A friend asked in open question why were seeing such an uptick of mistakes in medicine over the last few years.

It has been over fifteen years since “To Err is Human” was published by the Institute of Medicine. The answer lies in the book, but not in the press clippings and other dreck. Sadly, reading skills are required to get the gist of it, and even back in 1999, reading skills were not prized.

You may click on the executive summary, but do not stop there.  Read it.  It will tell you what was known before this tidal wave hit us, and how the purported innocence of “reformers” is to be doubted.

It offered useful insights on process improvement and integration – improvements that would have been unprofitable to those who have been parasites draining off the healthcare profession for a long time.

As the country raced towards a hidden insolvency, the medical system has been increasingly seen as a money spigot. Your money or your life, the bandits said in the old days.

The sheer flux of money through the healthcare system – some five billion a day – promises a lucrative harvest to those who can penetrate into the arterial flow.

The magic words are “productivity, efficiency, cost-containment,” as though those words were unknown in the 20th century. I hear tell that “Before ACA, the doctors were running the business of medicine, and now let’s try the experts.” Both ends of that sentence are incorrect.

The most profitable way to change healthcare is to remove the burden of responsibility, disseminate it into a vast bureaucracy, as well as dump it onto the “healthcare consumer.” In the name of choice, a mystical word, liability can be shed onto the consumer.

The old way was to place a highly-trained expert in the position of authority, and make informed decisions about the individual care of each person according to their individual situation.

It is much more efficient to tote up the cost of failure, determine the cost of success, and solve the integral which maximizes products. If the widget manufacturing company maximizes profits when it hits 99.995% efficiency, it does so. If it maximizes products when it hits 90% and throws the 10% failures away, anything better than 90% is a waste of money.

Friend, I fear you are merely seeing that the most profitable failure rate occurs under that 100% target that we physicians are instinctively driven to achieve. It is possible to reap a “quality harvest” by delivering worse care cheaper.

People speak of 24-hour wait times in ER’s and such horrors, as though they are mandated by the Will of God. Actually, you could easily staff an ER to turn around patients in two hours from door-to-placement. But that is expensive, “too expensive” by the current metric. It is achievable – it is merely “financially ridiculous” to staff an ER at that level.

Nobody has come to ACA with the idea of “improving American medical care at all costs.” It has been a matter of “how do we tweak the golden goose’s egg production?” We have spiraled into business superstitions and augury to come up with business decisions which only avoid being called thought disorders, because they are shared by so many.

In answer to your question, we are seeing an acceptable number of bad outcomes. Once the parameters of “acceptable” are plugged in, then the output is generated. I think that American national benchmarks for quality of care are going to be about those of Turkey – a decently poor country clinging to the hem of the First World.

As the American productivity continues to dwindle, we grasp for more things to squeeze money out of. Another Southwest Asia war will not come cheap, and we are easing back into one. And this, like the last one, will be “off-budget,” and China seems to be tiring of shoveling money to their idiot stepson, Uncle Sammy.

Could we somehow see medicine end, in an untidy way?  They seem to be contemplating such a horror in Britain, which is using its training system to squeeze the “junior doctors” in training as though they were Welsh coal miners on strike. Almost half of junior doctors left NHS after foundation training, notes the British publication The Guardian; and Hundreds of operations cancelled despite doctors’ strike being called off; 600 planned operations cancelled along with 3,500 outpatient appointments, according to survey of NHS trusts. When half of your doctors opt-out of a system that provides instruction and experience, to go into non-practice jobs and such, that’s a wake-up call.

When doctors are beat down like striking workers – and they were striking workers – the locum tenens system is often used as a “scab labor” system to break the resistance.  The litany of insult and denigration of doctors is wearing thin.  Unlike the propaganda insists, the system is not being ruined by greedy selfish doctors.  It is breaking down because there is something wrong with it.  The person having a seizure is not trying to showboat for attention – they’re really having a neurological storm in their brain.  Similarly, in Britain, their systems about to blow apart; and ours is founded on similar principles.

Of course the complications are not accurately recorded, no more than the Soviet Productivity numbers were. You learn how to put down exactly the correct results that keep you from a Siberian vacation. As the leadership more closely resembles the Aztec priests demanding blood sacrifice, the more the gifts are designed to appease their discomfort, not tell them the ugly truth.

Sorry, but if you don’t ask next time, I won’t say such unhappy things. Peace.