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Eat, Think & Be Wary

To change something, build a new model that makes the existing model obsolete.
-R. Buckminster Fuller

Which is more important to your survival? Medicine or food? If food is more important, why isn't someone with a vested interest in charge of telling us what to eat, without our having an opportunity to evaluate its quality and price, while someone else decides whether and how much to pay for it, like in medicine?

What would cuisine be like if that were how it was run? It would be like Spain under Franco. Franco's government took over food in Spain with the goal of making it cheap and plentiful. As a result, Spain came to be known as having the worst food in the world, until the government got out of it again. Now it has returned to having some of the best.

So why do we think medicine is different? People working on patient safety problems never think about the fundamental problem. They work on what amounts to nothing more than micromanaging the countless symptoms of the problem, often referring to them as "errors" (a misnomer stymieing progress) without ever focusing on the fundamental problem.

The Problem

Nothing can make it okay for second parties with vested interests to govern first parties, who have no ability to determine the odds of success or the price, while third parties decide whether and how much to pay for it.

(We are not talking about the 20% of medicine that is emergency medicine. That is the part of medicine that is like having a military or a coast guard. This is about the other 80%, the lionshare that if handled properly can reduce the part that currently consumes 20%).

The only box in which anyone thinks about this problem is the one that imagines that there is no choice but to work inside the box in which first parties have no ability to determine the odds of success or the price. In a century and half of working inside that box enforcement, education, micromanagement and all the other changing fashions in thought haven't managed to result even in providers washing their hands enough. And it never will. It's the wrong way to approach. It doesn't address the actual problem.

A better focus would be to make it possible for patients to learn what and where the problems are. If patients know where the problems are they can avoid them and let medicine respond by fixing itself in order to get patients to come back, the way it is in other parts of our economy.

This can be done by gathering the information necessary to know what treatments are worthless, where the infectious death traps are, what bankrupts the most patients, which physicians cannot be trusted, etc.

This is information that cannot be collected by anyone in medicine. Only 2% of adverse events are recorded accurately in medicine. That never will change. That is fundamental to the problem - people with vested interests being the only source of the data. The data must be collected from the outside by watching the patient community and how it fares depending on where patients have been.

This is not "big data." This is small counting - something no one in medicine ever will do accurately, which is the hardest thing for anyone inside or outside of medicine to understand. It is the first thing that must be understood to make patients safe.

A more complete attempt at explaining this can be seen at Patient Agency link and myriad other pages on this site.

 

Solutions ..........|.......... Problems
|
......................... | ............ Myth #1
|
Patient Agency... | .........................
|
Nequamitis ....... | ........................
|
......................... | Conflict/Interest
|
........................ | ............. Loyalty
|
......................... | ..Wall of Silence
|
.................. ...... | .......Blacklisting
|
........................ | ....Psych of Care
|
........................ | ... Transparency
|
........................ | .. Charles Cullen
|
........................ | Orville L Majors
|
........................ | ......... Kayshyap
|
........................ | .............. OSMB
|
........................ | ..... Semmelweis
|
........................ | . Benjamin Rush
|
........................ | .... Government
|
Patients Boards. | ........................
|
Campaign ... | ..................

"If we can get just 10% of people to be smart patients, it will change the system." - Mehmet Oz, surgery professor.

 

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With regard to the institution of the medical industry, I suggest that we do what was done by Hippocrates, the founding father of medicine. It can be done only from an objective position outside of medicine. Otherwise we have done nothing but allow medicine to coopt the effort until it is only another pretense.

What Hippocrates did was get to know everything about his patients - the water supply at the patient's residence, which direction the patient's residence faced, which way the prevailing winds blew, the patient's diet, family, blood, tears, sweat, etc. With data science we can do that again and look for what patients with similar conditions have in common. Like if in the last year, within the group of, say, 50,000 patients that you are monitoring, 6 are declining with symptoms that include dementia, blindness and heart failure and the one thing they have in common is metal on metal hip replacements.

Eat, think and be wary

How can patients be wary, or give informed consent, when they cannot even learn that the treatment being recommended has a history of poisoning patients?

For 20 years millions of patients around the world received metal on metal hip replacements that poisoned them with levels of cobalt that were toxic beyond what would be tolerated in industry. There were treatment providers who knew about the toxic levels in the blood, but who decided it would be all right. Decisions and policies in medicine frequently are based on nothing more that kind of than self-interest.

That is why no one monitors outcomes - self-interest. So no one checked to see if it actually was all right. It wasn't. But for 20 years no one in medicine gave any of their patients information about that to help them make their "informed" decisions.

It is time that we began monitoring outcomes from outside of medicine so that they are not monitored by people who think that toxic levels of cobalt probably will be all right for patients.