Who should lead care team? Not necessarily a doctor, and other letters

Regarding the Q&A with Dr. Robert Wah, the new American Medical Association president, “Doctors should be captain of the ship,” I wish to offer a more contemporary view that patients and families want the provider who is best prepared to meet their needs and preferences to lead the healthcare team, and the role of leader may shift over time and episodes of care.

At times, the physician will be the leader, but it might also be the nurse, pharmacist, therapist or nutritionist. If we are truly focused on person- and family-centric care, we place priority on who can best meet their needs.

Transformation in our healthcare system also calls for new roles and practices. The Patient Protection and Affordable Care Act increases access, emphasizes preventive, wellness and primary-care services, and improves care coordination—areas where nurses excel. To be successful, patients must be at the center of innovative care models featuring a team of healthcare professionals working in concert. Nurses are called upon to be leaders and full partners with physicians and other healthcare professionals in delivering efficient and effective care, as recommended in the 2010 Institute of Medicine's “Future of Nursing” report.

As we all know, to meet the growing demand for services, we must optimize the contributions of all healthcare professionals. Healthcare consumers and policymakers expect the leaders of our nation's healthcare professions to collaborate and lead change in patients' best interests.

Pamela Cipriano

Regarding the recent online article “Hospital patients no safer today than 15 years ago, Senate panel hears”: Show me the data.

The National Center for Health Statistics Discharge Survey shows inpatient hospital deaths between 2000 and 2010 declined 8% from 776,000 to 715,000, while the number of hospitalizations rose 11%. (Hospital death rates declined overall for the period, but death rates for septicemia increased by 17%—a subject for another day).

With respect to morbidity, the Centers for Disease Control and Prevention reports that in 2012, there was a 44% decrease in central line-associated bloodstream infections, a 20% decrease in colon cancer surgical-site infections, an 11% reduction in abdominal hysterectomy surgical-site infections and a 4% reduction in MRSA cases.

Market forces drive quality and excellence.

Moultrie D. Plowden

Regarding “D.C. appeals court strikes down ACA insurance subsidies for federal exchanges,” I guess Nancy Pelosi is vindicated for saying that, “We have to pass the bill so you can find out what is in it—away from the fog of the controversy.”

The problem with comprehensive laws of any nature (the ACA legislation was more than 2,000 pages long), is that there are bound to be things that would have been better left out of the bill. This is one of the parts that turns out to be illegal. Further, many of the most egregious and onerous demands on the population haven't yet fully kicked in, so there are other aggrieved parties with standing ready to sue.

The Hobby Lobby case, and now this one, are tearing the law to shreds, one aggrieved party at a time.

If the goal is catching a mouse, this law is like the game Mouse Trap, where several dozen pieces of elaborate and precariously balanced apparatus must all work perfectly well, and if you are lucky, the mouse gets caught. If even one of the interrelated pieces is found unlawful, the entire contraption becomes worthless. Whereas a simple mousetrap with only two moving parts (the spring and the release) works pretty much every time.

Rube Goldberg would be proud of the Patient Protection and Affordable Care Act, if only it worked as advertised.

Lawrence Jankowski