ON QUESTIONING MEDICAL CARE THE WRONG WAY

By Nicholas Regush

Is your favorite doctor wearing a "Question Health Care" button yet? No? Hang in there. He or she will one day soon. And have you received your "Speak Up: Help Prevent Errors in Your Care" brochure? You probably will if you visit a hospital. It just takes a while to get these grand and innovative programs in place.

The buttons and brochures are part of a campaign to get patients to ask a ton of questions and take a firm stand when visiting a health-care professional, which, of course, usually means a doctor.

The idea here is to change the doctor-patient relationship. Make it equal. Officials from the Joint Commission on Accreditation of Healthcare Organizations and the Centers for Medicare and Medicaid are concerned that about 100,000 Americans are killed each year by medical blunders. So they are enlisting patient power.

The new strategy will be to get the patient more involved in catching possible errors. This will be accomplished, it is presumed, by goosing patients into becoming more "interactive" with their doctors. That's right. According to this much-heralded new model of sprucing up health care, the patient will be the last line of defense and the buttons and brochures will anchor the turnaround.

That reminds me: didn't the Joint Commission recently ask patients undergoing surgery to mark the targeted part of the body? I'm trying to remember if patients were asked to mark the spot with a heavy black liner. Or maybe it was a touch of mascara. I guess we're still waiting to hear if that strategic move has helped to cut down the number of times a surgeon operates on the wrong side of the brain or invades a healthy knee.

Here's my problem with the latest campaign to get patients more involved in their care: except for the odd case here and there when someone with major smarts will detect a wrong prescription or tell the doctor he or she needs to go back to medicine 101, this is at best a skinny bandaid approach to a state of information chaos in medicine.

First, most doctors do not have the time to chit-chat with their patients and with the time constraints of a managed care system in full swing in the U.S. and with waiting lists for even regular checkups mounting in Canada and the U.K., patient boldness in the exam room will have next to zero clout. Chances are doctors will tell bold patients to take a hike.

Second, one major problem in medicine is that doctors are still taught in medical school to think of themselves as memory sharks. This is very bad news. That might have worked reasonably in the horse and buggy era, but in this day and age, given the explosion of medical information, if a doctor does not use a computer as a memory tool, to help remember all the possible things that might impact on any given individual, then GOOD LUCK! Notice I used the term, "individual," which suggests unique experiences and unique social and environmental contexts for illnesses to develop. In order to address individual needs, a doctor cannot possible rely upon limited human memory.

Maybe now you have a better idea of why I have a real problem with the buttons and brochures campaign when wholesale shifts in medical teaching and competence in computer technology are imperative, in order to make a dent in the huge number of OBVIOUS medical errors that are made annually in the U.S. and elsewhere. This, of course, doesn't even include the errors of judgement -- based on memory -- that lead to unnecessary tests and inappropriate surgeries.

What's the patient going to gain, for the most part, by extracting more information from his or her doctor? Exactly what type of information will that be? A tidbit of this? A fleck of that? It will be pretty much a case of the blind leading the blind.

What medicine badly needs -- and has been resisting for years -- is a system of computer information retrieval that empowers both doctor and patient. And do you know what? It actually exists and it has the potential to dramatically change the way medicine is practiced.

Come back next week and I'll introduce you to this system. Meanwhile, dump the buttons and brochures.