HEALTH CARE

Patient Protection

The most common medical mistakes and what you can do to avoid them.

By Tina Peng | Newsweek Web Exclusive

Jul 3, 2008 | Updated: 12:37 p.m. ET Jul 3, 2008

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Posted By: Nins @ 07/06/2008 11:39:38 PM

Comment: Did you know that if McCain is elected you will have to pay income tax on the value of the medical insurance that your employer gives you? Worse still, he is offering a tax break for people who pay their own insurance, BUT only $2,500 for individuals and $5,000 for families.

Let's say you have a family of four. Your insurance policy costs would be at least $1,500-2,500 per month under a self-pay plan, which cost more than employer group plans. So, you pay $18,000 -$30,000 per year for insurance, and you get to deduct only $5,000 of that. If you paid $25,000 for you insurance, you would be out of pocket $20,000 per year. This is FAR WORSE than the current system, where if you are self employed you can deduct 100% of you medical insurance costs.

So, if you're not self employed, you would stick with your Employer's plan. Employer plans for a family of four have a value of $900-$1,500 per month totaling 10,800-$18,000 per year. Surprise! On April 15th, you owe tax on all of that as INCOME to you. Say your bracket is 25%, and the value of your Employer medical plan is $14,000. You will OWE THE IRS an additional $3,500, and that's ON TOP of whatever monthly premium you already pay to your employer for your insurance.

Many analysts say that McCain's new rules would encourage employers to stop offering health benefits. If that happened, then far fewer Americans would be insured than are insured today, because what family of four can afford $18,000-$30,000 out of pocket per year for self-pay health insurance?

Furthermore, McCain's plan does not require insurance companies to cover pre-existing conditions of people who self-pay their insurance. People under employer group plans have all of their pre-existing conditions covered. This is a hugely unfair aspect of the current system. Insurance companies can afford to cover the pre-existing conditions of the much larger pool of people with group insurance, but they refuse to pay the pre-existing conditions on the smaller pool of self-pay customers. They have been allowed to price gouge the self-pay customers, which is a form of market manipulation that should be illegal.

So let's say one of your kids had diabetes and you have high blood pressure, then your employer stops offering insurance. You now have to buy your own, but you and your child are INELIGIBLE due to pre-existing conditions. Oh, yeah, they will let you buy the insurance, but you can't use it for any pre-existing condition until you have paid on time every month for two years. And you know what happens at one year and 11 months? You get a letter saying your policy has been cancelled. I have many patients this has happened to.

McCain's plan SUCKS.

It does nothing to help middle class working Americans afford or obtain medical insurance. In fact, it makes the current system WORSE.
Posted By: wright @ 07/06/2008 5:53:19 PM

Comment: The principal reason for the high level of medical errors is, in my opinion, that the medical establishment suffers little or no cost for them. The suffering public is not protected by the lobby-bound government, where the AMA is all powerful. For example, a major factor in medical errors is, I believe, the high rate of doctor failure to function under the stress of the work environment. Doctors are not only being pushed to more and more intense levels of service, but also keep hours that are manifestly unsafe and would be judged unacceptable in any other life critical profession, from airplane pilot to fireman to policeman. For archaic traditional reasons, or perhaps greed, inertia, or a psychology similar to that of hazing rituals in fraternities and gangs, interns, resideants and practicing doctors are routinely forced to endure 24 - 36 hours shifts with either no sleep, or with constant interruptions. Life threatening errors result from their all too human inability to function properly without sleep, resulting errors such as discuswsed in the article. The medical profession, the NIH and the other weak regulators that supposedly watch out for the public interest have a moral obligation to manage themselves responsibly, first by acknowledging that their long hours are not just the doctors' province to regulate, but should be done to provide best care for the patients, and second, by reviewing how airlines, the military and the police have already handled these issues responsibly for many years. New procedures should be tested and evaluated rapidl;y, and existing regulations should be enforced vigourously and promptly to protect the public. Also, the information technology exists today for each patient to carry the equivalent of a memory stick storing a medical "passport" that amply records all his history, medications and conditions, a set of pictures, etc. Also obvious is requiring that each presciption be typed and signed by a doctor, instead of the current artistic handwritten way it is done today.
All these changes, and others, will happen, I believe, only as government universal insurance and other programs that cannot tolerate the current scandalous level of errors will be implemented, and thus will bring medicine into the 21st century in areas of job safety and communications, since the medical establishment has demonstrated its inertia and recalcitrance.
- Posted By: C. MacLean @ 07/07/2008 12:15:23 PM
  
  Comment: Wright - your conclusions about the cause of hospital medical errors are incorrect.
  
  The majority of medical errors in hospitals - falls, bed sores, failure to recognize patient distress - have nothing to do with doctors. These are problems directly related to the number of nurses on a given unit, or more specifically, lack of nursing staff.
  
  Hospitals are not run by physicians, although the lay public and most doctors think they are. Hospitals are run by nurses. A doctor may see a patient for 10 minutes, spend another 20 reviewing the medical record. The nurse is directly responsible for a patient's care for the full 8 or 12 hours of the nurse's shift.
  
  Physicians depend on the nurse to communicate changes in a patient's condition. And it is exclusively the responsibility of the nursing staff to turn patient frequently, get them out of bed, and insure their safety. When nurse-to-patient ratios go down - when there are fewer nurses for more patients - study after study has shown that patient morbidity and mortality goes up.
  
  While there is no question that 24-36 hour shifts for medical residents are ridiculous, not all hospitals, in fact, only big teaching hospitals, have residents, but all hospitals have nurses. However, the amount of hospitals that now have mandatory overtime for nurses is rising, and one can only speculate on how many errors are made during forced 16 or 24 hour nursing shifts.
  
  Medical errors that happen outside of hospitals are due to many factors - too many prescriptions, poor written records, difficulty maneuvering a complex and over-stretched health care system - but blaming hospital medical errors on lack of phyisican oversight is inaccurate.
  
  In most instances of hospital medical errors, the phsyician is irrelevant.
  
  C.MacLean, RN, MS
Posted By: ksmith116 @ 07/04/2008 3:44:55 PM

Comment: The single most important thing to prevent errors is communication. A universal electronic medical record that would be available wherever you might get care, from your doctor's office to the walk in clinic to the emergency room to the pharmacist would be a huge step in the right direction. Every day I see patients who don't remember their medicines, allergies, surgeries, or medical history, yet I am expected to make perfect diagnoses and prescribe the perfect treatment based on incomplete information. Expecting the private sector to come up with the best electronic medical record system based on the free market is absurd. The government already mandates many other things that are universally applied, such as DEA numbers, UPIN numbers, diagnosis and procedure codes, and electronic submission of Medicare and Medicaid billing. The VA and the Department of Defense already have electronic medical record systems that are available across the US. The federal government needs to mandate a universal electronic medical record.
K. Smith, MS, ARNP
Posted By: DebraPRpro @ 07/04/2008 12:01:07 PM

Comment: At this critical crossroad in healthcare when quality is not meeting expectations, CMS (Medicare) and leading private insurance companies are mandating they will no longer pay hospitals for preventable errors, RWD offers hospitals, like St. Lukes Episcopal Hospital in Houston the only systemic solution proven to enable and empower organizations through a unique lean approach based on the Toyota Production System (TPS). For over 15 years, our approach has inspired innovation and independence within the culture of organizations. Not merely a quick-fix or executive mandate, the collaborative solution we offer engages everyone at all levels of the organization, inspiring innovation and skill-transfer thereby transforming the entire organization so hospitals can minimize preventable errors, maximize quality care and realize long-term continuous improvement. Jim Parish, EVP RWD Technologies
Posted By: C. MacLean @ 07/03/2008 8:23:02 PM

Comment: As a registered nurse, I can speak to items 1 and 3.

Medication errors - Americans take too much medication; we are a drug culture, and believe strongly that there is a pill for everything. There isn't. It is not unusual for patients over age 50 to be on 7 or 8 different medications. The article's advice about asking a doctor about side effects is misplaced - most doctors don't have a good handle on side effects and know even less about drug interactions - a pharmacist is a better person to ask. But ultimately, many of the medication Americans take are for conditions that can be treated or cured by lifestyle changes - exercise, weight loss, stopping smoking, less alcohol. Change the behavior and there is no need for medicine.

The best way to prevent medications errors is to take less medication, or no medication.

Hospital errors - "Bed sores, falls, hospital-acquired infections and failure to aid patients in distress." Three of these items - bed sores, falls and failure to aid - are exclusively nursing errors; hospital-acquired infections are also partly under nursing's watch, but other hopsital disciplines play a part as well. In study after study it has been shown that when nursing staffing is down (and I mean registered nurses, not nurse's aides), bad things happen. Increasing nurse-to-patient ratios decreases or eliminates all four of these preventable errors.

The best way to prevent bed sores, falls, infections and failure to recognize patient distress, as well as medication errors in a hospital setting, is to improve nursing staff numbers.

One of the strengths that nurses have always brought to the table is that of patient advocate. It is unfortunate that as the healthcare system has changed and the nursing shortage has intensified, family members are forced to take on this role - not everyone has a family member who can be at a loved one's bedside, and too many family members are intimidated by the system, and/or don't have the knowledge needed to know which questions to ask.

Taking less medication, behavior change, and improving nurse-to-patient ratios will go a long way towards eliminating many, perhaps most, of these errors.

C. MacLean, RN, MS
Posted By: DebraPRpro @ 07/03/2008 2:03:48 PM

Comment: At this critical crossroad in healthcare??? when quality is not meeting expectations, CMS (Medicare) and leading private insurance companies are mandating they will no longer pay hospitals for ???preventable errors,??? RWD offers hospitals, like St. Luke???s Episcopal Hospital in Houston ??? the only systemic solution proven to enable and empower organizations through a unique lean approach??? based on the Toyota Production System (TPS). For over 15 years, our approach has inspired innovation and independence within the culture of organizations. Not merely a quick-fix or executive mandate, the collaborative solution we offer engages everyone ??? at all levels of the organization, inspiring innovation and skill-transfer ??? thereby transforming the entire organization so hospitals can minimize preventable errors???, maximize quality care and realize long-term continuous improvement. Jim Parish, EVP RWD Technologies