The most frequent error in medicine

Feb 26, 2010

The most frequent error in medicine seems to occur nearly one out of three times a patient is referred to a specialist. A new study found that nearly a third of patients age 65 and older referred to a specialist are not scheduled for appointments and therefore do not receive the treatment their primary care doctor intended.

According to a new study appearing in the February 2010 issue of the Journal of Evaluation in Clinical Practice, only 71 percent of age 65 or older who are referred to a specialist are actually scheduled to be seen by that physician. Furthermore, only 70 percent of those with an appointment actually went to the specialist's office. Thus, only 50 percent (70 percent of 71 percent) of those referred to a specialist had the opportunity to receive the treatment their primary care doctor intended them to have, according to the findings by researchers from the Regenstrief Institute and the Indiana University School of Medicine.

The Institute of Medicine, in its seminal report "To Err is Human," defines a medical error as a "wrong plan" or a failure of a planned action to be completed.

"Patients fail to complete referrals with specialists for a variety of reasons, including those that the can correct, such as failure of the primary care doctor's office to make the appointment; failure of the specialist's office to receive the request for a consultation—which can be caused by something as simple as a fax machine without paper - or a failure to confirm availability with the patient," said Michael Weiner M.D., M.P.H., first author of the study.

"There will always be reasons - health issues or lack of transportation, for example - why a referred patient cannot make it to the specialist he or she needs, but there are many problems we found to be correctable using health information technology to provide more coordinated and patient-focused care. Using and other health IT to address the malfunction of the referral process, we were able to reduce the 50 percent lack of completion of referrals rate to less than 20 percent, a significant decrease in the medical error rate," said Dr. Weiner.

The JECP study followed 6,785 patients seen at an urban medical institution, all over age 65, with a mean age of 72. Nearly all (91 percent) of the patients were covered by Medicare.

"This is not necessarily the fault of patients or doctors alone, but it may take both working together - along with their health system - to correct this problem. Our study highlights how enormous a problem this is for patients who were not getting the specialized care they needed. Although our findings would likely differ among institutions, unfortunately overall trends are similar in other parts of the country" said Dr. Weiner.

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Provided by Indiana University School of Medicine

4.5 /5 (8 votes)

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richgibula
5 / 5 (3) Feb 26, 2010
In my practice, the leading reasons are: limited availability of local specialists making the referral a long distance, finding a provider who is on that patient's plan (even for Medicare), patients wanting to make their own appointments, tight schedule of the specialist, limited understanding of the purpose of the referral despite a 20-30 minute explanation and insurance approval delays.
dk2009
not rated yet Feb 26, 2010
Kind of off-topic but still related to health: I'd like to see something like a life-time prize offering from any government (or a pool set up by many govts.) for anyone who comes up with a cure for an "incurable" disease. Think about it. A scientist would receive, say, $100,000 or $200,000 (which is adjusted for inflation) per year for the rest of that person's natural life, or for the next, say, 70 years, whichever comes sooner.

The goal is to -really- provide an incentive to find a cure, and not to find a on-going treatment that does not cure the individual but that must be purchased/used on a monthly or daily basis. THAT would truly bring down medical costs I bet.

Note, this is not a fully thought-out plan, just an idea to drive innovation. Imagine the potential savings if huge segments of the population no longer had to buy medication for diabetes or MS or something. I could see that being worth $100-$200K/year/discovery/person.
wiserd
not rated yet Feb 26, 2010
dk2009 - I agree that we should focus on cures. I'd also say that you'd ideally account for partial cures. For instance; Serrapeptase, which is used in Japan and can be purchased in the states, increases the effectiveness of antibiotics by reducing inflammation which is helpful because inflamed tissues can prevent the penetration of an antibiotic or other chemotherapy. It also has the very novel property of removing biofilms in vivo which bacteria use to protect themselves from antibiotics.

Bacteriophage therapy also comes to mind.

Since the most helpful innovations would be broad-spectrum anti-pathogenic compounds and treatments, any prize would ideally account for that.
PPihkala
not rated yet Feb 27, 2010
There are already cures existing for different ailments, but it is not in the interest of drug manufacturers to let people know of them. They probably actively fight to shut that information ever reaching those who are suffering. The big question is how to modify this practice where drug companies lobby for their stuff that needs to be taken indefinitely and that does only alleviate the pains, but does not touch the reasons of illness. Many times invoking cures involves using cheap substances that can not be patented and therefore are not interesting to drug companies as there are no money for them.

We need to primary promote health, only secondary cures when that health is lost. And that suits current medical system not that well. They are good at fixing trauma, but not at promoting health. Illness prevention has higher upfront costs, but has bigger savings at the end. Just think of vaccines.
SMMAssociates
not rated yet Feb 27, 2010
What I see - my mom's 94 - is that she's seeing too many semi-specialists (i.e., foot doctor, eye doctor, GP Physician, etc.) and rarely referred to anybody "solid". Fortunately, she doesn't always need this....

We also have "hubris" issues, and "staff" mucking up the works. During a few days in hospital for pneumonia about ten years ago, a hematologist was called in (I've had anemia issues forever), and he told me that I should make an appointment to see him at his office. SOB charged me about $250 for that fifteen minutes, but that's not the worst....

The floor nurse in charge of the "homegoing instructions" interpreted "he should call for an appointment" as "YOU call for an appointment".... I ignored the appointment, and caught hell from his office for not showing up, including getting hung up on.

Told him that I wasn't going to be seeing him again in this lifetime....

(I did take care of it - turned out to be a benign tumor....)