Asking a simple question like that challenges the standard hierarchy of of medical decision-making where the doctor knows best. As Dr. Peter J. Provonost of Johns Hopkins Hospital tells the New York Times, challenging that hierarchy is one of the reforms health care needs. He tells Claudia Dreifus about his efforts to get doctors to follow simple checklists to reduce medical errors:
As at many hospitals, we had dysfunctional teamwork because of an exceedingly hierarchal culture. When confrontations occurred, the problem was rarely framed in terms of what was best for the patient. It was: “I’m right. I’m more senior than you. Don’t tell me what to do.” With... infection after a catheter insertion, our rates were sky high: about 11 per 1,000, which, at the time, put us in the worst 10 percent in the country.
Catheters are inserted into the veins near the heart before major surgery, in the I.C.U., for chemotherapy and for dialysis. The C.D.C. estimates that 31,000 people a year die from bloodstream infections contracted at hospitals this way. So I thought, “This can be stopped. Hospital infections aren’t like a disease there’s no cure for.” I thought, “Let’s try a checklist that standardizes what clinicians do before catheterization.” It seemed to me that if you looked for the most important safety measures and found some way to make them routine, it could change the picture.The checklist we developed was simple: wash your hands, clean your skin with chlorhexidine, try to avoid placing catheters in the groin, if you can, cover the patient and yourself while inserting the catheter, keep a sterile field, and ask yourself every day if the benefits of catheterization exceed the risks.
Q. Wash your hands? Don't doctors automatically do that?
A. National estimates are that we wash our hands 30 to 40 percent of the time. Hospitals working on improving their safety records are up to 70 percent. Still, that means that 30 percent of the time, people are not doing it [Dr. Peter J. Provonost, interview with Claudia Dreifus, "Doctor Leads Quest for Safer Ways to Care for Patients," New York Times, 2010.03.08].
A single-payer system will also save money and save lives. But while we wait for Stephanie Herseth Sandlin to develop a case of Kucinich courage, we can do some small do-it-ourselves reforms which challenge the prevailing hierarchical hospital culture and prevent unnecessary expense, sickness, and death.
Bonus reading: You might also want to ask your doctor if you really, really need that colonoscopy. (Now he tells me, says Mr. Epp.)