The Treatment Trap
Rosemary Gibson and Janardan Prasad Singh
237 pages
$24.95
Not meaning to overwhelm anyone with these book reviews. Both Collateral Damage (below) and The Treatment Trap are books I’ve discovered via Consumer Unions’ Safe Patient Project network of patient safety advocates. I met both Dan (previous review) and Rosemary (current review) at the Patient Safety Summit recently held at CU headquarters in Yonkers. So — professional colleagues, not people I owe favors to. But in the interests of ethical reviews…
Health care in the United States is in critical condition. Many and varied voices and approaches need to be raised to bring it to the public’s attention. There are substantial barriers to the knowledge we need in order to give ourselves a fighting chance when we enter glassy, glitzy, modern, (architecturally) state-of-the-art places of healing.
Large corporate entities that handle the hospital management and health insurance components of our health care system do not tolerate thoughtful criticism well. They do what they can to silence questioners. Physicians with their vested corporate interests often intimidate critics, including their own colleagues, with aggressive silencing techniques.
Government agencies sometimes collaborate in the secret-keeping. Consider the recent example of theHealth Resources and Services Administration( HRSA)’s removal of its Public Use Data File, which is used to track actions against physicians nationally. The confidential portion of the database contains identification information so that hospitals can check the database prior to hiring a doctor.
Journalists and researchers rely upon the public database to investigate whether state medical boards are acting on complaints against doctors in a timely fashion and whether they are reporting sanctions against doctors to HRSA as required. The public database does not identify sanctioned physicians, however, so it can’t be used by individuals to protect themselves from harm.
Smart journalists have managed to identify some of the physicians, however. Recently, a single doctor, so identified by an investigative reporter, fired off a sufficient number of communications to HRSA that HRSA closed down the public database without forewarning. And patient advocates and journalists have had a devil of a time getting it back up. But it did go back up recently after new administrative conditions were added.
HRSA is a government agency with a mandate to protect the public from medical harm.
This episode of a single physician bullying a public agency into acting to protect his individual interests (he was furious that a reporter had discovered his extensive malpractice history) before acting on its own mandate to protect the public comes as no surprise to many patients who have suffered at the hands of such doctors and hospitals.
It comes as no surprise to patient safety activists.
But it does complicate the public’s access to information that might help them to make wise health care decisions for themselves and their families. And it does illustrate why so many people unwittingly make health care decisions against their own best interests. They simply do not have access to information that would help them make informed decisions.
In his Foreward to The Treatment Trap by Rosemary Gibson and Janardan Prasad Singh, Consumers Union president, Jim Guest writes:
For the last several years, we at Consumers Union have gathered thousands of stories from consumers whose personal health-care experiences are compelling – and chilling. We have frequently found consumers whose problems with the health system began with overzealous testing or treatment. In some cases they have endured great physical and emotional suffering because of medical errors caused by procedures they didn’t need. As in The Treatment Trap, their pursuit of the truth was stymied by a lack of candor, transparency, or caring assistance from a health-care system they should have been able to trust. (p.11)
How to get around what Jim Guest generously labels “lack of candor”?
Clearly, a broad palette of options is needed. Individuals whose family members have been harmed do speak out in essays, videos, and self-published books. A few of those whose families have been touched by medical mistake have been able to speak to groups of medical students and residents or to administrators of community hospitals. A few have been working on legislation and regulations designed to improve patient safety and to lower the frequency of leaving the hospital in worse shape than when they were admitted.
None of this is sufficient. As a society, we have yet to reach a “tipping point” where the realities of the huge numbers involved with patient harm actually touch us sufficiently to push for change. What does it take?
Medicare reports that nearly one in three Medicare beneficiaries is harmed by their hospital stay. Authors projected that 15,000 Medicare beneficiaries actually died in the month (October 2008) under review. Another study reported that 98,000 people die each year in our hospitals due to medical error.
An estimated 13.5 percent of hospitalized Medicare beneficiaries experienced adverse events during their hospital stays. Of the nearly 1 million Medicare beneficiaries discharged from hospitals in October 2008, about 1 in 7 experienced an adverse event that met at least 1 of our criteria (13.5 percent). This rate projects to an estimated 134,000 Medicare beneficiaries experiencing at least 1 adverse event in hospitals during the 1-month study period. We calculated incidence rates for adverse events that met our three criteria: 0.6 percent of beneficiaries had an NQF Serious Reportable Event, 1.0 percent had a Medicare HAC event, and 13.1 percent experienced an adverse event resulting in the four most serious categories of patient harm. An estimated 1.5 percent of Medicare beneficiaries experienced an event that contributed to their deaths, which projects to 15,000 patients in a single month.
An additional 13.5 percent of Medicare beneficiaries experienced events during their hospital stays that resulted in temporary harm.
Adverse Events in Hospitals, Dept. of Health and Human Services, pp. i-ii.
http://oig.hhs.gov/oei/reports/oei-06-09-00090.pdf
Government reports that sound the alarm as this one does reach very few people. If you are considering surgery, you are not likely to find what you need here.
Rosemary Gibson and Jaradan Prasad Singh have written a wise, calm, persuasive book that connects research with common language, balances human needs against economics, and provides practical suggestions for self-protection. If there is any flaw in this approach, it may be that all of the reading, research, and advocacy in the world is insufficient to protect oneself or family members from unscrupulous or dishonest purveyors of medical services.
Although they do not make this limitation on self-advocacy explicit, they do report that it happens. And it does not just happen to disadvantaged people. In fact, as Gibson and Singh point out, when it comes to unneeded medical service, it is the people with “good” health coverage who are more at risk, because the people offering these services know they will be paid well for dispensing them.
When the term “overtreatment” occurs in health care discussions, listeners sometimes react with concern that what is really meant is “We intend to save money by letting you die.” (Remember the fiction about “Death Committees.”)
In fact, the opposite may be the case, as The Treatment Trap ably points out. If you die from an unnecessary surgery or procedure, or you live out the rest of your life disabled by surgery that you did not know was being prescribed in your community at two or three times the national rate, then it is overtreatment that has ruined your life and harmed your family. And this may happen far more often than you realize.
Gibson and Singh clearly separate two prominent hazards of medical care in the United States today.
Where is the fine line between appropriate care that makes people better and inappropriate treatment that does not?
…
Overuse is the third rail of contemporary American health care. Politicians and medical leaders prefer to stay far away from it. That’s because one person’s overuse is another person’s financial benefit. In this book we give voice to doctors, nurses, and hospital CEOs who witness it, and patients and family members who bear its consequences.
More medical care, not less, is an imperative for the sick who cannot afford it. It is an imperative for those who battle the faceless forces of insurance companies that deny legitimate claims. (pp. 21, 23)
Their focus on overtreatment makes for compelling reading. Based on solid research and careful interpretations of research findings, The Treatment Trap offers strong evidence and practical steps for those facing elective procedures.
(Note that many of the individual stories, whether from patients or providers, are reported anonymously, however. This necessary approach does protect the witness to medical malfeasance, but limits the reader’s ability to know where the reported hazards are happening.)
This is a book that can help the reader avoid medical mistreatment.
It is a book that can help consumers in the United States to reach a tipping point where we all comprehend that those of us who are healthy are merely “temporarily well.” And if we do not do something about the cultural values revealed in The Treatment Trap, we, too are vulnerable to future overtreatment ourselves.
For at bottom, the health care debate is both societal and personal. The Treatment Trap provides needed guidance in both dimensions.
