Thursday, September 19, 2013

Don Berwick on the NHS ..."unique example for all to learn from and emulate""-after examing the Mid Staffordhire horror show

Here is the entire sentence from which part of this posting's title derives:

"You are stewards of a globally important treasure: the NHS. In its form and mission, guided by the unwavering charter of universal care, accessible to all, and free at the point of service, the NHS is a unique example for all to learn from and emulate."

 That quote is from a letter from Dr. Berwick to officials of the NHS as part of the report from the committee he chaired to investigate the egregious treatment of patients at a NHS hospital,the Mid Staffordshire.

See here for Greg Scandlen comments in a  blog entry entitled "The Real Don Berwick"

In Scandlen's commentary there is a description of the horrible things to which patients were subjected and excerpts from the committee's report.

I cannot resist one other quote, this one from Paul Krugman.

"In Britain, the government itself runs the hospitals and employs the doctors. We've all heard about how that works in practice .Those stories are false."

The following is  from Berwick's  book written with the current Vice president of CVS Caremark (Troyen Brennan)

 "Today, this isolated relationship[ he is speaking of the physician patient relationship] is no longer tenable or possible… Traditional medical ethics, based on the doctor-patient dyad must be reformulated to fit the new mold of the delivery of health care...Regulation must evolve. Regulating for improved medical care involves designing appropriate rules with authority...Health care is being rationalized through critical pathways and guidelines. The primary function of regulation in health care, especially as it affects the quality of medical care, is to constrain decentralized individualized decision making.

So how did those appropriate rules with authority work out for those victims of the NHS? Was there too much residual "decentralized decision making"

Maybe one lesson to learn from the NHS tragedy is when no one is accountable or responsible, some really terrible things can happen. Berwick's committee did find that no one was really at fault."NHS staff were not to blame".

OK,one more quote, this time John McEnroe's  "you gottta be kidding me"

Another lesson all can learn from the NHS is how incredibly bad their electronic record system worked. See here for a report of what some have called the biggest IH foul up ever.

2 comments:

Roy M. Poses MD said...

I admit that the mid-Staffs episode was quite bad.

However, citing that one episode in isolation to say UK NHS bad, (and presumably US heavily for-profit corporate based health care good) does not make a lot of sense.

You can peruse Health Care Renewal (http://hcrenewal.blogspot.com) for hours and find lots of equally nasty episodes involving likely harm to patients occurring in the US, produced by our big for-profit (or non-profit) health care corporations.

Think about the over-use of SSRIs given to children and adolescents, likely resulting in self-harm and suicides, instigated by suppressed and manipulated research and deceptive marketing by large pharmaceutical companies. [Look here: http://hcrenewal.blogspot.com/search/label/SSRIs]

Think about the old National Medical Enterprises kidnapping psychiatric patients. (The company went on to become Tenet. No executives were punished.) [Look her: http://hcrenewal.blogspot.com/search/label/Tenet]

Then there were other dangerous drugs that were over-promoted, epoetins, Avandia, etc, etc.

Is the US system different than that in the UK? - yes. Is it morally superior? - I don't think there is any evidence of that.

james gaulte said...

Dr. Poses,thanks for your comments,they are always welcome.
I did not intend to categorically claim that the NHS was bad but was merely focusing on two recent bad occurrences;the egregious situation at one hospital and the monumental failure of their EHR system.And I certainly did not intend to imply that therefore US health care was better.I believe it is better in some regards and worse in others.Probably the same could be said in comparing health care in any two given countries.
Similarly your well documented instances of many egregious occurrences in US health care do not necessary imply that you prefer a system such as the NHS.

I didn't intend to imply a judgement regarding the relative moral worth of the two "systems" of medical care. I need to read and think a lot more about moral philosophy before I dip my toes into that water.

I believe the the folks responsible for the horror at Mid Staff should be held accountable (unlike Dr. Berwick) and that certain executives guilty of fraud in certain aspects of drug promotion should also be. There is no shortage of bad behavior regardless of the system but there is a shortage of holding folks responsible for their actions.(Well, maybe I am getting into morality here after all )