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Crisis = “A good excuse to do the wrong thing.”

Posted Mar 25 2009 3:44pm

Last week in Burlington, Vermont, there was a Forum on Health Reform hosted by Vermont Governor James Douglas, Massachusetts Governor Deval Patrick and the Director of the White House Office of Health Reform, Nancy-Ann Parle.

They held a town hall meeting of legislators, healthcare professionals, administrative types, representatives of medical societies, along with concerned citizens. Angry remarks were commingled with positive suggestions to address the problems of healthcare such as: cost issues; shortages; and electronic medical records.

The worrisome part was Governor Deval’s remarks. In response to demands for what he called an “Utopian system,” he said, “Let’s not get caught up on how to make our healthcare system perfect…or else we will just talk and not walk.”

That is exactly the approach that keeps us from ever healing healthcare. The crisis mentality says we must act now and take what we can get, do what we can do, because we are in a crisis. With respect, we have been in a healthcare crisis for at least 40 years and ad hoc crisis management has kept us from beginning to truly fix – to cure – healthcare.

Forty-six million have no health insurance. This is called a crisis and we must fix it now! Was it not a crisis when only 20 million were uninsured? Then too, we applied a quick fix and look where we are now.

The call to do what we can perpetuates the failure cycle in two ways. First, it accepts what is do-able rather than working toward something that really fixes. Second, it ignores the interdependence of the elements in a system such as healthcare. You cannot adjust (much less fix ) just one part without affecting the other parts, usually making them worse. Systems thinking and experience with healthcare should have taught us that by now.

In medical terms (we ARE talking about health care), those who advocate do something now make the patient look good, maybe even feel good. They presume that the patient cannot be cured and they do not try. They give morphine to a patient with headaches and an operable brain tumor, instead of going to the OR.

The excuse to do the wrong thing is that we have a crisis and must act now. In ARRA 2009, over $670 million is allocated to healthcare to: increase insurance coverage; promote electronic medical records; and beef up HIPAA. This piecemeal approach will work. It will work to: raise national healthcare expenditures; complicate communication; increase errors; expand the already bloated bureaucracy; and exacerbate shortages of nurses and doctors. All are unintended adverse consequences caused by ad hoc crisis management and the lack of systems thinking.

When I started training after medical school, I learned a great lesson from one of my seniors. Whenever there was a medical crisis even a cardiac arrest, he slowed down. He made sure everything was done right, in proper order with correct dosages, by the right persons. Rather than trying to look like he was valiantly saving the patient, he tried actually to save the patient.

Let’s not use a 40 year-old crisis in healthcare as an excuse to do the wrong thing (again)…and make things worse.

System MD

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