Doctor Changes Culture to Improve Odds for Patients

SALT LAKE CITY, Oct. 17, 2006 — -- To understand the lack of quality in our health care system, it helps to compare hospitals to airplanes. Air travel is remarkably safe because every pilot, mechanic and controller follows a specific checklist before takeoff. But while pilots rely on rules, protocol and universal wisdom, doctors do not.

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The system builds doctors who are the centers of their own little universe, free to diagnose and treat according to individual experience. But doctors are human.

"It is so complex that if you don't put them in the right environment, just like the pilot in that cockpit, they will screw it up," said Dr. Brent James, a Harvard-trained surgeon and statistician.

A zeal for health care reform and a love of numbers drew James to the Intermountain Health Care system in Utah, a group of roughly 20 hospitals renowned for its huge database of patient records. When James began researching to compare treatment results, he found the discrepancies were staggering.

"It turns out that physicians mis-estimate the truth about 20 to 50 percent," James said.

He found doctors were far less accurate if they relied on their memories rather than on computer data. Armed with his statistics, James began to change the medical culture.

Saving Lives and Millions

James decided all doctors should share their knowledge, work as a team and follow specific guidelines.

Among the changes: All cardiac patients would be sent home with five specific drugs. For pregnancies, there would be no more induced labor for the sake of convenience and all newborns would be tested for jaundice.

"It was a little controversial at first," James said. "The pediatricians said, 'I can look at [babies] and tell.' Of course, they couldn't."

As it turned out, the health center was sending 1,300 jaundiced babies home each year because they looked pink and healthy, only to have them return for intensive care. Since the new rule, the number has dropped by 900.

The cardiac drugs have saved 450 lives a year, and fewer induced deliveries means shorter labor, fewer sick babies and a savings of $10 million.

The experiment proves that higher quality care can lower costs, and doctors can save lives and money by doing it right the first time. But it also cuts profits, because Medicare pays doctors for the quantity of care they provide rather than quality of that care.

"You realize that the current health care system pays me to hurt you, pays me to create complications," James said. "I don't do it purposefully. I regard it as just an accident. But I get paid to treat the complications."

James is lobbying for a performance-based system of compensation and a national database of medical records.

And when he lectures doctors, he reminds them of why they got into medicine in the first place -- to send home happy, healthy babies who keep their parents up at night "for the right reasons."