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Thursday, March 01, 2001 Report hits medicine in U.S. hard Patients get poor care, says paper Utahn helped write By Lois M. Collins Deseret News staff writer American medicine is the most sophisticated and advanced in the world, but patients often receive poor or even dangerous care. Physicians don't do enough to keep updated on medical advances. Patients wait weeks and even months for nonurgent care. And fixing the health-care system will take a major overhaul that would refocus health care on the patient's needs. That's the view of a highly critical report released Thursday by the Institute of Medicine in the National Academy of Sciences, an organization created by Abraham Lincoln to advise the government. The report is a follow-up to the group's 1999 findings that medical mistakes kill from 44,000 to 98,000 hospitalized Americans each year. Some scientists have challenged those numbers, but hospitals nationwide have scrambled to reduce mistakes since its release. "American health care as currently practiced is poor," said Dr. Brent James, Intermountain Health Care vice president for medical research, who sat on the committee that wrote both reports. "It's as good as you can find anywhere in the world and it's better than any previous generation has experienced. But it's poor relative to its theoretic potential. What we ought to be able to achieve, we fall far short of. Far short." The report wants Americans to have more information about their health, doctors to have more information about newer treatment options and Congress to fork over $1 billion over three to five years to help make those changes occur. "The frustration levels of both patients and clinicians have probably never been higher," the report says. "Health care today harms too frequently and routinely fails to deliver its potential benefits." The report found that it can take 17 years for the average doctor to learn about and accept important research discoveries. For instance, beta blockers and ACE inhibitors have proven over the last decade to greatly improve survival for heart attack patients, but nearly half of those patients are not given the medication. For years, people have believed the best way to improve the practice of medicine is to improve technology and pharmaceuticals. Last year $7.2 billion was invested with the National Institutes of Health to generate new biologic science. But achieving real results requires fundamentally redirecting the focus of health-care practice, according to the study. "We could achieve at least as much good for the population of the United States by implementing this report as perhaps 10 years of investment in new biologic science," James said. The "craft of medicine" as it is currently experienced is "simply false," said James, because it's based on the concept that humans are perfectible. He said physicians tend to base treatment on what they recall in their heads, which is "woefully inadequate. I'm sorry, it just isn't realistic, no matter how trained, smart, rested or on top of the game you are. You will make mistakes. So we have to construct a system that makes it easy to do it right and hard to do it wrong." Studies indicate the human brain can consider no more than nine things at a time, he said. "As you go down the list of the things you have to do to practice medicine, there's not a single case you can readily identify where you don't have to consider more than nine factors. Just applying evidence from the medical literature, we publish more than 10,000 new randomized controlled trials and 5,002 reviewed journal articles a year. It's ludicrous. Even if you have people going through and gleaning out the facts, if you try to apply that directly to clinical practice, it would be impossible without a sophisticated structure." The alternative is turning the practice of medicine from being craft- based to being profession-based, where the profession comes together in groups to build an infrastructure that allows the practice of state-of- the-art medicine, James said. The report says giving patients more reasonable access to care would not always require face-to-face appointments. It could include telephone consultations or even e-mail correspondence with a doctor. In fact, James said, the scheduling option that seems to work best is the old barbershop model, where you poke your head in the door and the barber says there are two customers ahead of you. Several doctors in the IHC system are already offering open scheduling — the come-on- down theory — and James said more will do so in the future. The report also said that treatment should not vary with no trace of logic from one doctor to the next. It recommends that the government identify the 15 most problematic diseases and determine treatment protocols for them within the next five years. The interesting thing is that when things are done right, costs fall. "It's not ever going to be free," James said. "But to the extent we find and eliminate waste in the system, we can extend the reach much further. That's the real way to get costs out of the system." E-MAIL: [log in to unmask] http://www.deseretnews.com/dn/view/0,1249,255009586,00.html? *********