Evidence-based care takes a back seat II
By Shelley Burns
(This is the second installment of a three-part blog)
As I said in my earlier blog, all the stakeholders in an unnecessary C-section play an equal parts in the overutilization of the procedure. I am disappointed with everyone in this scenario. Our business culture worships productivity and wants babies delivered on a schedule, so that mom and dad can get back to work pronto. Our reimbursement incentives obviously don’t place a higher value on vaginal delivery, although it’s safer. Our litigious society looks for malpractice in every bad outcome, forcing clinicians to act directly in the process, rather than let nature take its course.
It goes on. Hospitals allow C-sections and inductions that are clearly NOT evidence-based best practice. Nurse educators aren’t preparing mothers appropriately for a normal vaginal delivery. Physicians are not protesting against this, and schedule C-sections and inductions that are not in the best healthcare interest for the mother and child. Finally, the mothers are not fighting for the best possible care and not taking the time to understand the statistics behind their decision.
There are lots of “nots” in there. Everyone involved is simply not doing the best job they could, due to the larger background forces. We’ve overcome these types of hurdles before. Once we all got on the same page about smoking, within a generation’s time, we redefined it from being a normal, almost required activity to an anti-social scourge. The concerted, synchronized voices of the public, the AMA, the legal system, the surgeon general, the AHA and countless others turned the tide on smoking in this country, to the benefit of everyone’s health. Can’t we do the same for mothers and children? Can we decide to do something about overutilization in healthcare?
Shelley Burns is director of knowledge management at HMC.
