As a follow up to my post last year about how we need to “learn to tolerate failure… even in the medical profession” I wanted to share this TEDx presentation (Doctors make mistakes. Can we talk about that?) from Dr. Brian Goldman (@NightShiftMD). In it Dr. Goldman captures perfectly the flawed logic of how we all try to portray perfection in our work, especially those god like creates called doctors. In business our failures can cost money or even jobs but in medicine our failures can cost lives. And not just the life of patient who suffered from the original error but the lives of other patients based on the repetition of that same error because it is never shared and thus never learned from.
While I think that Dr. Goldman’s presentation is spot on, I feel that it only covers half of the equation. We hope that our doctors will be more humble and mindful in their race to diagnose our illness. And we expect that because of this they will be less “likely” to err. But even the doctor recognizes that medicine is a less than perfect practice. Even a “refined physician” will still make mistakes.
My suggestion is that the other half of this prescription should be that we as patients need to alter our expectations of what medicine is. We know that medicine is part science but we also need to remember that it is still part art. When we expect nothing less than perfection we are not leaving the door open for doctors to admit their mistakes. And whether or not we want to “allow” these mistakes they will still happen. These failures may costs lives and maybe even the lives of our loved ones but that is part of our humanity, that is part of our human condition.
Dr. Goldman defines these new expectations as “the redefined physician” in which a physician is “human, knows she’s human, accepts it … and she works in a culture of medicine that acknowledges that human beings run the system.”
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A friend had dropped me an email after my post with concern that we are not pushing hard enough on doctors to come clean on their failures as part of this initiative to address mistakes in the medical industry. I thought it might be worth trying to clarify further my position so I have copied in my response below.
Maybe it didn’t come across strong enough in my post but I STRONGLY agree that doctors need to come clean but I also believe that we “the public” have to be honest about our expectations from medicine. It is still part “art” and not all science until we have machines take over. [As to a comparison with the airline industry] I would say air travel is a tough comparison because of the extremely low “failure” rate. Our expectations of perfection from doctors is what pushes the lawsuits out of control and strikes the fear that Dr. Goldman talks about… mistakes cost millions of $ and can result in extreme negative consequences for the doctor. I see it as all part of the system – If we can build in a tolerance for “mistakes” then we can demand more accountability and transparency.
Honestly… thank you for challenging my thinking – it forces me to again reexamine my ideas!
Here is an article that came out in Time today on how doctors are working less but making more mistakes. The article suggests that even though they are working less the doctors are not sleeping more… now how to solve for that?
http://healthland.time.com/2013/03/26/fewer-hours-for-doctors-in-training-leading-to-more-mistakes/
Yep.
There’s an entire literature on physician error, best place to start would be to look at the body of work by Brent James, MD, out of LDS Hospital in Salt Lake. Though maybe the better way to think of this is inappropriate practice variation.
Thanks for sharing Jeff! I have included a link to a NY Times article on “Making Health Care Better” that highlights the “Advanced Training Program” that James’ created.