Sunday, October 20, 2013

A healthy solution for the concerned patient

For those living in the lower South West corner of British Columbia surrounding Vancouver (aka the lower mainland), there was a very interesting article in the Vancouver Sun newspaper about CMPT, and POLQM, and our conference written by the health reporter  Pamela Fayerman.  The URL to her blog is:

Following the newspaper publishing the story which included a reference to MMLQR, I received the following comment: “I have been dealing with a particular lab for years now, I had paternity testing done there in 1994. It was HLA testing, there is no chain of custody of any sample. The lab has for years refused to release the work supporting their report. I wish to have it independently examined by my OWN genetics person. If you are currently reviewing lab error and have found all the problems mentioned in your news article on Saturday, imagine what is being hidden by labs like this particular lab who are refusing to release the file for independent review. This is no longer error, it is fraud that is being hidden to protect themselves. What lab error rate does in fact actually exist on DNA labs and or hospital labs conducting DNA testing. Does this review include this test? Please advise me of this. This sort of review would be most helpful. on”

I thought long and hard about whether I should allow the comment to be published, and ultimately decided that I would, first removing the name of the laboratory, in part because that would match the anonymity of the writer.  My reason for publishing was because it points out many of the principles of Quality that I support.

First off, this comment represents the voice of an interested party, whose feels that their concern and complaint has gone unresolved for now near 20 years.  Without taking sides, I can only state the obvious; 20 years is a long time, and whatever steps have or have not been taken are not producing a desirable outcome.  Conflict is not being resolved.  

Second, this invested person, as part of the general public, is asking some pretty basic questions, concerning laboratory error rates DNA labs and or hospital labs conducting DNA testing.  Whatever the circumstance that has led to the question, it is a question worth asking.  

In British Columbia we have a healthcare Quality Council that has taken a major and bold step forward by creating the software to allow people to report healthcare errors.  The program is voluntary and to the best of my knowledge the results are not publically available; but they are available and distributed to certain people and groups in authority.  

In time, sooner or later, I suspect that process is going to change.  At some point I can believe that reporting error rates will become mandated.  Patients will demand it, the public will demand it, and I suspect politicians will be put in a position of having to address the demand.  

From my perspective, the argument for regular reporting is too compelling to be ignored.  Ours is a public system, funded with public resources to address public interest.  We have a system that tolerates the reporting of physician incomes from the public purse; the argument for reporting error makes far more sense than reporting salaries.  

We do have intermittent situations where public notice of error occurs, such as when we locally had problems with X-ray reports, or when we had errors in reading breast biopsies in Newfoundland.  That is far too late, and gives off a poor message.  It points out the BIG problems without context.

Dealing with unhappy consumers likely occurs regularly, and I suspect more are resolved without going through court.  But we don’t know that.  Reporting error rates on a regular and open process would likely show that errors occur somewhere in the vicinity of 1-10 per 1000 people, probably closer to 1-2 as opposed to 8-9, generating a Six-sigma metric greater than 4.  Where it is lower we would have the active opportunity for improvement.

That would be a lot better than what we have now.

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