Patient Safety Blog

A new project, conceived of by Google and the Cleveland Clinic, will try to give patients the ability to access and control their health information.

This project would hopefully enable patients to give their information quickly and easily to multiple physicians and pharmacies. Such a thing would be beneficial because, as we have discussed often on this blog, lack of communication between physicians is a frequent cause of medical error. Patients might assume that doctors would automatically share relevant facts with each other in their medical histories, and this is indeed what is supposed to happen, but too often it does not. This new project would give the patient some control over making sure that doctors know important details.

The New York Times also has some comments on this, quoting Dr. John Halamka on the importance of "consumer-oriented health care."

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Communication , Disclosure

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Most scientists are extremely unwilling to part with the raw data of the studies they perform on cancer and other life-threatening illnesses.

The author of the article speculates that this reluctance is due to convenience and careerism, specifically the fear of having others (especially layfolk) analyze their work and possibly find flaws in it. This may be an uncharitable speculation but it is difficult to disagree with, especially when one considers the pathetic reasons scientists cite for hiding their data. From the article:

Dr John Kirwan, a rheumatologist from the University of Bristol in England, has studied researchers’ attitudes on sharing data from clinical trials. He found that three-quarters of researchers he surveyed, as well as a major industry group, opposed making original trial data available. It is worth restating this finding: most scientists doing research on how best to help those in pain, or at risk of death, want to keep their data a secret.

Dr. Kirwan went on to ask his subjects why. Their reasons were entirely trivial: one cited the difficult of putting together a data set (wouldn’t this have to be done anyway in order to publish a paper?); another was concerned that the data might be analyzed using invalid methods (surely a judgment for the scientific community as a whole). This is something of a clue that the real issue here has more to do with status and career than with any loftier considerations. Scientists don’t want to be scooped by their own data, or have someone else challenge their conclusions with a new analysis.

As the author points out, however, new analyses are exactly what cancer patients (and patients in general) need. We all need all the information available that pertains to our health, so we can look at it and think about it and use it to safeguard ourselves. This reluctance to part with information is contrary to the spirit of scientific openness and inquiry. It is also unsafe and unfair to patients.

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Posted In: Cancer , Communication , Disclosure

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The overwhelming majority of hospitals will not admit mistakes to patients if there is little chance of patients finding out, and may not even discuss the mistakes after the patients do find out. Of course, hospitals do this to fend off the threat of lawsuits.

Yet Dr. Steven Kramm, former chief of staff at the VA hospital in Lexington, Kentucky, argues that the opposite approach might be best from everybody's perspective. A PowerPoint file of Dr. Kramm's report entitled "Victim Compensation Without Litigation--the Lexington Experience" can be found on the SorryWorks website. To find it, scroll down and click on the link that says "Download."

Some of the key points of Dr. Kramm's assessment:

-As mentioned above, most hospitals say nothing to patients if something has gone wrong. If the patient does know and wants compensation, the hospital takes the same action regardless of whether it is at fault or not. That action often involves cutting off all contact with the patient; even where this is not the case, the patient is usually kept at a distance and given little information. (Slides 3-4)

-From 1987 onwards, the Lexington VA took the opposite approach and offered full disclosure even when the patient did not know anything had gone wrong.

-The process involved practitioners and administrators identifying cases where compensation might be justified, discussing the possibility of disclosure in those cases together, and finally making the disclosure to the patient with a presentation of compensation options. The hospital would also suggest that the patient might retain an attorney, as this would prevent the patient from having "buyer's remorse" or feeling cheated. (Slides 9-11)

-The result was that, from 1987 to 2003, the single largest payment made by the Lexington VA was $341, 000 for a wrongful death case and the average settlement was $16,000. They negotiated over 170 settlements and took only three cases to trial, out of which they lost two and won one. (Slide 15)

-By contrast, the mean malpractice judgment for VAs across the nation in 2000 was $413,000, the mean pre-trial settlement was $98,000 and the mean at-trial settlement $248,165.

-The overall mean payment for Lexington (regardless of whether the case was settled or went to trial) was $36,000 as of 2000.

Clearly, Lexington comes out as the financial winner, in addition to having a policy that gives more consideration to accountability and sympathy.

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Disclosure

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