Doctors know this. Medical researchers also know this. Medical studies have revealed the consistent deficiency of up-to-date care. Studies show that, in general, patients receive up-to-date and best treatment about 55 percent of the time, whether they’re getting treatment for an acute illness, a chronic illness or preventive medicine.* Another study shows that it takes about 17 years for researched, improved treatment to get into general medical practice.† (So sad!)
Now, that’s just the way it is, and we have to deal with it, and much of the time we may do just fine with that care. But, if my loved one had a heart attack, I’d want to make sure that they got 100 percent of the right care! Studies show huge disadvantages in lifespan between patients who get all of the best recommended heart attack treatments, and those who don’t get all those best treatments.
In 2003, for heart attack patients, there were six “recommended services” that hospitals (actually the doctors prescribing the care to patients in the hospital) were supposed to give to patients in order for the patients to get the best outcomes. “Overall, hospitals provided 82 percent of the recommended care, an increase of five percentage points from 2000-2001.”‡
Now, when that’s the statistic for my loved one receiving best care that will save his or her life after a heart attack, I don’t really want to take the chance that he or she might be in that 18 percent of patients who do not receive the best care. So what do you do?
You no longer have to sit and hope. Now, on the Internet, the Quality Improvement Organization Support Center has provided you with an “Acute Myocardial Infarction (AMI) Pocket Card.” (“AMI” or “MI” is what doctors call a sudden heart attack.) This pocket card is actually there as an improvement tool for doctors to use, so that they can treat their patients according to the most up-to-date guidelines. But since it’s there, you can use it to make sure your doctor treats your loved one to perfection.
Refer to the two page list found at Acute Myocardial Infarction (AMI)/Heart Failure (HF) Contraindications Pocket Card. At the present time, there are five recommended services that should be given to all heart attack patients unless contraindicated. (In this particular case, these services all happen to be drugs to be given to the patient.)
On the left-hand side of the pages, note that two of the drugs are to be given on arrival to the hospital (that means “as soon as a heart attack has been diagnosed”); on the right-hand side there are the contraindications (the only reasons why the patient should not take this drug if he or she is having or just had a heart attack). Take this statistics to your loved one’s doctor, and go over the two drugs that your loved one should be taking as soon as he or she has been diagnosed with a heart attack. For example:
“I want my husband to receive the latest and best treatment for his heart attack, and the American Heart Association and the American College of Cardiology say that this list is the minimum for good care."
Is my husband on this drug (point to first one)—ok.
Is he on this (point to second—no? Is there a contraindication (point to right-hand column)—no? Then you will start that right away, right?” (Then check later, to make sure he’s getting it.)
Then on discharge from the hospital, make sure that your loved one is taking those three drugs recommended on discharge.
Give your doctor a copy of the recommendations, and ask him or her to make it part of your loved one’s chart.
Some doctors will already know their business (approximately about 82 percent right now); and almost all doctors will pretend to (don’t get excited, that was just for a little chuckle); and you might get big sighs, and mutters, and glares, and “just leave things to me” and “who went to medical school here”—but when it’s your loved one’s life, well, you’ll have to decide if you want to do it.
All I know for sure—and this is for sure—is that any good doctor will not mind in the least. So keep that in mind.
Note: These five recommended treatments (drugs in this case) are sometimes referred to as “Quality Indicators” (for treatment of a heart attack or “MI”). When an organization is rating a hospital or doctor on whether they are giving good care (for a heart attack, in this case), they check the patient’s diagnosis, and then the chart to see if these important treatments were given—which shows quality of care.
*McGlynn, Elizabeth A., Steven M. Asch, and John Adams et al. “The Quality of Healthcare Delivered to Adults in the United States.” New England Journal of Medicine 348(26) (2003): 2635-2645.
†Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National Academy Press, 2001, pp. 1, 13-14, 236, 237.
‡http://www.commonwealthfund.org/Content/Performance-Snapshots/Hospital-Treatment/Heart-Attack-Treatment-in-the-Hospital.aspx, accessed September 13, 2010.
