Near Misses by Air Traffic Control Still Better than Healthcare System

ABC News reported that two regional jets nearly collided before Thanksgiving near Denver when an air traffic controller accidentally told an approaching aircraft to make a u-turn into the other.

The error was both unbeknownst both pilot crews of the airplanes as well as the air traffic controller. Only 200 feet apart in altitude and less than 2 miles away, these planes flying at hundreds of miles per hour were within seconds of catastrophe.

What prevented this disaster so that it was simply a near miss? Two critical factors.

Computers in both cockpits alarmed imminent collision and advised immediate course of action. Pilots trained to trust the safety systems built to identify threats and problems and not question them.

Although human error is to blame for the near miss, it is clear that technology can assist to improve safety. Also, more importantly is that those using the systems need to have a mindset of trust and act accordingly even if it isn't immediately obvious why the action must be taken. As a result, the aviation industry is the leader when it comes to safety.

When it comes to patient safety, the healthcare system could do much better. Approximately 100,000 Americans die annually due to these preventable medical errors or errors of omission and missed opportunities. However, since these typically only occur one death at a time throughout the country no one seems to notice.

100,000 Americans is about 250 Boeing 747 jumbo jets filled to capacity. Imagine if that many crashed in a year. Would that get your attention?

These errors and omissions occur because doctors and hospitals lack the basic information technology for making patients safer. The vast majority of healthcare providers still use paper charts and handwritten prescription pads. Without a comprehensive electronic medical record which would help identify drug-drug interactions, avoid dispensing the wrong medication or dosage due to illegible handwriting, suggest the lab tests due for specific medical conditions, or prompting both doctors and patients when to get important screening tests done, all of us instead depend on our doctors and pharmacists never to make a mistake.

This is of course impossible.

So why doesn't the healthcare system do better?

Two simple reasons. First, the implementation of technology like electronic medical records is costly and no one wants to pay for it. For a doctor to implement an electronic medical record can easily cost $30,000. If it prevents a drug drug interaction or stops from having the wrong prescription dispensed, the patient benefits. Does the doctor or pharmacist benefit?

Second and perhaps the biggest challenge is in changing the mindset of doctors. Pilots and flight crews are trained to communicate and speak up regardless of their rank. Doctors, however, operate in a world with a set hierarchy and perspective that impedes safety. The pecking order still is medical student, intern, resident, fellow, and attending physician. Medical assistants, physician assistants, nurses, and doctors. Attending doctors tell residents what to do. Residents tell medical students what to do. Doctors tell support staff what to do.

As a result, the mindset becomes one of self reliance and a top down approach rather than one that values collaboration and team orientation. Rules, regulations, and computerized systems aren't going to tell a doctor what to do. This perspective explains why wrong side surgeries still occur and surgical instruments are left in patients even though surgical timeouts and checklists have been implemented in hospitals. Despite built-in safety systems and reminders in electronic medical systems which could help doctors provide better and safer care, doctors balk at the hassle factor of being slowed down or being prompted by a computer even though using paper charts they have more potential for serious harm.

The aviation industry takes safety seriously. When two Northwest airline pilots were using personal laptops in the cockpit which resulted it distracting them from their duties, being out of contact with air traffic control for 90 minutes, and resulted in them missing their destination airport, the airline suspended the pilots immediately while the FAA revoked their license.

The healthcare system says that it takes patient safety seriously, but do we? If doctors don't wash their hands routinely before every patient and every time, should physicians be suspended? Watch your doctor next time you see him. If he doesn't wash his hands, a simple yet important ritual to avoid spreading germs, then what other important steps might he be skipping?

The healthcare industry still has a long way to go in regards to patient safety. Until the mindset changes where doctors embrace systems and teamwork to prevent adverse outcomes which will invariably occur due to human errors and flaws, you'll be far safer flying than staying overnight in a hospital.

How Effective Are Generic Drugs?

A brief ABC News video titled How Effective Are Generic Drugs? provides the truth about generic drugs. For the vast majority of individuals they are equally effective and less expensive. If you truly need a brand name drug, then obviously you'll pay more.

For many however, generic is perfectly fine.

Infant's Tylenol and Children's Tylenol Not the Same

My appearance at the local ABC affiliate in Sacramento today. Sharon Ito summarized the variety of topics beautifully.

I will be at the Sacramento - Arden-Dimick library on Monday July 20th from 630 pm to discuss how to talk to your doctor. It has been a topic well received when I have spoken at various places including Intel, Sun City Lincoln, and Borders.

SACRAMENTO, CA - On Monday's Live_Online, Kaiser family physician Davis Liu, talked about the proper use of medication and answered your medical questions.
In the wake of the FDA's recommendation about lowering the over-the-counter dosage of Tylenol, Liu said parents should know that infant and children Tylenol products contain different dosages.

Liu said the infant formula is more concentrated than the children's variety, so parents should stick with the age and dosage requirements for each Tylenol product.

Liu also said if patients have had a prior drug or alcohol addiction, they need to tell their doctor before they receive any new medications, so their sober status isn't put in jeopardy.

Liu also said patients need to tell their doctors if a medication or a medical test is too costly. Doctors might be able to substitute a cheaper drug or postpone a test, without putting the patient's health at risk.

Liu will be presenting a workshop on How to Talk to Your Doctor on Monday, July 20, at 6:30 p.m. at the Arden-Dimick Library in Sacramento.

You can see the entire interview with News10's Sharon Ito in the Live Online Archive.
You can always send an e-mail to: LiveOnline@news10.net

News10/KXTV Copyright 2009 / All Rights Reserved


Here's the entire interview.

The Doctor is In - Sacramento ABC Channel 10

Thanks again to Sharon Ito and the ABC Sacramento affiliate channel 10 for having me on their Live Online. The 30 minute interview goes by very fast! For those of you who missed it, the video is below. Also Sharon does an excellent summary of what we discussed which included whether it is too late for the flu vaccine (yes) and ways to afford prescription medications.



SACRAMENTO, CA - If you haven't had your flu shot yet, you can still ask your doctor for one, but it may not be especially effective, said Monday's Live_Online guest Kaiser family physician, Davis Liu, MD.

Liu told viewers the flu vaccine usually takes two weeks to take effect and flu season typically peaks in February and March. Liu said patients were better off washing their hands thoroughly in order to avoid germs. In fact, Kaiser has already closed its flu shot clinics.

Liu said you know you've come down with the flu if you're suddenly overcome by chills, muscle aches and fever. If you call your doctor within a day or two of your symptoms, several prescription medicines are available that can shorten the flu's duration by a day or two. The flu often lasts five days to two weeks.

Liu also gave some suggestions on how to save on prescription medicines. He said patients need to be upfront with their doctors and let them know that money is a consideration. Liu said patients need ask whether a medication is needed in the first place, and if it is, whether a cheaper generic drug can be just as effective. The doctor said patients need to shop around and determine which retailer offers the best price on specific drugs.

The doctor said surveys show the average doctor's visit lasts only 18 minutes, with the doctor interrupting the patient within 23 seconds.

Liu said to make the most of their limited time with a doctor, patients need to prepare a list of their most important health issues. In his book "Stay Healthy, Live Longer, Spend Wisely," Liu wrote, "If at all possible, I recommend tackling no more than four concerns in your office visit, especially if the four are new problems never before evaluated by your doctor. The goal is not to cram in as many problems as possible in a visit, but rather to get the most out of the visit by getting an accurate diagnosis and treatment plan. The aim is quality, not quantity."

You can view the entire interview by News10's Sharon Ito in the Live_Online archive.
News10/KXTV
Copyright 2009 / All Rights Reserved

Local ABC Channel 10 affiliate Part One - Open Enrollment

Was thrilled and priviledged to be on the local ABC Channel affiliate. Thanks to the host, Sharon Ito, who asked excellent and insightful questions.