Monday, July 25, 2005

Does the Devil Make Us Do It?

Some of us are old enough to remember a comedian named Flip Wilson. One of his characters was a spirited lady named Geraldine who, when caught in some misbehavior, liked to say “the devil made me do it.”

The July 21, 2005 issue of the Boston Globe carried a front-page article reporting on a study that ranked hospitals in 40 US cities on their treatment of heart attacks, congestive heart failure, and pneumonia. Boston was the top performer in heart attacks and congestive heart failure, but ranked 30th in pneumonia.

On the pneumonia front, Partners Health Care (Brigham and Women’s Hospital and Massachusetts General Hospital) had particularly dismal records. Dr. Elizabeth Mort, a Partners official involved in quality improvement, explained that emergency doctors were often distracted by more urgent cases. One component of pneumonia care is the administration of a vaccine and vaccination, she pointed out, is something that the specialists who see inpatients tended to leave to primary care physicians. She also said that cardiac care benefited from the existence of medical staff departments in that specialty, while pneumonia care did not.

As to what the hospital is doing about it, Dr. Mort said that it was developing a computer program to prompt physicians on the proper tests and treatments for pneumonia, as well as protocols to fast-track pneumonia patients in the Emergency Room.

She didn’t exactly say “the devil made us do it.”

But she came close.

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