05-26-2018  8:51 pm      •     
The Skanner Report
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NEWS BRIEFS

Attorney General Forms Hate Crime Task Force

The task force will study hate-motivated crimes and review existing legal protections for victims ...

Portland Art Museum Celebrates Art Museum Day with Free Admission on May 25

Portland Art Museum joins art museums across North America, with great works of art and public programs ...

June Key Delta Community Center Hosts May Week ’18 Health Fair May 26

Event includes vision, glucose screenings, medication disposal and car seat installation ...

Mississippi Avenue Giving Tuesday

On Tuesday, May 22, 10 percent of proceeds from participating Mississippi Ave. businesses will go to SEI ...

Oregon advances with 11-1 run-rule victory over Kentucky

EUGENE, Ore. (AP) — DJ Sanders hit a grand slam in a seven-run second inning and the Oregon Ducks are headed to the women's College World Series after an 11-1 run-rule victory over Kentucky Saturday night in the deciding game of the Eugene Super Regional.Shannon Rhodes hit a solo home run...

Amtrak: No evidence injured passenger was in fight

RENO, Nev. (AP) — The family of a 22-year-old train passenger found severely injured next to railroad tracks in Truckee, California, suspects he may have been the victim of a hate crime, but Amtrak said Saturday that investigators have found no evidence of foul play.Aaron Salazar's family...

City aims to block release of dangerous psychiatric patients

LAKEWOOD, Wash. (AP) — The city that houses Western State Hospital, Washington's main psychiatric facility, is fighting to keep patients from being released into its boundaries.The News Tribune reports Lakewood on Monday approved a moratorium on city business licenses for new adult family...

Missing fisherman found by divers in submerged vessel

SEATTLE (AP) — The body of a missing fisherman was found by divers inside the sunken vessel, the Kelli J.The Coast Guard said Saturday that the body was found before the vessel was refloated by contractors in Willapay Bay on Friday.The Pacific County Sheriff's Office took the fisherman's...

OPINION

Racism After Graduation May Just Be What's on the Menu

Dr. Julianne Malveaux says that for our young millennials, racism is inevitable ...

Prime Minister Netanyahu Shows Limits of Israel’s Democracy

Bill Fletcher, Jr. on racial politics in Israel and Prime Minister Benjamin Netanyahu’s uneven treatment of African immigrants ...

Golfing While Black Is Not a Crime

Grandview Golf Club asks five Black women to leave for golfing too slow ...

Discovering the Best of Black America in 2018

Dr. Benjamin F. Chavis discusses the DTU Journalism Fellowship & Scholarship Program ...

AFRICAN AMERICANS IN THE NEWS

Meeting draws people angry over fatal police shooting

RICHMOND, Va. (AP) — More than 200 people turned out for a community meeting Saturday to protest the death of a young black man who was fatally shot by a Virginia police officer after he ran naked onto an interstate highway.Speakers at the meeting at Richmond's Second Baptist Church said...

The Latest: Family: Police need to handle people better

RICHMOND, Va. (AP) — The Latest on the fatal police shooting of a naked and unarmed man in Richmond (all times local):5:16 p.m.Family and friends of a man who was fatally shot by Richmond police after running naked onto an interstate highway are calling on police to find non-lethal ways of...

White neighbor gets prison for harassing black family

EASTON, Pa. (AP) — A neighbor accused of harassing and using racial epithets against a black Pennsylvania family for years has been sentenced to prison.A Northampton County judge sentenced 45-year-old Robert Kujawa to the term Friday after a jury convicted him of ethnic intimidation,...

ENTERTAINMENT

Glenn Snoddy, inventor of fuzz pedal for guitarists, dies

MURFREESBORO, Tennessee (AP) — A recording engineer whose invention of a pedal that allowed guitarists to create a fuzzy, distorted sound most famously used by Keith Richards in the Rolling Stones' hit "(I Can't Get No) Satisfaction" has died.Glenn Snoddy was 96. His daughter Dianne Mayo...

Reaction to criminal charges filed against Harvey Weinstein

Reaction to rape and other criminal charges filed in New York on Friday against Harvey Weinstein:"I hope this gives hope to victims and survivors everywhere, that we are one step closer to justice. Because one win is a win for all of us." — Weinstein accuser Rose McGowan, to The Associated...

Vindication, triumph, also fear: Weinstein accusers react

NEW YORK (AP) — Watching the stunning images of Harvey Weinstein walking into a courthouse Friday in handcuffs, a detective on each arm, Louisette Geiss still felt a shiver of fear in reaction to the man who, she says, once cornered her and tried to physically force her to watch him...

U.S. & WORLD NEWS

Klay Thompson score 35, Warriors force Game 7 in West finals

OAKLAND, Calif. (AP) — Klay Thompson hit nine 3-pointers and scored 35 points, the Warriors held James...

AP FACT CHECK: Trump on border stats _ and a Merkel mystery

WASHINGTON (AP) — Illegal border crossings, as President Donald Trump measures them, have gone up since he...

US Gulf Coast prepares as Alberto brings wind, rain north

ST. PETERSBURG, Fla. (AP) — Florida, Alabama and Mississippi launched emergency preparations ahead of the...

Declassified US cables link Uribe to Colombia drug cartels

BOGOTA, Colombia (AP) — As Alvaro Uribe, Colombia's most powerful politician, was making his rise to the...

Ebola vaccinations begin in rural Congo on Monday: Ministry

KINSHASA, Congo (AP) — Ebola vaccinations will begin Monday in the two rural areas of Congo where the...

Israeli soldier badly wounded in West Bank arrest raid dies

JERUSALEM (AP) — The Israeli military says a soldier who was seriously wounded in action this week has...

Marshall Allen Propublica

Medical care has its own code and culture, which often does not put patients first, according to Dr. Marty Makary, a cancer surgeon and researcher at Johns Hopkins School of Medicine and the School of Public Health. And providers who speak against that code can pay a heavy price.

Makary's new book, "Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care," explores why patient harm persists in the medical system and what can be done about it.

PP: What led you to write "Unaccountable"?

Dr. Makary: The debates about health care reform frustrated me because our complex system of health care and culture of medicine were reduced to simple sound bites. People pushed the idea that changing the payment system would solve the problems. But I observed every day what I see to be the main driver of health care costs: the massive variation in the quality of care – across the country, within cities, and even within good hospitals.

I saw this variation in quality and the alarmingly high error rates, and it hit me that unless we can be open and honest that up to 30 percent of health care is unnecessary, and that 1 in 4 hospital patients are harmed by a mistake, then we're just going to be continuing to beat our heads against a wall trying to pay for a broken health care system, instead of fixing it.

PP: What type of problems did you observe?

Dr. Makary: I saw cases where a patient was not told about a minimally invasive way of doing a particular surgery because of physician preference or training, and the doctor would just hope that he wouldn't find out. If that patient were empowered by talking to the right people, or by doing his own research, he would be able to get superior care. It's no wonder that about a third of all second opinions about surgery yield different opinions.

Medical mistakes are the fifth- or sixth-most common cause of death in the United States, depending on the measure. But few people look at it that way. That's because we haven't been honest about it in the past. And we have hospitals that fire doctors and nurses when they speak up.There was a nurse recently fired in Florida for complaining about a doctor doing unnecessary procedures, a report substantiated by an internal report gotten by The New York Times. A cardiologist in Wisconsin was fired for pointing out that EKGs were misread more than 25 percent of the time. We need to change the culture of medicine.

There is New England Journal of Medicine-level data that suggests that almost half of care is not compliant with the evidence. In my own field of cancer surgery, I have seen patients treated in ways that are not supported with evidence.In the case of radiation treatment for pancreatic cancer, there is evidence from large cooperatives overseas that there is a harm to radiation. Many studies show no evidence of benefit to radiation, and yet patients are routinely offered radiation treatment and have the expectation that it's going to help them do better. I see PET scans offered routinely – an expensive test – that has never been shown to benefit diagnosing pancreatic cancer.

PP: Why do these problems persist?

Dr. Makary: There's been a corporatization of health care where we have a system where we tell the hospitals to fill the beds, so the hospital administrators fill the beds. We tell the doctors to do more procedures, so they do more procedures. For patients, we create a nation that more care is better care, and so they demand more care. Everyone is doing their job. The problem is we have good people working in a bad system.

The desire and reflex of docs to offer something to patients, even when there's not much more else they can offer. There's a strong financial incentive. Doctor groups pay for new equipment that they purchase on borrowed money.

We are also evaluated by the number of "value units" at the end of each fiscal quarter. Our management will sit down with us and say your work units are down or up and in order for you to receive a large bonus you need to increase the number of operations you do. There is increasing pressure on doctors to see more patients, prescribe more medications and do more procedures. This is something that the public is shocked about when they learned about it.

Medicine was not always this way. When I was growing up we had a great community hospital that had lots of community trust. It was almost a charitable institution. The head of the hospital was the head doctor. Now health care looks different. If you have an issue and want to deal with it, it's like trying to appeal a cell phone bill. Patient rights are limited, and the doctors themselves get frustrated by the growing divide between management and frontline providers.

We have a system where the frontline providers – doctors, nurses, secretaries, technicians, support staff – are part of a corporate culture. They don't feel that they own the medical culture. They feel like tenants where the management is their landlord. That translates, in our research, to more mistakes, more overtreatment and more waste. If we're going to get serious about reducing health care costs and improving patient safety, we need to get serious about replacing workplace culture in modern medicine. At about half of hospitals we've surveyed, most of the employees said they would not go to that same hospital for their own care.

PP: Can you point us to any bright spots?

Dr. Makary: In the book I try to balance every shocking story with a positive new trend in health care or an exciting success story. In medicine now we have some organizations that post complication rates online and discuss them. And younger doctors are changing the culture. The new generation comes from a different mindset. They have little tolerance for secrecy and demand transparency.

One doctor I found provides a video of each colonoscopy to the patient, to ensure quality control and to serve as a permanent record. He did research to show recording procedures improves quality by 30 to 40 percent. There's a campaign at Harvard and a few other hospitals called Open Notes, which makes the notes in health records immediately available for the patient to see and even edit. The Society of Thoracic Surgeons partnered with Consumer Reports magazine so patients can look up important metrics of hospital performance.

At Johns Hopkins we have gone through a metamorphosis. We've made mistakes in some care that have been tragedies. Based on these experiences, the hospital developed a strong research and practical interest in advancing patient safety. I feel fortunate to have Peter Pronovost as a research partner and an institution like Johns Hopkins, where the leadership has praised my book.

PP: What type of transparency should patients demand from doctors and hospitals?

Dr. Makary: Patients should be able to know all of their treatment options, including active surveillance or watchful waiting as legitimate options, as opposed to treatment, surgery or medication. All of these options should be disclosed to patients to get at the problem of overtreatment and undertreatment.

Patients should know about a mistake as soon as it happens. When I make a medical mistake and quickly disclose it to patients, they appreciate it. I can look back almost every year and think of a CT ordered on the wrong patient, or a lab test misinterpreted, or a delay in diagnosis because of a communication failure with my team. Patients are hungry for real honesty in their medical care.

Patients should have easy access to their medical records, which is not true at many hospitals. Sometimes patients are expected to pay $200 or $300 for their records.

Hospitals should report complication rates in a way that's risk-adjusted, meaningful and user-friendly to patients. They should report how many of each particular condition they see in a year and readmission rates, infection rates and other simple metrics of performance. Patients don't have to walk in blind.  

PP: What are the biggest barriers to increasing transparency?

Dr. Makary: Complacency and blind trust are the greatest barriers. The complacency is embodied in the traditions of medicine. Medicine has its own culture, values, vocabulary and justice system. Part of that culture is that we only listen to ourselves.There's a tremendous amount of appropriate respect for tradition and hierarchy, like in the military. But now that the knowledge has expanded, so there are so many services offered by a hospital that you have to ask why care isn't more coordinated. We've had little science behind how to implement good care safety and coordinate care safely. That's the greatest challenge now in the system, asking the questions of how we can cut the giant costs of health care, which is funding unnecessary overtreatment, medical mistakes.

And the blind trust is the blind trust of the public. It's not their fault. They have no choice but to walk into an emergency room and get treated by the first doctor on call. But the treatment is too often based on that individual's practice rather than what's the best evidence.

The exciting thing is that as organizations provide meaningful information to consumers, patients can do meaningful research and reward places that do well and not seek care at places that don't perform well and have a closed door culture. The general public's frustration with the hassles and lack of coordination in health care now have people hungry for common-sense and large-scale reforms. We're seeing that now with orgs stepping up and addressing quality. Health care costs are not going to reigned by different ways of financing our system, but by making it more transparent so that patients can fix the system. I'm convinced that the government is not going to fix health care. And doctors are not going to fix health care. It's going to be the patients.

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