Wednesday, August 04, 2010

Signs of Progress

The other night I happened upon a PBS television program about the historical development of surgery. One thing that struck me was the difficulty the profession has had in adapting to advances in practice. Hand washing before delivering babies and controls on the use of chloroform as anesthesia were offered as examples, both failing to be widely adopted for decades despite clear evidence that when practiced they saved many lives.

The story has its counterpart in the modern age, when the adoption of simple procedures for reducing surgically related infections has been so slow.

In thinking about that, it seemed to me that the only remedy would be some form of influence coming from outside the profession, such as market forces (e.g., insurance companies steering their patients to hospitals with low infection rates) or public opinion.

Those thoughts caused two items in the August 2 issue of The Boston Globe to catch my eye.

One was an article about laboratory mistakes. It told the stories of two patients, one of whom underwent an unnecessary removal of his prostate based on the biopsy of a different patient. The second had been mistakenly cleared of prostate cancer as a result of a similar error. His case was correctly diagnosed some eight months later.

According to the report, it is not clear that the delayed diagnosis adversely affected the second patient, but the first was experiencing incontinence and erectile dysfunction as a result of the surgery. Needless to say, both are suing.

The other item was an editorial urging doctors and hospitals to make greater use of the known methods for reducing surgically related infections.

Neither of those articles would have been published as recently as twenty-five years ago. Matters of that kind were considered to be the province of the medical profession and not suitable for consideration by non-physicians.

So while progress in health care reform seems slow, there are signs that it may be proceeding more rapidly than it has in earlier years.

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