Actually, Baucus is trying now. So far, three yards and a cloud of dust; he's being hit by his teammates as well as the other guys.

I am told swallowing the herring can taste better when you add sour cream and onions!

Not at all. What you could truthfully say, though, is that it is not about a problem solely concerning medicine.

I could have said “risk-taking” instead, and would still not have committed any blunder.

Yes, just like financial “innovation” is being threatened. This is a complete canard, in the vast majority of cases things should be done to best known practices and standards (as long as there is leeway for the practitioner to deviate on a case by case basis if they have a compelling reason) and deviations from that standard have proper channels already established. For health care if you want to have experimental techniques then you make an IRB proposal and go from there.

What was no real answer, of course, but I responded, anyway. What I had to say is about an obvious threat or dark side to standardization, that isn't as great as the benefits from the checklists — did I say anything wrong about having checklists themselves on aircraft or in medicine? [sigh] — but which is a threat. It's a crippler for truly experimental medicine (that it is at the same time that pharma firms and the doctors have pushed meds for off-label purposes does not change that fact), and for innovation in general. It's no different than any government trying something new and better with the roads but that is not in the Manual on Uniform Traffic Control Devices. Even something not in a checklist but in an algorithm is “prevailing practice” fodder for use against any deviation from it.

Example — I'm personally familiar with it but hell, it's obvious and should be well-known by now:

(See especially “Guidelines and Commentaries”)

http://www.kidney.org/Professionals/kdoqi/

* * *

Roro, if you're ever able, get your hands on the following book. Melvin Konner is a liberal academic and a medical doctor, who was greatly opposed to “corporate HillaryCare” at the time it was tried. (You may remember him for his capitalism-bashing “Medicine at the Crossroads” TV show in addition to a book by that name.)

http://www.amazon.com/Dear-America-Concerned-Do…

He has his own Web site and blog now, by the way.

http://www.melvinkonner.com/

This is where tort reform comes into play, as well as going out of courts completely with medical fault-finding and disciplinary practices. (This in fact is fully compatible with “single-payer” federal health care, even if not with the trial lawyer lobby and related activists; tort reform was acknowledged by a proponent of “single-payer” who was bitterly critical of the Clinton plan years ago, who said the model for non-judicial medical discipline is a desireable alternative.)

“the only fair way toward tort reform is to decrease the need for litigation by *decreasing the mistakes made*. How can you just throw out the term “tort reform” without that component? “

We all know what true tort reform is (along with the medical disciplinary model). That there may be standardization of care in addition to what we have now is a

separate issue

having nothing truly to do with tort reform itself. (It is associated instead with standardization and quality control.)

As to checklists (which I've benefited from, medically, already) and the idea of “prevailing generally accepted or preferred standard of care,” it's obvious additional lawsuit fodder (as is the general case of federalization of health care that keeps providers nominally private, so they have no sovereign immunity — which I've elaborated on to note already that we could see ratcheting-upward minima for liability insurance by providers, and even taxpayer-boosted insurance, to keep the lawsuits going).

And they DON”T! I have stood right there watching doctors go from patient to patient in the ICU without washing hands between touching patients. And then there is this huge mystery as to MRSA infections in hospitals.

To treat someone for a MRSA takes about three weeks in the hospital with 24/7 IV's of strong antibiotics. This “only” adds 10's of thousands to the bill and some people die from it.

If I were to pull a stunt like that and someone died, I would EXPECT to get sued. Why is a doctor any different?

That's aside from the need for tort reform and a new, separate (non-civil or criminal court-based) system for medical fault finding and “corrections” that should be mainly within the medical profession.

Just don't be naive about standardization. Innovation and divergence from any de facto standard is legally dangerous.

You can choose to be “challenged” about the obvious, but some of us prefer to be thoughtful. There is a dark as well as a bright side to improvements (that can become de facto standards) in this world.