Robert Pearl, Executive Director and CEO of The Permanente Medical Group, lays out the dismal details of our current health-care system in his new book, “Mistreated: Why We Think We’re Getting Good Health Care — and Why We’re Usually Wrong” (PublicAffairs).
“When independent researchers crunch the numbers, American health care ranks nowhere near the top of the list,” he writes. “Among developed countries, the United States has the highest infant mortality rate, the lowest life expectancy and the most preventable deaths per capita.”
Pearl’s book shows why this is, and how we can affect positive change. Here are some of his more disturbing charges:
Medical errors are the third-leading killer in the US, accounting for almost 10 percent of all American deaths.
A 1999 study found that “98,000 people die in hospitals each year due to medical error.” But that figure soars closer to 200,000 annually when you include “doctors who fail to communicate effectively with their colleagues, doctors and nurses who dole out the wrong medications, and doctors who are responsible for causing or spreading hospital infections.”
The leading cause of death for US hospital patients “isn’t heart attack or stroke, but infection,” and one cause is “doctors, nurses and other hospital staff failing to wash their hands as they go from one patient’s room to the next.” Pearl writes that one bacterium, C. diff, causes 14,000 deaths per year, making “decontamination of hands, rooms and hospital surfaces an absolute necessity,” and yet, “at least one-third of the time, doctors fail to wash their hands between patient visits.”
Fifty percent of US doctors use paper, rather than electronic, records, costing money and lives.
The average American sees “19 different doctors in their lifetime.” This makes clear why paper records — which are still relied on, Pearl writes, by “about 50 percent of all doctors” — are a problem.
“If you are like most patients, this amounts to 19 different physicians asking you about your allergies, medications and test results. Only one needs to get the information wrong to spell disaster.”
Pearl knows this topic all too well — his own father died because his doctors all assumed an important vaccination had been administered by someone else.
Medical providers do better financially when they make mistakes in patient care — because they get paid again to fix the problem.
Health-care providers are paid by insurance companies on a “fee-for- service” basis — they perform a service, they get paid. But this fails to account for whether that service did any good. Put another way, doctors get paid for the quantity of care they deliver, not the quality.
So if a surgical patient develops an infection, the money to treat the infection is gravy for the hospital. “Most insurance companies still reimburse care providers twice,” Pearl writes. “Once for the original problem and a second time for treating the complications they created.”
A stronger focus on disease prevention could save 200,000 American lives per year.
“The lack of prevention in our health-care system helps explain why our quality scores pale in comparison with most other industrialized nations,” Pearl writes.
The difference in health results between doctors who emphasize prevention and those who don’t should make everyone take notice.
“Health-care providers who make prevention a priority are able to lower hypertensive disease, stroke and heart-attack rates anywhere from 10 to 30 percent below national averages,” Pearl writes. “If every insured American received care from these higher performers, as many as 200,000 heart attacks and strokes could be prevented each year.”
Today’s opiate addiction crisis is a result of deliberate moves by pharmaceutical companies.
“Every year, 40,000 people die from drug overdoses in the United States. Up to 60 percent of these deaths come from prescription medication. That number is climbing,” Pearl writes, noting that “between 1990 and 2012, the frequency of patients dying from a drug overdose increased more than 100 percent.”
Pearl notes that “this didn’t happen by chance,” as it was “the result of a deliberate effort by some drug manufacturers to shift doctors’ perception in favor of prescribing more of these dangerous medications.”
In the 1960s, doctors became cautious about prescribing opiates after rates of drug addiction rose. As a result, by the early 1990s, the drugs were under-prescribed, with many patients’ pain going under-treated.
A correction was required. But in working to make this happen, Pearl writes, some drug companies dangerously fudged their claims.
“Pain management experts (many found and funded by the manufacturers of these powerful medications) began assuring doctors . . . that dependence and addiction would not occur in the face of genuine pain,” Pearl writes. “Many taught doctors that their patients would become immune to the life-threatening consequences of high-dose administration over time. Therefore, there was no limit to how high the dosages could go.”
Today, with opiate abuse killing 91 people a day in the US, according to the CDC, we know just how wrong this was.
“This all but guaranteed users for life,” Pearl writes. “Nearly all of these assertions about the protection from addiction and resistance to overdose have been proven wrong.”