How much does ‘never’ cost?

Way too much.

Do you like common sense?

Are you inflamed by the unintended consequences of well-meaning policies?

Read this young ER-doctor’s view on the medical and dollar costs of measures aimed at eliminating medical errors.

This is real, folks.


Very nice work, Dr. Graham Walker


5 replies on “How much does ‘never’ cost?”

Very interesting perspective from one who works daily in the trenches, so to speak, and a brilliant analogy with our anti-terrorist airport precautions. But when Dr. GW writes …

“How thorough is too thorough? How cautious is too cautious?”

… I’m reminded that E.R. docs are the gatekeepers to the rest of the hospital system.

One of the women in my heart health presentation audiences last year told me of this conversation she had overheard beyond the E.R. curtain – between a (male) patient in the next bed, and his E.R. doc, who was heard to say: “Your blood tests are normal, your EKG is normal, but we’re going to keep you for observation just to make sure it’s not your heart.” So, yet again, a man presenting with cardiac symptoms but with normal cardiac diagnostic results is admitted from the E.R, while (according to the NEJM) symptomatic women under the age of 55 are SEVEN TIMES more likely to be misdiagnosed in mid-heart attack and sent home from the E.R. compared to their male counterparts presenting with similar ACS symptoms. (I was one of them).

It’s hard enough for women (still!) to have alarming cardiac symptoms taken seriously in the E.R. (without being blown off as GERD, anxiety, gall bladder issues, stress, or menopause – a perfect all-purpose dx, by the way).

The Mayo Women’s Heart Clinic tells us that women are still being under-diagnosed in mid-MI – and then under-treated compared to their male counterparts even when appropriately diagnosed. A potentially deadly outcome, given that time equals muscle. So how “thorough” or “cautious” are the E.R. gatekeepers being when it comes to women presenting with cardiac symptoms? My guess: not “thorough” or “cautious” enough.

Thanks for the thoughtful-thought provoking link to Dr. Graham’s observations and conclusions from the front line. As a family NP, it was always at the back of the mind that most illness that presents CAN be mis-observed in the early stages. And as your colleague says, the cost of ruling-out definitely adds to the cost.

The cost of zero-mistake medicine is too high – unless you are that 1% that would have made it 100%!

And yes, as Carolyn says, we women with heart disease still have a tough time being heard sometimes……but it IS getting better!


Thanks ladies. Excellent points.

That women with heart disease are under-diagnosed and under-treated was featured prominently on the evening newscasts tonight. But this is something I was taught in residency more than twenty-years ago. You would have thought it would have taken hold by now.

I know some might disagree with this idea, but I honestly do not think doctors ‘blow-off’ females intentionally or because of sexism. Just like the recent data show, women present less ‘specifically.’ Women also have higher risks from therapy; more false-positives on stress tests; and you all know that I am now convinced that AF is tougher to treat in women.

More work needs to be done. Information and awareness always helps.

I understand the points being made (of course). But in endeavors where human beings are involved (medical or otherwise), why would anyone expect “never” to be a realistic goal? “Never” is a lofty aspirational goal only (the author doesn’t explain who exactly is out there calling for the ‘never’ in the medical context). No company, government, military, hospital, etc invests enough to truly achieve the ‘never’, because it just isn’t practical – and, frankly, the public really doesn’t want to pay for the huge costs.

But the problem I have with the author’s focus of arguing “against the never” is that it takes time away from arguing “for the least”. How many mis-diagnoses and other related medical errors are just that – errors – i.e., things that would not have occurred if proper procedure were followed and/or if better procedures were in place? Reducing errors and improving procedures – based on personal experience, that’s the key.

I doubt that anyone rationally expects NEVER ‘except’ if it’s them or their loved one. Then all but the rigidly rational expect positive outcome. That’s why I choose my provider and my facility with great care.

Even with the best training, proper procedure, and protocols, sometimes that doesn’t happen. Equipment malfunctions, someone on the team has a sudden health problem, or, or, or. Rare, but it happens.

It’s the risk we all take for the benefit from our high tech medicine. Above the table and ON the table. There is no NEVER.

And NO, we cannot afford to get to never. The real question it seems, is how much are we willing to spend as a nation/system to get as close to NEVER as possible? And who sets the guidelines? You? Me? The feds? The policing agencies? The providers? Years of dialogue to follow.


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