Solutions Personal(under construction) The Small PictureWhen the nurse asks why you have come to see the doctor, hand the nurse a piece of paper on which you've already written that and ask for it to be included in your records. Then at least there will be that. Usually it is not until after the fact that it is possible to know if an appointment was one at which it would have been important to have created such a record. But in general, for the patient, it is better to have a record than not. So it must be done as a matter of routine, or it will never have been done when it was important. School health classes should begin training students to make that record. The Medium PicturePeople seem to imagine that this is a problem best solved by the government. Sometimes I am asked questions like what government agencies or officials I write to and ply in effort to get something done. The government cannot stand up to the influence of medicine. Look what happened when it tried to do something about mammography. The last thing the healthcare industry will allow is for the government to collect data on what is happening in healthcare. One constantly hears about how much liability would be created and how much that could cost. Apparently it is too expensive to discover what is wrong in order to prevent unnecessary death and injury. Nurses won't write it down. Doctors will erase it (see survey and loyalty). Political interests will not allow tabulating what is left. The solutions have to come from outside government. The Larger PictureFor starters, I propose a national complaint line. Any time a patient thinks something might not be quite right, they should be able to log on to the Internet, follow the logic tree, and get the problem into the right box. A well-known phone number would be better, but for starters let's work with literate achievers. When we get the system working for them, they can be the pool from which we get the people to answer the phones for the phone number. If the database reveals that 20 people have called saying that a certain witchdoctor killed their cat, then it's working. It is not necessary to know anything about witch doctoring to know that one of them getting different results than all the rest should be paid attention to. The pharmacist who at some time or other shorts every one of his customers knowing that none of them ever will get anyone to pay attention to them, or the dentist who sells unnecessary crowns and appliances would have to consider that now someone might find out. Current complaint processes are Byzantine, off putting, and usually fruitless. It has to be set up so as to encourage, not discourage, the collection of data. For the patients who are in operating rooms unconscious, something else will have to be worked out. There still are no checks on doctors like Dr. James Burt. ____________ There is a logic tree that contains about 3000 items that I saw in clinical classification software. It could be a good place to start the logic tree. One Small ItemIf something were going to come through government regulation, it might be worth trying something as small as making it possible for patients to discover who their care-givers were. Currently nurses and doctors are required to put their signatures on forms having to do with a patient's care. But when something goes wrong and they don't want to be found, their signatures become illegible scrawls that risk management departments profess not to be able to decipher. Patients have a right know who their care-givers are. Perhaps a stamped or printed version of a signature should be required at least once in every patient's file. Perhaps a penalty should exist for care-givers who fail to adequately identify themselves. Perhaps the test should be whether the bailiff in a court room can read the signature out loud without help. At the very least, there should be someone who enforces the law that requires healthcare providers to reveal who our caregivers were. Currently, when they don't want to, they just don't, and there are no consequences for that. They flagrantly violate the law with impunity. Accountability is reasonable and important.At present there is so little accountability that if a doctor decides to beat the living daylights out of a patient, s/he can knowing that the patient will not even be able to locate the witnesses (they are, after all, wearing masks). For more on solutions, see
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