Blog post below is adapted from a talk I gave on 11/1/2018 in New York City at Medshadow Foundation.
I want to talk briefly about three things that I see on a daily basis in the hospital – that I believe increases the risk for patient harm:
1- Patients often come to the hospital without an accurate list of their medications and supplements. Supplements, herbs, anything can have adverse effects. Usually it is dose dependent and dependent on interactions with other substances you may be taking, but there are a lot of unknown-unknowns in medicine. This is dangerous because poly-pharmacy is like juggling many knives and without accurate information – your physician is doing it blind. It’s surprising but in 2018 there is no centralized database for us to verify every patient’s accurate medication list. We often have to chase down primary care physicians, pharmacies, family members and nursing homes. Sometimes none of these sources are available because patient’s come to the hospital overnight. Please have an accurate list on you – and make sure your loved ones do too.
2- Every single link in the chain of our healthcare system is fueled by a profits over patients ethos. Even not for profit health systems care about revenue (to build nicer buildings) and they sometimes cut costs by hiring inexperienced staff and force them to see more and more complex cases. We used to have a saying in medical school – what you don’t have behind your eyes…you will never see in front of your eyes. Essentially that means that those who lack knowledge will blissfully ignore reality. A sad but true fact is that many prescribers may not even be aware of the side effects of the therapies they’re prescribing – because they don’t have adequate training and experience. Physicians don’t have the option to go to online medical school. Sadly, many other professionals nowadays lack adequate training and close supervision and are allowed by State laws to practice medicine without a medical license.
3-Lastly – There are bad incentives and punishment structures in healthcare fueling the inappropriate prescribing of medication. As an example – what probably contributed greatly to the opiate epidemic was hospitals being worried about Press Ganey scores or patient satisfaction scores after pain was deemed the fifth vital sign in 1993. Appease the patient, control pain with narcotic, get a good score – but this may have led to a vast cohort of the population addicted to pain medication. What am I saying? Don’t listen to the patient. No! Absolutely not – but maybe we need things other than throwing prescriptions at them – things that the other speakers have addressed earlier; yoga, acupuncture comprehensive treatments and emotional support.
A similar situation applies to the inappropriate prescription of antibiotics particularly from urgent care centers and telemedicine factories. What I see sometimes is that a patient has a viral upper respiratory infection – but instead of being reassured and advised rest and fluids – they’re given Tamiflu, antibiotics, analgesics and steroids. Kill four birds with one stone – but at what cost? Besides breeding resistance they have a detrimental effect on our microbiome and effect everything from our immune system, to mood, to cancer risk.
Ask lots of questions and take care of yourself and your loved ones.
Photos taken at the event by https://www.jordanephotos.com/