By Deepak Chopra, MD, Rudolph E. Tanzi, PhD, Joseph B. Weiss, MD, Nancy Cetel Weiss, MD, and Danielle E. Weiss, MD
Complications in medical care occur at a staggering rate, resulting in over 440,000 accidental deaths from medical errors (the vast majority not considered malpractice, such as side effects from drugs) in U.S. hospitals each year. Self-governance by health systems and providers has not made significant inroads to reduce this catastrophic failure in patient safety. The inefficient and expensive medical malpractice lawsuit industry has neither reduced nor prevented the ever growing numbers of medical injuries and death, nor provided compensation or justice to the vast majority of those injured. The main beneficiaries of malpractice lawsuits are the attorneys, whose contingency fees can lead to multimillion-dollar windfalls, and insurance companies collecting high malpractice premiums. They profit at the expense of others and contribute to the continually escalating costs of medical care. The vast majority of medical injury and death does not result in a malpractice claim, and of those filed most fail at trial. In spite of this high failure rate, malpractice actions have worsened the situation by further encouraging excessive, expensive, and higher risk care under the rationale of defensive medicine.
Both our health and medical malpractice systems are severely dysfunctional and in critical need of corrective action. There is a better approach that can reduce medical errors and injury, enhance patient safety, and provide timely and fair compensation to those injured. A no-fault medico-legal compensation program should replace the present malpractice system with dedicated judges and expert panels to award compensation based on injury and need. Health care service providers should fund the program by the mandatory assessment of a fee that replaces malpractice insurance, based on a formula that incorporates practice type, volume, revenue, and quality assurance outcomes records. Health care licenses should be issued based on results of the quality review, including input from reports of the error compensation program. Licenses of negligent and error-prone providers should be suspended or revoked on a national basis, with mandatory re-education and reassessment before being allowed to resume patient care. The billions of dollars consumed by the industry of medical malpractice lawsuits and insurance should be redirected to serve those injured, and to programs and services enhancing patient safety and welfare.
Most importantly we need to proactively and aggressively address medical errors at the source, and correct the existing health care and malpractice system that contributes to the ongoing catastrophic status quo. The dysfunction is multifactorial and includes poor communication, incomplete data and records, and a system designed for population-based treatments that ignore the unique characteristics of each patient. The system needs to be redesigned to place patient safety and health outcomes as the singular priority, and to embrace the coming paradigm shift of personalized precision medicine.
The present health care system is also deficient in that it allows health care providers to be lax in incorporating new information into their practice of medicine. Recertification, educational programs, and examinations should be available, with participation actively encouraged by being inclusive in the health professional licensing fee. The individual health professional can select self-education or participation in formal course programming, but time-limited licensure to practice in any health care discipline should require ongoing demonstration of competence. The licensing examinations and demonstration of clinical competence should be under national standards, and removed from agencies such as specialty boards that may have a conflict of interest such as limiting practitioners under the guise of quality, but in actuality engaging in the restraint of trade.
While the above suggestions can make a meaningful reduction in medical errors, as well as provide reasonable and reliable compensation to those insured, a more holistic solution is dawning. We as a society need to recognize that a once in a lifetime historic paradigm shift in medicine is taking place, with more efficient and safer therapy on the horizon. As the knowledge base expands exponentially, our old population-based medicine with one-size fits all approach has been exposed as a weak approximation of optimal care. The number of adverse events, fatalities, and disabilities that have resulted from the focus on the treatment of the ‘average’ patient highlights how primitive the approach has proven to be. Even the present medical malpractice system has supported this dysfunction by the acceptance of a ‘standard of care defense’ that excuses harm because it is commonplace.
The vast majority of the extraordinary health care expenditures today are on the treatment and management of existing and chronic disease. The critical importance of public health and preventive medicine, with an emphasis on healthy lifestyle choices and disease avoidance, has been severely underfunded. The multiple descriptors of healing arts as complementary, integrative, and alternative are not mutually exclusive. They are now scientifically evaluated, with proper and efficient therapy consolidated under the umbrella of medicine. Acupuncture, meditation, exercise, diet, nutrition, rest, laughter, yoga, are being rediscovered by science and included in the armamentarium of contemporary modern medicine.
The new era of a safer and more efficient form of the healing arts and sciences is due to the dramatic advances in the life sciences, the result of a remarkable confluence of technology, knowledge, and insight. The ability to sequence genes and completion of the Human Genome Project has opened an ever-expanding horizon into the understanding and treatment of disease. The recognition of the profound role of epigenetic factors, the environmental influences that alter gene behavior and function, further amplifies these breakthroughs. The extraordinary importance of the microbiome, the trillions of organisms that reside within and on our bodies, in human health and disease is at the forefront of scientific exploration. Stem cells, regenerative medicine, biotechnology with organ replacement, gene transfers to replace defective genes, personalized precision medicine with prescriptions tailored to the individual, and a cornucopia of advances are opening vistas to a safer and more effective approach to maintaining health, prevention, and curing disease.
Personalized precision medicine will integrate the latest breakthroughs in technology and the life sciences with the rediscovered and newly appreciated wisdom of other healing arts and science. A recently published book Super Genes: Unlock the Astonishing Power of Your DNA for Optimum Health and Wellbeing (Harmony Books 2015) by Drs. Deepak Chopra and Rudolph Tanzi, provides a clear look at the groundbreaking advances in the life sciences. The book provides a holistic approach that integrates the rapidly advancing states of knowledge in a broad range of disciplines that are interdependent for optimal health, into a readable and proactive guide for the general public.
While the advances and enhanced safety will become integrated into the standard of medical care over the coming years, the patient and health care provider must remain vigilant partners in avoiding and reducing medical errors. The health of the public and the individual is dependent on a knowledgeable population of health care consumers, as well as health care professionals. Those without sufficient experience to make informed decisions about their care in today’s complicated heath care system should have access to the guidance and advice of medical advocates.
The empathy and compassion of a caring health care provider have been negatively impacted by ever-increasing stress leading to epidemic rates of ‘burnout’. The loss of health care providers to this disabling malady aggravates the already critical shortage of health care providers. The degree to which stress and fatigue contribute to the extremely high error rate in health care requires further investigation into the implementation of effective strategies for its management. The prevention of the loss of empathy and burnout would not only provide benefits in health care but in other relevant fields and aspects of society such as education, justice, business, etc.
As Dr. Francis Peabody so eloquently stated over one hundred years ago “the secret in the care of the patient is in caring for the patient.” All of society needs to care, health care providers, lawyers, insurance companies, health systems, and pharmaceutical companies included. Patient care and safety must become a non-negotiable priority. Human health and welfare are too important to allow any self-serving interests to detract from this moral and societal obligation.
Deepak Chopra, MD
Clinical Professor of Medicine, University of California, San Diego
Co-Founder of The Chopra Center for Wellbeing
Rudolph E. Tanzi, PhD
Professor of Medicine, Harvard University
Joseph B. Weiss, MD
Clinical Professor of Medicine, University of California, San Diego
Nancy Cetel Weiss, MD
President, Speaking of Health, Inc.
Danielle E. Weiss, MD
Clinical Assistant Professor of Medicine, University of California, San Diego
Medical Director, Center for Hormonal Health & Well-Being