Difficulties with the quality of medical care indicate that we are not getting our money’s worth when it comes to health care spending. When the World Health Organization compared key indicators of our health with the rest of the world, the United States did not rank number one or two, it ranked 37th, just above Slovenia. Clearly, a ranking of 37 leaves plenty of room for improvement.

Another study, published by the Commonwealth Fund in 2006, rated the health of U.S. citizens last among the six most industrialized nations in the world.

Medical outcomes data do not provide any reasons for comfort, either. A 2003 study published in the Journal of the American Medical Association revealed a diagnostic error rate of close to 20 percent based upon nationwide autopsy results. This means a major error occurs in one out of every five cases.

The rate of Class One errors – errors that affect patient outcome – was approximately 33 percent. That translates into significant suffering and harm in one out of three cases.

Perhaps most disturbing was a study, published in the Journal of the American Medical Association in 2006, that identified medical errors as between the third and 10th leading cause of death in the United States.

The work of the Best Doctors Occupational Health Institute and its parent organization confirms many of these findings. An analysis of the results of in-depth case reviews yielded the following findings in referred cases:

• Insufficient medical workups in 31 percent of cases

• Inappropriate surgical interventions in 38 percent

• Pathology and diagnostic test misinterpretations in 12 percent

• Treatment errors, ranging from minor to severe, in 61 percent

Through an in-depth financial analysis of each case, the institute has independently substantiated the costs of all of these errors: $16 million of wasted medical expenses for every 1,000 cases.

On a national level, this translates into massive unnecessary human suffering and billions of wasted medical care dollars.

There are a host of reasons why we are spending so much for so little – more than can be covered in a short article. Despite all the data that are regularly collected on the medical profession, however, one area that has received little attention is the clinical accuracy of a doctor’s diagnosis and treatment plan. In other words, did the doctor get it right?

Those who work in the trenches of medicine every day are well aware of the human suffering and waste caused by error rates. Fortunately, there is a growing set of tools to grapple with these challenging issues. These innovative approaches are likely to be an important part of the prescription to cure our present medical system ailments.

Asking the right questions

When given a concerning diagnosis, few people have the background to know if the information they are given is accurate. How can one make sure that the care one receives is based upon the correct diagnosis and the most up-to-date understanding of therapeutics? How can one make sure that one is about to receive the correct surgery at the correct time?

Fortunately, more resources are becoming available to help patients get the right care. For instance, if a person is facing the possibility of surgery, the Agency for Healthcare Research and Quality (www.ahrq.gov), a federal program within the Department of Health and Human Services, provides advice and questions to ask the surgeon.

The AHRQ recommends asking the following:

• What operation are you recommending?

• Why do I need the operation?

• Are there alternatives to surgery?

• What are the benefits of having the operation?

• What are the risks of having the operation?

• What if I don’t have this operation?

• Where can I get a second opinion?

• What is your training and experience to do this kind of surgery?

• Where will the operation be done?

• Will I have to stay overnight in the hospital?

• What kind of anesthesia will I need?

• How long will it take me to recover?

• How much will the operation cost?

• Can you please mark the part of my body where you will operate?

These are great questions that can help patients get the most out of a visit with their doctor. It is also quite useful to bring a spouse, relative or friend along for the visit, so there is another person in the room listening to the doctor’s responses. Writing the answers down and asking for written materials are also important practices for patients to follow.

If one is diagnosed with a concerning medical condition, or is frustrated because there hasn’t been a diagnosis, one should not be afraid to ask for a second opinion.

The AHRQ suggests taking the following steps before visiting a second doctor:

• Ask your doctor to send your medical records to the doctor giving the second opinion, which may help you avoid repeating tests you’ve already had.

• Call the second doctor’s office and make sure they have your records.

• Write down a list of questions to take with you to the appointment.

• Ask a friend or loved one to go to the appointment with you.

During the visit with the second doctor, the following is recommended:

• Tell the doctor what surgery you are considering.

• Tell the doctor what tests you’ve already had.

• Ask the questions you have on your list and encourage your friend or loved one to ask any questions that he or she may have.

The provider of the second opinion is of obvious importance. There are useful tools on the Web that can inform patients regarding the qualities and backgrounds of physicians and institutions.

One source is the Massachusetts Board of Registration in Medicine (http://profiles.massmedboard.org/MA-Physician-Profile-Find-Doctor.asp). Web MD offers information about hospital outcomes and experiences, through Blue Cross Blue Shield, at http://bcbsma.sqctool.com.

New approaches

One of the most intriguing developments to improve quality of care has been the introduction of a new kind of medical organization that provides expert medical opinions for a variety of conditions. These organizations call upon national experts to review your medical records, diagnostic tests and pathology results in order to provide an unbiased opinion on both diagnosis and treatment.

These services are provided outside the scope of traditional health insurance. Issues of local geography, usual referral patterns, and profits are removed from the equation. These resources can be both life- and cost-savers.

It took years for group health insurers to introduce disease management and health promotion efforts as an effective means to improve quality of care and reduce costs. When these efforts are done well, care can be improved and dollars are spent much more prudently.

By Michael J. Shor and Dr. Lewis Levy

Michael J. Shor, MPH, is the managing director of the Best Doctors Occupational Health Institute. Lewis Levy, M.D., is the medical director of the U.S. Group Health Division of Best Doctors, a practicing internist, and an instructor at Harvard Medical School.