Trust and Safety in Medicine: Part One by Matthew Waitner M2

George_WashingtonI have been participating in the Telluride East conference taking place in Washington, DC since August 1. In the whirlwind two days I have been barraged by information, struggled through leadership, boggled by safety concerns, and simply overwhelmed by my own emotions.  To put it bluntly, this is the most interesting two days I have spent all summer, and even though I am exhausted, I am beyond stimulated by the experience of this conference.  One minute we are hearing from Paul Levy on negotiations and the next we are working on teamwork and leadership in a teeter totter game with 9 teammates, a 2×8, a cinder block and 2 eggs.  Suffice to say this is truly a hands on and experiential learning experience like none other.

In reflecting on the past two days I have stumbled upon many thought trains (thanks Cliff), but one that my psyche continues to grapple with is the following conundrum: How can the medical community as a whole commit so many errors as to kill nearly 100,000 patients yearly (for at least 13 years according to the IOM), and still be considered one of the most trustworthy professions in the country?

All I have to say is, whatever PR firm is handling healthcare’s interest deserves some large bonuses for pulling off this feat.  Nurses, Pharmacists, and Doctors all top the list here in the US according to the most recent Gallup poll in November (http://www.gallup.com/poll/1654/honesty-ethics-professions.aspx), nurses rank #4 and physicians #6 in Australia (http://www.readersdigest.com.au/most-trusted-professions-2013) and doctors rank #1 in the UK (http://www.gponline.com/News/article/1171314/Poll-reveals-doctors-trusted-profession/).  Seriously – this PR firm not only succeeded here in the US, but internationally as well.  I am stunned because on average (in the US) we kill 272 people per day due to medical errors which is the equivalent of two Boeing 737 crashing each and every day (total capacity per 737 = 137).

According to today’s presentation by Terry Fairbanks, we have a 1:616 adverse incident rate as a field – akin to bungee jumping in safety, while other professions soar in safety comparatively.  How could we possibly still believe then that healthcare professionals are still worthy of the patient’s trust? My only conclusion is that we as a profession do not deserve such accolades until we get our house in order and focus on patient safety.

What continues to be mind-boggling about this conundrum is that the population polled must have had some interaction at one point or another with the medical field.  Healthcare touches nearly every life in the country either directly or indirectly, and yet we are still given the distinct honor of being one of the most trustworthy professions.  This is even after Press Ganey scores (indicating mediocre treatment in the hospital, as any front-line employee will indicate), after outrageous hospital acquired infection rates (about 1.7 million yearly according to the CDC), and our dismal rate of iatrogenic death previously discussed.  Why are people not more outraged at these numbers?  As a future physician, these numbers are staggering and show that truly patients should not trust our professions.  So, truly, whatever PR firm is handling medicine must be doing one hell of a job and be making a killing in the process.  Seriously though, these numbers and our perception are at complete odds with one another and deserve to be honestly considered.

The only conclusion I have been able to draw from this analysis is that the healthcare profession has been given nearly implicit trust by our patients, by simply putting on a white coat, and we have done a horrible and dismal job of accepting that trust and caring for our patients safely.  Again I ask, where is the outrage?  Are people not doing the math? Where is the expose on 60 minutes or 20/20?  Frankly I’m surprised anyone trusts us at all, and if we are going to continue to receive such trust, we best make some changes fast to ensure that this trust is correctly placed.   From my perspective, somewhere in our profession, we have determined that while patients are the reason we exist, they are not to be treated as having such power.  Instead of being patient centered and safety conscious, we have turned healing into a business focused on doing more and caring less.  I am appalled as a future professional that this has been allowed to occur.  I, as many others reading this blog, came to this profession in order to diagnose, heal, and comfort people in their most dire need.  How could our profession have lost sight of our reasons for entering the profession in the first place?

Stay tuned for Part 2…

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One Response to Trust and Safety in Medicine: Part One by Matthew Waitner M2

  1. Richard C. Boothman says:

    Dear Matthew,

    I read with much interest the Telluride postings and I fully support Dave Mayer’s work which is deeply rooted in his conviction that though we might work hard to change the status quo toward improvement, you and your colleagues represent the very best shot we all have in making serious and durable change. We all have choices to make about how we spend the ultimate fixed resource – our time and passion; Dave has dedicated himself smartly where effort may yield the greatest benefit. His passion and commitment to the young is not misplaced and your post confirms the wisdom of Dave’s choice.

    BUT . . . as we identify what is wrong and work to correct it, it is equally important not to lose our way and destroy what is right. Understandably, after a few intense days focusing on the negative, you ask “Where is the outrage?”

    Patience is not always a virtue, especially where lives are at stake. Without question, we’ve been far too patient with ourselves and the problems we’ve known about for a very long time. We must move deliberately and courageously to fix what’s broken, re-orient what’s misdirected, rethink what’s no longer relevant or useful.

    BUT . . . I worry that you and your colleagues will despair. That you’ll lose heart. That you’ll lose the drive and the dedication and the determination to salvage what is right while fixing what is wrong even before you get started. That you’ll give up before trying.

    Do not get jaded. Do not despair at the magnitude of the problems to which you’re being introduced. Despite more than thirty years of supporting health care providers in their very worst moments, I see more miracles large and small every single day. I see the positive difference all of you make for all of us. In spite of your human frailties and imperfections. In spite of systems that are fundamentally flawed, outdated and challenged by an unbelievable array of perverse incentives.

    Despite thirty years’ worth of opportunities to become cynical, I am humbled every day by all of you.

    Our daughter just finished her second year in medical school and she’s in the midst of her clinical rotations – I will never forget the sense of awe I saw in her face as she excitedly described for me and her mom the first time she actually laid hands on another person and diagnosed a heart murmur. And the overwhelming sense of responsibility she also felt when that patient put her life, her hopes, her body in my daughter’s amateur hands. I hope she will never forget that either. As I lawyer, I can only imagine that every one of you has had similar moments in your training.

    Self-flagellation may have its place somewhere I suppose, but I don’t think it’s very constructive in general. And being overly condemning only makes the status quo hunker down in defensiveness.

    As Dr. Mayer and his colleagues introduce you to the multiplicity and magnitude of the challenges we have, never lose your sense of awe. Work consciously your whole career to hold that profound feeling in your hearts and minds no matter what. Be proud of what you’re part of. And treasure the awesome privilege you have to touch us and heal us and help us.

    We are all in this together.

    Sincerely,

    Rick Boothman
    Executive Director of Clinical Safety
    The University of Michigan Health System

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