Health Care Crisis

Today’s tawdry spectacle of our time-serving Earmarkers squabbling over Obama’s Health Care Bill attests to the sad intellectual state our Congressional reps have sunken to. Jefferson and Madison would blush at the squalor of it all.

If only they would listen now to Dr. Peter J. Pronovost, 45, medical director of the Quality and Safety Research Group at Johns Hopkins Hospital in Baltimore. (See Claudia Dreifus,”Doctor Leads Quest for Safer Ways to Care for Patients,” IHT (3/11/10, p.10.) His father died of cancer at 50. He was diagnosed with leukemia. Pronovost was a first year med student at Hopkins when he asked for a second opinion. That second opinion brought the sad news that it was too late to cure his father’s lymphoma with a bone marrow transplant!

Some years later, after he won a Ph.D. on Hospital Safety, he encountered Sorrel King whose 18 month old daughter Josie had just died at Hopkins from infection and dehydration after a catheter insertion. Both mother and nurses knew something was wrong, but the doctors in charge wouldn’t take their counsel.

So you had the painful paradox of a child dying from a Third World disease in one of the world’s best hospitals! What gives? Pronovost decided it was dysfunctional teamwork deriving from an exceedingly hierarchical culture. He set out to break their dystemic stranglehold. An early victory:In 1965, checking out his checklist’s efficacy, in 18 months he saved 1500 lives and the state of Michigan $100 million!

He later found himself as anaesthetician in an operation where the patient was having latex allergy from the surgeon’s gloves. He wouldn’t budge when Pronovost warned him was happening. So he asked the scrub nurse to call the dean who he knew would back him. Before the call went through, the surgeon cursed his adviser and changed gloves!

And thus he persevered in establishing his operation checklist, with simple rules like washing hands, which simple responsibility rose from a disgraceful 30% to a still disgracefully iatrogenic 70%!So he perseveres in his commonsense checklist to keep on track busy professionals who assume,”I’m right. I’m more senior than you. Don’t tell me what to do.”

His persistence earned him a MacArthur grant to institutionalize his common sense program throughout the world’s hospitals. And “Time” added in 2008 to his clout by listing him as one of the most important 100 world citizens. The fullest story is in his new book, “Safe Patients, Smart Hospitals: How One Doctor’s Checklist Can Help Us Change Health Care from the Inside Out”, written with Eric Vohr. Simple, but oh so sensible!

That story was so enchanting to this narrow-minded, under-informed humanist that it moved me to Wikipediate one of his predecessors, the Hungarian medic Ignatz Semmelweiss. In 19th century Vienna there were two maternity hospitals serving the public, mainly illegitimate births/infanticides, including prostitutes.

One trained premed students; Two, midwives. Oddly the first had far more incidents of puerperal fever. Ignatz speculated (it was long before Pasteur discovered bacteria) that the autopsies the premeds performed somehow poisoned them. So he insisted they used a chlorine bleach to cleanse themselves of cadaver contamination. It worked! Within a half year there were no deaths in One from puerperal fever.

The medical establishment of that day, however, could not be engaged in thoughtful discourse on the issue. (What gives this pushy Hunky the gall to tell us how to run our birth clinics!) Eventually he was forced into an insane asylum where he died, possibly by his own hand. It would still be a hard slog to establish standards of cleanliness among “well-educated” medicos!