Interview with Carolyn M. Clancy, M.D.
21st Century Health Care Forum
Health care quality is
improving in the United States, but there is still a long way to go in reducing
medical mistakes. The only person who can really make sure you get good
health care is you, according to Carolyn M. Clancy, M.D, Director of the
Agency for Healthcare Research and Quality (AHRQ).
This interview highlights
tools and information to help consumers be involved, to help them know what
questions are good to ask, and to learn more about the ways they can stay
healthy. Sky Radio Networks
interviewed Dr. Clancy on January 18, 2008.
Select for to Download Audio (MP3 File, 12 MB; Windows Media® File , 3 MB) (Plugin Software Help).
Narrator: No matter what solutions are found in fixing America's troubled health care system, there is one key player that will have a central
role—and that's the patient. Our next guest is Carolyn Clancy, Director of the
Agency for Healthcare Research and Quality under the Department of Health and
Human Services. She believes, and has the facts to back up her belief, that
patient and consumer involvement is critical to all aspects of our health care
system. And she joins us now on Sky Radio to talk about it. Carolyn, welcome
Dr. Clancy: I'm delighted to be here.
Narrator: We're delighted to have you here. Why must consumers be involved in their health
Dr. Clancy: Well, if you think of it this way, most of us wouldn't
buy a car, a dishwasher, or a washing machine until we had looked into the
safety features, how often it needed to be repaired, other features, how noisy
it is, and so forth. And yet, most people walk right into health care settings,
whether that's a doctor's office, hospital, or emergency room, and just assume
that some guardian angel will take care of all of it for them. If you look at the
facts, what we know is that up to 100,000 patients die every year in hospitals
from medical mistakes. These are avoidable, and we have no reason to think that
that number is decreasing yet. We also know that when patients go to a doctor's
office, they get the right care only about half of the time.
Now, we know that quality is improving in recent years—there's a lot more
report cards and so forth—but the only person who can really make sure that you get good health care is you. And when consumers ask questions, and when
they understand what it is that they need to do to get the best possible care,
the system actually begins to respond. So my agency, the Agency for Healthcare
Research and Quality, which is a mouthful—shortened to AHRQ—actually actively encourages
consumers to be involved in their health care. So, to that end, we've
developed tools and information to help consumers be involved, to help them
know what questions are good to ask, and to learn more about the ways they can
Narrator: Well, on the downside, it is a complex task that's being
assigned to the health care consumer. It seems like now more than ever there's health care Web sites, there's TV shows, publications on health-related topics. How
do consumers make sense of all of it?
Dr. Clancy: You've asked an incredibly important question. There is a
lot of information out there on everything from Google™ to YouTube™ to you name it! There's a lot of
information, but the information on health care comes in many different forms,
and not all of it is good. So having some sense of how to evaluate this
information is very important.
The good news is that good health care information is available. There are a
number of organizations, for example, who have developed information about medical
conditions and about hospital quality. And you want to go to sites from groups
that don't gain financially when you make a decision about specific treatment
options or choose a particular hospital—for example, Consumer Reports. You can
get this information on the Internet, on your home computer, or at the local
library. One that's particularly good is called healthfinder®. That's all one word; it's healthfinder.gov. And this is sponsored by the
U.S. Department of Health and Human Services for consumers and gives links to
about 1,500 health-related organizations.
And on our Web site, that's www.ahrq.gov,
we actually have an entire section labeled, "Choosing Quality Care."
So some of the very specific, practical tools you can get there include advice
about what to do after a diagnosis. Most people hear the name of the diagnosis,
and their mind just goes to Mars right away. So this is very helpful
information in terms of followup questions and so forth. We also have
information on five steps that everyone can take to make sure that they get the
safest health care possible, tips on how to avoid medication errors, and other
valuable information about how you can actually be a sort of co-producer in
Narrator: Now, there's another player involved here. You encourage
consumers to do their own research, but how do doctors react when a patient
brings in information they found, say, on the Internet? Don't some doctors get
Dr. Clancy: Early on, I think some doctors got annoyed. I, for
one, as a doctor, would sometimes hear people make jokes about filing these big
printouts of material in the circular file. But increasingly, doctors, nurses,
and other health professionals really welcome patients who bring information
into the office. It gives them an opportunity to work with patients to identify
which sources are really good and which are far less good. And oftentimes,
they'll be able to point you to other sources of information.
Now, every patient, I think,
in the country—and most doctors would
agree with them—will tell you they don't
have enough time with their doctors. So it's very important to think about this
ahead of time. We found that most patients who we've had the opportunity to
work with agree that it's very important to ask questions. But if you ask them
do they write them down ahead of time, there's like a long pause. And they kind
of say, "Well, no." They sort of think that it will all come to them in the
waiting room, and what happens is they leave the office and realize, "Whoops, I
forgot what happened." So, on our Web site, we actually have a list of questions that
people can ask. And it gives you some sense of the types of things that you
should be asking. We know that, from our annual report on quality of care,
that people aren't asking a lot of questions.
So, for example, the problem
of obesity right now is getting a whole lot of attention. Every time we put out
a publication or analysis on bariatric surgery, the phone rings off the hook.
But the real reason this is important isn't so much the cosmetic or appearance
issue, it's because of the link to type 2 diabetes, to heart disease.
It turns out, though, that
only about 50 percent of obese adults are actually given any advice by health
care professionals about diet. I think that this is a direct reflection of
limited time together. But you can imagine the scenario and interaction is much
different when people go in and say, "This is what I need. I want to lose
weight. You're right. I need some specific advice or some specific places to go
You know, another example is
colon cancer. Every year, about a 150,000 new cases are diagnosed. The only way
colon cancer is cured is if we find it early. Anything else, and we're just
going to be treating symptoms. And yet, just over half of patients actually get
the screening test that's recommended every year. Asthma is another problem,
and the list goes on and on.
So, the take-home message is
it really helps if you think about going in to see a physician or other health
care professional in the same way you'd go in to see your child's teacher or
anyone else—with a list of questions and
issues that you want to cover.
Narrator: Now, is this an issue that affects everyone equally?
Dr. Clancy: Overall, for all of Americans, we know that we have
big quality problems. And it turns out that it doesn't matter where you live.
Virtually every community, every institution, every office practice has got
issues. There's a gap between best possible care and the care that people
We also know, though, that
Blacks, Hispanics, and lower-income people are likely to get even worse care,
according the annual report that my agency does on health care disparities. So,
for example, among people who are older than 65, Blacks, Hispanics, and the
poor are much less likely to receive a very straight-forward vaccine to help
prevent the most common kinds of pneumonia. We also know that different types
of care vary from State to State.
So, again, it really pays to
pay attention to these issues and to make sure that you know what conditions
you are at risk for, what you should be getting information about.
Narrator: Where do you see the quality of the U.S. health care system heading?
Dr. Clancy: Well, the really good news is, based on the data that
we organize every year in this annual
report to the U.S. Congress, we know that the quality of health care in
this country is improving—that's the
good news. The slightly less good news is that it's at a pretty slow pace. So,
it's about 3 percent a year across all settings and people of all ages. So, the
trend is in the right direction, and that's been steady for the last few years.
But it's pretty clear that we need to accelerate the pace of that change.
All of us like to think that
the quality of our health care is the best in the world. You hear
people say that all the time. "Well, you know where they come when they've got
a life-threatening disease," and so forth. And we all want to believe that if
we're sick or one of our loved ones has a life-threatening illness that our
doctors and hospitals are the very best at what they do. But, for all of the
miracle stories and the great results that we hear about on TV and other
sources, there are too many examples where we drop the ball; where patients
simply don't get good care, even when it's fairly routine. And, in fact,
sometimes the care they get makes their conditions worse because of avoidable
mistakes. So we've had to face some pretty tough facts about the quality of
health care in this country that you, as an involved consumer, ought to know
We are working very actively
right now with people who lead health care organizations, with physicians, with
nurses, and others to try to identify and put in place solutions that actually
make health care safer and make the right thing to do the easy thing to do. But
we can't wait until all of that work is perfected. We really need consumers to
Narrator: Over the next 5 years, what changes do you see the
U.S. health care system that will improve the quality of care?
Dr. Clancy: Right now, there's a lot of effort by the Department
of Health and Human Services working in close collaboration with many in the
private sector to try to actually have a health care system. Right now, we have
a sector. You know, for cell phones, if you have T-Mobile® and I have Verizon,
we can talk to each other. The way it works in health care, that's not how it
works, right? One doctor doesn't necessarily have easy, rapid communication
with the hospital; doesn't necessarily send the right information to the
nursing home or rehab facility; and so forth. So we're going to continue to do
the work that we are, supporting the adoption of health information technology,
which means electronic medical records... it means order entry.so that if a
physician prescribes a drug for you which is likely to have a serious adverse
interaction with one you're already taking, they know about it right then. And
the response of most doctors who use these systems now is: "Thank you. Thank
you for letting me know and helping me prevent a mistake." We have to do a lot
to make sure that more doctors find it easy to do that. We're also going to be
seeing more reporting systems for medical errors.
Right now, a lot of the
public is very concerned, as they should be, about the potential for getting
infections in hospitals, for example. So that's a big focus for us this year,
as we try to understand how it is that we can reduce those infections to a
minimum. One very large statewide project that we funded in Michigan actually
found that with fairly straightforward interventions, you can reduce the rates
of serious infections in intensive care units to almost zero and keep them that
low. That's the kind of work that we need to keep doing.
We're also going to be
seeing that, in the next few years, the information that's available to
consumers and that is customized to them is only going to get better. So, for
example, as a consumer you'll be able to log on to a site and say that I want
information about, say, breast cancer, and then you'll be asked if there's more
recent and updated information, do you want us to send that to send that to
you. And I think we're going to be seeing more and more of that in the future.
So all of these advances are incredibly promising, and if it all pulls together
so that in health care we have the equivalent of T-Mobile being able to talk to
Verizon and being able to talk to Sprint and so forth, that'll be wonderful.
But between here and the next few years, when we're hoping all of this begins
to gel, it's very important that consumers stay on alert and make sure that
they've got the right information for themselves.
Narrator: Carolyn Clancy, thank you so much for joining us here
on Sky Radio. Wonderful information.
Dr. Clancy: A pleasure to be here. Thank you.
Narrator: Our guest has been Carolyn Clancy, Director of the
Agency for Healthcare Research and Quality under the Department of Health and
Human Services. We reached her at the Agency's offices in Rockville, Maryland. The Agency and a great deal of very useful information can be found on the Web at www.ahrq.gov.
Current as of April 2008
Getting Involved for Better Health Care. Interview With Carolyn M.
Clancy, January 2008. Audio transcript. Agency for Healthcare Research and
Quality, Rockville, MD. http://www.ahrq.gov/news/trinvolved.htm