Monday, December 05, 2011

what will Dr. Big Work Up do?*

Oh here's an interesting development (straight from whitecoats blog), it seems JCAHO is proposing a national patient safety goal around overuse of procedures, tests and treatments. Will wonders never cease? Here's the link.

National patient safety goals are things like patient indentification, preventing medical errors, preventing mistakes in surgery. Hospitals have to comply with JCAHO regulations or risk losing accredidation and with it money.
That's why months of preparation go into JCAHO visits to prep the staff to parrot what the surveyors want to hear.

Personally, I think this is great. Hospitals and doctors refuse to stop ordering all these ridiculous, unnecessary tests on people, so apparently the government has to step in and do it. And guess what they don't give a rats ass about all the unfounded fears about liability.

Medical malpractice lawsuits are a real concern for doctors, nobody doubts that but the concern are blown way out of proportion. It is used as an excuse to order all of these tests which bumps up the level of care and puts more money into the hospital and doctors pockets.

What is so fascinating are some of the examples they give which are major areas of profit for hospitals:

1) the myriad of CT abdomens that are unnecessary and could probably be replaced by an ultrasound.
2) Doing angioplasties and stents on people with less than 40% blockage. (How about doing CT angios on every Tom, Dick and Harry that walks in with chest pain?)
3) Inducing labor in women who are less than 39 weeks.

Oh, I just can't wait to see how this all turns out. At the very least, it should start a necessary discussion around overtreatment. That's an accomplishment in and of itself.

*hi nurse k


Nurse K said...


Anonymous said...

the only problem with using U/S instead of CT for abdomen is the overwhelming number of underqualified people doing u/s. Got a foreign MD degree??-- well, guess you can do u/s instead of practising medicine. no shortage of people who will lie for you to qualify to write ARDMS.
And if the scanner doesn't see a mass, there's no hope in heck that the radiologist will.
At least with CT the mass should be on the image,

Anonymous said...

I whole heartedly agree with JCAHO. I work in an ER. Why do we do a CT scan on someone who has completely negative labs and x-rays? Not to mention, they have been seen 10 times in a month for the same thing and had a CT 8 out of those 10 times. All that does is raise health care prices and insurance premiums for others. Those "others" who wait until they are sometimes critically ill to seek treatment because they can't afford it.

Anonymous said...

Good and bad. Good to cure the Bigworkups (tm) of the world. Bad that I might have to argue to get something done that really is necessary.

Mark p.s.2 said...

To Dr Killpatient
I would think the new system would find those that over treat their patients over a period of time, say over a years time to show the tests ( with negative results) were un-necessary , then take action against those responsible for the error (waste of money).

Anonymous said...

This is a big issue. At what point can we safely deny a procedure while protecting the patient but also our jobs. True story here, in the ED I have had a patient with 10 out of 10 headache, "blurry vision" and severe chest pain. Then the patient proceeds to pull out a bag of Burger King out and chow down. Hmmm well something doesn't add up here. Well after a head CT, tons of lab draws and all that good stuff, nothing was wrong. Problem to me is so many things are subjective.

Also EMS abuse, the ambulance is not a taxi!!!! I'm sorry I know this is bad but I get a certain amount of satisfaction when a person comes in the ED via EMS for a very mild cough and then gets sent to the waiting room.

Briana said...

Or how about the new resident that doesn't listen to what the seasoned nurse says and orders a CT of the entire body plus a full work-up on a chronically homeless and alcoholic pt who has been coming to the Emergency Room DAILY for 30 years. I usually walk right past the resident and talk to the attending who says, 'Ya. Don't do any of that.'

But then I had a 13yo pt in Pedi who had classic appy signs/symptoms and the MD did NOT do a scan (but did labs and US) and was planning on taking the pt to the OR and the mom FREAKED because we didn't do a CT. People need to stop googling shit. You're not a doctor because you read WebMD.

Sorry for the novel... :)

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