Why Aren’t More Physicians at Patient Safety Conferences?

md and pt safetyThis will be a short blog post, with one question.  Why aren’t more physicians at patient safety conferences?  I am at one now in Canada, two hundred people were in the room.  When I asked how many were nurses over a hundred people raised their hands.  When I asked how many were physicians, guess how many hands went up?  Just two.  This happens everywhere I go.  Last week the same thing happened at an Interprofessional Education (IPE) meeting on the West Coast of the US.  Most patient safety conferences are populated with nurses, sometimes other health professionals, sometimes administrators.  But where are the MDs?  How can we have patient safety if the captain of the ship isn’t coming to the meetings and is not at the safety helm along with a real team as crew?   (Maybe, they just don’t want to hear me speak — always a possibility, except that I don’t think enough of them know about me to have an opinion about me one way or another)  Now maybe physicians will answer that they have their own meetings, physician only meetings that is. While I certainly hope … Continue reading

What Patient Safety Can Learn from New Airline Safety Videos

thumb.phpI’m writing this blogpost from the Delta airplane that I’m traveling on to Detroit to speak at a patient safety conference in Windsor, Canada. I’ve been wanting to write about airline safety videos for some time and what better moment to do so then after I have just seen one.

Airlines want passengers to watch their safety videos. Just like doing a checklist keeps you safe, so too the safety video reminds you that, to be safe, airline travel involves managing threats effectively. Part of the Crew Resource Management training we have written about in Beyond the Checklist: What Else Healthcare Can Learn from Aviation Teamwork and Safety contains modules on Threat and Error Management. Like any high reliability industry, commercial aviation is preoccupied with failure.

Great New Book on the Back Pain Industry

80140100113640LHave any of you ever had back pain? Or maybe the question should be, have any of you never had back pain? Whatever the answer, I want to tell you about a book our series The Culture and Politics of Health Care Work at Cornell University Press has just published. It’s called Watch Your Back: How the Back Pain Industry Is Costing Us More and Giving Us Less by Richard A. Deyo. It is really really important, not only because it will help back pain sufferers figure out what to do – exercise, PT etc.—and what not to do– surgery etc. It will help those who deal with patients with back pain –MDs, PAs, NPs etc – arm themselves with the necessary scientific evidence to resist false fixes and treat back pain with real evidence based practice.   It will also add to the literature on the impact of financial incentives on treatment decisions in an increasingly market driven healthcare system in the US.

Deyo begins his book with an overview of the back pain industry and then, in subsequent chapters, looks at the kinds of treatments this industry – made up … Continue reading

Why Should Physicians Be in Charge of the Dying?

 92111Medical ethicist Ezekiel Emmanuel – brother of Chicago Mayor Rahm – doesn’t want to live past 75. He’s against physician assisted suicide but, as a physician, he believes we should gracefully leave the stage when, in our seventies, we start to go in decline and are no longer at the top of our competitive game. Others like, Atul Gawande, are beginning to rethink the myth of cure when we’re diagnosed with a terminal illness, like lung or pancreatic cancer . Still others are fighting for the right to physician assisted suicide –whether for a person who has Alzeheimers, ALS, cancer or some other terrible disease. Some even think physicians should be able to administer euthanasia to the terminally ill.

For decades the debate about how to gracefully – and less expensively – make one’s final exit has raged in America. The choices are usually stark and limited. Choice number one: suffer till the bitter end under the guidance of physicians who continue to treat even when there is no hope of cure or even much relief from pain. Choice number two: physician assisted suicide or actual physician delivered … Continue reading

Shame and Blame with Ebola

2009-08-07-blame_toon_andgrantcardone1As I’ve traveled around the country recently talking to nurses, doctors, and others in healthcare about the recent Ebola scare, I am struck by how many people have been quick to blame nurses and other healthcare workers for what happened in Texas.   There seems to have somehow been a glitch – a very serious one – in communication between emergency room physicians nurses regarding Mr. Duncan’s care. Although it is impossible for us to know precisely what happened in this case, what seems clear is that nurses knew that Duncan was suffering from a fever but did not convey this with enough urgency to emergency room physicians. Similarly, emergency room physicians seem not to have read the nurses’ notes section of the patient’s electronic medical record. As a result of this and many other problems, Duncan was not admitted to the hospital early in his presentation of Ebola. He was instead discharged and took the disease into the community and did not get speedy treatment, which might have saved his life.

In my discussions of this case, many nurses and physicians I talked with were very critical of the actions … Continue reading