I no advice, there..

#1
Studies show most in-hospital medical complications -- including nearly all infections -- are entirely preventable through standard procedures. One doc instituted a checklist (set of lists, actually, one each for various situations/procedures) that he's been advocating for over a decade.

http://www.newyorker...e?currentPage=all

Pronovost and his colleagues monitored what happened for a year afterward. The results were so dramatic that they werenÂt sure whether to believe them: the ten-day line-infection rate went from eleven per cent to zero. So they followed patients for fifteen more months. Only two line infections occurred during the entire period. They calculated that, in this one hospital, the checklist had prevented forty-three infections and eight deaths, and saved two million dollars in costs.

Every hospital that implements the checklist cuts complications by two thirds and infections by more than that. Doctors hate the lists. They don't want to be told what to do.

Some physicians were offended by the suggestion that they needed checklists. Others had legitimate doubts about PronovostÂs evidence.

...

Tom Piskorowski, one of the I.C.U. physicians, told me his reaction: ÂForget the paperwork. Take care of the patient.Â

Here's the funny thing:

In the Keystone InitiativeÂs first eighteen months, the hospitals saved an estimated hundred and seventy-five million dollars in costs and more than fifteen hundred lives. The successes have been sustained for almost four yearsÂall because of a stupid little checklist.

They'd save more money if they did it. But they won't.

#2
Someone built a diagnosis app, based on the same type of algorithms Amazon and Netflix use for recommendations. You put in some symptoms, it starts asking questions. At the end of the process it suggests several possible diagnoses, along with prevalence, accuracy of match to symptoms, and the correct tests to confirm or rule out each option.

Hospitals won't use it because "no machine can replace years of experience" though figures show it clearly can. But the method they use to keep them out is to accuse the creator of the system of practicing medicine without a license.

Doctors hate being told what to do, and they're currently very well funded and well connected. It ain't changing just because it ain't working.

Post #359,600 by Ashton 6/26/12 3:38:18 PM Reply	I no advice, there.. Suggestion, though: I'd want to see a 'scorecard' on the medico doing the surgery and--if possible--talk to one or more whose situation was comparable, had the surgery, etc. There's no Consumer Reports re medico Actual performance--and their massive Trade Union ensures that it stays that way; we see the implications. Luck on flipping That coin--intelligence only goes sooo far in such matters. Fingers/prehensile-tail crossed..
Post #359,644 by dmcarls 6/26/12 11:11:00 PM Reply	Re: I no advice, there.. >>> "There's no Consumer Reports..." There may be in the future. Some sites are dabbling in this type of thing: http://www.ratemds.com/ http://www.vitals.co...rk%2C+il&x=64&y=8 http://www.healthgrades.com/ I expect this type of data to evolve over time, things cannot stay like they are now. (Can they?)
Post #359,647 by drook 6/26/12 11:42:18 PM Reply	Sure they can stay this way #1 Studies show most in-hospital medical complications -- including nearly all infections -- are entirely preventable through standard procedures. One doc instituted a checklist (set of lists, actually, one each for various situations/procedures) that he's been advocating for over a decade. http://www.newyorker...e?currentPage=all Pronovost and his colleagues monitored what happened for a year afterward. The results were so dramatic that they werenÂt sure whether to believe them: the ten-day line-infection rate went from eleven per cent to zero. So they followed patients for fifteen more months. Only two line infections occurred during the entire period. They calculated that, in this one hospital, the checklist had prevented forty-three infections and eight deaths, and saved two million dollars in costs. Every hospital that implements the checklist cuts complications by two thirds and infections by more than that. Doctors hate the lists. They don't want to be told what to do. Some physicians were offended by the suggestion that they needed checklists. Others had legitimate doubts about PronovostÂs evidence. ... Tom Piskorowski, one of the I.C.U. physicians, told me his reaction: ÂForget the paperwork. Take care of the patient.Â Here's the funny thing: In the Keystone InitiativeÂs first eighteen months, the hospitals saved an estimated hundred and seventy-five million dollars in costs and more than fifteen hundred lives. The successes have been sustained for almost four yearsÂall because of a stupid little checklist. They'd save more money if they did it. But they won't. #2 Someone built a diagnosis app, based on the same type of algorithms Amazon and Netflix use for recommendations. You put in some symptoms, it starts asking questions. At the end of the process it suggests several possible diagnoses, along with prevalence, accuracy of match to symptoms, and the correct tests to confirm or rule out each option. Hospitals won't use it because "no machine can replace years of experience" though figures show it clearly can. But the method they use to keep them out is to accuse the creator of the system of practicing medicine without a license. Doctors hate being told what to do, and they're currently very well funded and well connected. It ain't changing just because it ain't working. -- Drew

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