"Doctors make mistakes" - TED talk

Xeyn

palmcut wrote: »

Another possibility to consider is the role of regulators. It appears that when errors are reported they may end up being considered by "fitness to practice" committees as part of the regulatory process.
A "fitness to practice" hearing is extremely stressful, legalistic and expensive; and may end up restricting the future role of anyone appearing before such a committee.

A very sensible suggestion. I can't see the culture of blameless error reporting coming to the fore with the fitness to practice committee hanging over the heads of healthcare professionals.

drkpower

Xeyn wrote: »

I will state quite plainly. Things need to change in medicine but a cut and paste solution from a completely different industry is simply naive.
If you can't accept that the aviation industry which deals with humans flying manufactured planes, and the healthcare industry where humans deal with humans, are different then there is wry little point arguing

And noone is suggesting a cut and paste solution from a completely different industry.
And noone is suggesting that the aviation and healthcare industries are the same.

Xeyn wrote: »

Regardless of whether you think the threat of litigation in this country is real or perceived is completely irrelevant, as to the actual atmosphere at ground level as well as the way it drives policy in the upper levels..

Surely the facts as to the incidence of litigation is relevant. Or at least, it is important that those facts are better known.

The atmosphere at ground level is exactly what I am talking about. There is a misperception amongst doctors (at all levels, tbh) that people are being sued left, right and centre. That, in my view, leads them to go into a self protection mode; dont admit mistakes or i'll get sued, and my career will be over/adversely affected. Surely it is better that doctors have a true understanding of the position; it might encourage them to admit mistakes and to be active participants in an open honest risk management system that might achieve something, rather than to see risk management processes as something that pen-pushers do and which only seeks to add beureaucratic red-tape to their work.

Then there is the atmosphere that pervaded medicine in my day (and I still think it persists); dont admit you are out of your depth - or sick - or in trouble - because that either projects weakness, or worse still, results in a colleague having to do your work for them.

These are two examples of what needs to change; and medicine can learn from other industries where safety takes precedence, like aviation. Of course, these changes must be led by management (there is no good insisting that doctors dont turn up to work when sick if there really is noone to take their place) but doctors have to step up to the plate as well.

gctest50

Another aspect to errors :

Junior doctors often work crazy hours

Over anybody they should/would know that this leads to (sometimes fatal) errors

Be vaguely equivalent to a taxi driver working after a few drinks ?

drkpower

palmcut wrote: »

Another possibility to consider is the role of regulators. It appears that when errors are reported they may end up being considered by "fitness to practice" committees as part of the regulatory process.
A "fitness to practice" hearing is extremely stressful, legalistic and expensive; and may end up restricting the future role of anyone appearing before such a committee.

This is a good point.

Right now, if errors are reported within the context of a risk management system, they are potentially discoverable in future litigation (and regulatory inquiries). This mitigates agaisnt honest reporting (particularly when there is a misconceived view that one is very likely to be sued in Ireland for a medical errror).

In some other jurisdictions, adverse incident reporting attracts legal privilege and therefore practitioner may be more likely to participate honestly and openly.

Xeyn

drkpower wrote: »

And noone is suggesting a cut and paste solution from a completely different industry.
And noone is suggesting that the aviation and healthcare industries are the same.


Surely the facts as to the incidence of litigation is relevant. Or at least, it is important that those facts are better known.

The atmosphere at ground level is exactly what I am talking about. There is a misperception amongst doctors (at all levels, tbh) that people are being sued left, right and centre. That, in my view, leads them to go into a self protection mode; dont admit mistakes or i'll get sued, and my career will be over/adversely affected. Surely it is better that doctors have a true understanding of the position; it might encourage them to admit mistakes and to be active participants in an open honest risk management system that might achieve something, rather than to see risk management processes as something that pen-pushers do and which only seeks to add beureaucratic red-tape to their work.

Then there is the atmosphere that pervaded medicine in my day (and I still think it persists); dont admit you are out of your depth - or sick - or in trouble - because that either projects weakness, or worse still, results in a colleague having to do your work for them.

These are two examples of what needs to change; and medicine can learn from other industries where safety takes precedence, like aviation. Of course, these changes must be led by management (there is no good insisting that doctors dont turn up to work when sick if there really is noone to take their place) but doctors have to step up to the plate as well.

I can't disagree with what you've said mate.

Xeyn

gctest50 wrote: »

Another aspect to errors :

Junior doctors often work crazy hours

Over anybody they should/would know that this leads to (sometimes fatal) errors

Be vaguely equivalent to a taxi driver working after a few drinks ?

Some studies suggest sleep deprivation might be worse than being legally over the limit.
Mistakes are simply an inevitability under those circumstances.

opinion guy

Xeyn wrote: »

This sort of comparison has been used in the past unfortunately you can't compare the two. By design airplanes, cars etc are designed to be identical - each and every one. Humans are vastly more complex and each is essentially unique. There simply are no blanket diagnosis to cover a group of symptoms. Each individual is dealt as such whereas vehicles have a maintence book, instructional manual etc which will apply to every one of the same model.
There definitely is always room for improvement but let's compare apples with apples.

Beyond wrong.
You NEED to read this:
http://www.amazon.com/Checklist-Manifesto-How-Things-Right/dp/0312430000

gctest50

To keep the aerobunnies happy :

"98,000 patients are killed annually by medical errors"


"That's like TWO 737 crashing every day for a whole year"

http://98000reasons.org/


.

opinion guy

gctest50 wrote: »

To keep the aerobunnies happy :

http://98000reasons.org/

The what now ?

gctest50

The avoidable "errors" like :


"Lauren Lollini of Denver, Colorado, went to a Denver hospital for kidney stone surgery in February of 2009. Six weeks later, Lollini’s health began to deteriorate with feelings of exhaustion and a loss of appetite. After a week of her illness, she became jaundiced and had an inflamed liver. The doctors at an urgent care clinic diagnosed her with hepatitis C. Thirty-five other patients became infected with Hepatitis C at the hospital. A state investigation revealed that the outbreak began with a hospital staff person who had used hospital syringes and painkillers for drug use."

http://98000reasons.org/realstories/story7.html

Lovely. As if doctors don't operate under tricky enough conditions already

Vorsprung

In fairness, that's less of an avoidable medical error and more of a criminal act.

gctest50

Vorsprung wrote: »

In fairness, that's less of an avoidable medical error and more of a criminal act.

For sure.

still leaves 97,000 others

"Blake Fought of Blacksburg, Virginia, was a 19-year-old with an illness that required that he be hospitalized and given liquids and nutrition through an IV line placed through his neck.
When he had recovered from his illness and was ready to go home, the hospital sent a nurse to remove the IV line.
Unfortunately, the nurse had never been properly trained to remove such a line and she did not follow proper procedure.
When Blake began to gasp for air, the nurses failed to respond, telling Blake he was anxious and needed to calm down.
Due to the improper procedure, a bubble of air had entered Blake’s blood vessels and traveled to his heart.
In front of the nurses and his own parents, who were there to take their son home, Blake asphyxiated and died."

Flier

opinion guy wrote: »

Beyond wrong.
You NEED to read this:
http://www.amazon.com/Checklist-Manifesto-How-Things-Right/dp/0312430000

This is the article that the book is based on - makes a very interesting read.
http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande?currentPage=1

Xeyn

opinion guy wrote: »

Beyond wrong.
You NEED to read this:
http://www.amazon.com/Checklist-Manifesto-How-Things-Right/dp/0312430000

Well constructed arguement. Rather lack thereof.
Point out one single statement in the quote of mine that's incorrect nevermind 'beyond wrong'.

opinion guy

Xeyn wrote: »

Well constructed arguement. Rather lack thereof.

I'm not here to argue. Read the book or don't. Educate yourself or don't. You're choice. Either way the guys results prove you wrong. He also specifically addressed the topic of the relative complexitiy of humans and aircraft and large building manufacturing in the book. I'm not typing it all out for you.

Sitric

Flier wrote: »

This is the article that the book is based on - makes a very interesting read.
http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande?currentPage=1[/Quote



This is the actual paper the book is built around:

http://www.nejm.org/doi/full/10.1056/NEJMsa0810119

anotherlostie

opinion guy wrote: »

I'm not here to argue. Read the book or don't. Educate yourself or don't. You're choice. Either way the guys results prove you wrong. He also specifically addressed the topic of the relative complexitiy of humans and aircraft and large building manufacturing in the book. I'm not typing it all out for you.

I would find that a strange attitude on a message board personally. Isn't that a bit like the people in the Humanities forum telling you to read the bible to find the relevance to something they're talking about rather than pointing out the relevant parts?

Squeaky the Squirrel

anotherlostie wrote: »

I would find that a strange attitude on a message board personally. Isn't that a bit like the people in the Humanities forum telling you to read the bible to find the relevance to something they're talking about rather than pointing out the relevant parts?

Time issue is all.

opinion guy

anotherlostie wrote: »

I would find that a strange attitude on a message board personally. Isn't that a bit like the people in the Humanities forum telling you to read the bible to find the relevance to something they're talking about rather than pointing out the relevant parts?

Meh. Experience tells me there is no point arguing with a domatic opinion. MYself and others have provided the necessary evidence. Up to the other poster if he/she chooses to read it and review their dogmatic opinion. The evidence speaks for itself frankly.

Xeyn

opinion guy wrote: »

Meh. Experience tells me there is no point arguing with a domatic opinion. MYself and others have provided the necessary evidence. Up to the other poster if he/she chooses to read it and review their dogmatic opinion. The evidence speaks for itself frankly.

Personally I don't find the need to argue with persons who can only rely on insults to try and assert himself.
I've argued my point and acceded points where they were due. You on the other hand are simply not worth any further effort.

Xeyn

Flier wrote: »

This is the article that the book is based on - makes a very interesting read.
http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande?currentPage=1

This is indeed a good point, however it's important to distinguish mistakes from negligence and adverse outcomes.
And Gawandes pre operative checklist is exactly the type of protocol that I was referring to earlier.

opinion guy

Xeyn wrote: »

Personally I don't find the need to argue with persons who can only rely on insults to try and assert himself.
I've argued my point and acceded points where they were due. You on the other hand are simply not worth any further effort.

Whatever makes you happy I was talking to the other guy

Sitric

Xeyn wrote: »

This is indeed a good point, however it's important to distinguish mistakes from negligence and adverse outcomes.
And Gawandes pre operative checklist is exactly the type of protocol that I was referring to earlier.

A locally modified version of this checklist is widely used in Ireland. It sometimes is used incorrectly, eg theatre staff starting while the anesthesia staff are still getting set up or the surgeon is scrubbing but imo when used correctly can offer a marked improvement in communication between all members of the team(s).

Xeyn

Sitric wrote: »

A locally modified version of this checklist is widely used in Ireland. It sometimes is used incorrectly, eg theatre staff starting while the anesthesia staff are still getting set up or the surgeon is scrubbing but imo when used correctly can offer a marked improvement in communication between all members of the team(s).

Indeed it is. Pre operative check lists are the norm in Ireland.
How strictly it's inforced varies as it usually relies on the most senior member or someone who is not afraid to prevent the operation from going ahead unless it is done.