Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, May 1, 1990 TAG: 9005010370
SECTION: EDITORIAL PAGE: A-9 EDITION: METRO
SOURCE: Bob Willis Associate Editor
DATELINE: LENGTH: Long
Welcome - again - to the world of Charles Inlander, president of the People's Medical Society. I introduced readers to him more than two years ago after hearing him speak at a health-care seminar held by the Washington (D.C.) Journalism Center.
A couple of months ago the center held another seminar on the topic. It wouldn't be the same without Inlander and his blunt, irreverent comments about the medical establishment that strikes most of us dumb with awe.
"In this country," he says, "and in most countries, we have essentially no information as health-care consumers about the quality or competence of the people who give care." Thanks to the efforts of his organization, based in Pennsylvania, that state has a law - the only one in the country - providing for the first systematic reporting of data on morbidity, mortality and costs at hospitals. "It's a very narrow and very small beginning" toward the kind of disclosure the People's Medical Society seeks.
"What you think in your own community are the best hospitals are purely from hearsay," says Inlander. He travels a lot around the country to speaking engagements, and every time he's picked up from the airport, "they'll always drive me past what is identified as the best hospital in town. It's right near the Kmart, then you get to the hotel.
"And I always ask them, `How do you know?' and they say, `Oh, it's the best in town.' Well, how do you know it's good? Do you know the infection rate at that hospital? Do you know the mortality rates by procedure? Can you name me the doctors or staff who have had their privileges suspended because of alcoholism, incompetence or drug addiction? Can you tell me the drug-error rate at the hospital?"
His listener never knows the answers, but insists that everybody says it's the best in town. "That's what we know about hospitals," sums up Inlander. "We have hospitals that run on major reputations that have nothing to back those up."
On average, says Inlander, one of every 10 people who goes into a hospital as a patient comes out with an infection - called nosocomial - caused by his or her stay there. "Eight percent shouldn't get them. The No. 1 cause right now is catheter-related problems, failure to check on sterilization.
"The No. 2 reason, close behind it and growing, is staffers not washing their hands. I'm not talking just about doctors and nurses, I'm talking about food-service staff. They're reusing and resterilizing equipment that was not meant to be. These are all documentable problems. Ten years ago the nosocomial rate was 5 percent. Now it's 10 percent. This is when everybody is looking at quality.
"We have a 2 to 3 percent drug-error rate in hospitals. Doesn't sound like very much? That's using the unit rate where the packaged medicine is brought up to you. No longer does the nurse mix it; it comes from the pharmacy.
"In a hospital with 300 beds, that comes out to 60 medication errors an hour, 24 hours a day. In hospitals that don't use the unit-dose system, they have approximately a 10 percent error rate. That means 300 medication errors an hour in the average such hospital: either the wrong medication, the wrong dose or the wrong time.
"Why should someone get the wrong medication? Well, you know the old joke that nobody can read the doctor's handwriting? That turns out to be the main cause."
Inlander declares that consumers have the right to demand, and providers the obligation to give, the data that help people make informed decisions on quality of care and where they should go when they are sick. There are no Consumer Reports on medical equipment, "including your doctor's blood-pressure cuff."
Inlander told of getting an unexpectedly high blood-pressure reading from a physician ("an older man, in practice for a long time") who admitted that he'd been getting high readings on a lot of other patients too. "It's the times, it's stress," he quoted the doctor as saying. Inlander asked that he get his instrument calibrated; the physician called later to say he'd found it was "really off."
"I sat there thinking to myself, how many people are on medication as a result of this? A lot of people are because of the failure of the system to monitor itself.
"We as consumers can't allow the doctors to guard the chicken coop any longer. The medical licensing boards are physicians. The medical-practice laws have been drawn by physicians. The staff of the committees that deal with the health-care issues are physicians. The Food and Drug Administration, the drug companies on the clinical side are physicians.
"That's not to say physicians are bad people. But you don't allow them to be the judge, the jury and the seller. That's why we have such a poor record of sanctioning physicians in this country. Ten percent of doctors are incompetent according to most of the good studies, 7 percent are alcoholic, 5 to 10 percent are drug users, another 4 or 5 percent at any given time just can't do it anymore, and there's no retesting of doctors, no checking.
"The doctors determine who gets the license, who keeps it, whether my complaint is valid. Only 12 states require, when a doctor loses a malpractice case, that it be reported to the state licensing board."
I could go on, as Inlander does. But the gist of his message is: "We have to shift control of the system to us." He sees a consumer revolution coming in health care. If you're interested in his message or his non-profit organization, the People's Medical Society is located at 462 Walnut St., Allentown, Pa. 18102. Dues are $15 a year; members get a bimonthly newsletter, and the society also publishes self-help books and brochures.
by CNB