Friday, Sep 5, 2008
The culture of secrecy
BY DR. JEFF DRAYER
(12/02/99)
and
Who's watching the docs?
BY JAMES B. STEWART
(12/02/99)
Substitute the words "airline pilot" (or "copilot" or "mechanic") every time the word "doctor," "resident," "intern" or "attending" appears in this story. Would it then be so easy to wonder how health care professionals can overcome the imperatives of a "culture of secrecy" (and worse, shame and anxiety) in order to save the lives of more people? How did the airline industry do it? If all those pilots and engineers and mechanics could manage safety, why can't health care professionals manage the same kind of thing?
I have a passionate personal interest in this matter. My husband was killed by medical negligence at the medical center associated with the university whose English department he chaired. I wrote a book about his death and about the lawsuit my children and I brought in order to find out what caused that death, but to this day no one at his (and my) institution has violated the "culture of secrecy" to explain to us exactly what happened to my husband -- their colleague.
-- Sandra M. Gilbert
Author, "Wrongful Death: A Memoir" (W.W. Norton, 1997)
Paris
U.S. hospitals must maintain accreditation from the federal government. The accreditation requirements include extensive programs for monitoring and improving quality. Mistakes that are fatal or contribute to a poor outcome are discussed at morbidity and mortality conferences, departmental meetings, nursing staff meetings, pharmacy committees, risk management committees, review boards, credentialing committees, state medical review boards, etc. This is a code of silence?
Only a handful of bad medical outcomes result from truly incompetent health care professionals whose lack of skills were not reported by colleagues. The majority of mistakes in medicine are made by good, caring professionals who erred due to a wide variety of factors: stress, fatigue, distraction, ignorance, confusion, etc. Hang around an emergency room, intensive care unit or surgical recovery suite and try to imagine yourself functioning in that environment for eight to 12 hours a day, day after day, week after week. Could you perform at 100 percent efficiency all the time? Could anyone?
Medical professionals are not surprised that fatal mistakes occur during hospitalizations. Frail patients may not tolerate even relatively minor, short-term mistakes (like one incorrect drug dosage). Many of the patients who died from medical mistakes may not have survived the hospitalization even with perfect care. The errors and deaths are still tragic, but their impact may not be as bad as claimed in the media.
Health care professionals welcome changes that would decrease the chances of making serious mistakes. How much are payors willing to pay for such changes? Some nurses have been replaced by "patient care technicians." Some medical technologists have been replaced by laboratory assistants. Some doctors have been replaced by physician assistants or nurse practitioners. These changes raised the likelihood of error. They were implemented to save money. As with all endeavors, there is a tradeoff between cost and quality. Recently, the pendulum has swung toward saving money. If we Americans change our priorities, then greater efforts can be exerted to improve health care and decrease the likelihood of serious mistakes.
-- Gregory Tetrault, M.D.
As an R.N. with 25 years experience, I wish it were that easy. Medical errors do occur, both by nurses and physicians, but the medical community covers for rather than censures those physicians whose mistakes are egregious, while hospitals continue to allow them to practice in spite of recurring errors. Nursing has no such luxury -- serious mistakes are generally quickly and harshly dealt with.
Until the medical community takes responsibility for itself, deals with incompetent physicians, provides quality assurance and polices its own practices, there will continue to be more mistakes than necessary
-- Rex Walters, R.N.
Savannah, Ga.
Jeff Drayer's article carefully dodges another very touchy issue: a physician's bloated ego. As a professional medical transcriptionist, I have encountered too many mistakes made by careless and/or exhausted physicians which could have easily endangered patient care. I'll never forget the orthopedic surgeon who dictated: "What am I trying to say? I don't know what I'm trying to say. You know what I'm trying to say. Why don't you just put it in, OK?"
One definite improvement would be an impartial board to which medical transcriptionists could report those doctors whose dictation is inaccurate, incompetent or downright dangerous to patients. Peer review by the Medical Records Committee never works because doctors don't like to rat on each other.
-- George Heymont
The prime movers behind the legislation giving patients the right to sue are the trial lawyers. Unfortunately, most of the Congressmen are attorneys themselves and most have received major campaign contributions from both the legal establishment and those in the medical community who'd love to go back to the good old days of fee-for-service and minimal cost controls.
-- Arnold Koch
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