Deane Waldman | University of New Mexico (original) (raw)
Papers by Deane Waldman
American Journal of Cardiology, 1977
Journal of Investigative Medicine, 2007
The present medical malpractice (med-mal) tort system is intended to accomplish two goals: deter ... more The present medical malpractice (med-mal) tort system is intended to accomplish two goals: deter wrongdoers and help victims. It does neither. Many widely held assumptions about med-mal are in error, including the bad apple theory. Consequences of the current system include huge and underestimated costs; strong risk aversion constraining innovation; increasing shortages of providers; and lack of appropriate compensation to injured patients. Detailed analysis of 86 med-mal lawsuits shows that only 31 cases (38%) were preventable adverse outcomes caused by mistakes. Nine percent of cases were initiated by an erroneous autopsy conclusion. Most injured patients received no or inadequate compensation. There are three reasons for bad medical outcomes: (1) providers are human, that is, imperfect; (2) medical knowledge is incomplete and individual patient outcomes are not predictable; and (3) the system is inherently flawed, sometimes frankly contradictory, and fails to protect both patient and provider from error. The United States has a malprocess rather than a malpractice problem.
PubMed, Apr 29, 2014
In a previous part of this "The Health of Healthcare" series, the etiology of sickness in our hea... more In a previous part of this "The Health of Healthcare" series, the etiology of sickness in our healthcare system was established as cancer. This article offers a method to "cure" healthcare, taken from strategic management thinking called VOSIE. In this article, the use of VOSIE is described as well as who needs to apply this cure: the public. A unifying mantra is suggested: Think and decide.
This chapter explores the relationship between two components of our healthcare system: physician... more This chapter explores the relationship between two components of our healthcare system: physicians, representing all providers of direct care, and hos- pital executives, referring to those with administrative responsibilities, regulatory obligations, and resource control. Currently, there is a wide gulf, or gap, represent- ing an adversarial interaction. Over the past 50 years, there have been dramatic, frankly, revolutionary, changes in
PubMed, Sep 1, 1990
Cardiac catheterization, once the mainstay of diagnosis in children with congenital heart disease... more Cardiac catheterization, once the mainstay of diagnosis in children with congenital heart disease, has become a therapeutic modality for many conditions. Balloon dilatation can now open stenotic valves and vessels, coils and umbrellas can now close unwanted communications, and emboli can be withdrawn without surgical intervention.
Pediatric Clinics of North America, Apr 1, 1999
Although one could divide cyanotic heart lesions by their physiology (i.e., right-to-left shuntin... more Although one could divide cyanotic heart lesions by their physiology (i.e., right-to-left shunting, inadequate pulmonary blood flow (PBF), or common mixing lesions), many defects have multiple physiologic abnormalities. The classic mnemonic, the "five T' s" of cyanotic congenital heart disease, continues
EC Nursing & Healthcare, Jul 30, 2020
Clinical journal of nursing care and practice, May 29, 2020
The Journal of Pediatrics, Jul 1, 1975
Health Care Management Review, 2004
Review of turnover costs at a major medical center helps health care managers gain insights about... more Review of turnover costs at a major medical center helps health care managers gain insights about the magnitude and determinants of this managerial challenge and assess the implications for organizational effectiveness. Here, turnover includes hiring, training, and productivity loss costs. Minimum cost of turnover represented a loss of >5 percent of the total annual operating budget.
Systems research and behavioral science, Jul 30, 2007
After describing machine and complex adaptive systems (CASs), we define thinking system as a CAS ... more After describing machine and complex adaptive systems (CASs), we define thinking system as a CAS with two additional, unique characteristics: (1) having goal(s) separate from survival, and (2) having the capability to structure its own learning and to innovate purposefully. Thinking systems always learn. Healthcare can be considered a paradigm of the thinking system and is repeatedly plagued with unintended, adverse outcomes, particularly fixes that fail. Systems thinking can dissolve such dysfunction in healthcare and by extension in any thinking system. Specific recommendations follow from this rationale.
American Journal of Cardiology, 1975
... None had a continuous murmur, bounding pulses, mid-diastolic rumble or differential cyanosis.... more ... None had a continuous murmur, bounding pulses, mid-diastolic rumble or differential cyanosis. ... A lung biopsy at this time revealed grade 2 (Heath-Edwards classification) pulmonary vascular disease.6 Fourteen months postoperatively the mean pulmonary arte-rial systolic ...
Pediatric Cardiology, May 1, 2000
Pediatric Research, Apr 1, 1974
Catheterization and Cardiovascular Diagnosis, 1977
The comparability of the main pulmonary artery pressure (PAP) and the pulmonary venous wedge pres... more The comparability of the main pulmonary artery pressure (PAP) and the pulmonary venous wedge pressure (PVWP) was assessed durlng cardiac catheterization in 89 patients with pulmonary artery hypertension (PAH) and Increased pulmonary blood flow. Preliminary evaluation revealed a wide disparity between the 2 determinations. Flfty-five pull-back pressure recordings from branch-to-main pulmonary artery were analyzed. Twenty-four percent (13155) had systolic pressure gradients >20 mm Hg. between branch and main pulmonary artery. When PVWP and only ipsilateral branch PAP were compared (n=48), diastolic and mean (m), but not systolic PVWP, correlated closely with branch PAP (r=0.77, r=0.73 and r=0.59, respectlvely). In 46 of 48 patients the PVWP, was not signlficantly greater than the ipsilateral PAP. Twenty-nine of 30 patlents with PVWP, <30 mm Hg. had an ipsilateral PAP, <40 mm Hg. in 15 patients with PVWP, between 30 and 39 mm Hg, there was a wide range (30-59 mm Hg) of PAP,. Three patients with PVWP, >40 mm Hg. had severe PAH. It Is concluded that: 1) hernodynamically signiflcant branch-to-main PAP gradients are present in some patients with PAH and may result in erroneously high pulmonary arteriolar vascular resistance when calculated from maln PAP; 2) properly performed PVWP determination can define the lower limit of mean pressure in the ipsilateral branch pulmonary artery; 3) a PVWP, 4 0 mm Hg. usually indicatesan lpsilateral PAP, <40 rnm Hg; 4) a PVWP, >30 mm Hg.
The Annals of Thoracic Surgery, Nov 1, 1993
Health and primary care, 2022
COVID revisits a children's fairy tale, the Emperor's New Clothes. The swindler-s... more COVID revisits a children's fairy tale, the Emperor's New Clothes. The swindler-salesmen are Biden, Fauci, et al. The magical clothes are their deliberate "pandemic of fear," and the duped emperor is the American public. Extensive evidence is presented here of a great scam. The data details the true and low health risks of COVID; viral biology of natural immunity and the immune response from experimental mRNA gene therapy;
American Journal of Cardiology, 1977
Journal of Investigative Medicine, 2007
The present medical malpractice (med-mal) tort system is intended to accomplish two goals: deter ... more The present medical malpractice (med-mal) tort system is intended to accomplish two goals: deter wrongdoers and help victims. It does neither. Many widely held assumptions about med-mal are in error, including the bad apple theory. Consequences of the current system include huge and underestimated costs; strong risk aversion constraining innovation; increasing shortages of providers; and lack of appropriate compensation to injured patients. Detailed analysis of 86 med-mal lawsuits shows that only 31 cases (38%) were preventable adverse outcomes caused by mistakes. Nine percent of cases were initiated by an erroneous autopsy conclusion. Most injured patients received no or inadequate compensation. There are three reasons for bad medical outcomes: (1) providers are human, that is, imperfect; (2) medical knowledge is incomplete and individual patient outcomes are not predictable; and (3) the system is inherently flawed, sometimes frankly contradictory, and fails to protect both patient and provider from error. The United States has a malprocess rather than a malpractice problem.
PubMed, Apr 29, 2014
In a previous part of this "The Health of Healthcare" series, the etiology of sickness in our hea... more In a previous part of this "The Health of Healthcare" series, the etiology of sickness in our healthcare system was established as cancer. This article offers a method to "cure" healthcare, taken from strategic management thinking called VOSIE. In this article, the use of VOSIE is described as well as who needs to apply this cure: the public. A unifying mantra is suggested: Think and decide.
This chapter explores the relationship between two components of our healthcare system: physician... more This chapter explores the relationship between two components of our healthcare system: physicians, representing all providers of direct care, and hos- pital executives, referring to those with administrative responsibilities, regulatory obligations, and resource control. Currently, there is a wide gulf, or gap, represent- ing an adversarial interaction. Over the past 50 years, there have been dramatic, frankly, revolutionary, changes in
PubMed, Sep 1, 1990
Cardiac catheterization, once the mainstay of diagnosis in children with congenital heart disease... more Cardiac catheterization, once the mainstay of diagnosis in children with congenital heart disease, has become a therapeutic modality for many conditions. Balloon dilatation can now open stenotic valves and vessels, coils and umbrellas can now close unwanted communications, and emboli can be withdrawn without surgical intervention.
Pediatric Clinics of North America, Apr 1, 1999
Although one could divide cyanotic heart lesions by their physiology (i.e., right-to-left shuntin... more Although one could divide cyanotic heart lesions by their physiology (i.e., right-to-left shunting, inadequate pulmonary blood flow (PBF), or common mixing lesions), many defects have multiple physiologic abnormalities. The classic mnemonic, the "five T' s" of cyanotic congenital heart disease, continues
EC Nursing & Healthcare, Jul 30, 2020
Clinical journal of nursing care and practice, May 29, 2020
The Journal of Pediatrics, Jul 1, 1975
Health Care Management Review, 2004
Review of turnover costs at a major medical center helps health care managers gain insights about... more Review of turnover costs at a major medical center helps health care managers gain insights about the magnitude and determinants of this managerial challenge and assess the implications for organizational effectiveness. Here, turnover includes hiring, training, and productivity loss costs. Minimum cost of turnover represented a loss of >5 percent of the total annual operating budget.
Systems research and behavioral science, Jul 30, 2007
After describing machine and complex adaptive systems (CASs), we define thinking system as a CAS ... more After describing machine and complex adaptive systems (CASs), we define thinking system as a CAS with two additional, unique characteristics: (1) having goal(s) separate from survival, and (2) having the capability to structure its own learning and to innovate purposefully. Thinking systems always learn. Healthcare can be considered a paradigm of the thinking system and is repeatedly plagued with unintended, adverse outcomes, particularly fixes that fail. Systems thinking can dissolve such dysfunction in healthcare and by extension in any thinking system. Specific recommendations follow from this rationale.
American Journal of Cardiology, 1975
... None had a continuous murmur, bounding pulses, mid-diastolic rumble or differential cyanosis.... more ... None had a continuous murmur, bounding pulses, mid-diastolic rumble or differential cyanosis. ... A lung biopsy at this time revealed grade 2 (Heath-Edwards classification) pulmonary vascular disease.6 Fourteen months postoperatively the mean pulmonary arte-rial systolic ...
Pediatric Cardiology, May 1, 2000
Pediatric Research, Apr 1, 1974
Catheterization and Cardiovascular Diagnosis, 1977
The comparability of the main pulmonary artery pressure (PAP) and the pulmonary venous wedge pres... more The comparability of the main pulmonary artery pressure (PAP) and the pulmonary venous wedge pressure (PVWP) was assessed durlng cardiac catheterization in 89 patients with pulmonary artery hypertension (PAH) and Increased pulmonary blood flow. Preliminary evaluation revealed a wide disparity between the 2 determinations. Flfty-five pull-back pressure recordings from branch-to-main pulmonary artery were analyzed. Twenty-four percent (13155) had systolic pressure gradients >20 mm Hg. between branch and main pulmonary artery. When PVWP and only ipsilateral branch PAP were compared (n=48), diastolic and mean (m), but not systolic PVWP, correlated closely with branch PAP (r=0.77, r=0.73 and r=0.59, respectlvely). In 46 of 48 patients the PVWP, was not signlficantly greater than the ipsilateral PAP. Twenty-nine of 30 patlents with PVWP, <30 mm Hg. had an ipsilateral PAP, <40 mm Hg. in 15 patients with PVWP, between 30 and 39 mm Hg, there was a wide range (30-59 mm Hg) of PAP,. Three patients with PVWP, >40 mm Hg. had severe PAH. It Is concluded that: 1) hernodynamically signiflcant branch-to-main PAP gradients are present in some patients with PAH and may result in erroneously high pulmonary arteriolar vascular resistance when calculated from maln PAP; 2) properly performed PVWP determination can define the lower limit of mean pressure in the ipsilateral branch pulmonary artery; 3) a PVWP, 4 0 mm Hg. usually indicatesan lpsilateral PAP, <40 rnm Hg; 4) a PVWP, >30 mm Hg.
The Annals of Thoracic Surgery, Nov 1, 1993
Health and primary care, 2022
COVID revisits a children's fairy tale, the Emperor's New Clothes. The swindler-s... more COVID revisits a children's fairy tale, the Emperor's New Clothes. The swindler-salesmen are Biden, Fauci, et al. The magical clothes are their deliberate "pandemic of fear," and the duped emperor is the American public. Extensive evidence is presented here of a great scam. The data details the true and low health risks of COVID; viral biology of natural immunity and the immune response from experimental mRNA gene therapy;