There was a small, important article in Bloomberg News last week by David Klein, the CEO of Excellus, the large BlueCross BlueShield insurer in Upstate New York.
Mr. Klein discusses lessons learned during his wife's battle with cancer. He speaks plainly about what must be a very confounding and very emotional period in their life together. He notes that sometimes "clear answers don't exist" in medicine, despite the best research and despite the care of able practitioners.
David Klein's article emphasizes both the human and the humane: respect for the art of medicine, not just its scientific content, and the importance of emotional and spiritual support in patient care.
These are important reminders for professionals and lay people alike.
Showing posts with label Dr. Jerome Groopman. Show all posts
Showing posts with label Dr. Jerome Groopman. Show all posts
Tuesday, December 28, 2010
Saturday, January 30, 2010
'Best practices' . . . not always best
Dr. Jerome Groopman, whom I have mentioned before, has a fascinating article in the current New York Review of Books about the government's role in setting and requiring "best practices" in health care.
"Best practices" is in quotes because, as Dr. Groopman points out, such standards may not always be "best."
The government requires hospitals to adhere to its standards, and it reports on how well hospitals comply with them. Increasingly, Medicare, Medicaid, and non-government payers penalize hospitals with reduced or recouped payments for failing to comply with expert-defined best practices.
Yet, as Dr. Groopman writes: "[D]octors and other experts acting for the government and making use of research on comparative effectiveness. . . have repeatedly identified 'best practices,' only to have them shown to be ineffective or deleterious."
He ticks off a number of examples of "best practices" gone wrong, including:
This is not to say that research-based "best practices" are wrong. Adherence to such standards has improved hospital care, and I note Community General's success in such areas a low infection rates and low ventilator-acquired pneumonia.
It turns out, however, there is a difference between standards that are applicable in the same way for all patients (such as infection control practices) and standards as applied to an individual, given the complexity of the patient's illness (such a blood sugar management).
"[O]nce we depart from. . . mechanical procedures and impose a single 'best practice' on a complex malady," according to Dr. Groopman, "our treatment is too often inadequate."
"Best practices" is in quotes because, as Dr. Groopman points out, such standards may not always be "best."
The government requires hospitals to adhere to its standards, and it reports on how well hospitals comply with them. Increasingly, Medicare, Medicaid, and non-government payers penalize hospitals with reduced or recouped payments for failing to comply with expert-defined best practices.
Yet, as Dr. Groopman writes: "[D]octors and other experts acting for the government and making use of research on comparative effectiveness. . . have repeatedly identified 'best practices,' only to have them shown to be ineffective or deleterious."
He ticks off a number of examples of "best practices" gone wrong, including:
Dr. Groopman even discusses a "best practice" that he helped develop that turned out to be in error. He also talks about common errors a researcher can make leading to a bogus "best practice."- Medicare's tightly controlled blood sugar levels for intensive care patients "resulted in a higher likelihood of death."
- Medicare's recommendations for hip and knee replacements had "no effect" on complications.
- Federally-approved measures for congestive heart failure patients had "no major impact."
- Medicare's requirement for the speedy administration of antibiotics for pneumonia patients in emergency departments made things "worse."
This is not to say that research-based "best practices" are wrong. Adherence to such standards has improved hospital care, and I note Community General's success in such areas a low infection rates and low ventilator-acquired pneumonia.
It turns out, however, there is a difference between standards that are applicable in the same way for all patients (such as infection control practices) and standards as applied to an individual, given the complexity of the patient's illness (such a blood sugar management).
"[O]nce we depart from. . . mechanical procedures and impose a single 'best practice' on a complex malady," according to Dr. Groopman, "our treatment is too often inadequate."
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