Sunday, May 20, 2018

Are we commodities or individuals?

"There's a right way and a wrong way to fail," wrote B Ritholtz, comparing the airline and healthcare industries. "High stakes make aviation an excellent subject for the study of failure. In other fields, errors may be subtle, and the results not recognized for years. When there is a flying failure, planes fall out of the sky, and footage of the wreckage is on the news." "In 1912, the US army had 14 pilots, and even before the war, more than half (eight) would die in crashes." But, "...in 2013, there were 36.4 million commercial flights worldwide carrying three billion passengers. That year, there were only 210 commercial aviation fatalities." "Last year (2017), zero commercial airline passengers died." Compared to that, "preventable medical errors" "might result in as many as half-million deaths in the US at a cost estimated at $17 billion a year". Why? "First, there is little publicly available data and no sort of standardized review process when errors occur." "There is an attitude among some that doctors are infallible saviours." Comparing airlines with healthcare is like comparing travelling in a bus with a Formula 1 racing car. Airlines are standardized because human beings a treated as commodities. Airlines have reduced leg room for passengers in economy class to just 29 inches to pack in more people like cattle. The airline decides what fees to levy. Ryanair has a long list of fees, including for extra legroom and for checked in bags. Flights are deliberately overbooked because empty seats are a waste of money and a bonafide passenger, who has paid for his ticket, maybe removed by force at the will of airline staff. If any hospital treated any patient as airlines treat passengers it will not only be sued but the people involved will be imprisoned. Even a violent patient is treated with great care. In contrast airlines staff are treated with extreme care, with huge salaries and long periods of rest mandated by the regulator. Every person on an aircraft is treated exactly the same but every patient is completely different. Thus symptoms of heart attack may vary from a crushing pain in the front of the chest, to pain between shoulder blades, to a feeling of suffocation. While passengers in an aircraft cannot tell the captain what to do, a doctor has to get 'informed consent' from a patient for an operation, or even to examine certain parts of the body. While most flights are uneventful and pilots are very rarely asked to make urgent decisions such emergencies are common in patient care. Why do people trust doctors? Because when anyone is seriously ill she thinks, " Why me". She needs reassurance and a discussion of what best course to take. Healthy people accept being treated as things but a sick person is an individual. Cannot be compared.   

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