In an NY Times Op-Ed article yesterday, neurosurgeon and journalist Sanjay Gupta (@sanjayguptaCNN) cited a recent anonymous survey where orthopedic surgeons said “24 percent of the tests they ordered were medically unnecessary.” The suggestion was that the surgeons were performing the unnecessary tests as a form of “defensive medicine” that is meant less to help the patient than to protect the doctor and hospital from lawsuits. Why has it come to this? How has society come to expect “zero defects” from the medical industry?
Much of my response comes from my work in progress on a book examining the role of failure in both our work and personal lives.
When I think of different professions that don’t “tolerate” failure I think of NASA engineers, military generals, and medical doctors. Why I am not exactly sure. Maybe it was because of the quote “We will not fail” from from the movie Apollo 13, Winston Churchill’s memorable quote “We shall not fail or falter…” from WWII, or from all of those years watching NBC’s hit TV show ER where there always seemed to be a doctor performing some superhuman feat to revive the “defining patient” from that week’s episode? It would be dramatic but more times than not that patient would go on to live happily ever after. For the most part that is how the show ended but not always. The truth was that not every patient survived but most did – just as in real life. Some patients died in the emergency room of “County General” from their condition or injuries and some died because of mistakes made by the doctors and staff – just as in real life.
According to a 1999 report from the Institute of Medicine at least 44,000 people and as many as 98,000 people die in hospitals each year as a result of medical errors that could have been prevented. When you think of that fact for a few minutes and let it soak it that seems like a staggering number. Even if we use the lower estimate that would put the number of deaths from medical errors higher than the number of deaths from vehicle accidents, breast cancer, and AIDS.
Now even one death from error is tragic especially if that error impacts a member of your family but these numbers need to be weighed against astonishing number of hospital visits occur each year. According to a hospital utilization report from the national Center for Disease Control and Prevention (CDC) there are 36.1million inpatient, 109.9 million outpatient, and 123.8 million emergency room visits per year in the United States. With almost 270 million hospital visits per year and less than 100,000 error related deaths calculates to less than a 4% error rate. Now think of the complexity in dealing with that many patients with that many problems – this isn’t quite the same as manufacturing the same product over and over driving toward zero defects.
While the medical industry strives for perfection they understand that there will be mistakes and those failures will have the dire consequences. To learn from those mistakes, most hospitals use a tool they refer to as a “Morbidity and Mortality” (M & M) conference. During these routinely scheduled M & M conferences physicians and sometimes hospital administrators conduct a peer review of the errors made during the care of their patients. The goal of these conferences is to learn from previous complications or errors, modify behaviors and judgments based on those examples, and ultimately avoid making the same mistake in the future. The conferences are generally kept confidential and are not meant to be punitive to the individuals involved, instead focusing on identifying, discussing, and learning from their previous failures.
The life and death industry of human medicine has come to understand the importance of acknowledging our failures and learning from those failures. Why is this concept so foreign in our business organizations? Why do we pretend that failure isn’t an option? Why do we expect that our leaders will have “failure free” records and expect them as criteria for promotion?
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