""We brought a two-minute checklist into operating rooms in eight hospitals," Gawande says. "I worked with a team of folks that included Boeing to show us how they do it, and we just made sure that the checklist had some basic things: Make sure that blood is available, antibiotics are there."
You do realize that pre-op antibiotics and such are pushed by anesthesia, blood availability is a blood bank and nursing issue. None of these "checklists" really apply to the operating surgeon.
I am an anesthesiologist. When I am on overnight call I am always off the next day. Our group of Anesthesiologist strongly believes this is the right thing to do.
On overnight call I don't come in until 3pm because 24 hours it too tiring.
The motto of the American Society of Anesthesiologists is "Vigilance" You can not be vigilant if you are sleep deprived.
On several occasions I have seen heart surgeons who are up at night with emergencies call off scheduled, elective cases in the morning.
Perhaps we just have a good bunch of surgeons here, but all of the OR team (nurses, perfusionists, Anesthesiologists...) think it is the right thing to do.
Respectfully... the reason why anesthesiologists need stricter work hours, "breaks" during their cases, etc., is because their job is so f'ing boring that even the well-rested often fall asleep at their anesthesia consoles.
The medical world should borrow two things from military aircraft maintenance... CHECKLISTS.
Pilots, who are at least as studly and narcissistic as physicians, KNOW ignoring checklists is a great way to fuck shit up. That's why it is PUNISHED.
As to the civilian custom of working interns to exhaustion, that's just stupid. The military can train enough folks for wars, the civilian side of the house should "militarize" medical care (including quality control and open chain of command for complaints) and get shit done.
Checklists for surgeons are a silly idea. Why? You know an aircraft's blueprints. You know that the aircraft has been through a rigorous certification procedure whereby each and every maintenance technique has been methodically tested and examined.
My patient? I don't know how my patient is built. I don't know how he or she will react to this medication or this surgical procedure. I don't know for a fact their anatomy. That nerve I see, is it a vital cranial nerve or an anatomical variant of a meaningless or redundant nerve?
Medicine and surgery is, and remains, an art. If you spend a week in the OR with different surgeons performing the same procedure, you will see that each surgeon does things differently. From the type of incision, to the order of the steps of the surgery, to which vessels are taken and which ones are preserved, to the type of suture that is used. There's no rhyme or reason besides the fact that it "works" for this surgeon. Checklists? You'll be forcing square surgeons into round surgeon holes, and the outcomes aren't pretty.
And most importantly-- every surgery that is commonly performed was "new" at one point. There's no reason to think that my way of doing, say, a thyroidectomy is better than the way they do it in, say, Japan, where axillary endoscopic dissections are more common. What if I want to try that in the US, saving my patient a large anterior neck scar. What? No checklist for that? Oh, too bad. There's no room for innovation in medicine, I guess.
The health care system in the USA gets a larger share of the richest economy in the world than any other health system anywhere. If the problem is lack of money, I must ask...where is the money going, then?
The health care expenditures of the US increase on a yearly basis, and average physician salaries decrease on a yearly basis.
On the other hand, hospitals are happy to hire new nurse managers, paperwork associates, EHR czars.
Oh, and not to mention the lawyers. Always need more lawyers....
Part of the problem is the medical profession's method of "training" physicians by putting them through an extended period of hazing: working around the clock, being awakened at random intervals, etc. Many of the ones who get through it develop the delusion from it that they can do the work properly under any conditions, especially sleep deprivation. It's a badge of honor for them, and they will engage in all sorts of denial and rationalization to keep at it.
Respectfully disagree. I'm a resident in a surgical subspecialty, a subspecialty I chose in no small part because there aren't nearly as many surgical emergencies compared to general surgery. That being said, residents don't go through "hazing" as much as "trial by fire." For instance-- awakened at random intervals. It's not as though residents got woken up for the fun of it (well... depending on the nurse.). It's because there's an issue for a patient that needs attention-- be it a new consult in the ER, a trauma being choppered in, or issues on the inpatient floor. Now, there's certainly (many) instances when I'm woken up for a completely nonsense page-- my favorite example is getting a page at midnight because the nurse thought the patient needed "butt paste." There should be mechanisms for limiting the amount of sleep disruption to the on-call staff; limiting work hours, IMO, raises as many problems as it solves. Particularly the new ACGME regulations for interns starting next July which limits you to 16 hours in-hospital and rules for "strategic napping."
And there's no badge of honor. I value my sleep. When I finish my training, I don't intend to operate beyond the hours of 7am and 6pm. But I know that there will be instances where I have to. Even more so for general surgery, vascular surgery, neurosurgery, etc. And the problem is worse in rural settings where there might be one surgeon on call for weeks at a time. Do you tell them not to book any OR cases for a month or two? Ridiculous.
As a resident, this is my time to learn how to become a surgeon. It's my time to learn habits that I need to use when I'm an attending, when I don't have a supervisor who can step in and tell me that I'm doing something wrong or can offer suggestions on how to improve my technique and habits.
So the question is, if they can channel 'huge' amounts of water from the Red Sea, why don't they use that for irrigation?
That's what they're planning to do; they're going to desalinate the Red Sea to provide water to communities instead of using the Jordan River.
What's left-over from the desalination process will be pumped into the Dead Sea to increase it's level.
It's, you know, all in TFA.
As spectacular as some of its failures have been -- like slamming a probe into Mars because one group failed to convert the units the other group was using -- it's important to recognize that NASA is capable of equally spectacular successes. These rovers have done way more than anyone expected and helped us learn a tremendous amount about Mars. We definitely got more than our money's worth on this project, and the scientists and engineers whose hard work made it happen deserve some serious accolades.
I think it's also important to note that NASA is something like 5/6 in Mars landings.... no other agency in the world has even landed 1 successfully. People (correctly?) shit on NASA for its perceived failings in manned spaceflight but it has an unbeatable record in interplanetary exploration.
That's why healthcare is a market failure. There is not perfect access, or anything even approaching it. You cannot make informed decisions based on quality of service and cost and all that when you think you might be dying. You'll go wherever's closest, no matter HOW badly they do their job, if you think that they're at least basically competent WRT lifesaving.
That may apply to emergency situations, but healthcare >>> emergency room. Consider, for instance, that you want to get Lasik, or you need to have an angioplasty, or you have a mass in your oral cavity. These are 3 different instances, of varying levels of exigency, in which a free market allows you to choose a health care provider based on not only geography, but skill, experience, ratings by other patients, cost, personality, etc. etc.
Yes, it's true that if you're shot in the chest, you're going to whichever trauma service is closest to you. But those are extraordinary circumstances.
But do you really think the ER is going to look up your name (if they have it), find your record and spend the time looking at it before they treat you? And heaven forbid if the file is the wrong one or their is some important inaccurate information (and there always is).
I do. I always look up a patient's medical record when I admit a patient. Why? Because, almost invariably, when I ask the patient a question about their medical history, they will either forget to mention something or will just tell me to "look in the damn chart." It also helps me to formulate a battery of questions to ask when I end up seeing the patient.
Does that mean that the medical record is accurate? No, of course not. And that's why I always ask the questions to confirm. Usually I'll say something like, "I looked in your record and I saw that you were in the hospital last year for.... and that you have a history of.... and..... Is there anything else?" And if you've ever tried to take a history and physical on a cantankerous patient, you'll be glad that there's a record in the computer because more often than I care to admit, that's the only information I have to go on when patient's refuse to cooperate.
Insurance for my family (me, wife, 2 kids) through my employer would cost $1,200/month. I make 30k/yr. Do the math. That's half my salary BEFORE taxes.
So if they are against people like me, an educator and a community-oriented person who goes out of their way to help people having access to health care then FUCK THEM.
That's great for employees of LMC, but you're overlooking two things:
(1) LMC was able to negotiate that kind of blanket coverage with their insurance provider because, well, they're Large. Smaller business don't have that kind of leverage.
(2) There's absolutely nothing to stop the insurance provider from telling LMC, "Right now you're paying $x million per year for blanket coverage. We can offer you the same coverage for 0.9$x million per year [which will actually cost us 50%, not 90%, of what it does now, although we're not going to mention that] if you accept our suggestions about which types of employees you might want to ease out the door." Nor is there anything to stop LMC's management from thinking this offer is a really good idea.
If you think there's a way to solve either of these problems without serious government regulation, please feel free to make a suggestion.
Well, it has been suggested. Read Matt Miller (a liberal political commentator) and his book The Two Percent Solution.
In response to your points, in Pt 1, my response to that is that issues like this are precisely why Barack Obama's plan to force companies to provide health care to their employees is biased in favor of big business. A company with 100,000 employees can negotiate far better insurance terms and rates than a company with 10,000, or 1,000, or 100. In fact, my "ideal" solution to universal health care (and the one championed in "The Two Percent Solution") would be to offer a mandatory tax rebate/tax credit which must be used to buy health insurance. As a condition of receiving this tax rebate, insurance companies must cover anyone for the same rate and offer the same exact policy.
This works for the insurance companies because they get to spread out their risk over 300 million rather than over 1 individual. It vastly multiplies the advantage that Large Multinational Corporation has in terms of buying insurance, and distributes that advantage over the entire country instead of one company. It works for the populace, because they now not only get insurance, but because any insurance company can cover you, the insurance companies must compete on coverage. This last point is precisely why single payer socialized health care will be a net negative for health care in this country. A government run organization has no impetus for innovation, whereas multiple companies competing in the same field do.
As far as pt 2, that issue is moot under Matt Miller's plan. Ignoring that, that's walking a fine line towards employment discrimination, and I'm sure the Large Multinational Corporation's lawyers would have something to say if management were inclined to accept such an offer.
Doctors who can't accept that the patient is in the driver's seat are obsolete.
OK, so as a doctor, if a patient is asking for narcotic pain meds, I should accept that the patient is the driver's seat and acquiesce? If a patient is asking for antibiotics and the doctor is sure that the patient's symptoms are due to a virus, I have to accept what the patient is demanding?
You do understand the concept of audit trails, right?...digital signatures to keep track of who is updating the record is exactly that.
So when I'm admitting a patient to the hospital, I have to now second-guess the entries in a patient's medical record to see if the patient mucked around with the records or whether it was genuine?
It is fundamentally irrelevant whether I can regurgitate a specific definition.
What matters is that the record is the property of the patient and the patient bears the ultimate responsibility for its contents.
I'm asking this because I suspect you don't know what a medical record exactly entails, and why it would be absolute foolishness to allow it to be modified in any way other than by appending to it.
Gee, I don't see any words to the effect of "haphazrdly edit" anywhere in "MS is taking the position that patients should be able to see their own records, and even correct their own medical records. (But with digital signatures to keep track of who is updating the record.)" Perhaps you can point them out?
I make the assumption that most patients, without medical training, aren't qualified to make edits to their medical record. I equate that with haphazardly edit.
Look, legally, even a patient's physician isn't supposed to "edit" a medical record. It's like a file that you only have append privileges to. Why does it make any bit of sense to allow someone with no medical knowledge whatsoever to make edits?
I'm still waiting for an answer. do you even know what a medical record is?
Who has the most to lose if somebody fucks up a medical record? That's the person who should have the final say about the contents. Authority without responsibility is a major part of what has fucked up our medical system today.
By that logic, passengers on a flight should be allowed to edit the contents of the flight data recorder.
Look, I'll re-iterate my point. The electronic medical record is intended to be an objective record of a patient's health assessment. A patient is not qualified to make an objective assessment of their health status. They're able to make subjective reports that are recorded in the medical record. A medical record does not work if it gets to be edited. In fact, many successful lawsuits have hinged on the fact that the medical record had been added to or edited after the fact. At the risk of sounding cocky, I honestly don't think you understand what the medical record is, if you think that a patient should be allowed to edit it.
To read it, sure. To comment on it to their physician, sure. But to edit it, no f'ing way.
That's because only a compulsory single payer is able to avoid discriminating for pre-existing conditions.
That's completely untrue. Say, for instance, I work for LargeMultinationalCorporation. I could have diabetes, high blood pressure and had 3 heart attacks, and I'll still get coverage because I work for LargeMultinationalCorporation. And I did it without the federal government!
"Dumbing down", as opposed to **OBFUSCATING** in order to maintain the status-quo, so that people keep believing that "the government is **BAAAAD**" so private insurer can continue to gouge the public???
Please give me one example of the U.S. federal government taking over for a private industry, where the end results were better than if the federal government did not meddle at all.
Bullshit. What happens is that insurance companies are looking at all possible ways of weaseling out of their contracts in order to increase their profits, and to do this, they have armies of "investigators" who social-engineered their ways into medical records.
Now you're just making shit up. Do you have any proof of your claims that large insurance companies are committing mass fraud to gain access to medical records?
This is an unacceptable invasion of privacy. If you believe that croporations shall have the right of life or death to people, you are truly a fascist.
Or you have been sorely misinformed and swallowed the whole hook line and sinker of fascists arguments.
Sorely misinformed? My friend, I work in the hospital and see day to day what goes on. Do you?
If you were a millionnaire whose fortune would depend on maintaining the status-quo, as you are pitifully trying to do, you would not hang on Slashdot on a sunday morning.
Don't you know that Sunday morning is vacation day for millionaires whose fortunes depend on maintaining the status quo?
First off, I'm all for universal health care. I'm just against having the federal government run it. I'm all for enacting NEEDED health care reform. I'm just against expanding failed or failing government programs like Medicare and especially Medicaid in order to do it. Of course, it seems that you're under the assumption that if you're not pounding the socialization drum, you must be a facist, right?
How about you? Why are you so hell bent on preseving the "liberty" you have been led to believe you have? Why are you thinking like a zillionnaire???
I'm not thinking like a zillionnaire. I'm thinking like a medical student who's going to be a medical doctor in 5 months, and worrying that the federal government is going to completely fuck up the medical system as it has with, say, the railroads, banking, space, high technology, and the like.
The reason for the requirement of stringent privacy requirements for health-record keeping is solely due to the sheer number of unregulated, unaccountable organizations dealing with them.
I am talking, of course, of private health-insurance companies.
The obvious cost-effective solution is to get rid of them, and implement an universal, single-payer insurer that would cover absolutely everyone (no opting-out) with exactly the same coverage (no more time wasted to figure out if some procedure is covered or not).
Since coverage of everyone will be compulsory, there will be no more need to discriminate for pre-existing conditions, thus removing the need for intrusive record snooping in the first place.
In fact, such a solution is currently in place in **ALL** the industrialized countries, except in the USA.
There shall be no more pussyfooting around the bush with this issue, the bull's apple need to be bitten by the horns right now.
In addition to finally covering everyone, the USA will no longer be a turd-world country and a laughingstock in respect to health-care, and in bonus, all the rotten parasites that fester in and around private health-insurance companies will be forced to find an honourable way of paying the bills.
First off, I just don't understand why people insist that universal health care == single payer. The two are completely separate; you can certainly have the former without requiring the latter.
There are MANY reasons to argue against single payer health care.... and that is beyond the scope of this/. discussion. I do, however, have to object to your dumbing down of the issue. While one of the main goals of HIPAA was to insure privacy of health care with respect to portability of insurance (the H, I, and P in HIPAA), there is far more to HIPAA than just dealing with private insurance companies. If that weren't so, then HIPAA wouldn't be relevant for, say, Medicare purposes.
For instance, what if a prospective employer wants to take a look at your EMR to see if you have chronic medical conditions that would require you to take days off in the future? What if your prospective spouse wants to see what heritable diseases run in your family?
Of course, that's not important for you. What's important for you seems to be inserting a rant supporting your political viewpoint. Kudos, my friend, kudos, for trying to distract a real argument with your strawman.
I understood Obama's spokespeople to making a big deal about moving to electronic records. Are you telling me that it was actually Bush who made it happen?
Obama's health care plans includes an emphasis on evidence based medicine, preventive medicine, and improved efficiency and safety.
In other words, a pretty much verbatim duplication of the CURRENT requirements of JCAHO - the accreditation body that Medicare uses to certify hospitals as compliant and eligible for Medicare funds.
(Most medical records today aren't things that patients get--MS is taking the position that patients should be able to see their own records, and even correct their own medical records. (But with digital signatures to keep track of who is updating the record.))
IANAD (but I will be one in 5 months or so). If that is Microsoft's position, that is the stupidest fucking thing I have ever heard. Worse than Clippy. Worse than Bob.
Look, a patient's medical record is supposed to be an OBJECTIVE documentation of a patient's health status and treatment. How, exactly, is a patient qualified to make an objective assessment of their medical problems, diagnostic workups and treatment regimens?
One thing about electronic records in general--patient accessible ones--is that it should make a difference in accountability. Normally, at many hospitals in the US, if a doctor makes a significant mistake the records disappear. If patients have direct access to their own records, that will become a less common practice.
Well, that's just complete BS. I don't know where you get your information, but altering a patient's medical record is illegal and, at the very least, will result in a physician's suspension of privileges from a hospital... and most likely, a revocation of their medical license.
Btw, your patient record is completely accessible. You just have to make a request to the medical records office. No, it's not available on the web, but it's not as if your MR is a secret like your FBI file.
My wife and I had almost the same experience. Our fridge died. We went to Best Buy, Home Depot, Lowes.. Everybody said that it would take four of five days to get one delivered. We decided to check out a local place. They had a great fridge for a great price. Then came the delivery, the answer was how about tomorrow?
Ugh. I hate it when people answer a question with a question. Bastards.
Where else are kids gonna be able to take a good mid-afternoon nap? The seats in 10-250 were so comfortable. And in these smaller classes, everyone can see you fall asleep.
Ugh. I don't know if it's changed recently (I know that they recently re-did 10-250) but the LIGHTING in that room was horrendous. The flicker, man, the flicker!
MIT's Open Courseware is lacking in the fact that (a) the classes don't count for credit, (b) nobody's there to grade any work you do, and (c) many classes are not posted in the entirety (video lectures are IFAIK non-existent, answer sheets to the assigned HW questions are never there, and entire slideshow lectures are occasionally missing).
Oh knoes! I have to go to college to get a college education??
The fact of the matter is, an A-330 sized airliner is far too big as a 1-to-1 replacement for the KC-135. Hell, the KC-45 is far too big as a *KC-10* replacement, much less a KC-135. The GAO upheld Boeing's claim that the USAF did not judge the competition based on its own rules, and decided suddenly that they DID want an aircraft the size of the A-330 only after the proposals were submitted by Boeing and Northrup.
In which case, the 777 kinda kicks both airplanes out of the water...
Slashdot Mirror
""We brought a two-minute checklist into operating rooms in eight hospitals," Gawande says. "I worked with a team of folks that included Boeing to show us how they do it, and we just made sure that the checklist had some basic things: Make sure that blood is available, antibiotics are there."
You do realize that pre-op antibiotics and such are pushed by anesthesia, blood availability is a blood bank and nursing issue. None of these "checklists" really apply to the operating surgeon.
Although, I suppose after a few cycles of this, they'd have to operate 24/7 to pay their alimony....
I am an anesthesiologist. When I am on overnight call I am always off the next day. Our group of Anesthesiologist strongly believes this is the right thing to do. On overnight call I don't come in until 3pm because 24 hours it too tiring. The motto of the American Society of Anesthesiologists is "Vigilance" You can not be vigilant if you are sleep deprived.
On several occasions I have seen heart surgeons who are up at night with emergencies call off scheduled, elective cases in the morning. Perhaps we just have a good bunch of surgeons here, but all of the OR team (nurses, perfusionists, Anesthesiologists...) think it is the right thing to do.
Respectfully... the reason why anesthesiologists need stricter work hours, "breaks" during their cases, etc., is because their job is so f'ing boring that even the well-rested often fall asleep at their anesthesia consoles.
=)
The medical world should borrow two things from military aircraft maintenance... CHECKLISTS.
Pilots, who are at least as studly and narcissistic as physicians, KNOW ignoring checklists is a great way to fuck shit up. That's why it is PUNISHED.
As to the civilian custom of working interns to exhaustion, that's just stupid. The military can train enough folks for wars, the civilian side of the house should "militarize" medical care (including quality control and open chain of command for complaints) and get shit done.
Checklists for surgeons are a silly idea. Why? You know an aircraft's blueprints. You know that the aircraft has been through a rigorous certification procedure whereby each and every maintenance technique has been methodically tested and examined.
My patient? I don't know how my patient is built. I don't know how he or she will react to this medication or this surgical procedure. I don't know for a fact their anatomy. That nerve I see, is it a vital cranial nerve or an anatomical variant of a meaningless or redundant nerve?
Medicine and surgery is, and remains, an art. If you spend a week in the OR with different surgeons performing the same procedure, you will see that each surgeon does things differently. From the type of incision, to the order of the steps of the surgery, to which vessels are taken and which ones are preserved, to the type of suture that is used. There's no rhyme or reason besides the fact that it "works" for this surgeon. Checklists? You'll be forcing square surgeons into round surgeon holes, and the outcomes aren't pretty.
And most importantly-- every surgery that is commonly performed was "new" at one point. There's no reason to think that my way of doing, say, a thyroidectomy is better than the way they do it in, say, Japan, where axillary endoscopic dissections are more common. What if I want to try that in the US, saving my patient a large anterior neck scar. What? No checklist for that? Oh, too bad. There's no room for innovation in medicine, I guess.
The health care system in the USA gets a larger share of the richest economy in the world than any other health system anywhere. If the problem is lack of money, I must ask...where is the money going, then?
The health care expenditures of the US increase on a yearly basis, and average physician salaries decrease on a yearly basis.
On the other hand, hospitals are happy to hire new nurse managers, paperwork associates, EHR czars.
Oh, and not to mention the lawyers. Always need more lawyers....
Part of the problem is the medical profession's method of "training" physicians by putting them through an extended period of hazing: working around the clock, being awakened at random intervals, etc. Many of the ones who get through it develop the delusion from it that they can do the work properly under any conditions, especially sleep deprivation. It's a badge of honor for them, and they will engage in all sorts of denial and rationalization to keep at it.
Respectfully disagree. I'm a resident in a surgical subspecialty, a subspecialty I chose in no small part because there aren't nearly as many surgical emergencies compared to general surgery. That being said, residents don't go through "hazing" as much as "trial by fire." For instance-- awakened at random intervals. It's not as though residents got woken up for the fun of it (well... depending on the nurse.). It's because there's an issue for a patient that needs attention-- be it a new consult in the ER, a trauma being choppered in, or issues on the inpatient floor. Now, there's certainly (many) instances when I'm woken up for a completely nonsense page-- my favorite example is getting a page at midnight because the nurse thought the patient needed "butt paste." There should be mechanisms for limiting the amount of sleep disruption to the on-call staff; limiting work hours, IMO, raises as many problems as it solves. Particularly the new ACGME regulations for interns starting next July which limits you to 16 hours in-hospital and rules for "strategic napping." And there's no badge of honor. I value my sleep. When I finish my training, I don't intend to operate beyond the hours of 7am and 6pm. But I know that there will be instances where I have to. Even more so for general surgery, vascular surgery, neurosurgery, etc. And the problem is worse in rural settings where there might be one surgeon on call for weeks at a time. Do you tell them not to book any OR cases for a month or two? Ridiculous. As a resident, this is my time to learn how to become a surgeon. It's my time to learn habits that I need to use when I'm an attending, when I don't have a supervisor who can step in and tell me that I'm doing something wrong or can offer suggestions on how to improve my technique and habits.
So the question is, if they can channel 'huge' amounts of water from the Red Sea, why don't they use that for irrigation?
That's what they're planning to do; they're going to desalinate the Red Sea to provide water to communities instead of using the Jordan River. What's left-over from the desalination process will be pumped into the Dead Sea to increase it's level. It's, you know, all in TFA.
As spectacular as some of its failures have been -- like slamming a probe into Mars because one group failed to convert the units the other group was using -- it's important to recognize that NASA is capable of equally spectacular successes. These rovers have done way more than anyone expected and helped us learn a tremendous amount about Mars. We definitely got more than our money's worth on this project, and the scientists and engineers whose hard work made it happen deserve some serious accolades.
I think it's also important to note that NASA is something like 5/6 in Mars landings.... no other agency in the world has even landed 1 successfully. People (correctly?) shit on NASA for its perceived failings in manned spaceflight but it has an unbeatable record in interplanetary exploration.
Just do not fully understand Apple's poo-pooing the netbook space. I see a Netbook as a supplement to my bigger system, that I prefer not to carry.
Netbooks don't have the profit margins that Apple desires. Simple as that.
That's why healthcare is a market failure. There is not perfect access, or anything even approaching it. You cannot make informed decisions based on quality of service and cost and all that when you think you might be dying. You'll go wherever's closest, no matter HOW badly they do their job, if you think that they're at least basically competent WRT lifesaving.
That may apply to emergency situations, but healthcare >>> emergency room. Consider, for instance, that you want to get Lasik, or you need to have an angioplasty, or you have a mass in your oral cavity. These are 3 different instances, of varying levels of exigency, in which a free market allows you to choose a health care provider based on not only geography, but skill, experience, ratings by other patients, cost, personality, etc. etc.
Yes, it's true that if you're shot in the chest, you're going to whichever trauma service is closest to you. But those are extraordinary circumstances.
But do you really think the ER is going to look up your name (if they have it), find your record and spend the time looking at it before they treat you? And heaven forbid if the file is the wrong one or their is some important inaccurate information (and there always is).
I do. I always look up a patient's medical record when I admit a patient. Why? Because, almost invariably, when I ask the patient a question about their medical history, they will either forget to mention something or will just tell me to "look in the damn chart." It also helps me to formulate a battery of questions to ask when I end up seeing the patient.
Does that mean that the medical record is accurate? No, of course not. And that's why I always ask the questions to confirm. Usually I'll say something like, "I looked in your record and I saw that you were in the hospital last year for .... and that you have a history of .... and ..... Is there anything else?" And if you've ever tried to take a history and physical on a cantankerous patient, you'll be glad that there's a record in the computer because more often than I care to admit, that's the only information I have to go on when patient's refuse to cooperate.
Insurance for my family (me, wife, 2 kids) through my employer would cost $1,200/month. I make 30k/yr. Do the math. That's half my salary BEFORE taxes.
So if they are against people like me, an educator and a community-oriented person who goes out of their way to help people having access to health care then FUCK THEM.
I really hope you're not a math teacher.
That's great for employees of LMC, but you're overlooking two things:
(1) LMC was able to negotiate that kind of blanket coverage with their insurance provider because, well, they're Large. Smaller business don't have that kind of leverage.
(2) There's absolutely nothing to stop the insurance provider from telling LMC, "Right now you're paying $x million per year for blanket coverage. We can offer you the same coverage for 0.9$x million per year [which will actually cost us 50%, not 90%, of what it does now, although we're not going to mention that] if you accept our suggestions about which types of employees you might want to ease out the door." Nor is there anything to stop LMC's management from thinking this offer is a really good idea.
If you think there's a way to solve either of these problems without serious government regulation, please feel free to make a suggestion.
Well, it has been suggested. Read Matt Miller (a liberal political commentator) and his book The Two Percent Solution.
In response to your points, in Pt 1, my response to that is that issues like this are precisely why Barack Obama's plan to force companies to provide health care to their employees is biased in favor of big business. A company with 100,000 employees can negotiate far better insurance terms and rates than a company with 10,000, or 1,000, or 100. In fact, my "ideal" solution to universal health care (and the one championed in "The Two Percent Solution") would be to offer a mandatory tax rebate/tax credit which must be used to buy health insurance. As a condition of receiving this tax rebate, insurance companies must cover anyone for the same rate and offer the same exact policy.
This works for the insurance companies because they get to spread out their risk over 300 million rather than over 1 individual. It vastly multiplies the advantage that Large Multinational Corporation has in terms of buying insurance, and distributes that advantage over the entire country instead of one company. It works for the populace, because they now not only get insurance, but because any insurance company can cover you, the insurance companies must compete on coverage. This last point is precisely why single payer socialized health care will be a net negative for health care in this country. A government run organization has no impetus for innovation, whereas multiple companies competing in the same field do.
As far as pt 2, that issue is moot under Matt Miller's plan. Ignoring that, that's walking a fine line towards employment discrimination, and I'm sure the Large Multinational Corporation's lawyers would have something to say if management were inclined to accept such an offer.
Doctors who can't accept that the patient is in the driver's seat are obsolete.
OK, so as a doctor, if a patient is asking for narcotic pain meds, I should accept that the patient is the driver's seat and acquiesce? If a patient is asking for antibiotics and the doctor is sure that the patient's symptoms are due to a virus, I have to accept what the patient is demanding?
You do understand the concept of audit trails, right? ...digital signatures to keep track of who is updating the record is exactly that.
So when I'm admitting a patient to the hospital, I have to now second-guess the entries in a patient's medical record to see if the patient mucked around with the records or whether it was genuine?
It is fundamentally irrelevant whether I can regurgitate a specific definition. What matters is that the record is the property of the patient and the patient bears the ultimate responsibility for its contents.
I'm asking this because I suspect you don't know what a medical record exactly entails, and why it would be absolute foolishness to allow it to be modified in any way other than by appending to it.
Gee, I don't see any words to the effect of "haphazrdly edit" anywhere in "MS is taking the position that patients should be able to see their own records, and even correct their own medical records. (But with digital signatures to keep track of who is updating the record.)" Perhaps you can point them out?
I make the assumption that most patients, without medical training, aren't qualified to make edits to their medical record. I equate that with haphazardly edit.
Look, legally, even a patient's physician isn't supposed to "edit" a medical record. It's like a file that you only have append privileges to. Why does it make any bit of sense to allow someone with no medical knowledge whatsoever to make edits?
I'm still waiting for an answer. do you even know what a medical record is?
Only if you are more interested in making specious arguments.
Look, I'll re-iterate my point. If a person's medical record gets fucked up, they could end up dying as a result. Nothing trumps that. Nothing.
And exactly how would letting patients haphazardedly edit their medical record going to do a thing to prevent that?
Do you even know what a medical record is?
Who has the most to lose if somebody fucks up a medical record? That's the person who should have the final say about the contents. Authority without responsibility is a major part of what has fucked up our medical system today.
By that logic, passengers on a flight should be allowed to edit the contents of the flight data recorder.
Look, I'll re-iterate my point. The electronic medical record is intended to be an objective record of a patient's health assessment. A patient is not qualified to make an objective assessment of their health status. They're able to make subjective reports that are recorded in the medical record. A medical record does not work if it gets to be edited. In fact, many successful lawsuits have hinged on the fact that the medical record had been added to or edited after the fact. At the risk of sounding cocky, I honestly don't think you understand what the medical record is, if you think that a patient should be allowed to edit it.
To read it, sure. To comment on it to their physician, sure. But to edit it, no f'ing way.
That's because only a compulsory single payer is able to avoid discriminating for pre-existing conditions.
That's completely untrue. Say, for instance, I work for LargeMultinationalCorporation. I could have diabetes, high blood pressure and had 3 heart attacks, and I'll still get coverage because I work for LargeMultinationalCorporation. And I did it without the federal government!
"Dumbing down", as opposed to **OBFUSCATING** in order to maintain the status-quo, so that people keep believing that "the government is **BAAAAD**" so private insurer can continue to gouge the public???
Please give me one example of the U.S. federal government taking over for a private industry, where the end results were better than if the federal government did not meddle at all.
Bullshit. What happens is that insurance companies are looking at all possible ways of weaseling out of their contracts in order to increase their profits, and to do this, they have armies of "investigators" who social-engineered their ways into medical records.
Now you're just making shit up. Do you have any proof of your claims that large insurance companies are committing mass fraud to gain access to medical records?
This is an unacceptable invasion of privacy. If you believe that croporations shall have the right of life or death to people, you are truly a fascist.
Or you have been sorely misinformed and swallowed the whole hook line and sinker of fascists arguments.
Sorely misinformed? My friend, I work in the hospital and see day to day what goes on. Do you?
If you were a millionnaire whose fortune would depend on maintaining the status-quo, as you are pitifully trying to do, you would not hang on Slashdot on a sunday morning.
Don't you know that Sunday morning is vacation day for millionaires whose fortunes depend on maintaining the status quo?
First off, I'm all for universal health care. I'm just against having the federal government run it. I'm all for enacting NEEDED health care reform. I'm just against expanding failed or failing government programs like Medicare and especially Medicaid in order to do it. Of course, it seems that you're under the assumption that if you're not pounding the socialization drum, you must be a facist, right?
How about you? Why are you so hell bent on preseving the "liberty" you have been led to believe you have? Why are you thinking like a zillionnaire???
I'm not thinking like a zillionnaire. I'm thinking like a medical student who's going to be a medical doctor in 5 months, and worrying that the federal government is going to completely fuck up the medical system as it has with, say, the railroads, banking, space, high technology, and the like.
The reason for the requirement of stringent privacy requirements for health-record keeping is solely due to the sheer number of unregulated, unaccountable organizations dealing with them.
I am talking, of course, of private health-insurance companies.
The obvious cost-effective solution is to get rid of them, and implement an universal, single-payer insurer that would cover absolutely everyone (no opting-out) with exactly the same coverage (no more time wasted to figure out if some procedure is covered or not).
Since coverage of everyone will be compulsory, there will be no more need to discriminate for pre-existing conditions, thus removing the need for intrusive record snooping in the first place.
In fact, such a solution is currently in place in **ALL** the industrialized countries, except in the USA.
There shall be no more pussyfooting around the bush with this issue, the bull's apple need to be bitten by the horns right now.
In addition to finally covering everyone, the USA will no longer be a turd-world country and a laughingstock in respect to health-care, and in bonus, all the rotten parasites that fester in and around private health-insurance companies will be forced to find an honourable way of paying the bills.
First off, I just don't understand why people insist that universal health care == single payer. The two are completely separate; you can certainly have the former without requiring the latter.
There are MANY reasons to argue against single payer health care.... and that is beyond the scope of this /. discussion. I do, however, have to object to your dumbing down of the issue. While one of the main goals of HIPAA was to insure privacy of health care with respect to portability of insurance (the H, I, and P in HIPAA), there is far more to HIPAA than just dealing with private insurance companies. If that weren't so, then HIPAA wouldn't be relevant for, say, Medicare purposes.
For instance, what if a prospective employer wants to take a look at your EMR to see if you have chronic medical conditions that would require you to take days off in the future? What if your prospective spouse wants to see what heritable diseases run in your family?
Of course, that's not important for you. What's important for you seems to be inserting a rant supporting your political viewpoint. Kudos, my friend, kudos, for trying to distract a real argument with your strawman.
I understood Obama's spokespeople to making a big deal about moving to electronic records. Are you telling me that it was actually Bush who made it happen?
Obama's health care plans includes an emphasis on evidence based medicine, preventive medicine, and improved efficiency and safety.
In other words, a pretty much verbatim duplication of the CURRENT requirements of JCAHO - the accreditation body that Medicare uses to certify hospitals as compliant and eligible for Medicare funds.
Change we can believe in, indeed.
(Most medical records today aren't things that patients get--MS is taking the position that patients should be able to see their own records, and even correct their own medical records. (But with digital signatures to keep track of who is updating the record.))
IANAD (but I will be one in 5 months or so). If that is Microsoft's position, that is the stupidest fucking thing I have ever heard. Worse than Clippy. Worse than Bob. Look, a patient's medical record is supposed to be an OBJECTIVE documentation of a patient's health status and treatment. How, exactly, is a patient qualified to make an objective assessment of their medical problems, diagnostic workups and treatment regimens?
One thing about electronic records in general--patient accessible ones--is that it should make a difference in accountability. Normally, at many hospitals in the US, if a doctor makes a significant mistake the records disappear. If patients have direct access to their own records, that will become a less common practice.
Well, that's just complete BS. I don't know where you get your information, but altering a patient's medical record is illegal and, at the very least, will result in a physician's suspension of privileges from a hospital... and most likely, a revocation of their medical license.
Btw, your patient record is completely accessible. You just have to make a request to the medical records office. No, it's not available on the web, but it's not as if your MR is a secret like your FBI file.
My wife and I had almost the same experience. Our fridge died. We went to Best Buy, Home Depot, Lowes.. Everybody said that it would take four of five days to get one delivered. We decided to check out a local place. They had a great fridge for a great price. Then came the delivery, the answer was how about tomorrow?
Ugh. I hate it when people answer a question with a question. Bastards.
Where else are kids gonna be able to take a good mid-afternoon nap? The seats in 10-250 were so comfortable. And in these smaller classes, everyone can see you fall asleep.
Ugh. I don't know if it's changed recently (I know that they recently re-did 10-250) but the LIGHTING in that room was horrendous. The flicker, man, the flicker!
MIT's Open Courseware is lacking in the fact that (a) the classes don't count for credit, (b) nobody's there to grade any work you do, and (c) many classes are not posted in the entirety (video lectures are IFAIK non-existent, answer sheets to the assigned HW questions are never there, and entire slideshow lectures are occasionally missing).
Oh knoes! I have to go to college to get a college education??
The fact of the matter is, an A-330 sized airliner is far too big as a 1-to-1 replacement for the KC-135. Hell, the KC-45 is far too big as a *KC-10* replacement, much less a KC-135. The GAO upheld Boeing's claim that the USAF did not judge the competition based on its own rules, and decided suddenly that they DID want an aircraft the size of the A-330 only after the proposals were submitted by Boeing and Northrup. In which case, the 777 kinda kicks both airplanes out of the water...