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QUALITY: NEJM sneaks in early about “To Err is Human” plus 5

The NEJM has an article about the IOM patient safety report five years on. It’s by by a pretty elite group; Drew Altman of Kaiser Family Foundation, Carolyn Clancy, head of AHQR, and Bob Blendon at Harvard. Basically they are over kind to the system, suggesting that a move from 4% to 7% of hospitals putting in CPOE is a big deal, when it’s not really. I hope to have Michael Millenson, who is not so kind to the system commenting on this in the near future in TCHB. Anyway, the authors also note that the public perception of health care providers’ safety has been considerably reduced:

Unfortunately, despite five years of focused attention, people do not seem to feel safer. More than half (55 percent) of the respondents in our survey said that they are currently dissatisfied with the quality of health care in this country — as compared with 44 percent four years ago.5 In fact, 40 percent believe that the quality of health care has “gotten worse” in the past five years, whereas only 17 percent think it is better. And half are worried about the safety of their medical care.

Altman, Clancy and Blendon think that we’ll likely solve the patient safety issue as there’s bi-partisan agreement on the need to solve it and the info-tech needed to solve it is becoming more widely used. But they also stumble upon the key issue which is that:

Physicians also strongly oppose public reporting of information on medical errors — perhaps because of worries about malpractice lawsuits, which physicians name as the top concern facing health care and medicine today. In stark contrast, 71 percent of the public believes that public reporting of medical errors by government agencies would be very effective in reducing errors, and 7 in 10 persons say that such reports would tell them “a lot” about the quality of a hospital or a health plan.

Well they’re a lot more optimistic than I am. In over a century of conflicts between what’s good for doctors and what’s good for the public, only one side has ever won. Some leadership from the AMA on this issue would be nice, but I guess they’re busy pissing off the trial lawyers. And the importance placed on that conflict is most of the problem, and it’s one that I fear that the reasonable authors of this article understate.

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