Dr. Peter J. Weiss

I’ve just been lis­ten­ing to National Pub­lic Radio (NPR) while run­ning errands on a drive across town.

The show was about the con­tro­versy sur­round­ing gov­ern­ment fund­ing for NPR itself, and one of on-air per­son­al­i­ties sug­gested that the com­mon view that NPR has a lib­eral bias is just plain wrong.  Really?  I doubt it.

Truth is, he just can’t see it.  We all have biases on most com­mon issues.  I don’t believe there is any such thing as a “totally unbi­ased” news report on a con­tro­ver­sial sub­ject.

As I was get­ting ener­gized about respond­ing to NPR via email, it occurred to me that it was prob­a­bly point­less, and my mind went to the biases I often detect in cov­er­age of health­care issues.  So I thought I’d chan­nel my energy into this blog and stay within my area of exper­tise.

Let me start with the story of a fic­tional patient, “Steve.”

Steve passed away yes­ter­day at the age of 55.  He had been a pack-a-day cig­a­rette smoker since high school and never “got around” to quit­ting.

Last month Steve started cough­ing up blood, and a chest X-ray showed a mass in his right lung.  After appro­pri­ate test­ing, he was diag­nosed with early stage lung can­cer and sched­uled for surgery.

The oper­a­tion went well but post­op­er­a­tively he had com­pli­ca­tions includ­ing blood clots, pneu­mo­nia and an intra­venous catheter-related infec­tion in his blood­stream. Despite aggres­sive treat­ment in the Inten­sive Care Unit for these con­di­tions he became pro­gres­sively ill and died on the fifth post­op­er­a­tive day.

Upon review of his chart, sev­eral avoid­able but com­mon lapses in the usual treat­ment pro­to­cols were iden­ti­fied.

Although these mis­takes may have made it more likely for Steve to have the post­op­er­a­tive com­pli­ca­tions, no one can say for cer­tain if they did or did not cause the prob­lems that directly resulted in his death.

The ques­tion for you is, what killed Steve?

Think about it for a minute or two before read­ing beyond this para­graph.  Do you think it’s obvi­ous?  Per­haps that’s your bias show­ing up.  I’m an expert in health and health­care, and it’s not obvi­ous to me.

Some would say that the “med­ical mis­takes” or med­ical errors killed Steve.  After all don’t we hear about med­ical mis­takes killing hun­dreds of thou­sands of Amer­i­cans every year?  Espe­cially from the lawyers?

Cer­tainly that would be the argu­ment of the mal­prac­tice attor­ney retained by Steve’s wife, but this is just one view.

Another view is that Steve would never have needed the surgery if he had not been a life­long cig­a­rette smoker.  This is cer­tainly true.  If he hadn’t smoked, or if he had quit much ear­lier, he would not have died yes­ter­day.

So did cig­a­rettes kill Steve?  Maybe.

That depends on how you look at it.  And if you agree that it was the cig­a­rettes more than the med­ical errors, then you face another ques­tion.  Who was respon­si­ble for Steve’s tobacco abuse?

Was it purely due to “Steve’s choices,” or was it a result of the influ­ence of tobacco com­pa­nies that work to cre­ate the admit­tedly addic­tive habit of smok­ing?  Hard ques­tions all.

So, you see it’s not so easy now to know what killed Steve.  Many will argue that it was the poor state of the health­care sys­tem.  Oth­ers will say it was the evil tobacco com­pa­nies.  Some will say it was Steve’s choices.

A lot depends on your own biases, and biases may cause us to over­sim­plify com­plex issues.  And let’s be hon­est — our biases also tend to build us up, to pro­tect us from respon­si­bil­ity.  We don’t want to think that we’re the prob­lem.

I’m not ask­ing you to get rid of you biases.  I’m ask­ing you to rec­og­nize them.

Next time, you hear about “med­ical mis­takes killing hun­dreds of thou­sands of peo­ple each year,” I want you to remem­ber that health­care isn’t per­fect and that most of that care involv­ing mis­takes was prob­a­bly only nec­es­sary because of lifestyle choices by the patients.

How about you?  Could you be liv­ing an unhealthy lifestyle and have a bias towards blam­ing oth­ers for your ill­ness?  Believe me it hap­pens.

If it didn’t we wouldn’t be talk­ing so much about health­care.  We’d be talk­ing about more health and less care.

Be well.