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You can follow her on Twitter: \u003ca title=\"https://twitter.com/laliferis\" href=\"https://twitter.com/laliferis\">@laliferis\u003c/a>","avatar":"https://secure.gravatar.com/avatar/86c339d5cdcb0dcd2b6cf5d7c3f5886b?s=600&d=blank&r=g","twitter":"laliferis","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"news","roles":["subscriber"]},{"site":"futureofyou","roles":["subscriber"]},{"site":"stateofhealth","roles":["subscriber"]},{"site":"science","roles":["subscriber"]},{"site":"food","roles":["contributor"]}],"headData":{"title":"Lisa Aliferis | KQED","description":null,"ogImgSrc":"https://secure.gravatar.com/avatar/86c339d5cdcb0dcd2b6cf5d7c3f5886b?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/86c339d5cdcb0dcd2b6cf5d7c3f5886b?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/lisaaliferis"},"state-of-health":{"type":"authors","id":"8344","meta":{"index":"authors_1591205172","id":"8344","found":true},"name":"State of Health","firstName":"State of Health","lastName":null,"slug":"state-of-health","email":"stateofhealth@kqed.org","display_author_email":false,"staff_mastheads":[],"title":null,"bio":null,"avatar":"https://secure.gravatar.com/avatar/66de4bf6d331fa7402bba1ffe8135e17?s=600&d=blank&r=g","twitter":null,"facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"arts","roles":["author"]},{"site":"stateofhealth","roles":["editor"]}],"headData":{"title":"State of Health | KQED","description":null,"ogImgSrc":"https://secure.gravatar.com/avatar/66de4bf6d331fa7402bba1ffe8135e17?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/66de4bf6d331fa7402bba1ffe8135e17?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/state-of-health"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"firebase":{"requesting":{},"requested":{},"timestamps":{},"data":{},"ordered":{},"auth":{"isLoaded":false,"isEmpty":true},"authError":null,"profile":{"isLoaded":false,"isEmpty":true},"listeners":{"byId":{},"allIds":[]},"isInitializing":false,"errors":[]},"navBarReducer":{"navBarId":"home","fullView":true,"showPlayer":false},"navMenuReducer":{"menus":[{"key":"menu1","items":[{"name":"News","link":"/","type":"title"},{"name":"Politics","link":"/politics"},{"name":"Science","link":"/science"},{"name":"Education","link":"/educationnews"},{"name":"Housing","link":"/housing"},{"name":"Immigration","link":"/immigration"},{"name":"Criminal Justice","link":"/criminaljustice"},{"name":"Silicon Valley","link":"/siliconvalley"},{"name":"Forum","link":"/forum"},{"name":"The California Report","link":"/californiareport"}]},{"key":"menu2","items":[{"name":"Arts & Culture","link":"/arts","type":"title"},{"name":"Critics’ Picks","link":"/thedolist"},{"name":"Cultural Commentary","link":"/artscommentary"},{"name":"Food & Drink","link":"/food"},{"name":"Bay Area Hip-Hop","link":"/bayareahiphop"},{"name":"Rebel Girls","link":"/rebelgirls"},{"name":"Arts Video","link":"/artsvideos"}]},{"key":"menu3","items":[{"name":"Podcasts","link":"/podcasts","type":"title"},{"name":"Bay Curious","link":"/podcasts/baycurious"},{"name":"Rightnowish","link":"/podcasts/rightnowish"},{"name":"The Bay","link":"/podcasts/thebay"},{"name":"On Our Watch","link":"/podcasts/onourwatch"},{"name":"Mindshift","link":"/podcasts/mindshift"},{"name":"Consider This","link":"/podcasts/considerthis"},{"name":"Political Breakdown","link":"/podcasts/politicalbreakdown"}]},{"key":"menu4","items":[{"name":"Live Radio","link":"/radio","type":"title"},{"name":"TV","link":"/tv","type":"title"},{"name":"Events","link":"/events","type":"title"},{"name":"For Educators","link":"/education","type":"title"},{"name":"Support KQED","link":"/support","type":"title"},{"name":"About","link":"/about","type":"title"},{"name":"Help Center","link":"https://kqed-helpcenter.kqed.org/s","type":"title"}]}]},"pagesReducer":{},"postsReducer":{"stream_live":{"type":"live","id":"stream_live","audioUrl":"https://streams.kqed.org/kqedradio","title":"Live Stream","excerpt":"Live Stream information currently unavailable.","link":"/radio","featImg":"","label":{"name":"KQED Live","link":"/"}},"stream_kqedNewscast":{"type":"posts","id":"stream_kqedNewscast","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1","title":"KQED Newscast","featImg":"","label":{"name":"88.5 FM","link":"/"}},"stateofhealth_59882":{"type":"posts","id":"stateofhealth_59882","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"59882","score":null,"sort":[1439322380000]},"guestAuthors":[],"slug":"how-rudeness-in-health-care-can-hurt-patients","title":"How Rudeness in Health Care Can Hurt Patients","publishDate":1439322380,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Say you're at work, at a training workshop. You're told that a visiting expert will be observing you. Just before the training starts, he makes a brief statement, telling you and your colleagues that he's \"not impressed\" with the quality of work he's seen at your organization.\u003c/p>\n\u003cp>Rude, huh? Maybe upsetting? But would such behavior affect how you do your job?\u003c/p>\n\u003cp>A new analysis published Monday in the journal \u003ca href=\"http://pediatrics.aappublications.org/content/early/2015/08/05/peds.2015-1385.abstract\" target=\"_blank\">Pediatrics\u003c/a> found exactly that -- even mild rudeness can have \"adverse consequences\" on how medical teams diagnose and treat patients.\u003c/p>\n\u003cp>The experiment that they devised was quite specific: The researchers invited doctors and nurses from the neonatal intensive care unit to a training and disclosed that an outside expert would be studying them. Participants were split into two groups -- one group had the \"rudeness\" intervention, the other did not.\u003c/p>\n\u003cp>Ten minutes after delivering the statement above, the visiting expert also told the intervention group that judging from what he'd seen, the teams \"wouldn't last a week\" in his department at home.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Each group then worked on a mannequin of a 28-week premature infant who had developed \u003ca href=\"http://www.nlm.nih.gov/medlineplus/ency/article/001148.htm\" target=\"_blank\">necrotizing enterocolitis\u003c/a> -- death of intestinal tissue, a serious condition that kills one in four babies who develop it. Their tasks were to diagnose, rapidly and accurately, what was happening to the baby, to determine a course of treatment and correctly perform the treatments.\u003c/p>\n\u003cp>The team that had experienced rudeness performed worse than the control group across a variety of measures, including getting the diagnosis right, performing resuscitation, asking for the right lab tests and much more.\u003c/p>\n\u003cp>Such rudeness is a distraction and affect people's \"cognitive resources,\" said study author Peter Bamberger, a professor of organizational behavior at the Tel Aviv University School of Management. \"Negative interactions in the workplace draw from those resources and put patients at risk because those caring for (patients) just aren’t able to make decisions or process information the way they should,”\u003c/p>\n\u003cp>He said he was surprised by the magnitude of the finding.\u003c/p>\n\u003cp>“Rudeness is a very mild form of incivility,\" he said. \"The statements that were made [in this study] were kind of tactless. This rudeness was really mild -- and the effects were huge.\"\u003c/p>\n\u003cp>Bamberger and his colleagues put their study squarely in the frame of patient safety. They noted that while there had been \"some modest improvements\" since the seminal 1999 Institute of Medicine Report \"\u003ca href=\"http://iom.nationalacademies.org/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf\" target=\"_blank\">To Err Is Human\u003c/a>\" tallied as many as 98,000 deaths a year due to patients error, significant gaps in safety remain.\u003c/p>\n\u003cp>They wrote that they suspected that one major reason was because \"many of the improvements were directed at refining systems and technologies, while neglecting human/relational factors.\"\u003c/p>\n\u003cp>Dr. Calvin Chou is a professor of clinical medicine who \u003ca href=\"http://profiles.ucsf.edu/calvin.chou\" target=\"_blank\">teaches bedside manner courses\u003c/a> to physicians at UC San Francisco. Chou said that while many researchers are looking at ways to improve the quality of care, many efforts are simply window dressing.\u003c/p>\n\u003cp>“This [study] is just emblematic of how complicated health care is and the many different factors that can go into the quality of health care,\" Chou said, and added that \"interpersonal communication is key.\"\u003c/p>\n\u003cp>Bamberger said that it was not just physicians and nurses who need to watch their manners, but that rudeness from patients and families matters too -- although teaching staff to better handle negative interactions with patients and families could help.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“When people are in those kinds of situations where patients’ lives are at stake, emotions sometimes get the best of people,\" Bamberger said. \"Efforts have to be made to try to educate all of those involved in those situations to try to show a little bit more care towards one another.”\u003c/p>\n\n","blocks":[],"excerpt":"You \"wouldn't last a week\" in my department, doctors and nurses were told in a study -- then performed more poorly at diagnosis and treatment. ","status":"publish","parent":0,"modified":1439330761,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":18,"wordCount":633},"headData":{"title":"How Rudeness in Health Care Can Hurt Patients | KQED","description":"You "wouldn't last a week" in my department, doctors and nurses were told in a study -- then performed more poorly at diagnosis and treatment. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"How Rudeness in Health Care Can Hurt Patients","datePublished":"2015-08-11T19:46:20.000Z","dateModified":"2015-08-11T22:06:01.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"59882 http://ww2.kqed.org/stateofhealth/?p=59882","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/08/11/how-rudeness-in-health-care-can-hurt-patients/","disqusTitle":"How Rudeness in Health Care Can Hurt Patients","nprByline":"Alvin Tran","path":"/stateofhealth/59882/how-rudeness-in-health-care-can-hurt-patients","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Say you're at work, at a training workshop. You're told that a visiting expert will be observing you. Just before the training starts, he makes a brief statement, telling you and your colleagues that he's \"not impressed\" with the quality of work he's seen at your organization.\u003c/p>\n\u003cp>Rude, huh? Maybe upsetting? But would such behavior affect how you do your job?\u003c/p>\n\u003cp>A new analysis published Monday in the journal \u003ca href=\"http://pediatrics.aappublications.org/content/early/2015/08/05/peds.2015-1385.abstract\" target=\"_blank\">Pediatrics\u003c/a> found exactly that -- even mild rudeness can have \"adverse consequences\" on how medical teams diagnose and treat patients.\u003c/p>\n\u003cp>The experiment that they devised was quite specific: The researchers invited doctors and nurses from the neonatal intensive care unit to a training and disclosed that an outside expert would be studying them. Participants were split into two groups -- one group had the \"rudeness\" intervention, the other did not.\u003c/p>\n\u003cp>Ten minutes after delivering the statement above, the visiting expert also told the intervention group that judging from what he'd seen, the teams \"wouldn't last a week\" in his department at home.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Each group then worked on a mannequin of a 28-week premature infant who had developed \u003ca href=\"http://www.nlm.nih.gov/medlineplus/ency/article/001148.htm\" target=\"_blank\">necrotizing enterocolitis\u003c/a> -- death of intestinal tissue, a serious condition that kills one in four babies who develop it. Their tasks were to diagnose, rapidly and accurately, what was happening to the baby, to determine a course of treatment and correctly perform the treatments.\u003c/p>\n\u003cp>The team that had experienced rudeness performed worse than the control group across a variety of measures, including getting the diagnosis right, performing resuscitation, asking for the right lab tests and much more.\u003c/p>\n\u003cp>Such rudeness is a distraction and affect people's \"cognitive resources,\" said study author Peter Bamberger, a professor of organizational behavior at the Tel Aviv University School of Management. \"Negative interactions in the workplace draw from those resources and put patients at risk because those caring for (patients) just aren’t able to make decisions or process information the way they should,”\u003c/p>\n\u003cp>He said he was surprised by the magnitude of the finding.\u003c/p>\n\u003cp>“Rudeness is a very mild form of incivility,\" he said. \"The statements that were made [in this study] were kind of tactless. This rudeness was really mild -- and the effects were huge.\"\u003c/p>\n\u003cp>Bamberger and his colleagues put their study squarely in the frame of patient safety. They noted that while there had been \"some modest improvements\" since the seminal 1999 Institute of Medicine Report \"\u003ca href=\"http://iom.nationalacademies.org/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf\" target=\"_blank\">To Err Is Human\u003c/a>\" tallied as many as 98,000 deaths a year due to patients error, significant gaps in safety remain.\u003c/p>\n\u003cp>They wrote that they suspected that one major reason was because \"many of the improvements were directed at refining systems and technologies, while neglecting human/relational factors.\"\u003c/p>\n\u003cp>Dr. Calvin Chou is a professor of clinical medicine who \u003ca href=\"http://profiles.ucsf.edu/calvin.chou\" target=\"_blank\">teaches bedside manner courses\u003c/a> to physicians at UC San Francisco. Chou said that while many researchers are looking at ways to improve the quality of care, many efforts are simply window dressing.\u003c/p>\n\u003cp>“This [study] is just emblematic of how complicated health care is and the many different factors that can go into the quality of health care,\" Chou said, and added that \"interpersonal communication is key.\"\u003c/p>\n\u003cp>Bamberger said that it was not just physicians and nurses who need to watch their manners, but that rudeness from patients and families matters too -- although teaching staff to better handle negative interactions with patients and families could help.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“When people are in those kinds of situations where patients’ lives are at stake, emotions sometimes get the best of people,\" Bamberger said. \"Efforts have to be made to try to educate all of those involved in those situations to try to show a little bit more care towards one another.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/59882/how-rudeness-in-health-care-can-hurt-patients","authors":["byline_stateofhealth_59882"],"categories":["stateofhealth_13"],"tags":["stateofhealth_53","stateofhealth_456"],"featImg":"stateofhealth_60318","label":"stateofhealth"},"stateofhealth_12574":{"type":"posts","id":"stateofhealth_12574","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"12574","score":null,"sort":[1367953485000]},"guestAuthors":[],"slug":"doctors-mistakes-in-diagnosis-rarely-mentioned-harm-patients","title":"Rarely Mentioned Medical Mistake: Patients Harmed by High Rates of Misdiagnosis","publishDate":1367953485,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>\u003cstrong>By Sandra G. Boodman\u003c/strong>, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/May/07/doctor-errors-misdiagnosis-more-common-than-known-serious-impact.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_12578\" class=\"wp-caption aligncenter\" style=\"max-width: 508px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/05/07/doctors-mistakes-in-diagnosis-rarely-mentioned-harm-patients/mistake_gettyimages_thinkstock/\" rel=\"attachment wp-att-12578\">\u003cimg class=\"size-full wp-image-12578\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/05/Mistake_GettyImages_Thinkstock.jpg\" alt=\"(Getty Images)\" width=\"508\" height=\"337\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/05/Mistake_GettyImages_Thinkstock.jpg 508w, https://ww2.kqed.org/app/uploads/sites/27/2013/05/Mistake_GettyImages_Thinkstock-400x265.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/05/Mistake_GettyImages_Thinkstock-320x212.jpg 320w\" sizes=\"(max-width: 508px) 100vw, 508px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Until it happened to him, Dr. Itzhak Brook, a pediatric infectious disease specialist at Georgetown University School of Medicine, didn't think much about the problem of misdiagnosis.\u003c/p>\n\u003cp>That was before doctors at a Maryland hospital repeatedly told Brook his throat pain was the result of acid reflux, not cancer. The correct diagnosis was made by an astute resident who found the tumor -- the size of a peach pit -- using a simple procedure. The experienced head and neck surgeons who regularly examined Brook had never tried it. Because the cancer had grown undetected for seven months, Brook was forced to undergo surgery to remove his voice box, a procedure that has left him speaking in a whisper. He believes that might not have been necessary had the cancer been found earlier.\u003c/p>\n\u003cp>\"I consider myself lucky to be alive,\" said Brook, now 72, of the 2006 ordeal, which he described at a \u003ca href=\"http://www.hopkinscme.edu/CourseDetail.aspx/80028747\">recent international conference\u003c/a> on diagnostic mistakes held in Baltimore. A physician for 40 years, Brook said he was \"really shocked\" by his misdiagnosis.\u003c/p>\n\u003caside class=\"pullquote alignright\">Misdiagnosis “happens all the time ... This is an enormous problem.\"\u003c/aside>\n\u003cp>But patient safety experts say Brook's experience is far from rare. Diagnoses that are missed, incorrect or delayed are believed to affect \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=1362034\">10 to 20 percent\u003c/a> of cases, far exceeding drug errors and surgery on the wrong patient or body part, both of which have received considerably more attention.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Recent studies underscore the extent and potential impact of such errors. To cite just two examples:\u003c!--more-->\u003c/p>\n\u003cul>\n\u003cli>In \u003ca href=\"http://archinte.jamanetwork.com/article.aspx?articleid=1108559\" target=\"_blank\">a 2009 report\u003c/a> of nearly 600 diagnostic mistakes, a full 28 percent of them were life-threatening or resulted in either death or permanent disability\u003c/li>\n\u003cli>Another \u003ca href=\"http://qualitysafety.bmj.com/content/early/2012/07/23/bmjqs-2012-000803.abstract\" target=\"_blank\">analysis last year\u003c/a> found that 40,500 people die annually due to fatal diagnostic errors in U.S. intensive care units. That's roughly equal to the number of deaths each year from breast cancer.\u003c/li>\n\u003c/ul>\n\u003cp>Misdiagnosis \"happens all the time,\" said \u003ca href=\"http://www.hopkinsmedicine.org/neurology_neurosurgery/experts/profiles/team_member_profile/516F40C024FCA3D4B4B633D0E080FE1B/David_Newman-Toker\">David Newman-Toker\u003c/a>, who studies diagnostic errors and helped organize the recent international conference. \"This is an enormous problem, the hidden part of the iceberg of medical errors that dwarfs\" other kinds of mistakes, said Newman-Toker, an associate professor of neurology and otolaryngology at the Johns Hopkins School of Medicine. Studies repeatedly have found that diagnostic errors, which are more common in primary-care settings, typically result from flawed ways of thinking, sometimes coupled with negligence, and not because a disease is rare or exotic.\u003c/p>\n\u003cp>Despite their prevalence and impact, such mistakes have been largely ignored, Newman-Toker and others say. They were mentioned only twice in the \u003ca href=\"http://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx\">Institute of Medicine's landmark 1999 report\u003c/a> on medical errors, an omission some patient safety experts attribute to difficulties measuring such mistakes, the lack of obvious solutions and generalized resistance to addressing the problem.\u003c/p>\n\u003cp>\"You need data to start doing anything,\" said internist \u003ca href=\"http://www.rti.org/newsroom/news.cfm?obj=EF576FDC-5056-B100-0C98FF173CFB5D3F\">Mark L. Graber\u003c/a>, founding president of the Society to Improve Diagnosis in Medicine and a leading errors researcher. Despite dozens of quality measures, Graber said, he is unaware of \"a single hospital in this country trying to count diagnostic errors.\"\u003c/p>\n\u003cp>In the past few years, a confluence of factors has elevated the long-overlooked issue. In his 2007 bestseller, \"\u003ca href=\"http://www.jeromegroopman.com/how-doctors-think.html\">How Doctors Think\u003c/a>,\" Boston hematologist-oncologist Jerome Groopman vividly deconstructed the flawed thought processes that underlie many diagnostic errors, including several he made during his long career.\u003c/p>\n\u003cp>More recently, an influential cadre of medical leaders has been pushing for greater attention to the problem. They cite concerns about the growing complexity of medicine and increasing fragmentation of the health-care system, as well as relentless time pressures squeezing doctors and the overuse of expensive, high-tech tests that have supplanted traditional hands-on skills of physical diagnosis.\u003c/p>\n\u003cp>Publicity about the death last year of 12-year-old \u003ca href=\"http://www.nytimes.com/2012/10/26/nyregion/tale-of-rory-stauntons-death-prompts-new-medical-efforts-nationwide.html\">Rory Staunton\u003c/a>, sent home from an emergency room in New York after doctors missed the raging systemic infection that quickly killed him, have put a human face on the problem.\u003c/p>\n\u003cp>\"One of the reasons it's time to begin looking at it is that so many of the quality measures we use now assume that the diagnosis is the right one in the first place,\" said Christine Cassel, president of the American Board of Internal Medicine.\u003c/p>\n\u003cp>But what if it's not?\u003c/p>\n\u003cp>In a much-cited essay, Robert Wachter, associate chair of the Department of Medicine at the University of California at San Francisco, wrote that a hospital could earn \"performance incentives for giving all of its patients diagnosed with heart failure, pneumonia and heart attack the correct, evidence-based and prompt care -- even if every one of the diagnoses was wrong.\"\u003c/p>\n\u003cp>\u003cstrong>No obvious fix\u003c/strong>\u003c/p>\n\u003cp>Unlike drug errors and wrong-site surgery -- mistakes that patient safety experts consider to be \"low-hanging fruit\" amenable to solutions such as color-coded labels and preoperative timeouts by the surgical team -- there is no easy or obvious fix for diagnostic errors. Many are complex and multifaceted, and may not be discovered for years if ever, said Graber, a senior fellow at RTI International, a research firm based in Research Triangle Park, N.C.\u003c/p>\n\u003cp>\"There is probably nothing more cognitively complicated\" than a diagnosis, he said, \"and the fact that we get it right as often as we do is amazing.\"\u003c/p>\n\u003cp>But doctors often don't know when they've gotten it wrong. Some patients affected by misdiagnosis simply find a new doctor. Unless the mistake results in a lawsuit, the original physician is unlikely to learn that he blew it -- particularly if the discovery is delayed. While diagnostic errors are a leading cause of malpractice litigation, the vast majority do not result in legal action.\u003c/p>\n\u003cp>There is another reason such mistakes have been long ignored: They are regarded as an unusually personal failure in a profession where diagnostic acumen is considered the gold standard.\u003c/p>\n\u003cp>\"This really gets to who we are as clinicians,\" said internist Robert Trowbridge, who directs the medicine clerkship program for Tufts University medical students at Maine Medical Center in Portland.\u003c/p>\n\u003cp>\"Overconfidence in our abilities is a major part of the problem,\" said Graber, who believes doctors have gotten a pass for too long when it comes to diagnostic accuracy. \"Physicians don't know how error-prone they are.\"\u003c/p>\n\u003cp>Many, he noted, wrongly believe that the problem is \"the other guy\" and that they don't make mistakes. A \u003ca href=\"http://www.quantiamd.com/q-qcp/QuantiaMD_PreventingDiagnosticErrors_Whitepaper_1.pdf\">2011 survey\u003c/a> of more than 6,000 physicians found that 96 percent felt that diagnostic errors are preventable; nearly half said they encountered them at least once a month.\u003c/p>\n\u003cp>At Maine Medical Center, Trowbridge spearheaded a pilot program launched in 2010 to persuade doctors to anonymously report diagnostic errors, which would then undergo comprehensive analysis. He said he had to \"hound\" his colleagues to report mistakes. During the first six months, 36 errors that would otherwise have gone unreported were identified; most were deemed to have caused moderate to severe harm.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Trowbridge said the program has changed how he practices. \"I'm much more reflective, much more attuned to the errors I'm prone to make. I work with checklists more.\"\u003c/p>\n\n","blocks":[],"excerpt":"Until it happened to him, Dr. Itzhak Brook, a pediatric infectious disease specialist at Georgetown University School of Medicine, didn't think much about the problem of misdiagnosis.\r\n\r\nThat was before doctors at a Maryland hospital repeatedly told Brook his throat pain was the result of acid reflux, not cancer. The correct diagnosis was made by an astute resident who found the tumor -- the size of a peach pit -- using a simple procedure. The experienced head and neck surgeons who regularly examined Brook had never tried it. Because the cancer had grown undetected for seven months, Brook was forced to undergo surgery to remove his voice box, a procedure that has left him speaking in a whisper. He believes that might not have been necessary had the cancer been found earlier.","status":"publish","parent":0,"modified":1368159957,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":27,"wordCount":1207},"headData":{"title":"Rarely Mentioned Medical Mistake: Patients Harmed by High Rates of Misdiagnosis | KQED","description":"Until it happened to him, Dr. Itzhak Brook, a pediatric infectious disease specialist at Georgetown University School of Medicine, didn't think much about the problem of misdiagnosis.\r\n\r\nThat was before doctors at a Maryland hospital repeatedly told Brook his throat pain was the result of acid reflux, not cancer. The correct diagnosis was made by an astute resident who found the tumor -- the size of a peach pit -- using a simple procedure. The experienced head and neck surgeons who regularly examined Brook had never tried it. Because the cancer had grown undetected for seven months, Brook was forced to undergo surgery to remove his voice box, a procedure that has left him speaking in a whisper. He believes that might not have been necessary had the cancer been found earlier.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Rarely Mentioned Medical Mistake: Patients Harmed by High Rates of Misdiagnosis","datePublished":"2013-05-07T19:04:45.000Z","dateModified":"2013-05-10T04:25:57.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"12574 http://blogs.kqed.org/stateofhealth/?p=12574","disqusUrl":"https://ww2.kqed.org/stateofhealth/2013/05/07/doctors-mistakes-in-diagnosis-rarely-mentioned-harm-patients/","disqusTitle":"Rarely Mentioned Medical Mistake: Patients Harmed by High Rates of Misdiagnosis","path":"/stateofhealth/12574/doctors-mistakes-in-diagnosis-rarely-mentioned-harm-patients","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By Sandra G. Boodman\u003c/strong>, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/May/07/doctor-errors-misdiagnosis-more-common-than-known-serious-impact.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_12578\" class=\"wp-caption aligncenter\" style=\"max-width: 508px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/05/07/doctors-mistakes-in-diagnosis-rarely-mentioned-harm-patients/mistake_gettyimages_thinkstock/\" rel=\"attachment wp-att-12578\">\u003cimg class=\"size-full wp-image-12578\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/05/Mistake_GettyImages_Thinkstock.jpg\" alt=\"(Getty Images)\" width=\"508\" height=\"337\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/05/Mistake_GettyImages_Thinkstock.jpg 508w, https://ww2.kqed.org/app/uploads/sites/27/2013/05/Mistake_GettyImages_Thinkstock-400x265.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/05/Mistake_GettyImages_Thinkstock-320x212.jpg 320w\" sizes=\"(max-width: 508px) 100vw, 508px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Until it happened to him, Dr. Itzhak Brook, a pediatric infectious disease specialist at Georgetown University School of Medicine, didn't think much about the problem of misdiagnosis.\u003c/p>\n\u003cp>That was before doctors at a Maryland hospital repeatedly told Brook his throat pain was the result of acid reflux, not cancer. The correct diagnosis was made by an astute resident who found the tumor -- the size of a peach pit -- using a simple procedure. The experienced head and neck surgeons who regularly examined Brook had never tried it. Because the cancer had grown undetected for seven months, Brook was forced to undergo surgery to remove his voice box, a procedure that has left him speaking in a whisper. He believes that might not have been necessary had the cancer been found earlier.\u003c/p>\n\u003cp>\"I consider myself lucky to be alive,\" said Brook, now 72, of the 2006 ordeal, which he described at a \u003ca href=\"http://www.hopkinscme.edu/CourseDetail.aspx/80028747\">recent international conference\u003c/a> on diagnostic mistakes held in Baltimore. A physician for 40 years, Brook said he was \"really shocked\" by his misdiagnosis.\u003c/p>\n\u003caside class=\"pullquote alignright\">Misdiagnosis “happens all the time ... This is an enormous problem.\"\u003c/aside>\n\u003cp>But patient safety experts say Brook's experience is far from rare. Diagnoses that are missed, incorrect or delayed are believed to affect \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=1362034\">10 to 20 percent\u003c/a> of cases, far exceeding drug errors and surgery on the wrong patient or body part, both of which have received considerably more attention.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Recent studies underscore the extent and potential impact of such errors. To cite just two examples:\u003c!--more-->\u003c/p>\n\u003cul>\n\u003cli>In \u003ca href=\"http://archinte.jamanetwork.com/article.aspx?articleid=1108559\" target=\"_blank\">a 2009 report\u003c/a> of nearly 600 diagnostic mistakes, a full 28 percent of them were life-threatening or resulted in either death or permanent disability\u003c/li>\n\u003cli>Another \u003ca href=\"http://qualitysafety.bmj.com/content/early/2012/07/23/bmjqs-2012-000803.abstract\" target=\"_blank\">analysis last year\u003c/a> found that 40,500 people die annually due to fatal diagnostic errors in U.S. intensive care units. That's roughly equal to the number of deaths each year from breast cancer.\u003c/li>\n\u003c/ul>\n\u003cp>Misdiagnosis \"happens all the time,\" said \u003ca href=\"http://www.hopkinsmedicine.org/neurology_neurosurgery/experts/profiles/team_member_profile/516F40C024FCA3D4B4B633D0E080FE1B/David_Newman-Toker\">David Newman-Toker\u003c/a>, who studies diagnostic errors and helped organize the recent international conference. \"This is an enormous problem, the hidden part of the iceberg of medical errors that dwarfs\" other kinds of mistakes, said Newman-Toker, an associate professor of neurology and otolaryngology at the Johns Hopkins School of Medicine. Studies repeatedly have found that diagnostic errors, which are more common in primary-care settings, typically result from flawed ways of thinking, sometimes coupled with negligence, and not because a disease is rare or exotic.\u003c/p>\n\u003cp>Despite their prevalence and impact, such mistakes have been largely ignored, Newman-Toker and others say. They were mentioned only twice in the \u003ca href=\"http://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx\">Institute of Medicine's landmark 1999 report\u003c/a> on medical errors, an omission some patient safety experts attribute to difficulties measuring such mistakes, the lack of obvious solutions and generalized resistance to addressing the problem.\u003c/p>\n\u003cp>\"You need data to start doing anything,\" said internist \u003ca href=\"http://www.rti.org/newsroom/news.cfm?obj=EF576FDC-5056-B100-0C98FF173CFB5D3F\">Mark L. Graber\u003c/a>, founding president of the Society to Improve Diagnosis in Medicine and a leading errors researcher. Despite dozens of quality measures, Graber said, he is unaware of \"a single hospital in this country trying to count diagnostic errors.\"\u003c/p>\n\u003cp>In the past few years, a confluence of factors has elevated the long-overlooked issue. In his 2007 bestseller, \"\u003ca href=\"http://www.jeromegroopman.com/how-doctors-think.html\">How Doctors Think\u003c/a>,\" Boston hematologist-oncologist Jerome Groopman vividly deconstructed the flawed thought processes that underlie many diagnostic errors, including several he made during his long career.\u003c/p>\n\u003cp>More recently, an influential cadre of medical leaders has been pushing for greater attention to the problem. They cite concerns about the growing complexity of medicine and increasing fragmentation of the health-care system, as well as relentless time pressures squeezing doctors and the overuse of expensive, high-tech tests that have supplanted traditional hands-on skills of physical diagnosis.\u003c/p>\n\u003cp>Publicity about the death last year of 12-year-old \u003ca href=\"http://www.nytimes.com/2012/10/26/nyregion/tale-of-rory-stauntons-death-prompts-new-medical-efforts-nationwide.html\">Rory Staunton\u003c/a>, sent home from an emergency room in New York after doctors missed the raging systemic infection that quickly killed him, have put a human face on the problem.\u003c/p>\n\u003cp>\"One of the reasons it's time to begin looking at it is that so many of the quality measures we use now assume that the diagnosis is the right one in the first place,\" said Christine Cassel, president of the American Board of Internal Medicine.\u003c/p>\n\u003cp>But what if it's not?\u003c/p>\n\u003cp>In a much-cited essay, Robert Wachter, associate chair of the Department of Medicine at the University of California at San Francisco, wrote that a hospital could earn \"performance incentives for giving all of its patients diagnosed with heart failure, pneumonia and heart attack the correct, evidence-based and prompt care -- even if every one of the diagnoses was wrong.\"\u003c/p>\n\u003cp>\u003cstrong>No obvious fix\u003c/strong>\u003c/p>\n\u003cp>Unlike drug errors and wrong-site surgery -- mistakes that patient safety experts consider to be \"low-hanging fruit\" amenable to solutions such as color-coded labels and preoperative timeouts by the surgical team -- there is no easy or obvious fix for diagnostic errors. Many are complex and multifaceted, and may not be discovered for years if ever, said Graber, a senior fellow at RTI International, a research firm based in Research Triangle Park, N.C.\u003c/p>\n\u003cp>\"There is probably nothing more cognitively complicated\" than a diagnosis, he said, \"and the fact that we get it right as often as we do is amazing.\"\u003c/p>\n\u003cp>But doctors often don't know when they've gotten it wrong. Some patients affected by misdiagnosis simply find a new doctor. Unless the mistake results in a lawsuit, the original physician is unlikely to learn that he blew it -- particularly if the discovery is delayed. While diagnostic errors are a leading cause of malpractice litigation, the vast majority do not result in legal action.\u003c/p>\n\u003cp>There is another reason such mistakes have been long ignored: They are regarded as an unusually personal failure in a profession where diagnostic acumen is considered the gold standard.\u003c/p>\n\u003cp>\"This really gets to who we are as clinicians,\" said internist Robert Trowbridge, who directs the medicine clerkship program for Tufts University medical students at Maine Medical Center in Portland.\u003c/p>\n\u003cp>\"Overconfidence in our abilities is a major part of the problem,\" said Graber, who believes doctors have gotten a pass for too long when it comes to diagnostic accuracy. \"Physicians don't know how error-prone they are.\"\u003c/p>\n\u003cp>Many, he noted, wrongly believe that the problem is \"the other guy\" and that they don't make mistakes. A \u003ca href=\"http://www.quantiamd.com/q-qcp/QuantiaMD_PreventingDiagnosticErrors_Whitepaper_1.pdf\">2011 survey\u003c/a> of more than 6,000 physicians found that 96 percent felt that diagnostic errors are preventable; nearly half said they encountered them at least once a month.\u003c/p>\n\u003cp>At Maine Medical Center, Trowbridge spearheaded a pilot program launched in 2010 to persuade doctors to anonymously report diagnostic errors, which would then undergo comprehensive analysis. He said he had to \"hound\" his colleagues to report mistakes. During the first six months, 36 errors that would otherwise have gone unreported were identified; most were deemed to have caused moderate to severe harm.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Trowbridge said the program has changed how he practices. \"I'm much more reflective, much more attuned to the errors I'm prone to make. I work with checklists more.\"\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/12574/doctors-mistakes-in-diagnosis-rarely-mentioned-harm-patients","authors":["8344"],"categories":["stateofhealth_14"],"tags":["stateofhealth_53","stateofhealth_456","stateofhealth_461"],"featImg":"stateofhealth_12578","label":"stateofhealth"},"stateofhealth_12178":{"type":"posts","id":"stateofhealth_12178","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"12178","score":null,"sort":[1366306129000]},"guestAuthors":[],"slug":"6-factors-that-help-save-lives-in-a-disaster","title":"6 Factors That Help Save Lives In A Disaster","publishDate":1366306129,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>\u003cscript type=\"text/javascript\" src=\"http://platform.twitter.com/widgets.js\">\u003c/script>\u003cstrong>From Olympic Park to the Boston Marathon to Texas\u003c/strong>\u003c/p>\n\u003cp>The New Yorker's Atul Gawande writes often and well about medicine. This week, \u003ca href=\"http://www.newyorker.com/online/blogs/newsdesk/2013/04/why-bostons-hospitals-were-ready.html\" target=\"_blank\">he described \u003c/a>how disaster planning and training in hospitals saves lives. This morning he added a series of tweets:\u003c/p>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>.@\u003ca href=\"https://twitter.com/artkellermanmd\">artkellermanmd\u003c/a>, who helped manage ER response to the 1996 Olympic Park bombing, wrote with 6 factors that aid a city ability to rescue.\u003c/p>\n\u003cp>— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862659289817088\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>1. The explosion occurs at a big event with extra police and EMS pre-deployed.\u003c/p>\n\u003cp>— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862675433697280\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>2. The explosion occurs when hospital ORs and other services are operating at less than full capacity due to the event.\u003c/p>\n\u003cp>— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862691158134785\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>3. The explosion occurs during business hours so lots of staff are around.\u003cbr>\n— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862708082163712\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>4. The explosion occurs at the city center, close to many hospitals and, ideally, multiple trauma centers.\u003c/p>\n\u003cp>— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862722888048640\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>5. The explosion is detonated outside (lessening fatality count and blast severity) rather than inside.)\u003c/p>\n\u003cp>— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862742634852353\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>6. The first responders and hospital providers have received advance training regarding the essentials of blast injury care.\u003c/p>\n\u003cp>— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862758606753792\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>Atlanta had 5 of 6 of these factors in its favor. Boston had 6 of 6. Waco TX responders have 1 of 6 at best. Thoughts are with them.\u003c/p>\n\u003cp>— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862981143932928\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cp>In his \u003ca href=\"http://www.newyorker.com/online/blogs/newsdesk/2013/04/why-bostons-hospitals-were-ready.html\" target=\"_blank\">New Yorker piece\u003c/a>, Gawande talked described how the years of post-September 11 training in hospitals led to the \"orchestration\" that happened after Monday's Boston Marathon explosions:\u003c/p>\n\u003cblockquote>\u003cp>There’s a way such events are supposed to work. Each hospital has an incident commander who coördinates the clearing of emergency bays and hospital beds to open capacity, the mobilization of clinical staff and medical equipment for treatment, and communication with the city’s emergency command center. At my hospital, Stanley Ashley, a general surgeon and our chief medical officer, was that person. I talked to him after the event—I had been out of the city at the time of the explosions—and he told me that no sooner had he set up his command post and begun making phone calls then the first wave of victims arrived. Everything happened too fast for any ritualized plan to accommodate.\u003c/p>\u003c/blockquote>\n\u003cp>Even without the \"ritualized plan,\" staff had been so thoroughly trained that one emergency department director told Gawande he didn't have to tell people much at all. “Everybody spontaneously knew the dance moves,” he said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/news/2013/04/17/learning-how-to-respond-to-a-boston-style-emergency/\" target=\"_blank\">Learning How to Respond To A Boston-Style Emergency\u003c/a>\u003c/p>\n\n","blocks":[],"excerpt":"The New Yorker's Atul Gawande writes often and well about medicine. This week, he described how disaster planning and training in hospitals saves lives. This morning he added a series of tweets:\r\n","status":"publish","parent":0,"modified":1366322250,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":25,"wordCount":456},"headData":{"title":"6 Factors That Help Save Lives In A Disaster | KQED","description":"The New Yorker's Atul Gawande writes often and well about medicine. This week, he described how disaster planning and training in hospitals saves lives. This morning he added a series of tweets:\r\n","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"6 Factors That Help Save Lives In A Disaster","datePublished":"2013-04-18T17:28:49.000Z","dateModified":"2013-04-18T21:57:30.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"12178 http://blogs.kqed.org/stateofhealth/?p=12178","disqusUrl":"https://ww2.kqed.org/stateofhealth/2013/04/18/6-factors-that-help-save-lives-in-a-disaster/","disqusTitle":"6 Factors That Help Save Lives In A Disaster","path":"/stateofhealth/12178/6-factors-that-help-save-lives-in-a-disaster","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cscript type=\"text/javascript\" src=\"http://platform.twitter.com/widgets.js\">\u003c/script>\u003cstrong>From Olympic Park to the Boston Marathon to Texas\u003c/strong>\u003c/p>\n\u003cp>The New Yorker's Atul Gawande writes often and well about medicine. This week, \u003ca href=\"http://www.newyorker.com/online/blogs/newsdesk/2013/04/why-bostons-hospitals-were-ready.html\" target=\"_blank\">he described \u003c/a>how disaster planning and training in hospitals saves lives. This morning he added a series of tweets:\u003c/p>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>.@\u003ca href=\"https://twitter.com/artkellermanmd\">artkellermanmd\u003c/a>, who helped manage ER response to the 1996 Olympic Park bombing, wrote with 6 factors that aid a city ability to rescue.\u003c/p>\n\u003cp>— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862659289817088\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>1. The explosion occurs at a big event with extra police and EMS pre-deployed.\u003c/p>\n\u003cp>— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862675433697280\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>2. The explosion occurs when hospital ORs and other services are operating at less than full capacity due to the event.\u003c/p>\n\u003cp>— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862691158134785\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>3. The explosion occurs during business hours so lots of staff are around.\u003cbr>\n— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862708082163712\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>4. The explosion occurs at the city center, close to many hospitals and, ideally, multiple trauma centers.\u003c/p>\n\u003cp>— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862722888048640\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>5. The explosion is detonated outside (lessening fatality count and blast severity) rather than inside.)\u003c/p>\n\u003cp>— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862742634852353\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>6. The first responders and hospital providers have received advance training regarding the essentials of blast injury care.\u003c/p>\n\u003cp>— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862758606753792\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cblockquote class=\"twitter-tweet\">\u003cp>Atlanta had 5 of 6 of these factors in its favor. Boston had 6 of 6. Waco TX responders have 1 of 6 at best. Thoughts are with them.\u003c/p>\n\u003cp>— Atul Gawande (@Atul_Gawande) \u003ca href=\"https://twitter.com/Atul_Gawande/status/324862981143932928\">April 18, 2013\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cp>In his \u003ca href=\"http://www.newyorker.com/online/blogs/newsdesk/2013/04/why-bostons-hospitals-were-ready.html\" target=\"_blank\">New Yorker piece\u003c/a>, Gawande talked described how the years of post-September 11 training in hospitals led to the \"orchestration\" that happened after Monday's Boston Marathon explosions:\u003c/p>\n\u003cblockquote>\u003cp>There’s a way such events are supposed to work. Each hospital has an incident commander who coördinates the clearing of emergency bays and hospital beds to open capacity, the mobilization of clinical staff and medical equipment for treatment, and communication with the city’s emergency command center. At my hospital, Stanley Ashley, a general surgeon and our chief medical officer, was that person. I talked to him after the event—I had been out of the city at the time of the explosions—and he told me that no sooner had he set up his command post and begun making phone calls then the first wave of victims arrived. Everything happened too fast for any ritualized plan to accommodate.\u003c/p>\u003c/blockquote>\n\u003cp>Even without the \"ritualized plan,\" staff had been so thoroughly trained that one emergency department director told Gawande he didn't have to tell people much at all. “Everybody spontaneously knew the dance moves,” he said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/news/2013/04/17/learning-how-to-respond-to-a-boston-style-emergency/\" target=\"_blank\">Learning How to Respond To A Boston-Style Emergency\u003c/a>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/12178/6-factors-that-help-save-lives-in-a-disaster","authors":["240"],"categories":["stateofhealth_14"],"tags":["stateofhealth_456","stateofhealth_461"],"featImg":"stateofhealth_12187","label":"stateofhealth"},"stateofhealth_11481":{"type":"posts","id":"stateofhealth_11481","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"11481","score":null,"sort":[1363736276000]},"guestAuthors":[],"slug":"hospital-ratings-are-in-the-eye-of-the-beholder","title":"Hospital Ratings Are In The Eye Of The Beholder","publishDate":1363736276,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>By Jordan Rau, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/March/18/expanding-number-of-groups-offer-hospital-ratings.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_11485\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/19/hospital-ratings-are-in-the-eye-of-the-beholder/ratings-300_khn/\" rel=\"attachment wp-att-11485\">\u003cimg class=\"size-full wp-image-11485\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Ratings-300_KHN.jpg\" alt=\"(Courtesy: Kaiser Health News)\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Courtesy: Kaiser Health News)\u003c/figcaption>\u003c/figure>\n\u003cp>How good a hospital is St. Mary Mercy Livonia Hospital in Michigan? It depends on whom you ask.\u003c/p>\n\u003cp>The Leapfrog Group, a respected nonprofit that promotes patient safety, gave an \"A\" to the hospital. The company Healthgrades named it one of America's best 50 hospitals.\u003c/p>\n\u003cp>But the Joint Commission, a nonprofit organization that accredits hospitals, and U.S. News and World Report omitted St. Mary from their best hospital lists. Consumer Reports gave it an average safety score of 47 points out of 100, citing high numbers of readmissions, poor communication with patients and excessive use of scans. Medicare, which has a new program \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/December/21/medicare-hospitals-value-based-purchasing.aspx\" target=\"_blank\">rewarding hospitals\u003c/a> for meeting certain quality measures, is reducing St. Mary's payments by a fraction this year.\u003c/p>\n\u003cp>Is your head spinning yet?\u003c/p>\n\u003caside class=\"pullquote alignleft\">As ratings multiply, more and more hospitals have something they can brag about. A third of U.S. hospitals won at least one distinction from a major rating group or company.\u003c/aside>\n\u003cp>Evaluations of hospitals are proliferating, giving patients unprecedented insight into institutions where variations in quality can determine whether they live or die. Many have similar names, such as \"\u003ca href=\"http://health.usnews.com/best-hospitals\" target=\"_blank\">Best Hospitals Honor Roll\u003c/a>,\" \"\u003ca href=\"http://www.healthgrades.com/quality/top-hospitals-2013\" target=\"_blank\">America's Best Hospitals\u003c/a>\" and \"\u003ca href=\"http://www.100tophospitals.com/\" target=\"_blank\">100 Top Hospitals\u003c/a>.\" Some states have created their own report cards. In California there are more than a dozen organizations offering assessments on hospital quality.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But those ratings, each using its own methodology, often come to wildly divergent conclusions, sometimes providing as much confusion as clarity for consumers.\u003c!--more-->\u003c/p>\n\u003cp>\"We've alternatively been labeled the least safe hospital in Maine and the safest hospital in Maine,\" said Dr. Douglas Salvador, vice president of quality at Maine Medical Center in Portland.\u003c/p>\n\u003cp>And the ratings do not always jibe with the views of authorities who oversee hospitals. For instance, UCSF Medical Center has gotten good grades from multiple safety raters even as \u003ca href=\"http://www.cdph.ca.gov/certlic/facilities/Pages/APCountySanFrancisco.aspx\" target=\"_blank\">California public health officials\u003c/a> have fined it $425,000 repeatedly for endangering patients.\u003c/p>\n\u003cp>As ratings multiply, more and more hospitals have something they can brag about. A third of U.S. hospitals — more than 1,600 — last year won at least one distinction from a major rating group or company, according to a Kaiser Health News analysis. In the greater Fort Lauderdale hospital market, 21 of 24 hospitals were singled out as exemplary by at least one rating source. In the Baltimore region, 19 out of 22 hospitals won an award.\u003c/p>\n\u003cp>\"I worry a lot about these ratings,\" said Jerod Loeb, executive vice president for health care quality evaluation at the Joint Commission. \"They're all justifiable efforts to provide information, but at the end of the day every single one of them is flawed in some respect. Rather than enlightening, we may be confusing.\"\u003c/p>\n\u003cp>\u003cstrong>Not A 'Complete Picture Of The Care'\u003c/strong>\u003c/p>\n\u003cp>There are so many report cards on hospitals that the Informed Patient Institute \u003ca href=\"http://www.informedpatientinstitute.org/index.html\" target=\"_blank\">runs a website\u003c/a> that grades the raters. Carol Cronin, its executive director, said most report cards are not easy for consumers to use. \"A lot of them don’t help users quickly understand which hospital is better than another,\" she said.\u003c/p>\n\u003cp>But many hospitals are eager to trump these distinctions in their marketing. Healthgrades, U.S. News and Leapfrog not only encourage this but also profit from it by charging licensing fees to hospitals that want to advertise their awards. \"A hospital cannot buy an award, they must achieve it,\" Healthgrades said in a statement.\u003c/p>\n\u003cp>Dr. Andrew Brotman, chief clinical officer at NYU Langone Medical Center in Manhattan, said the fees can be substantial. \"Healthgrades, which is one we did well on, charges $145,000 to use this even on the website as a logo, so we don't do that,\" he said. \"U.S. News is in the $50,000 range. Leapfrog is $12,500.\"\u003c/p>\n\u003cp>Consumer Reports bars hospitals from using its ratings in marketing, but patients must subscribe to read them online. (Others generally provide free access to ratings on their sites.) The Joint Commission does not charge hospitals that make its top quality list.\u003c/p>\n\u003cp>The calculations that go into these ratings are complex. Most hospital assessments synthesize dozens of pieces of data Medicare publishes on its \u003ca href=\"http://www.medicare.gov/hospitalcompare/\" target=\"_blank\">Hospital Compare website\u003c/a>, including death rates and the results of patient satisfaction surveys. They also examine other sources and use private surveys to create user-friendly lists or grades, which they display on their websites.\u003c/p>\n\u003cp>Here's a snapshot of what different ratings measure:\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"http://www.jointcommission.org/accreditation/top_performers.aspx\" target=\"_blank\">The Joint Commission\u003c/a> looks at how frequently patients received recommended treatments, such as flu shots for those with pneumonia.\u003c/li>\n\u003cli>Consumer Reports examines the numbers of patients who die or are readmitted, infection rates and Medicare patient surveys of their experiences.\u003c/li>\n\u003cli>Leapfrog looks at data from its surveys of hospitals, the consistency with which hospitals followed safe surgical practices and frequencies of infections and some types of patient harm.\u003c/li>\n\u003cli>Healthgrades analyzes detailed Medicare records to find death and complication rates for 27 procedures and conditions.\u003c/li>\n\u003cli>Truven considers profitability along with quality in its assessments.\u003c/li>\n\u003cli>U.S. News surveys physicians about which places they think are the best, and those reputation ratings account for a third of most of its assessments. U.S. News ranks hospitals by geography and singles out hospitals that do well in 16 specialties, including cancer, neurology and orthopedics.\u003c/li>\n\u003c/ul>\n\u003cp>\"Ratings and ranking programs certainly offer people information they can use to make their hospital selections, but we don’t recommend relying on any one of them completely,\" Jennifer Kennedy, a spokeswoman for St. Mary Mercy, said in an e-mail. \"None are able to tell the whole story or paint a complete picture of the care that is delivered.\"\u003c/p>\n\u003cp>Patient safety rankings are based on how frequently correct procedures or errors occur, so hospitals can get good grades even if they have made some egregious errors. \u003ca href=\"http://leapfrog-hss.web01.atlasworks.com/hospital-details?location_id=298\" target=\"_blank\">Leapfrog gave\u003c/a> a \"B\" to UCSF Medical Center in San Francisco even though California regulators have penalized UCSF eight times for infractions since 2008, most recently for \u003ca href=\"http://www.cdph.ca.gov/certlic/facilities/Documents/HospitalAdministrativePenalties-2567Forms-LNC/2567UCSFMedCTR-V65C11-SanFran.pdf\" target=\"_blank\">leaving a sponge\u003c/a> in one patient and a \u003ca href=\"http://www.cdph.ca.gov/certlic/facilities/Documents/HospitalAdministrativePenalties-2567Forms-LNC/2567UCSFMedCTR-CW9Y11-SanFran.pdf\" target=\"_blank\">plastic clip in the skull\u003c/a> of another. Those errors cost UCSF $200,000 in fines.\u003c/p>\n\u003cp>Dr. Josh Adler, the chief medical officer at UCSF, said penalties were partly a result of the hospital's policy to make sure that all errors are reported to authorities. \"The key is that we constantly strive to deliver the highest quality, safest, and most satisfying care, and that we are a learning organization,\" he said in an e-mail.\u003c/p>\n\u003cp>The ratings groups believe the public benefits from the multitude of ratings. Dr. John Santa, who directs Consumer Reports' health ratings, said consumers benefit from different vantages just as they do for cars or electronic devices, and the competition spurs each rating group to get better. \"We think that’s consistent with good science,\" Santa said.\u003c/p>\n\u003cp>\u003cstrong>Constant Turnover\u003c/strong>\u003c/p>\n\u003cp>Much of the quality data is rudimentary, as the science of evaluating hospitals is still in its adolescence. Adding to the confusion is that hospitals can rise and fall from year to year as groups tweak their methods of assessment and as hospital performance shifts, even slightly.\u003c/p>\n\u003cp>In some cases, hospitals that have won awards are being penalized financially by Medicare for falling short on the government's quality assessment. Saint Francis Hospital in Tulsa, Okla., which is losing 0.54 percent of its Medicare payments this year under the government's quality program, is a Healthgrades Distinguished Hospital for Clinical Excellence and was ranked the second best hospital in Oklahoma by U.S. News.\u003c/p>\n\u003cp>Some of the hospitals that do the best in the rankings have limited respect for them. Advocate Christ Medical Center in Oak Lawn, Ill., last year received praise from Leapfrog, U.S. News, the Joint Commission, Truven and Healthgrades. But Dr. William Adair, vice president for clinical transformation, says the hospital doesn't license any of the distinctions. \"We're all made a little bit uneasy, to be frank about it,\" Adair says. \"Some of these organizations are looking for revenue. It blurs the effectiveness of the ratings processes.\"\u003c/p>\n\u003cp>Still, many hospitals are happy to use the praise. Dr. Brotman from NYU said: \"Even though there's not a hospital executive who won't tell you that they have a great deal of skepticism about a lot of the methodology, there’s not one who will tell you they don't want to be on the lists.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This article was produced by Kaiser Health News with support from \u003ca href=\"http://www.thescanfoundation.org/\">The SCAN Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"How good a hospital is St. Mary Mercy Livonia Hospital in Michigan? It depends on whom you ask.\r\n\r\nThe Leapfrog Group, a respected nonprofit that promotes patient safety, gave an \"A\" to the hospital. The company Healthgrades named it one of America's best 50 hospitals.\r\n\r\nBut the Joint Commission, a nonprofit organization that accredits hospitals, and U.S. News and World Report omitted St. Mary from their best hospital lists. Consumer Reports gave it an average safety score of 47 points out of 100, citing high numbers of readmissions, poor communication with patients and excessive use of scans. Medicare, which has a new program rewarding hospitals for meeting certain quality measures, is reducing St. Mary's payments by a fraction this year.\r\n\r\nIs your head spinning yet?","status":"publish","parent":0,"modified":1363736692,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":30,"wordCount":1442},"headData":{"title":"Hospital Ratings Are In The Eye Of The Beholder | KQED","description":"How good a hospital is St. Mary Mercy Livonia Hospital in Michigan? It depends on whom you ask.\r\n\r\nThe Leapfrog Group, a respected nonprofit that promotes patient safety, gave an "A" to the hospital. The company Healthgrades named it one of America's best 50 hospitals.\r\n\r\nBut the Joint Commission, a nonprofit organization that accredits hospitals, and U.S. News and World Report omitted St. Mary from their best hospital lists. Consumer Reports gave it an average safety score of 47 points out of 100, citing high numbers of readmissions, poor communication with patients and excessive use of scans. Medicare, which has a new program rewarding hospitals for meeting certain quality measures, is reducing St. Mary's payments by a fraction this year.\r\n\r\nIs your head spinning yet?","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Hospital Ratings Are In The Eye Of The Beholder","datePublished":"2013-03-19T23:37:56.000Z","dateModified":"2013-03-19T23:44:52.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"11481 http://blogs.kqed.org/stateofhealth/?p=11481","disqusUrl":"https://ww2.kqed.org/stateofhealth/2013/03/19/hospital-ratings-are-in-the-eye-of-the-beholder/","disqusTitle":"Hospital Ratings Are In The Eye Of The Beholder","path":"/stateofhealth/11481/hospital-ratings-are-in-the-eye-of-the-beholder","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Jordan Rau, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/March/18/expanding-number-of-groups-offer-hospital-ratings.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_11485\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/19/hospital-ratings-are-in-the-eye-of-the-beholder/ratings-300_khn/\" rel=\"attachment wp-att-11485\">\u003cimg class=\"size-full wp-image-11485\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Ratings-300_KHN.jpg\" alt=\"(Courtesy: Kaiser Health News)\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Courtesy: Kaiser Health News)\u003c/figcaption>\u003c/figure>\n\u003cp>How good a hospital is St. Mary Mercy Livonia Hospital in Michigan? It depends on whom you ask.\u003c/p>\n\u003cp>The Leapfrog Group, a respected nonprofit that promotes patient safety, gave an \"A\" to the hospital. The company Healthgrades named it one of America's best 50 hospitals.\u003c/p>\n\u003cp>But the Joint Commission, a nonprofit organization that accredits hospitals, and U.S. News and World Report omitted St. Mary from their best hospital lists. Consumer Reports gave it an average safety score of 47 points out of 100, citing high numbers of readmissions, poor communication with patients and excessive use of scans. Medicare, which has a new program \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/December/21/medicare-hospitals-value-based-purchasing.aspx\" target=\"_blank\">rewarding hospitals\u003c/a> for meeting certain quality measures, is reducing St. Mary's payments by a fraction this year.\u003c/p>\n\u003cp>Is your head spinning yet?\u003c/p>\n\u003caside class=\"pullquote alignleft\">As ratings multiply, more and more hospitals have something they can brag about. A third of U.S. hospitals won at least one distinction from a major rating group or company.\u003c/aside>\n\u003cp>Evaluations of hospitals are proliferating, giving patients unprecedented insight into institutions where variations in quality can determine whether they live or die. Many have similar names, such as \"\u003ca href=\"http://health.usnews.com/best-hospitals\" target=\"_blank\">Best Hospitals Honor Roll\u003c/a>,\" \"\u003ca href=\"http://www.healthgrades.com/quality/top-hospitals-2013\" target=\"_blank\">America's Best Hospitals\u003c/a>\" and \"\u003ca href=\"http://www.100tophospitals.com/\" target=\"_blank\">100 Top Hospitals\u003c/a>.\" Some states have created their own report cards. In California there are more than a dozen organizations offering assessments on hospital quality.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But those ratings, each using its own methodology, often come to wildly divergent conclusions, sometimes providing as much confusion as clarity for consumers.\u003c!--more-->\u003c/p>\n\u003cp>\"We've alternatively been labeled the least safe hospital in Maine and the safest hospital in Maine,\" said Dr. Douglas Salvador, vice president of quality at Maine Medical Center in Portland.\u003c/p>\n\u003cp>And the ratings do not always jibe with the views of authorities who oversee hospitals. For instance, UCSF Medical Center has gotten good grades from multiple safety raters even as \u003ca href=\"http://www.cdph.ca.gov/certlic/facilities/Pages/APCountySanFrancisco.aspx\" target=\"_blank\">California public health officials\u003c/a> have fined it $425,000 repeatedly for endangering patients.\u003c/p>\n\u003cp>As ratings multiply, more and more hospitals have something they can brag about. A third of U.S. hospitals — more than 1,600 — last year won at least one distinction from a major rating group or company, according to a Kaiser Health News analysis. In the greater Fort Lauderdale hospital market, 21 of 24 hospitals were singled out as exemplary by at least one rating source. In the Baltimore region, 19 out of 22 hospitals won an award.\u003c/p>\n\u003cp>\"I worry a lot about these ratings,\" said Jerod Loeb, executive vice president for health care quality evaluation at the Joint Commission. \"They're all justifiable efforts to provide information, but at the end of the day every single one of them is flawed in some respect. Rather than enlightening, we may be confusing.\"\u003c/p>\n\u003cp>\u003cstrong>Not A 'Complete Picture Of The Care'\u003c/strong>\u003c/p>\n\u003cp>There are so many report cards on hospitals that the Informed Patient Institute \u003ca href=\"http://www.informedpatientinstitute.org/index.html\" target=\"_blank\">runs a website\u003c/a> that grades the raters. Carol Cronin, its executive director, said most report cards are not easy for consumers to use. \"A lot of them don’t help users quickly understand which hospital is better than another,\" she said.\u003c/p>\n\u003cp>But many hospitals are eager to trump these distinctions in their marketing. Healthgrades, U.S. News and Leapfrog not only encourage this but also profit from it by charging licensing fees to hospitals that want to advertise their awards. \"A hospital cannot buy an award, they must achieve it,\" Healthgrades said in a statement.\u003c/p>\n\u003cp>Dr. Andrew Brotman, chief clinical officer at NYU Langone Medical Center in Manhattan, said the fees can be substantial. \"Healthgrades, which is one we did well on, charges $145,000 to use this even on the website as a logo, so we don't do that,\" he said. \"U.S. News is in the $50,000 range. Leapfrog is $12,500.\"\u003c/p>\n\u003cp>Consumer Reports bars hospitals from using its ratings in marketing, but patients must subscribe to read them online. (Others generally provide free access to ratings on their sites.) The Joint Commission does not charge hospitals that make its top quality list.\u003c/p>\n\u003cp>The calculations that go into these ratings are complex. Most hospital assessments synthesize dozens of pieces of data Medicare publishes on its \u003ca href=\"http://www.medicare.gov/hospitalcompare/\" target=\"_blank\">Hospital Compare website\u003c/a>, including death rates and the results of patient satisfaction surveys. They also examine other sources and use private surveys to create user-friendly lists or grades, which they display on their websites.\u003c/p>\n\u003cp>Here's a snapshot of what different ratings measure:\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"http://www.jointcommission.org/accreditation/top_performers.aspx\" target=\"_blank\">The Joint Commission\u003c/a> looks at how frequently patients received recommended treatments, such as flu shots for those with pneumonia.\u003c/li>\n\u003cli>Consumer Reports examines the numbers of patients who die or are readmitted, infection rates and Medicare patient surveys of their experiences.\u003c/li>\n\u003cli>Leapfrog looks at data from its surveys of hospitals, the consistency with which hospitals followed safe surgical practices and frequencies of infections and some types of patient harm.\u003c/li>\n\u003cli>Healthgrades analyzes detailed Medicare records to find death and complication rates for 27 procedures and conditions.\u003c/li>\n\u003cli>Truven considers profitability along with quality in its assessments.\u003c/li>\n\u003cli>U.S. News surveys physicians about which places they think are the best, and those reputation ratings account for a third of most of its assessments. U.S. News ranks hospitals by geography and singles out hospitals that do well in 16 specialties, including cancer, neurology and orthopedics.\u003c/li>\n\u003c/ul>\n\u003cp>\"Ratings and ranking programs certainly offer people information they can use to make their hospital selections, but we don’t recommend relying on any one of them completely,\" Jennifer Kennedy, a spokeswoman for St. Mary Mercy, said in an e-mail. \"None are able to tell the whole story or paint a complete picture of the care that is delivered.\"\u003c/p>\n\u003cp>Patient safety rankings are based on how frequently correct procedures or errors occur, so hospitals can get good grades even if they have made some egregious errors. \u003ca href=\"http://leapfrog-hss.web01.atlasworks.com/hospital-details?location_id=298\" target=\"_blank\">Leapfrog gave\u003c/a> a \"B\" to UCSF Medical Center in San Francisco even though California regulators have penalized UCSF eight times for infractions since 2008, most recently for \u003ca href=\"http://www.cdph.ca.gov/certlic/facilities/Documents/HospitalAdministrativePenalties-2567Forms-LNC/2567UCSFMedCTR-V65C11-SanFran.pdf\" target=\"_blank\">leaving a sponge\u003c/a> in one patient and a \u003ca href=\"http://www.cdph.ca.gov/certlic/facilities/Documents/HospitalAdministrativePenalties-2567Forms-LNC/2567UCSFMedCTR-CW9Y11-SanFran.pdf\" target=\"_blank\">plastic clip in the skull\u003c/a> of another. Those errors cost UCSF $200,000 in fines.\u003c/p>\n\u003cp>Dr. Josh Adler, the chief medical officer at UCSF, said penalties were partly a result of the hospital's policy to make sure that all errors are reported to authorities. \"The key is that we constantly strive to deliver the highest quality, safest, and most satisfying care, and that we are a learning organization,\" he said in an e-mail.\u003c/p>\n\u003cp>The ratings groups believe the public benefits from the multitude of ratings. Dr. John Santa, who directs Consumer Reports' health ratings, said consumers benefit from different vantages just as they do for cars or electronic devices, and the competition spurs each rating group to get better. \"We think that’s consistent with good science,\" Santa said.\u003c/p>\n\u003cp>\u003cstrong>Constant Turnover\u003c/strong>\u003c/p>\n\u003cp>Much of the quality data is rudimentary, as the science of evaluating hospitals is still in its adolescence. Adding to the confusion is that hospitals can rise and fall from year to year as groups tweak their methods of assessment and as hospital performance shifts, even slightly.\u003c/p>\n\u003cp>In some cases, hospitals that have won awards are being penalized financially by Medicare for falling short on the government's quality assessment. Saint Francis Hospital in Tulsa, Okla., which is losing 0.54 percent of its Medicare payments this year under the government's quality program, is a Healthgrades Distinguished Hospital for Clinical Excellence and was ranked the second best hospital in Oklahoma by U.S. News.\u003c/p>\n\u003cp>Some of the hospitals that do the best in the rankings have limited respect for them. Advocate Christ Medical Center in Oak Lawn, Ill., last year received praise from Leapfrog, U.S. News, the Joint Commission, Truven and Healthgrades. But Dr. William Adair, vice president for clinical transformation, says the hospital doesn't license any of the distinctions. \"We're all made a little bit uneasy, to be frank about it,\" Adair says. \"Some of these organizations are looking for revenue. It blurs the effectiveness of the ratings processes.\"\u003c/p>\n\u003cp>Still, many hospitals are happy to use the praise. Dr. Brotman from NYU said: \"Even though there's not a hospital executive who won't tell you that they have a great deal of skepticism about a lot of the methodology, there’s not one who will tell you they don't want to be on the lists.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This article was produced by Kaiser Health News with support from \u003ca href=\"http://www.thescanfoundation.org/\">The SCAN Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/11481/hospital-ratings-are-in-the-eye-of-the-beholder","authors":["240"],"categories":["stateofhealth_14"],"tags":["stateofhealth_456","stateofhealth_461"],"featImg":"stateofhealth_11485","label":"stateofhealth"},"stateofhealth_11070":{"type":"posts","id":"stateofhealth_11070","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"11070","score":null,"sort":[1362535499000]},"guestAuthors":[],"slug":"checklists-and-more-systems-matter-in-aviation-can-save-lives-in-health-care-too","title":"Checklists and More: Systems Matter in Aviation, Can Save Lives in Health Care, Too","publishDate":1362535499,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_11082\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/05/checklists-and-more-systems-matter-in-aviation-can-save-lives-in-health-care-too/boeing787_brownpau_flickr/\" rel=\"attachment wp-att-11082\">\u003cimg class=\"size-medium wp-image-11082\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Boeing787_brownpau_Flickr-300x225.jpg\" alt=\"High standards for aviation safety led to the grounding of the Boeing 787. A systems approach to patient safety is spreading to health care. (brownpau/Flickr)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">High standards for aviation safety led to the grounding of the Boeing 787. A systems approach to patient safety is spreading to health care. (brownpau/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Hippocrates may have told doctors to \"First, do no harm\" more than 2,000 years ago, but it's taken almost that long for modern medicine to \"begin approaching the problem of medical mistakes as a system and create a concerted movement,\" says Dr. Robert Wachter, Associate Chairman of the Department of Medicine at UC San Francisco.\u003c/p>\n\u003cp>In a \u003ca href=\"http://annals.org/article.aspx?articleid=1657884\" target=\"_blank\">report\u003c/a> published Tuesday intended to move American health care closer to a safer system, Wachter and his colleagues identified the top ten strategies that doctors and nurses should embrace to help protect patients from unintended harm.\u003c/p>\n\u003cp>The goal is to move doctors, hospitals and nurses toward a recognition that even the most dedicated doctors and nurses can make mistakes, so health care needs systems that help catch errors before patients are harmed.\u003c/p>\n\u003cp>Health care providers can read the complete list of strategies \u003ca href=\"http://annals.org/article.aspx?articleid=1657884\" target=\"_blank\">here\u003c/a>, but for the casual reader, they include items such as:\u003c/p>\n\u003cul>\n\u003cli>Hand washing\u003c/li>\n\u003cli>Interventions to reduce bedsores\u003c!--more-->\u003c/li>\n\u003cli>Preoperative checklists and anesthesia checklists to prevent harm during and after operations\u003c/li>\n\u003c/ul>\n\u003cp>If you're thinking hand washing and check lists might sound a little basic, Wachter agrees. \"It doesn’t sound like rocket science and it’s not. But if until 12 years ago, the view of a doctor, including me, was the way we deliver safe care is ‘I am perfect. I never screw up,’ then you never thought that way. You never thought about the importance of a ... checklist because you just say, 'I have to be infallible and if I do blow it, I have to try harder. I have to be careful.'\"\u003c/p>\n\u003caside class=\"pullquote alignright\">\"My Chinese takeout restaurant has been reading back my order to them for the last 25 years. The idea that we just discovered this idea eight or 10 years ago in health care is in some ways laughable.\"\u003c/aside>\n\u003cp>That \"doctor infallibility\" changed a dozen years ago when \"\u003ca href=\"http://www.nap.edu/openbook.php?isbn=0309068371\" target=\"_blank\">To Err is Human\u003c/a>,\" a major report from the Institute of Medicine detailed that medical mistakes were killing between 44,000 and 98,000 Americans every year -- the equivalent of a major plane crash every day.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Think what we would be doing if a large plane crashed every day,\" Wachter said. \"There would be no limit on what we would do to fix that. We would shut down airlines. We woulld change training and regulation.\"\u003c/p>\n\u003cp>Yes, aviation is a less complex field than medicine. For starters, authorities can ground planes, as we've seen lately with the\u003ca href=\"http://www.nytimes.com/2013/01/17/business/faa-orders-grounding-of-us-operated-boeing-787s.html?pagewanted=all\" target=\"_blank\"> Boeing 787 Dreamliner\u003c/a>. Note that those planes were grounded after events that -- while alarming -- did not result in any passenger deaths. In general, hospitals have to stay open through bad weather, strikes, power failures, and the list goes on.\u003c/p>\n\u003cp>Instituting new systems is a process that can take years. Even for something as basic as hand washing, it takes time, effort and systems to help people remember. Wachter estimates that hand washing rates were 10-15 percent just a dozen years ago. Today, at UCSF, he says official audits show rates above 90 percent. He'd love to get to 100 percent, he says, but acknowledges the pressures on a nurse, for example, who might be in and out of patients' rooms all day and can easily forget to wash hands once or twice.\u003c/p>\n\u003cp>Wachter envisions a system that would beep if anyone crosses a line in a patient's room -- but hasn't pressed a button on a hand-wash machine.\u003c/p>\n\u003cp>\"Of course other industries have thought about this forever which is why they had checklists and technologies,\" Wachter says. \"My Chinese takeout restaurant has been reading back my order to them for the last 25 years. The idea that we just discovered this idea eight or 10 years ago in health care is in some ways laughable, but it reflects the fact that we never really thought about the role of systems.\"\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande\" target=\"_blank\">The Checklist\u003c/a> (Atul Gawande, The New Yorker)\u003c/p>\n\n","blocks":[],"excerpt":"Hippocrates may have told doctors to \"First, do no harm\" more than 2,000 years ago, but it's taken almost that long for modern medicine to \"begin approaching the problem of medical mistakes as a system and create a concerted movement,\" says Dr. Robert Wachter, Associate Chairman of the Department of Medicine at UC San Francisco.\r\n\r\nIn a report published Tuesday intended to move American health care closer to a safer system, Wachter and his colleagues identified the top ten strategies that doctors and nurses should embrace to help keep protect patients from unintended harm.","status":"publish","parent":0,"modified":1362635011,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":15,"wordCount":685},"headData":{"title":"Checklists and More: Systems Matter in Aviation, Can Save Lives in Health Care, Too | KQED","description":"Hippocrates may have told doctors to "First, do no harm" more than 2,000 years ago, but it's taken almost that long for modern medicine to "begin approaching the problem of medical mistakes as a system and create a concerted movement," says Dr. Robert Wachter, Associate Chairman of the Department of Medicine at UC San Francisco.\r\n\r\nIn a report published Tuesday intended to move American health care closer to a safer system, Wachter and his colleagues identified the top ten strategies that doctors and nurses should embrace to help keep protect patients from unintended harm.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Checklists and More: Systems Matter in Aviation, Can Save Lives in Health Care, Too","datePublished":"2013-03-06T02:04:59.000Z","dateModified":"2013-03-07T05:43:31.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"11070 http://blogs.kqed.org/stateofhealth/?p=11070","disqusUrl":"https://ww2.kqed.org/stateofhealth/2013/03/05/checklists-and-more-systems-matter-in-aviation-can-save-lives-in-health-care-too/","disqusTitle":"Checklists and More: Systems Matter in Aviation, Can Save Lives in Health Care, Too","path":"/stateofhealth/11070/checklists-and-more-systems-matter-in-aviation-can-save-lives-in-health-care-too","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_11082\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/05/checklists-and-more-systems-matter-in-aviation-can-save-lives-in-health-care-too/boeing787_brownpau_flickr/\" rel=\"attachment wp-att-11082\">\u003cimg class=\"size-medium wp-image-11082\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Boeing787_brownpau_Flickr-300x225.jpg\" alt=\"High standards for aviation safety led to the grounding of the Boeing 787. A systems approach to patient safety is spreading to health care. (brownpau/Flickr)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">High standards for aviation safety led to the grounding of the Boeing 787. A systems approach to patient safety is spreading to health care. (brownpau/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Hippocrates may have told doctors to \"First, do no harm\" more than 2,000 years ago, but it's taken almost that long for modern medicine to \"begin approaching the problem of medical mistakes as a system and create a concerted movement,\" says Dr. Robert Wachter, Associate Chairman of the Department of Medicine at UC San Francisco.\u003c/p>\n\u003cp>In a \u003ca href=\"http://annals.org/article.aspx?articleid=1657884\" target=\"_blank\">report\u003c/a> published Tuesday intended to move American health care closer to a safer system, Wachter and his colleagues identified the top ten strategies that doctors and nurses should embrace to help protect patients from unintended harm.\u003c/p>\n\u003cp>The goal is to move doctors, hospitals and nurses toward a recognition that even the most dedicated doctors and nurses can make mistakes, so health care needs systems that help catch errors before patients are harmed.\u003c/p>\n\u003cp>Health care providers can read the complete list of strategies \u003ca href=\"http://annals.org/article.aspx?articleid=1657884\" target=\"_blank\">here\u003c/a>, but for the casual reader, they include items such as:\u003c/p>\n\u003cul>\n\u003cli>Hand washing\u003c/li>\n\u003cli>Interventions to reduce bedsores\u003c!--more-->\u003c/li>\n\u003cli>Preoperative checklists and anesthesia checklists to prevent harm during and after operations\u003c/li>\n\u003c/ul>\n\u003cp>If you're thinking hand washing and check lists might sound a little basic, Wachter agrees. \"It doesn’t sound like rocket science and it’s not. But if until 12 years ago, the view of a doctor, including me, was the way we deliver safe care is ‘I am perfect. I never screw up,’ then you never thought that way. You never thought about the importance of a ... checklist because you just say, 'I have to be infallible and if I do blow it, I have to try harder. I have to be careful.'\"\u003c/p>\n\u003caside class=\"pullquote alignright\">\"My Chinese takeout restaurant has been reading back my order to them for the last 25 years. The idea that we just discovered this idea eight or 10 years ago in health care is in some ways laughable.\"\u003c/aside>\n\u003cp>That \"doctor infallibility\" changed a dozen years ago when \"\u003ca href=\"http://www.nap.edu/openbook.php?isbn=0309068371\" target=\"_blank\">To Err is Human\u003c/a>,\" a major report from the Institute of Medicine detailed that medical mistakes were killing between 44,000 and 98,000 Americans every year -- the equivalent of a major plane crash every day.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Think what we would be doing if a large plane crashed every day,\" Wachter said. \"There would be no limit on what we would do to fix that. We would shut down airlines. We woulld change training and regulation.\"\u003c/p>\n\u003cp>Yes, aviation is a less complex field than medicine. For starters, authorities can ground planes, as we've seen lately with the\u003ca href=\"http://www.nytimes.com/2013/01/17/business/faa-orders-grounding-of-us-operated-boeing-787s.html?pagewanted=all\" target=\"_blank\"> Boeing 787 Dreamliner\u003c/a>. Note that those planes were grounded after events that -- while alarming -- did not result in any passenger deaths. In general, hospitals have to stay open through bad weather, strikes, power failures, and the list goes on.\u003c/p>\n\u003cp>Instituting new systems is a process that can take years. Even for something as basic as hand washing, it takes time, effort and systems to help people remember. Wachter estimates that hand washing rates were 10-15 percent just a dozen years ago. Today, at UCSF, he says official audits show rates above 90 percent. He'd love to get to 100 percent, he says, but acknowledges the pressures on a nurse, for example, who might be in and out of patients' rooms all day and can easily forget to wash hands once or twice.\u003c/p>\n\u003cp>Wachter envisions a system that would beep if anyone crosses a line in a patient's room -- but hasn't pressed a button on a hand-wash machine.\u003c/p>\n\u003cp>\"Of course other industries have thought about this forever which is why they had checklists and technologies,\" Wachter says. \"My Chinese takeout restaurant has been reading back my order to them for the last 25 years. The idea that we just discovered this idea eight or 10 years ago in health care is in some ways laughable, but it reflects the fact that we never really thought about the role of systems.\"\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande\" target=\"_blank\">The Checklist\u003c/a> (Atul Gawande, The New Yorker)\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/11070/checklists-and-more-systems-matter-in-aviation-can-save-lives-in-health-care-too","authors":["240"],"categories":["stateofhealth_14"],"tags":["stateofhealth_456"],"featImg":"stateofhealth_11082","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. 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But is this once sleepy suburb ready for them?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/American-Suburb-Podcast-Tile-703x703-1.jpg","officialWebsiteLink":"/news/series/american-suburb-podcast","meta":{"site":"news","source":"kqed","order":"13"},"link":"/news/series/american-suburb-podcast/","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=1287748328","tuneIn":"https://tunein.com/radio/American-Suburb-p1086805/","rss":"https://ww2.kqed.org/news/series/american-suburb-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkMzMDExODgxNjA5"}},"baycurious":{"id":"baycurious","title":"Bay Curious","tagline":"Exploring the Bay Area, one question at a time","info":"KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg","imageAlt":"\"KQED Bay Curious","officialWebsiteLink":"/news/series/baycurious","meta":{"site":"news","source":"kqed","order":"4"},"link":"/podcasts/baycurious","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/bay-curious/id1172473406","npr":"https://www.npr.org/podcasts/500557090/bay-curious","rss":"https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvbmV3cy9jYXRlZ29yeS9iYXktY3VyaW91cy1wb2RjYXN0L2ZlZWQvcG9kY2FzdA","stitcher":"https://www.stitcher.com/podcast/kqed/bay-curious","spotify":"https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"}},"bbc-world-service":{"id":"bbc-world-service","title":"BBC World Service","info":"The day's top stories from BBC News compiled twice daily in the week, once at weekends.","airtime":"MON-FRI 9pm-10pm, TUE-FRI 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.bbc.co.uk/sounds/play/live:bbc_world_service","meta":{"site":"news","source":"BBC World Service"},"link":"/radio/program/bbc-world-service","subscribe":{"apple":"https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2","tuneIn":"https://tunein.com/radio/BBC-World-Service-p455581/","rss":"https://podcasts.files.bbci.co.uk/p02nq0gn.rss"}},"code-switch-life-kit":{"id":"code-switch-life-kit","title":"Code Switch / Life Kit","info":"\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. 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