Monday, March 26, 2018

Errors, Lack of Physical Exams and Deaths Due to Doctor

In the USA medical errors are known to cause over 100,000 deaths per year. This is the amount known and admitted to. Some of the reasons for this has been indicated to be a lack of organization, the lack of medical disclosure required by institutions and practitioners, as well as cognitive diagnostic errors.

Recently I was reading a medical review article on the demise of the physical exam and the errors due to a lack of using physical exams or errors in interpreting the exam or errors in decision based on a poor exam. This data was based on a survey that  was given to physicians  to get an idea of how the present day lack of time spent physically looking at patients is taking its toll on the patient. I post some of their findings here to give you some insight into how important it is for practitioners to spend time physically looking at their patients and how often this is not done. You can see the survey results here.

Note that the manner in which this was reported gives percents here that will not always add up to 100% as this data comes from a questionnaire and they list the percent for each question separately.

The article said only 18% of on-duty time was spent in direct patient care in hospitals by Docs. They specifically found that internal medicine interns spend 12% of their time with patients and 40% of their time was spent on the computer. This review article wanted to know what kind of errors took place when so little time is now being spent with patients and specifically the decreased time spent on physical exams.

It was found that in 63% of the cases where there were errors, most errors were due to not performing a physical exam at all.  An additional 14% of patients did have an exam and it was a correct exam but the practitioner interpreted the exam results incorrectly. 11% of the cases did not note an important sign or forgot to look for an important sign. The additional 12% of cases where there were errors were for unknown reasons.

In the cases examined 76% had incorrect diagnoses, 18% of patients received unnecessary treatment, 42% of the patients had either no treatment or delayed treatment, 25%  had costs that should not have incurred due to the improper treatment, 17% had exposure to radiation or contrast dyes that should not have taken place and 4% had complications due to improper treatment.

The electronic records have drop down boxes that has added to the confusion of whether an exam has been performed or not. By the way, the new mandate by our government that all Docs who are part of the insurance system have to use their new computerized software has created it's own set of issues. 

In my opinion, the requirement for practitioners to take notes on the computer and put every test, every bit of data on the computer is an issue and a time consuming regulation that takes attention away from the patient. Additionally, we need to look at the fact that many of the practitioners who were drawn to being a Doc for the interaction between them and the patient, as well as their love to help people have now left medicine for some other job or retired. Medicine has been taken over by the government and insurance companies and their long list of rules and regulations that have nothing to do with health care. It is no longer a satisfying job for many of the people who were originally drawn to the medical profession. They have either retired early, found a new career or started a private practice where they do not take insurance. The U.S.A. has a real issue with a lack of Docs at this point and many of the empty positions are being filled by people who want to immigrate into the U.S.A. that have a diploma in medicine. This creates a situation where the people from other countries wanting to immigrate, know they can get into the U.S.A. by becoming a nurse, a physician or any other medical profession that is lacking in the U.S.A I am sure you can see how this could create an issue. Luckily some of them actually like caring for people. However, for some it is just a means to an end. The end result of what has taken place in medicine though is that many patients no longer have a health advocate as their practitioner. They have someone taking care of their health care who is obligated to rules and regulations made by big-government and insurance companies. They have to dance to their tune or they do not have a job.

From my point of view, if we want good health care, we have to go outside of the current governmental/insurance controlled system and go to a private provider who does not take insurance.  Watch out though, as in the future even that choice may be taken away from you.