👥 Groupthink in integrated health systems: a cautionary tale

Plus: the edge of medical knowledge; nursing home incentives are bad; crisis standards of care are good

Most of the smart money in healthcare says that when specialists talk to each other, patient care benefits. In fact, below I recommend a podcast episode from Ross Douthat and Meghan O’Rourke which concludes exactly that.

But I have a counter-example to share here, one that’s been gnawing at me. I think this episode shows that integrated systems, while generally good, also create a danger for a kind of group-think about care management that can have very negative outcomes in individual cases.

Here’s the story:

Someone close to me has ulcerative colitis and has been on the drug Sulfasalazine for decades. The Sulfasalazine keeps the colitis controlled and in remission. Simultaneously, blood tests for the past ten years have all shown this person has abnormally low red blood cell counts, and since red blood cells carry oxygen to the body’s tissues, he has also periodically had very low blood oxygen levels.