Safe Care continued

Safe Care continued

I believe that safe care is a continuum. If this is the case, then it follows that debating safe care without reference to resources is pointless. It seems logical that the greater the resources, the "safer" care can be. If the patient is not paying for his or her healthcare directly, then there are issues about resource allocation. I will use the example of thrombolysis (clot-busting) for myocardial infarction (heart attack) to make two points about safe care.

1) Safe care is predicated on a medico-legal standard of reasonable precautions which is based on imperfect knowledge and often risk aversion. 

When thrombolysis was first used, it was considered correct to obtain a chest X-Ray prior to administration to rule out an uncommon alternative diagnosis aortic dissection, which would be worsened by thrombolysis. Probably any physician omitting this step would have been successfully sued if this complication had arisen. The current guidance is to omit chest X-Ray, because a) it doesn't actually rule out aortic dissection and b) the benefits of swift thrombolysis outweigh the risks of harm

2) Safe care depends on who the bill-payer is.

A study some years ago showed that when a patient was having a myocardial infarction, if they were Medicare patients they wanted the latest thrombolytic drug which reduced the chances of suffering a stroke. If they were paying for their own treatment, they were far more likely to opt for the older treatment which was much cheaper, but had a small chance of causing a stroke.