Joel Diamond 10/19/11

All That’s Good About Healthcare

There’s a new book by Candice Millard about the life and assassination—or better yet, death by medical malpractice– of President James A. Garfield. It turns out that his doctors’ refusal to wash their hands before probing his wounds after his shooting contributed more to his death than the bullet delivered by Charles Guiteau, which missed the president’s spinal cord and vital organs.

This travesty occurred despite the tireless campaign of Joseph Lister, who demonstrated that simple hand washing could save lives by preventing infection. And here we are, 130 years later, looking at technology and financial incentives to convince physicians to perform this simple act.

Ahh, but I am much too cynical. It’s so easy to point out what is wrong with medicine today. Instead, I’d like to change my usual tone, and focus on what’s good (and oh, there is so much good.)

• Laparoscopic surgery
• Immunotherapy’s profound effects on the treatment of rheumatologic and inflammatory bowel diseases
• Breast implants
• Robotic-assisted surgery
• Routine options for organ transplant
• Breast implants
• Advanced imaging technologies
• Cameras that when swallowed take Ansel Adams- like portraits of your bowels
• Breast implants
• Insulin pumps and patient-controlled analgesia
• And have you seen those TV commercials with former coach Jimmy Johnson for Extenze?

For those of you who insist on maintaining a cynical outlook, it is true that medical science now allows Bubba to eat pork rinds and pizza while never moving from his couch except to procreate– treating his acid reflux with OTC Prilosec, popping daily Cialis to help with the inbreeding, chasing it with Prozac because he’s bummed at “The Jersey Shore” hair-product line that messed with his Rogaine-induced mullet, while ultimately getting insurance to pay for his gastric bypass so he can fit through the door of his double-wide trailer.

But the reality is that Prilosec and other acid-blocking medicines have virtually eliminated the surgical treatment for peptic ulcer disease. Viagra and similar medicines have allowed Senator Bob Dole to keep Elizabeth happy. SSRI medicines have allowed millions of American to lead productive lives while decreasing the horrible stigma associated with mental health treatment. Laparoscopic bariatric surgery has finally reversed heretofore incurable obesity and its costly and devastating sequelae of diabetes, sleep apnea, and coronary disease.

Extending the analogy, medical technology has fueled its fair share of cynics. Like the television Dr. Oz, stethoscopes and scrubs seem to be more a fashion statement, as young physicians favor ordering echocardiograms than listening to heart murmurs, and it’s infrequent that they actually come into contact with blood and guts. Non-peer-reviewed Google searches have supplanted careful review of Harrison’s Textbook of Medicine, and template driven EMRs often get mistaken for a careful review of symptoms.

But ready access to imaging and information technology has markedly improved the way that new physicians approach diagnostic dilemmas, and a standardized approach to history and physical acquisition (along with improved decision support) will continue to drastically alter patient outcomes

Finally, let’s get back to hand washing initiatives (finally) taking placed in hospitals across the country. Along with other seemingly simple interventions such as marking the correct site before surgery, these measures represent an organized attempt to bring quality on a massive scale to an industry previously ignorant of evidence-based best practices.

Oh yeah, did I mention the new hair-removing laser that I got on eBay? I can finally say goodbye to those uncomfortable Brazilian waxes.

 

Joel Diamond, MD is chief medical officer at dbMotion, adjunct associate professor at the Department of Biomedical Informatics at the University of Pittsburgh, and a practicing physician at UPMC and of the Handelsman Family Practice in Pittsburgh, PA. He also blogs on interoperability.