15 ys of blogging – unintended consequences

When I started blogging in 2002, I did not understand where blogging would go.  I took a rather vanilla name – medical rants – due purely to naivety.  Perhaps if I could have seen the future I would have used the phrase unintended consequences in the blog’s title. Medical care in 2017 suffers often from the unintended consequences that government has induced.  I have written about this problem many times over the past 15 years.  This problem is not just a US problem, but seemingly a problem throughout the world. Our jobs have become unnecessarily complex.  When Congress passes laws and when CMS develops regulations.  Here are some examples: The 4 hour rule for giving antibiotics for community acquired pneumonia (CAP) A retrospective “big data” analysis suggested that patients who received their antibiotics within 4 hours of reaching the emergency department had better outcomes than those who had a “delay” in starting antibiotics.  What could go wrong? The first most obvious problem with that hospitals “encouraged” the emergency department to err on the side of giving antibiotics if CAP was likely.  But how do we define likely?  Hospital administrators saw the money attached to this measure and decided (implicitly) that sensitivity trumped specificity.  You cannot increase the % of CAP patients receiving rapid antibiotics without also increasing the % of non-CAP patients receiving antibiotics. Several articles doc...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs