There can be no question that the sharing of information positively influences the quality of medical care, whether that care is being provided by a top hospital in New York or Boston, or by a country doctor in a remote area of Appalachia. The sharing might occur through an article in a medical journal, such as the New England Journal of Medicine. Or, it could take place through the wonders of closed circuit videocasts, during which a physician on one side of the country can observe a physician on the other side perform a surgery about which that first physician needs to know. The bottom line is that physicians have plenty of knowledge that could benefit their younger and less experienced colleagues, which, when shared, ends up benefitting you, the medical consumer, because of the better medical care it generates.
Why, then, does American medicine not do all it can to exploit this principle for the greater good? We are in a political climate in which state medical associations, and medical liability insurers react to medical malpractice lawsuits by blaming the lawyers who bring them, instead of looking to how the healthcare system could be improved so that the mistakes that underlie such suits happen less frequently, or even not at all.
A case in point is our failure to implement a national registry—a nationwide data bank of results for particular surgeries using particular medical devices—so that problems can be detected early, and fixed quickly. The “fix” might be a modification to the medical device, i.e., an artificial hip socket, or additional training to the surgeons installing them. The New York Times addressed this subject on its front page earlier this week (7-29-08) in the context of artificial joints (“A Call for a Warning System on Artificial Joints”). Because we do not have such a registry, patients undergoing joint replacement surgery here run up to twice the risk as patients in countries with a registry that they will need to undergo a replacement procedure in the future, according to the Times article. This failure to implement such a basic system results in more, and unnecessary surgeries, along with more surgical risks, including infection; more costs to patients and insurers; and more time lost from work. And, not having the benefits of the wealth of information such a registry would provide means that many surgeons end up providing less- than- optimal care, when they could easily have the best and most recent knowledge at their fingertips.
To the same deleterious effect is the HIPAA law (The Health Insurance Portability and Accountability Act of 1996). Ostensibly created to protect the privacy rights of patients, it has resulted in a system in which obtaining a patient’s medical records in a timely manner requires needless paperwork, and sometimes dangerously large amounts of time. Wouldn’t it make more sense to create and maintain a national databank of medical records of everyone who has ever received medical care, and make it accessible to every hospital and doctor in the United States? When you are brought into your local emergency room, unconscious after a car accident, and your family cannot be contacted, wouldn’t it be wonderful if the hospital’s staff could plug your name into a computer, and learn what medications you are fatally allergic to? Would it really be so bad if the staff learned about that anal fissure repair surgery from 20 years ago? This is another step that would be relatively painless to implement, and would end up saving lives, in addition to medical costs. Why is it not yet in place?
Solutions are out there. It is up to our government and the healthcare industry to make use of them. And the sooner, the better.