Scary Stuff

by Kim Bellard, October 25, 2010

Two studies were released in the past week that are appropriate harbingers of Halloween.  The Centers for Disease Control announced that one in three adult Americans will have diabetes by 2050.  Earlier in the week, researcher Philip F. Stahel, M.D. and his colleagues published a study in the Annuals of Surgery detailing the disturbing number of wrong site or even wrong patient surgeries.

I’m not sure which study scares me more.

The CDC projections suggest a sharp increase from the current one in ten prevalence of adult diabetes.  An aging population, an increase of minority populations most at risk of developing diabetes, and persons with diabetes living longer are cited as key reasons for the increase.  Diabetes rates have already more than doubled over the last thirty years, and are closely tied to higher health expenditures and adverse health effects on impacted individuals.  Even if actual rates end up only half as bad as the CDC fears, it would still be a train wreck for health care in America.

Dr. Stehel’s study found 27,370 adverse events from January 2002 through June 2008, using a database of 6,000 physicians in Colorado.  These adverse events included 25 wrong patient and 107 wrong site operations, and came despite widely adopted universal protocols developed by the Joint Commission that were intended to avoid such mistakes.  “These happen much more frequent than we think,” Dr. Stehel says. “This is just the tip of the iceberg.” 

Diabetes, of course, can be often controlled through proper diet and exercise.  Its increase has often been tied to the similarly large increases in obesity in America – nearly 34% of adults are now considered obese, double the percentage thirty years ago, while childhood obesity rates have tripled during the same period; 17% of children are now obese.  Increased availability of fast food and lack of adequate exercise are commonly cited as reasons for the increase in obesity.  While many persons with diabetes are often unaware of having it, obesity is harder to not be aware of.  It’s not that people don’t know that they should eat better, get more exercise, and keep control of their weight; it just seems that fewer people are willing to make the necessary efforts to do so. 

Similarly, the universal protocols are supposed to ensure “never events” such as surgery on the wrong patient don’t happen, but “never events” reflect more of a goal than an achieved outcome.  The researchers note that the blame for the mistakes fall across the medical profession.  Dr. Stehel says doctors should take more personal responsibility for their errors.  

For both problems, we don’t need magic bullets; we need the appropriate parties taking responsibility for themselves.  Unfortunately, that is not as easy as it sounds.  No one wants to develop diabetes, and no physician wants to operate in the wrong site/patient.  Yet here we are.

It does seem that somehow personal accountability in health care is getting lost.  Patients too often abdicate their own decision-making for their physician’s judgment and treatment, and physicians often don’t have adequate mechanisms to admit, track and improve on their errors.  Physicians should be able to expect that patients are doing their best to maintain and improve their own health, and patients should be able to expect that physicians are doing the right thing at the right time for the right reasons.  One would have to be something of an optimist to believe that either of those behaviors are always the case. 

Halloween is all about mock scares, with children trick-or-treating in cute costumes (while receiving lots of candy that probably help drive up those childhood obesity rates!).  These studies reveal real boogeymen, things that should frighten us and cause us all to act.  These aren’t the first unsettling revelations about how poorly our health system works at times, despite its high costs.  How many more of these scary stories do we need to see before we get serious about improving it?