because his only life-experience was either being in charge or rising to a position of being in charge. He hit a brick wall reporting to the President, and was almost literally body-slammed out of office due to his lack of loyalty.

O'Neil commenting on infection rates of "central lines" (which he probably first read about the suspenseful stories in Atul's first book), is as absurd
as Dr. Buckeye weighing in on the best alloy and annealing processes to avoid aluminum fatigue in aircraft structures.

As an aside....

An area similar to medical errors is aircraft airworthiness. Their diagnostic procedures have
analogies to the medical profession. Once you inspect an aircraft component, and certify it "good" (disease free?), that component is good for another N flights of compression/decompression.

This is all good, but the problem is that defects
are missed in the certifying inspection. This is what led to several disasters (Aloha flight 243 and UAL 232 ) Both missed key defects.


How is O'Neil going to address human error, that even if decreased to 0.01%, amounts to a significant number when you multiply it by the number of examinations performed every year.

He does not understand that the only way to drive
errors and undesirable outcomes to zero, is to fund a system designed to do so. Can you imagine the specifications?

It would amount to plugging 300 million people into a reliability failure model. To produce zero
failures overall with 300 million components,
would require a "per procedure" failure rate well below (1 - 0.9e12)

Ain't gonna happen in any universe we live in.

O'Neil is beyond his scientific reasoning capabilities. He should stick to running aluminum rolling mills.

Anonymous said...

It gets to be a little unnerving when the media and the public start touting your profession as the source of all the world's problems. Sort of like when the insurance industry enlisted the help of doctors to scream about a "malpractice crisis" and held all lawyers up as boogeymen. Now that tort reform is in place in many places, and your malpractice insurance rates haven't lowered, you can see the real problem was the insurance industry, not lawyers. People will come to realize doctors are not to blame for the health care crisis, too, but not until it is too late.

Anonymous said...

Buckeye,
Just a couple of links in reference to the air disasters in my previous posting.

http://www.aloha.net/~icarus/index.htm

http://www.airdisaster.com/special/special-ua232.shtml

These narratives rival those of Atul's corresponding white-knuckle stories of issues with the medical profession.

The analogies and learning are there for the taking.

Trader Bob said...

Who is anonymous? If you have something to say show your face? Whether you like it or not reimbursement will be cut and taxes will increases period.

Trader Bob said...

From Denniger at Market Ticker
Health care "reform" is the current hot-button, with the Obama administration now talking about a "public" health-insurance system to "keep the system honest."

Uh huh.

Look folks, you want to know why we have the health cost problems we have? I'll lay it out for you - in a way you can't refute or argue with:

There are no published prices. In no other line of work is it legal to do this. Nowhere. You can't sell someone a hot dog and tell them after they eat it what it just cost them. You can't hire a lawyer and have him tell you "I'll tell you what this will cost when we're done." You can't hire an electrician and have him tell you "I'll make up a bill when I'm done." In every line of work except health care, this is illegal. There are even laws

Trader Bob said...

Bush fired Paul O'Neil because he told the administration they shouldn't run budget deficits. At some point the United States could end up like Argentina and have huge inflation. The United States at some point will have to live with in its means.

Anonymous said...

"E.U. Warns Drugmakers on Blocking Generics"

This is what [good] Government should do. Who else has the muscle and jurisdiction necessary to wrestle with Big Industry?

SuperBadJack said...

"E.U. Warns Drugmakers on Blocking Generics"

This is what [good] Government should do. Who else has the muscle and jurisdiction necessary to wrestle with Big Industry?

July 8, 2009 1:11 PM


---

Yeah! Screw them!

Screw them out of their profits so when it comes time to research, develop, test and bring to market a new drug, that costs in the billions, they'll....oh....wait.

Anonymous said...

"Lawmakers Are Warned [by two Economists] Against Expanding Fed’s Power" (article)

In such contrast.... Without the necessary ballast, American consumers will always fall prey to practice of unbridled enterpourship (or do we prefer to call it the "free market").

Anonymous said...

Interesting reaction, SBJ.

You do realize what "blocking generics" mean, don't you? It means instead of selling generic baking soda (sodium bicarbonate) for $0.99 per box, they pull the product off the shelf and sell GNIKAB Ultra at $39.99 per bottle.

Perhaps it only matters if you are on the receiving end of the counter.

Anonymous said...

In Europe, industries like Pharma are fined heavily for violations; in US, Pharma gets tax reduction for running ad on various media outlets.

Now the tide is changing - you can see how some parties feel as if they have been run over by a truck as their privileges get reduced.

"TV Networks Go to Bat for Drug Makers (and Themselves)" (WSJ)

tom said...

Odd that the Governments perception of everything negative that happens in a hospital is:
a. Avoidable
b. The fault of either the doctor or the staff
c. Has nothing to do with the well being of the patient BEFORE they arrived at the hospital

After 30+ years in the business Ihave yet to meet a physician or hospital employee that has started their day by saying' Today I will infect someone"

tom said...

Odd that the Governments perception of everything negative that happens in a hospital is:
a. Avoidable
b. The fault of either the doctor or the staff
c. Has nothing to do with the well being of the patient BEFORE they arrived at the hospital

After 30+ years in the business Ihave yet to meet a physician or hospital employee that has started their day by saying' Today I will infect someone"

Bongi said...

we must smite those evil surgeons.
everyone, to the pitch forks and burning torches!

Anonymous said...

Some clinician should write a post on their encounter with

[eg.] Pseudomonas aeruginosa

to let people know just how difficult (if not impossible) it is to prevent nosocomial infection 100% of the time. Link one & two.

Anonymous said...

“Doctors are very individualistic,” said Representative Michael C. Burgess, Republican of Texas and an obstetrician. “We all think we’re right.” (article)