June 17, 2025 • 28 mins
Why Are We Paying More for Worse Health? | ShiftShapers
In this episode of ShiftShapers, host David A. Saltzman welcomes Helene M. Epstein—writer, speaker, and patient advocate behind the Substack series Patient No More. Helene dives deep into America’s epidemic of medical errors, misdiagnoses, and system failures. She breaks down why even the most advanced technology and training haven’t improved patient safety, how profit-driven healthcare puts patients at risk, and—most importantly—what individuals can do to protect themselves and their families.
From shocking statistics about misdiagnosis to the hidden realities of rural hospital closures, Helene provides practical advice and hope for patients who are ready to become their own advocates.
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🔑 Key Takeaways from This Episode
📌 Medical Harm Is Underreported and Overlooked
One in four hospital patients is harmed—and most of those incidents aren’t even recorded. Medical error remains a massive, hidden problem.
📌 Diagnostic Error Is Common—and Dangerous
5–25% of U.S. adults are misdiagnosed each year. The most common errors? Testing failures, insurance barriers, and lack of communication between patients and providers.
📌 The System Is Built for Billing, Not Healing
EMRs, insurance company rules, and corporate healthcare ownership have prioritized profits and paperwork over patients—leaving safety and transparency behind.
📌 Rural and Marginalized Patients Are at Greater Risk
Access to care is shrinking as hospitals close pediatric and maternal units, especially in rural and underserved communities.
📌 Patient Advocacy Is Rising
Helene shares why empowered patients—armed with information, organized records, and second opinions—are the best defense against medical error.
📌 Practical Steps: Protect Yourself
Keep copies of your records, use health portals, seek second opinions, and research providers before major procedures. Being “patient no more” means taking an active role in your own care.
More from Helene M. Epstein
Patient No More is a free Substack by patient advocate Helene M. Epstein, offering practical advice to help you avoid misdiagnosis and medical error. Read her ongoing guide to surviving American healthcare at https://helenemepstein.substack.com/
⏱️ In This Episode
- 00:00 – Why Does U.S. Healthcare Cost So Much and Deliver So Little?\
- 01:00 – What Counts as Medical Error and Harm?
- 03:00 – The Impact on America’s Workforce
- 04:30 – Corporatization and the Decline of Access
- 07:45 – The Prevalence of Diagnostic Errors
- 10:00 – The Role of Insurance in Delaying Proper Treatment
- 12:00 – Medication Errors, Pharmacy Mistakes, and Communication Gaps
- 15:00 – Why Electronic Medical Records Don’t Fix the Problem
- 18:30 – Patient Advocacy, “Patient No More,” and Surviving American Healthcare
- 21:00 – Misdiagnosis in Women, Children, and Marginalized Groups
- 24:30 – The Future of Patient Safety and System Reform
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
It's a widely acknowledged fact that in the
United States, we spend more onhealth care than other countries
, but our metrics and ourresults are worse.
They're much worse, and ourlife expectancies are getting
shorter.
So why in the hell are wespending so much and getting so
little?
What are the root causes?
We'll find out on this episodeof Shift Shapers.
Speaker 2 (00:23):
Change either energizes or paralyzes.
The choice is yours.
This is the Shift Shaperspodcast, bringing the employee
benefits industry interviewswith individuals and companies
who are shaping the industryshifts.
And now here's your host, davidSaltzman.
Speaker 1 (00:45):
To help us answer that question.
We've invited Helene M Epstein,writer, speaker and advocate,
who is investigating that in herterrific and very informative.
If you haven't signed up for it, you should.
New Substack series Patient noMore.
Welcome, helene.
Thank you, david, happy to behere.
It's our pleasure.
Let's start a little bit andwe'll go right to Chapter 1.
(01:07):
In Chapter 1, you talk abouterrors and harms.
What are errors and harms andkind of?
How do they manifest?
Speaker 3 (01:18):
So medical errors let's be specific or patient
harm, those are two differentelements.
Specific or patient harm, thoseare two different elements.
Medical errors are every singlemistake that's made in a
hospital, in a nursing home, inyour primary care doctor's
office, in the specialist'soffice.
It's every mistake that's madein surgery.
Patient harm is what happenswhen those mistakes are made and
(01:41):
there's a gap betweenmeasurement of medical error and
patient harm because hospitalsdon't track it properly.
Speaker 1 (01:49):
So could you give us a couple of examples, just top
level, and then we'll deep diveon them, one at a time, sure.
Speaker 3 (01:57):
The number one cause of medical error is diagnostic
error, or misdiagnosis of it'scommonly called it's across
every medical malpractice metric, across every hospital's risk
management department.
That is the issue that theyhave to deal with the most, but
(02:18):
it's probably not the biggestissue.
That's really happening becausehospitals are not properly
tracking the medical issue.
That's really happening Becausehospitals are not properly
tracking the medical error thatis happening.
They're not even aware of howbig this issue is.
Speaker 1 (02:32):
That's interesting, you know, for our audience, who
are largely client-facingadvisors.
How does this have?
What impact does this have onthe workforce?
Speaker 3 (02:40):
So we know that an adult employee with an illness
is the rule.
It's not the exception.
60% of American adults have atleast one chronic illness.
40% of them have two or more.
You add in the 50 millionpeople who have autoimmune
illnesses and you have aworkforce that is constantly
(03:03):
dealing with trying to getdiagnosed, trying to get proper
treatment and trying to survivethe eight to 10 hours that
they're supposed to be survivingin your office.
Absenteeism is growing.
It's not decreasing.
Error and medical error havestayed exactly the same for 20
(03:24):
years and are possibly gettingworse as our system gets more
focused on profit and not on thepatient.
Speaker 1 (03:33):
It's not hard to imagine that our system is more
focused on profit.
It is hard to imagine that,with all of the technology and
all of the training and the vastamounts of resources, both
financial and educational andotherwise, that we spend, that
that's continuing to happen.
And this is not a newphenomenon, is it?
Speaker 3 (03:51):
No, it's not a new phenomenon.
Look, the corporatization ofhealth care goes back to the
beginning of insurance companiesmaking it difficult for primary
care doctors to get approvaland for specialists and surgeons
to get approval, and we cantalk about the history of that
for a while.
What's gotten worse is that wenow have financial firms, health
(04:14):
equity firms, that are buyingup hospitals in rural areas or
community hospitals, and thenthey're closing pediatrics,
they're closing maternal health,you know actually labor and
delivery, because those are theleast profitable.
So there are people in ourcountry, quite a few, who have
to travel over six hours iftheir child gets sick, if a
(04:38):
pregnant woman needs some sortof help.
That's what the helicopters, Iguess, are for, but the access
to care is just falling apart inthe country.
Speaker 1 (04:48):
And yet getting a certificate of need has become
almost impossible.
So we're not seeing newhospitals or facilities being
built in rural areas and, heavenforbid, we're not seeing any
specialty hospitals being built.
How does that make any kind ofsense?
Wouldn't if we werecorporatizing stuff?
(05:09):
We would want to draw morepatients, wouldn't we?
Speaker 3 (05:13):
Well, I guess the issue across the board for all
the investors in health care, aswell as for health insurance
companies, is short-termthinking, and it's been a
problem in this country for along time.
We live quarter by quarter, wedon't live decade by decade, and
that's where we get beat byother countries that have much
stronger public health systems,or even, you know, the communist
(05:37):
countries or the socialistcountries that we look down on.
They're thinking decade bydecade and they're thinking
prevention more than we are.
Speaker 1 (05:46):
Yeah, and that's always been a particularly and
peculiarly American trait.
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And now back to ourconversation.
Let's dive down a little bitinto what some of these errors
(07:37):
are.
One of the first things thatyou talk about is diagnosis
error.
Talk about that a little bit.
How pervasive is it?
Speaker 3 (07:44):
So diagnostic error there is not a person listening
to this podcast that will notexperience it at least once in
their lifetime, and you willmost definitely experience it in
your immediate family.
So we know that anywhere from 5to 25% of American adults
that's 12 to 40 million aregoing to be misdiagnosed every
(08:09):
single year in this country.
A third of those are harmedgreatly.
So diagnostic error ormisdiagnosis, it's common, it's
costly and it's catastrophic.
So it happens everywhere.
It happens just going to yourprimary care doctor.
70% of diagnosis errors are dueto testing errors and I just
(08:32):
dropped a chapter about that.
Speaker 1 (08:36):
Can you give us an example?
Speaker 3 (08:49):
So if you think of testing as a relay race, where
you go from the very beginning,from providing the sample, you
have to go to the lab, that labsample has to be properly
handled, it has to go to thelaboratory where it's going to
be taken care of or just fuckingblood sample, for example and
then it has to be processedcorrectly, the results have to
be communicated correctly andthey have to get back to you.
But let's start even a stepearlier than that.
(09:10):
The doctor has to order theright test.
They have to know which test toorder, and sometimes that
decision is not made by thedoctor, it's made by the
insurance company.
Insurance companies are gatingexpensive tests.
Here's a perfect example, and Ihope you have this gentleman on
(09:31):
your podcast soon.
His name is Matthew Zachary.
He is a cancer patient advocate, one of the things that we know
and, by the way, my husband'sin precision medicine.
So I'm getting this from twodifferent directions.
We have the ability to dogenetic testing on patients to
identify what type of cancerthey have and to identify what
(09:55):
specific treatment will be bestfor that cancer and for that
patient's body.
But uniformly, routinely,insurance companies don't pay
for the genetic tests, which canbe expensive and they don't
permit the identified treatmentplan to be used first.
They want some standardizedtreatment to be used first, so
(10:19):
patients become more ill andthey metastasize.
So this is a battle thatpatients and patient groups from
all over the country are havingwith insurance companies right
now, and since cancer affects somany of us, it's going to
affect the people who arelistening to this podcast as
well personally, as well astheir family members the people
(10:40):
who are listening to thispodcast as well, personally, as
well as their family members.
Speaker 1 (10:46):
Even though the cost of pharmacogenetic testing has
come down, I would saydramatically I mean, you can get
a really, really broad assayfor under 200 bucks.
It's not widely available topeople, right, you know you have
to kind of ferret it out, butit would seem to me that we
waste more money, or insurancecompanies waste more money, on
incorrect tests and thenmedications which we'll talk
(11:07):
about next than $200.
It would seem least expensiveI've seen for a complete genetic
workup is $1,200.
Speaker 3 (11:22):
But the genetic workup for cancer is very
specialized and you're talkingabout genetic typing, so that's
a lot more expensive becauseit's harder to do.
Speaker 1 (11:36):
So we touched on this kind of briefly.
Let's talk a little bit aboutmedication errors.
We spend a lot of time on thepodcast talking about pharmacy
because it's one of the biggestcost drivers and it's also been
a litigation driver in the last12 or 18 months, starting with
the johnson and johnson suit,which has now gone its own way
for a variety of reasons.
(11:56):
But there are medication errorsthat are endemic to the system.
What's the scope of that andwhat can be done about it?
Speaker 3 (12:05):
Well, again, we have to start with the doctor.
So there are new medicationscoming out all the time and
there are salespeople that aregoing to the doctors trying to
sell them on it and giving themsamples.
But doctors are not pharmacists.
They're not experts on thecontraindications of medications
.
They're not experts on whichmedication should not be taken
with other medications.
(12:26):
We use the pharmacy as thefirst line of defense for that.
But pharmacies make mistakesall the time.
I'll tell you a funny one thathappened to me was I went to go
pick up birth control pills afew years ago and got someone's
heart medicine and the guy whoneeded the heart medicine got my
birth control pills.
That's a very simple error thathappens frequently on the
(12:51):
retail side.
Medications that patientsshould be taking for two weeks.
Let's say you have GERD or youhave IBS, you have some sort of
digestive issue that's affectingyour esophagus and giving you
chest pain.
They're supposed to be takenfor two weeks and for most
(13:15):
patients it affects their bones.
As you age your bones getsofter faster, bone density
decreases and I can tell youjust of people I know in my own
telephone book at least the 40people who have been taking it
for two years or more.
So if something works, you takeit.
(13:38):
Patients also can't affordtheir medications, and one of
the biggest medication errorsare when patients try to take it
only when they feel bad forpreventative medicine or an
asthma medicine, or they try todecide do I buy this medicine or
am I buying food this week?
And they don't tell the doctorand they don't tell the doctor.
The other big issue and thisaffects testing as well are
(14:02):
supplements.
So I tell the story of myfather-in-law, who was on blood
thinners for heart condition andthey test every two or three
weeks something called the INR.
It's a measure of how yourblood is clotting and he could
not get his INR under control.
The doctor was trying to figureout like why, why, what, what
(14:24):
are you eating, what are youdoing?
And what my father-in-law nevertold him was that he was taking
ginkgo biloba because it'ssupposed to help with memory.
But ginkgo biloba is a bloodthinner that's how it helps with
memory.
And so one day, as myfather-in-law accidentally cuts
himself and turns to me andsquirts me in the face with
(14:47):
blood that's just pumping out ofhis heart, I said you've got to
tell your doctor about theginkgo biloba, please, and then
you can get your INR undercontrol.
So these are the kinds oferrors that we make because we
don't communicate.
The doctors don't tell us whatwe need to know.
We don't tell them what we'reactually doing.
Speaker 1 (15:05):
Well, I mean, we're fractured and every attempt has
been made you mentioned denyingconsultations and whatnot
earlier on but pretty much everyattempt has been made at doing
away with the concept of medicalhome.
That said, it's 2025.
We don't have electronicmedical records yet where you
(15:27):
know your new doctor can look atyour old records and see what
it is you've been prescribed andwhat you're taking.
I mean, I recently had asimilar experience.
I went to a new doc and theanswer was okay, we're going to
do this blood panel and thatblood panel and the other blood
panel.
I said, well, I just had thosedone two weeks ago.
Well, we don't have access tothose results.
I said, well, maybe you don't,but I do.
(15:47):
Can I get them for you?
We need to do our own tests andI walk out the door, but most
patients don't do that.
So it's a combination of thetwo, isn't it?
You're kind of getting a doublewhammy.
Speaker 3 (15:59):
Well, absolutely.
First of all, let's talk aboutthe EMR.
It was not designed for patientdiagnosis and treatment.
It was designed for billing.
That's really the truth.
Everything in this industry hasbeen designed for billing and
it's almost impossible to beable to utilize the EMR properly
for diagnosis and treatment.
(16:20):
They're difficult, they'reunwieldy.
People are trying to work withthem, but they end up copying
and pasting information that'soften incorrect into the new
record, so that for everypatient visit, the list of
issues gets longer and longer,even though the patient might
have been there for one simpleproblem.
(16:40):
The other issue is that thecompany that I won't name here
that runs most of the electronicmedical records for most of the
hospitals they're the bigplayer in the system.
They have been buying upcompanies that have worked hard
to improve the product, maybeusing AI to make it easier to
(17:00):
identify the issues that youneed, or for interoperability,
so two hospitals can worktogether on the same patient
that perhaps had an accident andis traveling and needs to go to
a hospital in a different state.
They have bought thosecompanies and then they've
squashed the technology.
We have lots and lots ofstories about that.
Speaker 1 (17:22):
How do we solve that problem?
Speaker 3 (17:26):
There's a lot of people working on it.
There's a lot of people workingon it, and I would say that the
big issue we have right now, in2025, is that fewer people are
getting to work on it becausetheir funding has been cut.
No matter where you stand onpolitics, public health affects
every single one of us, and whenwe kill the type of
(17:48):
cutting-edge medical researchthat used to be done in this
country and that is no longerproperly funded, or the attacks
on universities, again it's nota political thing for me, it's a
healthcare problem.
So patients are the ones whoare going to suffer, and your
clients' employees are thepeople who are going to suffer
(18:08):
the most.
However, and while we aretrying to work that out, and
while there are people who areworking on things like bringing
more diagnostic AI to work year,I'm dropping two chapters a
month, which is kind talks ingeneral about the issue by the
end of December.
(18:28):
So it's a full book that willtake you from identifying that
(19:08):
you have a problem to gettingheard, getting solved, getting
treated and surviving, and thebook is called A Guide to
Surviving American HealthcarePatient.
No More is where I'm posting it.
Speaker 1 (19:22):
It's, you know, longtime listeners of the
podcast will know that I've saidthis more than once.
The best thing I ever heard outof a physician's mouth was that
patients would get doctorswould get off their pedestals.
When patients get off theirknees, it's a great line.
Speaker 3 (19:38):
It's a great line.
Speaker 1 (19:39):
And so, since you kind of detoured us there, what
are some of the things, maybethe top two, three or four
things that patients can do andshould be doing?
Speaker 3 (19:48):
They have to keep control of their records.
I recommend everybody joinevery portal for every doctor
and if you can get them onto mychart, then they can talk to
each other, because you can givepermission for every doctor to
see everything else that'shappening through my chart.
So that's one thing people cando.
The second thing that peoplecan do is don't have any surgery
(20:11):
, Don't do any invasive orexpensive tests without first
going for a second opinion.
In fact, I have a chaptercoming up called Get a Second
Opinion.
Get a Second Opinion.
Get a Second Opinion because Icannot believe how many people
jump into a surgery and haven'tdouble-checked that the
(20:32):
diagnosis is correct, and thatis a gigantic.
Well, how many diagnoses are?
Speaker 1 (20:35):
wrong.
You write about that even inchapter one.
How often do they just getdiagnoses flat wrong?
Speaker 3 (20:42):
Oh well, for at least 10 to 20% of Americans every
single year.
So that is, 24 to 50 millionAmericans are misdiagnosed every
single year, and sometimes thediagnosis is close, like they
might be 100% correct it'scardiological but they don't
(21:03):
have the right issue.
Most of the time, though, whathappens to patients is that they
get dismissed.
They get ignored.
There are people in Facebookgroups who are undiagnosed and
suffering and are not going tosee doctors anymore because they
have been dismissed and ignoredso many times.
(21:23):
So we're talking specificallyabout women with endometriosis.
We're talking about people withME, cfs or long COVID as well
people with Lyme disease, peoplewith autoimmune diseases of all
kinds.
They have checked out of thesystem, but they're employees.
They're working full-time forcompanies like your clients.
Speaker 1 (21:47):
I have a daughter who's well into her 30s who was
diagnosed with endometriosiswhen she was 18.
And it's only because both sheand her mother were a giant pain
in the ass to the medicalsystem that she got the
diagnosis.
And the stories that she tellsabout just being summarily
dismissed by doctors arefrightening, and I know that
(22:08):
that happens to women with lotsof other diagnoses as well.
Are you seeing that in yourresearch more prevalent with
women than with men, or is itjust pretty much across the
board?
Speaker 3 (22:16):
You know, even white men 21 to 45 get misdiagnosed.
But yes, if you have an accent,if English is your second
language, if you're a woman, ifyou're a senior, 4 million
children are misdiagnosed.
It's a working, it's a roughnumber, but it's actually 4 to 8
million.
But, to be conservative, 4million children in this country
(22:38):
are misdiagnosed every year.
And for children it is much,much worse than it is for adults
, because they have developingbodies, because they're
developing their brains andtheir systems and their immune
system, and when that getsinterrupted you have immediate
chronic illness.
So that's a gigantic problem.
And if you're Black, forget it.
(23:02):
If you're a Black woman, thechances of you being properly
diagnosed are lower than theyare for almost any other group.
And then, of course, we havematernal health issues, the fact
that if you are Black orHispanic, you have a chance of
dying four times higher than awhite woman does.
But even white women who aregiving birth are harmed more in
(23:28):
this country than they are inany other country, any other
developed country, any otherwealthy country in the world and
the other developed country andthe other wealthy country in
the world.
Speaker 1 (23:37):
And I want to be clear none of what you just said
because I've done some researchas well none of what you just
said is political.
It's all borne out by actualreal-life numbers of actual
real-life patients who've beenharmed.
Yeah, it's facts.
Speaker 3 (23:49):
And it's not because any doctor starts out wanting to
cause harm.
I'm not doctor bashing here,because most doctors do it for
the very simple reason that theywant to help people.
There is a very tiny percentageof doctors that are responsible
for a majority of the medicalmalpractice lawsuits.
(24:12):
89% of doctors have never beensued Never.
That means 11% have, and two ofthat 11% are responsible for
more than half.
So one of the issues that wehave is that the state medical
boards are not quick enough toidentify the bad players and
(24:36):
even if they remove theirlicense in their state, that
doctor can go to another statethat he's already licensed in or
she's already licensed in andthey jump around.
So I do give advice aboutbefore you choose a doctor.
There are tools, there areplaces that you can go to look
up their background and see ifthey were ever sued, and if they
(24:58):
were sued once in a careerthat's 40 years, don't worry
about it.
But if they were sued multipletimes and recently, stay far,
far away.
Speaker 1 (25:08):
We've got a couple of minutes left.
Where do you see this going inthe near term, let's say, the
next four or five years?
Speaker 3 (25:16):
going in the near term, let's say, the next four
or five years.
I think that patients have beenactivated and so the patient
advocacy world is growing andgetting stronger, and even with
Maha, they're listening topatients more than they're
listening to doctors andresearchers.
So I think that is going to beour pathway to improving
(25:39):
healthcare.
But the big issue is alwaysgoing to be about the
profitability.
States need to be on top ofwhat's happening in their
hospitals, because that's wherea lot of the certification
happens.
There are three certificationgroups for hospitals, and I hope
that we can get them to step upand identify diagnostic error
(26:04):
and medical error as acertification problem.
And the third avenue that thepatients are looking at and
patient advocates specificallyare looking at, are medical
malpractice insurers, becausethey're the ones who have to pay
out when something goes wrong.
And patient advocatesspecifically are looking at Our
medical malpractice insurersbecause they're the ones who
have to pay out when somethinggoes wrong, so they can make
requirements that theirhospitals, if they want to be
(26:27):
insured, have to meet certainpatient safety reporting
standards.
I'm just going to say one morethought quickly.
One out of four people in thehospitals, people who are in the
hospital, are harmed One out offour and we only know that from
voluntary reporting of the harmis not reported because it's
(26:58):
not identified, because it's notfound.
The system doesn't get andthat's what the report's going
to come out.
There's a report coming outthis year, late in the year,
that's going to say that we aremissing 95 percent of harm that
is happening in hospital.
So if we can get the medicalmalpractice companies and the
hospital certification companiesto join with us to require
mandatory patient safetyreporting, we can solve a lot of
(27:19):
these problems very quickly andAI would help.
Speaker 1 (27:23):
And that's a great place to end our conversation,
but we do hope you'll come backas this all expands and goes on
and whatnot.
Helene M Epstein, writer,speaker, advocate, and please,
if you want to know more aboutthis and you should, because it
will help you inform yourclients and make better
decisions, especially in theself-funded universe where
you're selecting vendors to helpbuild a plan from the ground up
(27:44):
please subscribe to herSubstack series.
It's called Patient no More.
Helene, thanks so much forspending some time with us.
Speaker 3 (27:50):
Thank you.
I think you and I could talkall day.
We probably will one day.
Speaker 1 (28:02):
I want to give a quick shout out to our sponsor
and our producer, hatcher Media.
Hey, if you need podcastproduction or professional
graphic design, josh Hatcher isthe expert to contact For more
information.
Visit him at HatcherMedianet.
That's H-A-T-C-H-E-R-Medianet.
Speaker 2 (28:24):
This Shift Shapers podcast is copyrighted content
and may not be reproduced inwhole or in part without the
express written permission ofShift Shapers Solutions LLC.
Copyright 2024.
It's a widely acknowledged fact that in the
United States, we spend more onhealth care than other countries
, but our metrics and ourresults are worse.
They're much worse, and ourlife expectancies are getting
shorter.
So why in the hell are wespending so much and getting so
little?
What are the root causes?
We'll find out on this episodeof Shift Shapers.
Speaker 2 (00:23):
Change either energizes or paralyzes.
The choice is yours.
This is the Shift Shaperspodcast, bringing the employee
benefits industry interviewswith individuals and companies
who are shaping the industryshifts.
And now here's your host, davidSaltzman.
Speaker 1 (00:45):
To help us answer that question.
We've invited Helene M Epstein,writer, speaker and advocate,
who is investigating that in herterrific and very informative.
If you haven't signed up for it, you should.
New Substack series Patient noMore.
Welcome, helene.
Thank you, david, happy to behere.
It's our pleasure.
Let's start a little bit andwe'll go right to Chapter 1.
(01:07):
In Chapter 1, you talk abouterrors and harms.
What are errors and harms andkind of?
How do they manifest?
Speaker 3 (01:18):
So medical errors let's be specific or patient
harm, those are two differentelements.
Specific or patient harm, thoseare two different elements.
Medical errors are every singlemistake that's made in a
hospital, in a nursing home, inyour primary care doctor's
office, in the specialist'soffice.
It's every mistake that's madein surgery.
Patient harm is what happenswhen those mistakes are made and
(01:41):
there's a gap betweenmeasurement of medical error and
patient harm because hospitalsdon't track it properly.
Speaker 1 (01:49):
So could you give us a couple of examples, just top
level, and then we'll deep diveon them, one at a time, sure.
Speaker 3 (01:57):
The number one cause of medical error is diagnostic
error, or misdiagnosis of it'scommonly called it's across
every medical malpractice metric, across every hospital's risk
management department.
That is the issue that theyhave to deal with the most, but
(02:18):
it's probably not the biggestissue.
That's really happening becausehospitals are not properly
tracking the medical issue.
That's really happening Becausehospitals are not properly
tracking the medical error thatis happening.
They're not even aware of howbig this issue is.
Speaker 1 (02:32):
That's interesting, you know, for our audience, who
are largely client-facingadvisors.
How does this have?
What impact does this have onthe workforce?
Speaker 3 (02:40):
So we know that an adult employee with an illness
is the rule.
It's not the exception.
60% of American adults have atleast one chronic illness.
40% of them have two or more.
You add in the 50 millionpeople who have autoimmune
illnesses and you have aworkforce that is constantly
(03:03):
dealing with trying to getdiagnosed, trying to get proper
treatment and trying to survivethe eight to 10 hours that
they're supposed to be survivingin your office.
Absenteeism is growing.
It's not decreasing.
Error and medical error havestayed exactly the same for 20
(03:24):
years and are possibly gettingworse as our system gets more
focused on profit and not on thepatient.
Speaker 1 (03:33):
It's not hard to imagine that our system is more
focused on profit.
It is hard to imagine that,with all of the technology and
all of the training and the vastamounts of resources, both
financial and educational andotherwise, that we spend, that
that's continuing to happen.
And this is not a newphenomenon, is it?
Speaker 3 (03:51):
No, it's not a new phenomenon.
Look, the corporatization ofhealth care goes back to the
beginning of insurance companiesmaking it difficult for primary
care doctors to get approvaland for specialists and surgeons
to get approval, and we cantalk about the history of that
for a while.
What's gotten worse is that wenow have financial firms, health
(04:14):
equity firms, that are buyingup hospitals in rural areas or
community hospitals, and thenthey're closing pediatrics,
they're closing maternal health,you know actually labor and
delivery, because those are theleast profitable.
So there are people in ourcountry, quite a few, who have
to travel over six hours iftheir child gets sick, if a
(04:38):
pregnant woman needs some sortof help.
That's what the helicopters, Iguess, are for, but the access
to care is just falling apart inthe country.
Speaker 1 (04:48):
And yet getting a certificate of need has become
almost impossible.
So we're not seeing newhospitals or facilities being
built in rural areas and, heavenforbid, we're not seeing any
specialty hospitals being built.
How does that make any kind ofsense?
Wouldn't if we werecorporatizing stuff?
(05:09):
We would want to draw morepatients, wouldn't we?
Speaker 3 (05:13):
Well, I guess the issue across the board for all
the investors in health care, aswell as for health insurance
companies, is short-termthinking, and it's been a
problem in this country for along time.
We live quarter by quarter, wedon't live decade by decade, and
that's where we get beat byother countries that have much
stronger public health systems,or even, you know, the communist
(05:37):
countries or the socialistcountries that we look down on.
They're thinking decade bydecade and they're thinking
prevention more than we are.
Speaker 1 (05:46):
Yeah, and that's always been a particularly and
peculiarly American trait.
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And now back to ourconversation.
Let's dive down a little bitinto what some of these errors
(07:37):
are.
One of the first things thatyou talk about is diagnosis
error.
Talk about that a little bit.
How pervasive is it?
Speaker 3 (07:44):
So diagnostic error there is not a person listening
to this podcast that will notexperience it at least once in
their lifetime, and you willmost definitely experience it in
your immediate family.
So we know that anywhere from 5to 25% of American adults
that's 12 to 40 million aregoing to be misdiagnosed every
(08:09):
single year in this country.
A third of those are harmedgreatly.
So diagnostic error ormisdiagnosis, it's common, it's
costly and it's catastrophic.
So it happens everywhere.
It happens just going to yourprimary care doctor.
70% of diagnosis errors are dueto testing errors and I just
(08:32):
dropped a chapter about that.
Speaker 1 (08:36):
Can you give us an example?
Speaker 3 (08:49):
So if you think of testing as a relay race, where
you go from the very beginning,from providing the sample, you
have to go to the lab, that labsample has to be properly
handled, it has to go to thelaboratory where it's going to
be taken care of or just fuckingblood sample, for example and
then it has to be processedcorrectly, the results have to
be communicated correctly andthey have to get back to you.
But let's start even a stepearlier than that.
(09:10):
The doctor has to order theright test.
They have to know which test toorder, and sometimes that
decision is not made by thedoctor, it's made by the
insurance company.
Insurance companies are gatingexpensive tests.
Here's a perfect example, and Ihope you have this gentleman on
(09:31):
your podcast soon.
His name is Matthew Zachary.
He is a cancer patient advocate, one of the things that we know
and, by the way, my husband'sin precision medicine.
So I'm getting this from twodifferent directions.
We have the ability to dogenetic testing on patients to
identify what type of cancerthey have and to identify what
(09:55):
specific treatment will be bestfor that cancer and for that
patient's body.
But uniformly, routinely,insurance companies don't pay
for the genetic tests, which canbe expensive and they don't
permit the identified treatmentplan to be used first.
They want some standardizedtreatment to be used first, so
(10:19):
patients become more ill andthey metastasize.
So this is a battle thatpatients and patient groups from
all over the country are havingwith insurance companies right
now, and since cancer affects somany of us, it's going to
affect the people who arelistening to this podcast as
well personally, as well astheir family members the people
(10:40):
who are listening to thispodcast as well, personally, as
well as their family members.
Speaker 1 (10:46):
Even though the cost of pharmacogenetic testing has
come down, I would saydramatically I mean, you can get
a really, really broad assayfor under 200 bucks.
It's not widely available topeople, right, you know you have
to kind of ferret it out, butit would seem to me that we
waste more money, or insurancecompanies waste more money, on
incorrect tests and thenmedications which we'll talk
(11:07):
about next than $200.
It would seem least expensiveI've seen for a complete genetic
workup is $1,200.
Speaker 3 (11:22):
But the genetic workup for cancer is very
specialized and you're talkingabout genetic typing, so that's
a lot more expensive becauseit's harder to do.
Speaker 1 (11:36):
So we touched on this kind of briefly.
Let's talk a little bit aboutmedication errors.
We spend a lot of time on thepodcast talking about pharmacy
because it's one of the biggestcost drivers and it's also been
a litigation driver in the last12 or 18 months, starting with
the johnson and johnson suit,which has now gone its own way
for a variety of reasons.
(11:56):
But there are medication errorsthat are endemic to the system.
What's the scope of that andwhat can be done about it?
Speaker 3 (12:05):
Well, again, we have to start with the doctor.
So there are new medicationscoming out all the time and
there are salespeople that aregoing to the doctors trying to
sell them on it and giving themsamples.
But doctors are not pharmacists.
They're not experts on thecontraindications of medications
.
They're not experts on whichmedication should not be taken
with other medications.
(12:26):
We use the pharmacy as thefirst line of defense for that.
But pharmacies make mistakesall the time.
I'll tell you a funny one thathappened to me was I went to go
pick up birth control pills afew years ago and got someone's
heart medicine and the guy whoneeded the heart medicine got my
birth control pills.
That's a very simple error thathappens frequently on the
(12:51):
retail side.
Medications that patientsshould be taking for two weeks.
Let's say you have GERD or youhave IBS, you have some sort of
digestive issue that's affectingyour esophagus and giving you
chest pain.
They're supposed to be takenfor two weeks and for most
(13:15):
patients it affects their bones.
As you age your bones getsofter faster, bone density
decreases and I can tell youjust of people I know in my own
telephone book at least the 40people who have been taking it
for two years or more.
So if something works, you takeit.
(13:38):
Patients also can't affordtheir medications, and one of
the biggest medication errorsare when patients try to take it
only when they feel bad forpreventative medicine or an
asthma medicine, or they try todecide do I buy this medicine or
am I buying food this week?
And they don't tell the doctorand they don't tell the doctor.
The other big issue and thisaffects testing as well are
(14:02):
supplements.
So I tell the story of myfather-in-law, who was on blood
thinners for heart condition andthey test every two or three
weeks something called the INR.
It's a measure of how yourblood is clotting and he could
not get his INR under control.
The doctor was trying to figureout like why, why, what, what
(14:24):
are you eating, what are youdoing?
And what my father-in-law nevertold him was that he was taking
ginkgo biloba because it'ssupposed to help with memory.
But ginkgo biloba is a bloodthinner that's how it helps with
memory.
And so one day, as myfather-in-law accidentally cuts
himself and turns to me andsquirts me in the face with
(14:47):
blood that's just pumping out ofhis heart, I said you've got to
tell your doctor about theginkgo biloba, please, and then
you can get your INR undercontrol.
So these are the kinds oferrors that we make because we
don't communicate.
The doctors don't tell us whatwe need to know.
We don't tell them what we'reactually doing.
Speaker 1 (15:05):
Well, I mean, we're fractured and every attempt has
been made you mentioned denyingconsultations and whatnot
earlier on but pretty much everyattempt has been made at doing
away with the concept of medicalhome.
That said, it's 2025.
We don't have electronicmedical records yet where you
(15:27):
know your new doctor can look atyour old records and see what
it is you've been prescribed andwhat you're taking.
I mean, I recently had asimilar experience.
I went to a new doc and theanswer was okay, we're going to
do this blood panel and thatblood panel and the other blood
panel.
I said, well, I just had thosedone two weeks ago.
Well, we don't have access tothose results.
I said, well, maybe you don't,but I do.
(15:47):
Can I get them for you?
We need to do our own tests andI walk out the door, but most
patients don't do that.
So it's a combination of thetwo, isn't it?
You're kind of getting a doublewhammy.
Speaker 3 (15:59):
Well, absolutely.
First of all, let's talk aboutthe EMR.
It was not designed for patientdiagnosis and treatment.
It was designed for billing.
That's really the truth.
Everything in this industry hasbeen designed for billing and
it's almost impossible to beable to utilize the EMR properly
for diagnosis and treatment.
(16:20):
They're difficult, they'reunwieldy.
People are trying to work withthem, but they end up copying
and pasting information that'soften incorrect into the new
record, so that for everypatient visit, the list of
issues gets longer and longer,even though the patient might
have been there for one simpleproblem.
(16:40):
The other issue is that thecompany that I won't name here
that runs most of the electronicmedical records for most of the
hospitals they're the bigplayer in the system.
They have been buying upcompanies that have worked hard
to improve the product, maybeusing AI to make it easier to
(17:00):
identify the issues that youneed, or for interoperability,
so two hospitals can worktogether on the same patient
that perhaps had an accident andis traveling and needs to go to
a hospital in a different state.
They have bought thosecompanies and then they've
squashed the technology.
We have lots and lots ofstories about that.
Speaker 1 (17:22):
How do we solve that problem?
Speaker 3 (17:26):
There's a lot of people working on it.
There's a lot of people workingon it, and I would say that the
big issue we have right now, in2025, is that fewer people are
getting to work on it becausetheir funding has been cut.
No matter where you stand onpolitics, public health affects
every single one of us, and whenwe kill the type of
(17:48):
cutting-edge medical researchthat used to be done in this
country and that is no longerproperly funded, or the attacks
on universities, again it's nota political thing for me, it's a
healthcare problem.
So patients are the ones whoare going to suffer, and your
clients' employees are thepeople who are going to suffer
(18:08):
the most.
However, and while we aretrying to work that out, and
while there are people who areworking on things like bringing
more diagnostic AI to work year,I'm dropping two chapters a
month, which is kind talks ingeneral about the issue by the
end of December.
(18:28):
So it's a full book that willtake you from identifying that
(19:08):
you have a problem to gettingheard, getting solved, getting
treated and surviving, and thebook is called A Guide to
Surviving American HealthcarePatient.
No More is where I'm posting it.
Speaker 1 (19:22):
It's, you know, longtime listeners of the
podcast will know that I've saidthis more than once.
The best thing I ever heard outof a physician's mouth was that
patients would get doctorswould get off their pedestals.
When patients get off theirknees, it's a great line.
Speaker 3 (19:38):
It's a great line.
Speaker 1 (19:39):
And so, since you kind of detoured us there, what
are some of the things, maybethe top two, three or four
things that patients can do andshould be doing?
Speaker 3 (19:48):
They have to keep control of their records.
I recommend everybody joinevery portal for every doctor
and if you can get them onto mychart, then they can talk to
each other, because you can givepermission for every doctor to
see everything else that'shappening through my chart.
So that's one thing people cando.
The second thing that peoplecan do is don't have any surgery
(20:11):
, Don't do any invasive orexpensive tests without first
going for a second opinion.
In fact, I have a chaptercoming up called Get a Second
Opinion.
Get a Second Opinion.
Get a Second Opinion because Icannot believe how many people
jump into a surgery and haven'tdouble-checked that the
(20:32):
diagnosis is correct, and thatis a gigantic.
Well, how many diagnoses are?
Speaker 1 (20:35):
wrong.
You write about that even inchapter one.
How often do they just getdiagnoses flat wrong?
Speaker 3 (20:42):
Oh well, for at least 10 to 20% of Americans every
single year.
So that is, 24 to 50 millionAmericans are misdiagnosed every
single year, and sometimes thediagnosis is close, like they
might be 100% correct it'scardiological but they don't
(21:03):
have the right issue.
Most of the time, though, whathappens to patients is that they
get dismissed.
They get ignored.
There are people in Facebookgroups who are undiagnosed and
suffering and are not going tosee doctors anymore because they
have been dismissed and ignoredso many times.
(21:23):
So we're talking specificallyabout women with endometriosis.
We're talking about people withME, cfs or long COVID as well
people with Lyme disease, peoplewith autoimmune diseases of all
kinds.
They have checked out of thesystem, but they're employees.
They're working full-time forcompanies like your clients.
Speaker 1 (21:47):
I have a daughter who's well into her 30s who was
diagnosed with endometriosiswhen she was 18.
And it's only because both sheand her mother were a giant pain
in the ass to the medicalsystem that she got the
diagnosis.
And the stories that she tellsabout just being summarily
dismissed by doctors arefrightening, and I know that
(22:08):
that happens to women with lotsof other diagnoses as well.
Are you seeing that in yourresearch more prevalent with
women than with men, or is itjust pretty much across the
board?
Speaker 3 (22:16):
You know, even white men 21 to 45 get misdiagnosed.
But yes, if you have an accent,if English is your second
language, if you're a woman, ifyou're a senior, 4 million
children are misdiagnosed.
It's a working, it's a roughnumber, but it's actually 4 to 8
million.
But, to be conservative, 4million children in this country
(22:38):
are misdiagnosed every year.
And for children it is much,much worse than it is for adults
, because they have developingbodies, because they're
developing their brains andtheir systems and their immune
system, and when that getsinterrupted you have immediate
chronic illness.
So that's a gigantic problem.
And if you're Black, forget it.
(23:02):
If you're a Black woman, thechances of you being properly
diagnosed are lower than theyare for almost any other group.
And then, of course, we havematernal health issues, the fact
that if you are Black orHispanic, you have a chance of
dying four times higher than awhite woman does.
But even white women who aregiving birth are harmed more in
(23:28):
this country than they are inany other country, any other
developed country, any otherwealthy country in the world and
the other developed country andthe other wealthy country in
the world.
Speaker 1 (23:37):
And I want to be clear none of what you just said
because I've done some researchas well none of what you just
said is political.
It's all borne out by actualreal-life numbers of actual
real-life patients who've beenharmed.
Yeah, it's facts.
Speaker 3 (23:49):
And it's not because any doctor starts out wanting to
cause harm.
I'm not doctor bashing here,because most doctors do it for
the very simple reason that theywant to help people.
There is a very tiny percentageof doctors that are responsible
for a majority of the medicalmalpractice lawsuits.
(24:12):
89% of doctors have never beensued Never.
That means 11% have, and two ofthat 11% are responsible for
more than half.
So one of the issues that wehave is that the state medical
boards are not quick enough toidentify the bad players and
(24:36):
even if they remove theirlicense in their state, that
doctor can go to another statethat he's already licensed in or
she's already licensed in andthey jump around.
So I do give advice aboutbefore you choose a doctor.
There are tools, there areplaces that you can go to look
up their background and see ifthey were ever sued, and if they
(24:58):
were sued once in a careerthat's 40 years, don't worry
about it.
But if they were sued multipletimes and recently, stay far,
far away.
Speaker 1 (25:08):
We've got a couple of minutes left.
Where do you see this going inthe near term, let's say, the
next four or five years?
Speaker 3 (25:16):
going in the near term, let's say, the next four
or five years.
I think that patients have beenactivated and so the patient
advocacy world is growing andgetting stronger, and even with
Maha, they're listening topatients more than they're
listening to doctors andresearchers.
So I think that is going to beour pathway to improving
(25:39):
healthcare.
But the big issue is alwaysgoing to be about the
profitability.
States need to be on top ofwhat's happening in their
hospitals, because that's wherea lot of the certification
happens.
There are three certificationgroups for hospitals, and I hope
that we can get them to step upand identify diagnostic error
(26:04):
and medical error as acertification problem.
And the third avenue that thepatients are looking at and
patient advocates specificallyare looking at, are medical
malpractice insurers, becausethey're the ones who have to pay
out when something goes wrong.
And patient advocatesspecifically are looking at Our
medical malpractice insurersbecause they're the ones who
have to pay out when somethinggoes wrong, so they can make
requirements that theirhospitals, if they want to be
(26:27):
insured, have to meet certainpatient safety reporting
standards.
I'm just going to say one morethought quickly.
One out of four people in thehospitals, people who are in the
hospital, are harmed One out offour and we only know that from
voluntary reporting of the harmis not reported because it's
(26:58):
not identified, because it's notfound.
The system doesn't get andthat's what the report's going
to come out.
There's a report coming outthis year, late in the year,
that's going to say that we aremissing 95 percent of harm that
is happening in hospital.
So if we can get the medicalmalpractice companies and the
hospital certification companiesto join with us to require
mandatory patient safetyreporting, we can solve a lot of
(27:19):
these problems very quickly andAI would help.
Speaker 1 (27:23):
And that's a great place to end our conversation,
but we do hope you'll come backas this all expands and goes on
and whatnot.
Helene M Epstein, writer,speaker, advocate, and please,
if you want to know more aboutthis and you should, because it
will help you inform yourclients and make better
decisions, especially in theself-funded universe where
you're selecting vendors to helpbuild a plan from the ground up
(27:44):
please subscribe to herSubstack series.
It's called Patient no More.
Helene, thanks so much forspending some time with us.
Speaker 3 (27:50):
Thank you.
I think you and I could talkall day.
We probably will one day.
Speaker 1 (28:02):
I want to give a quick shout out to our sponsor
and our producer, hatcher Media.
Hey, if you need podcastproduction or professional
graphic design, josh Hatcher isthe expert to contact For more
information.
Visit him at HatcherMedianet.
That's H-A-T-C-H-E-R-Medianet.
Speaker 2 (28:24):
This Shift Shapers podcast is copyrighted content
and may not be reproduced inwhole or in part without the
express written permission ofShift Shapers Solutions LLC.
Copyright 2024.
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