Doctors reflect on medical errors and their profession
In 1927, Harvard physician Francis W. Peabody wrote, “The secret to the care of the patient is in the caring for the patient.”
This is the art of medicine. But is it the culture of medicine? …
Following the 1999 report To Err is Human, and its finding that almost 98,000 Americans die each year from medical errors (a number that came out of the 1999 report), the health care industry could no longer avoid the old aphorism, “physician, heal thyself.”
Put the patient first. Disclose errors immediately, honestly, and completely. That’s the prescription many in the profession have written for themselves. There’s intense resistance from many sectors, of course. But, it’s a remarkable idea. It’s like asking newspapers to emblazon their errors on the front page instead of burying them in a small corrections box deep inside the paper. You don’t see journalists clamoring to do that.
The three physicians (and one medical student) I met were passionate, committed, and determined to improve their profession. They had much more to say than I could fit in one report.
It’s worth listening to Dr. Jerome Groopman talk about what patients can do to prevent misdiagnoses; medical student Deborah Vinton describes the new way she’s being trained; Dr. Sigall Bell shares the emotional impact errors have on doctors and patients; and Dr. Allan Frankel talks about the challenges medicine faces in moving to a culture of transparency.
Dr. Jerome Groopman
Chief of Experimental Medicine, Beth Israel Deaconess Medical Center, and author of How Doctors Think
Groopman is one of the most respected physicians in the Boston area. (He was a member of the medical team that treated the late King Hussein of Jordan.) A prolific writer as well, Groopman’s latest book is about what he calls the “thinking errors” that doctors routinely make in a health care system that forces them to rush.
As a result, almost 20% of patients are routinely misdiagnosed. “The most radical part of my book,” Groopman says, “is the idea that patients have a critical role to play in avoiding errors.”
He says every patient should ask their doctor three simple questions:
Q1: What’s past your first impression?
Q2: Are there pieces of the puzzle that don’t fit?
Q3: Can it be more than one thing?
Deborah Vinton
Third year medical student, Harvard Medical School
There’s been a revolution in medical education in the past decade. Students now routinely take “bedside manner” courses, medical law and ethics seminars, and communications classes. Harvard Medical School recently overhauled its curriculum. Now, students stay at one hospital, and follow a group of patients through their entire health care journey, rather than see patients only once as they rotate from hospital to hospital.
Students like Deborah Vinton are also a “different breed” of doctor, as one physician told me. They know they’ll probably make a medical error sometime in the future. Vinton says it’s a “virtual certainty.” The focus in her medical education now is what to do when a mistake happens.
Dr. Sigall Bell
Infectious Disease Specialist, site director of Harvard’s “Patient-Doctor 3″ course, Beth Israel Deaconess Medical Center
“To err is human,” yes, but also, “to forgive, divine.” Dr. Sigall Bell and her colleague, Dr. Thomas Delbanco investigated that second half of the equation. Dr. Bell wants to understand why the human dimensions of the issue hadn’t been better discussed among physicians.
The findings, published in a paper Guilty, Afraid and Alone - Struggling with Medical Error, were surpising:
She brings these lessons to medical students in Harvard’s “patient-doctor” course. What to do when there’s an error? Bell describes a novel program being piloted at many hospitals: a team of “first responders” or “coaches” who are on-call to attend to the immediate emotional needs of patients and doctors in the chaotic wake of a medical mistake.
Dr. Allan Frankel
Institute for Healthcare Improvement
Dr. Frankel has practiced anesthesiology for a quarter century. He was asked to lead a patient safety team at Newton-Wellesely Hospital in 1995, following a series of maternal deaths. Frankel became one of the leading experts in patient safety, serving as director of patient safety for Partners HealthCare System, and as a board member for the Massachusetts Coalition for the Prevention of Medical Errors.
Frankel looks at the totality of the health care system, everything from lab errors to medical malpractice. Patient safety has everything to do with physician attitude, he says. One of the challenges doctors face, he says, is changing the expectations they have for the historic autonomy in their own profession:
But doctors aren’t working in isolation. They’re part of an enormous health care system that’s very risk averse, he says. Frankel believes that the “culture of the health care industry” deserves equal scrutiny:
Making patients safe means examining the entire health care system, Frankel says. He believes, like many in the patient safety world, that health care needs to adopt techniques used in engineering and aviation: look at the entire system design, identify failures when they happen, be transparent about those failures, collect data, collaborate on solutions, encourage innovation rather than discouraging discussion when there’s a problem, offer liability protection to hospitals that are aggressive about patient safety.
A very daunting task, Frankel admits. But, he says, medicine doesn’t have a choice:
