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Medical Professor Without Borders

Dr. Ross Donaldson: When you look at errors in medicine, this is a huge issue that we've begun to address, but really it's like having airplanes crash daily. People are not addressing it. This is something that we really need to look into.


Question: Does the U.S. need a greater focus on health outcomes?


Dr. Ross Donaldson: I certainly agree that outcomes are very low part of the focus of the American system, as it were. I think that's one of the main things that we need to do, moving forward, to improve things.

I spend half my time here in the States and half my time abroad, currently in Iraq, and when I'm here in the States, what I'm working on is quality assurance and trying to improve those outcomes in our hospitals. There's been a movement towards that lately with pay-to-performance and other things that have an outcome basis.

When you look at the health care system, especially from a European perspective, whenever they talk about the American system it's almost a joke to them. They put it in quotes--"as a system"--because, in fact, it's really not so much a system here as it is a conglomeration of interest. And those interests aren't really aligned to focus on outcomes as much as on other things.

A physician gets paid based on how many things they do, how many tests did you order, how many patients did you see. Actually, it really has no connection whatsoever with how did the patients do.


Question: What new technologies are improving outcomes?


Dr. Ross Donaldson: The electronic medical record really has the potential to be very beneficial for error reduction on several levels. One is that having the information from a patient from other hospitals, or even from your own hospital right there and readily available can really reduce the amount of errors you're making. You don't have to ask the patient again if they have an allergy because it's already there.

And the newer computer technology systems can actually prevent you from making an error. For example, if the patient has an allergy to a certain medication, and you prescribe a related medication, the computer might pop up a screen and say, "Hey are you sure you really want to do that?" You always have to have the physician able to work around that, because sometimes you do actually want to do that, but it's somebody asking you the question that can really reduce the errors in the system.


Question: How important is integrated medicine?


Dr. Ross Donaldson: I think the medical record potentially is going to help a lot with integrative care. But what's happened is that because we've a very low focus on primary health care, we've put a high focus on specialization, and what happens is that a patient comes in and they go to this specialist and that specialist, and if you don't have a person coordinating everything, you really can get in a lot of potential problems as a patient.

I think it's like having 12 chefs cooking something. Each one has his own thing that they're trying to do. What you really need to do, even if you have a bunch of people make parts of your meal, make one person being in charge in taking the overall care for the patient in mind. In our current health care system, we have dropped that ball, the primary health care push. I think the specializations are important, as is access to emergency care, but you really need somebody after you're done with the emergency or to coordinate with other things to look after the patient going forward.


Question: What have you learned about preventative care?


Dr. Ross Donaldson: I think preventive health care is a big and important push, especially for the American health care system. When we look at our rates of different indices compared to other countries, our vaccination rates and other things, a lot of those are reduced from what you would think they would be for a country with so much money. It's really that kind of preventative care that can save money at a later date. We tend to focus in America on the high technology afterward. We'll come up with some great drug to treat measles after you've had it. We have cheap vaccines to treat all these disease. It's on the public health level that we're really lacking here in the States.


Question: Are mobile devices enabling safer global expeditions?


Dr. Ross Donaldson: On this trip up to Mt. Licancabur I had a pulse ox [pulse oximeter], which is a little machine that tests how much oxygen you have in the body, how much of the oxygen has bonded to hemoglobin. In the old days we didn't have them. I'm old enough to remember not having them in emergency departments. In the States they are a larger machine. Now, the new technology has a little thing that you can just snap on to your finger.

It was quite interesting because you get up to the top of this mountain, and the amount or percentage of hemoglobin that's bonded to oxygen for us is normally 98% or 99%. And when you get to the top of this mountain, I think my own pulse ox was something like 66%.

If I had that same level down here in the States, everybody would have been running around like it was quite a severe emergency. And yet for all these people up there, it was fairly normal. Being able to see that in real time, while you're on the top of a mountain in this, very desolate area, it was very beneficial as a physician to have that point-of-care testing.


Question: How are these discoveries improving health care in the developing world?


Dr. Ross Donaldson: There's a lot of new technologies that are taking very new technology approach to low-income countries. There's a bunch of work using mobile phone technology to do tests that are very expensive or difficult to do in the third world, that are taking them and automating those processes. With the very cheap technology, like a cell phone and the cell phone networks and a lot of the third world, low-income countries work quite well, and then taking the test, essentially from the patient, but doing the analysis in the cloud, as it were, and being able to provide very low cost solutions in a high technology way to low-income countries.


Recorded on: June 1, 2009.


Dr. Ross Donaldson is a physician, teacher, and author who has worked in hospitals from Los Angeles to Iraq. In this video, he shares his most important medical insights from around the world.

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