Last summer, I attended a fascinating conference put on by CAE Healthcare, a company that specializes in healthcare simulation and that is part of CAE, the largest aviation simulation company in the world. The conference gave me greater insight into the promise of simulation technology in healthcare. More on that later.
What I want to write about here, is the message of first speaker at the conference. He was a former Blue Angel – for those not into aviation, the Blue Angels are the elite flying squad of the Navy – John Foley. Foley, like many other former pilots, is now on the business/healthcare/management speaking circuit. His message is one that is dominant in the management world and demands exploration and comment. Read more >>
I just wrote this oped which is being sent out by the Progressive Media Project and has been published in a number of newspapers. Here’s one from the Merced Sun-Star.
For National Patient Safety Awareness Week, we need to take more care
By SUZANNE GORDON
McClatchy-Tribune News ServiceMarch 4, 2014
As we celebrate National Patient Safety Awareness Week, we should ask ourselves why so many doctors are violating the Hippocratic Oath: “First Do No Harm.” It’s what newly minted physicians promise when they graduate from medical school. But it’s a promise that too often goes unkept, with lethal consequences.
As many as 440,000 patients die each year from preventable mistakes. Shockingly, medical harm is the third leading cause of death in the United States, just behind heart disease and cancer.
One reason for this epidemic of patient harm is that hospitals and other health care institutions tolerate staff who routinely ignore proven safety procedures. Fifty percent of health-care workers don’t clean their hands, even though hand-cleaning is the most effective infection prevention mechanism. Too many surgeons fail to implement checklists and timeouts that would assure they are operating on the right limb or organ. Nurses are so harried that they don’t have time to make sure they are giving the right medication to the right person, in the right dose at the right time. And too many lower-level hospital staff don’t challenge higher-level professionals who are about to make a mistake because they fear being reprimanded or even fired.
We know that more than 75 percent of medical errors and injuries result from poor communication and lousy teamwork. Yet, the health care industry (unlike the airline industry) does not routinely train staff at all levels in the basic skills of teamwork and communication. Another reason so many people suffer from medical harm is that too many physicians are putting patients at risk by prescribing invasive treatments patients don’t even need.
For example, decades worth of studies document the dangers of mammograms to women between 40 and 49 with no risk of breast cancer, yet they are still part of routine screening programs. Orthopedists are still recommending surgery for back pain even though studies have long documented that this often does more harm than good.
Or consider the cancers that result from unnecessary CT scans, which are doled out to patients who have no idea that a CT is not in fact one X-ray but a bundle of hundreds. Finally, think of how many people are placed in jeopardy – and dollars misspent – when for-profit health care chains, like Hospital Corporation of America or Health Management Associates, push physicians to admit more patients who would be better treated on an outpatient basis.
Reducing the high number of deaths and injuries caused by medical error is not hard. The federal government has already developed a voluntary program (called TeamSTEPPS) to improve the quality and safety of patient care. Many hospitals have started to use it, with excellent results.
But more need to do so, and every medical facility should upgrade its own internal patient-safety standards.
Until that happens, Hippocrates’ injunction to doctors – “first do no harm” – will remain neatly framed, but too often ignored, on many a medical office wall.
ABOUT THE WRITER
Suzanne Gordon’s latest book is “Beyond the Checklist: What Else Health Care Can Learn from Aviation Teamwork and Safety,” published by Cornell University Press. She is co-editor of the Culture and Politics of Health Care Work Series at Cornell University Press. She wrote this for Progressive Media Project, a source of liberal commentary on domestic and international issues; it is affiliated with The Progressive magazine. Readers may write to the author at: Progressive Media Project, 409 East Main Street, Madison, Wis. 53703; email: firstname.lastname@example.org; Web site: www.progressive.org. For information on PMP’s funding, please visit http://www.progressive.org/pmpabout.html#anchorsupport.
This article was prepared for The Progressive Media Project and is available to MCT subscribers. McClatchy-Tribune did not subsidize the writing of this column; the opinions are those of the writer and do not necessarily represent the views of McClatchy-Tribune or its editors.
It is National Patient Safety Awareness Week and we need to be aware of a serious patient safety problem. That is the failure of many health care professionals to understand the work of their colleagues in other professions or occupations. This makes it difficult for people who should be working together on real teams to value, respect, and share critical information with one another– particularly when making critical patient care decisions. The relationship of physicians and nurses is today, as it has historically been, emblematic of this problem.
Several years ago, for example, a chief resident at a major teaching hospital asked the Dean of the university’s school of nursing if she could explain what nurses actually do. Can you imagine a quarterback asking a coach to explain the role of a defensive end or a pitcher wondering what precisely the third baseman was doing out there? This lack of knowledge is, however, typical or the “healthcare team.”
Sadly, for patient safety, physicians-in-training aren’t the only ones who seem to find the work of their nursing colleagues an impenetrable mystery. In a recent article in the New York Review of Books, one of the most famous physicians in the world publicly confessed that he never really appreciated the importance of nursing until he recently broke his neck and landed in an ICU and then a rehab hospital.
At age 90, Arnold Relman was the editor of the New England Journal of Medicine. a medical educator and long-time commentator about healthcare policy. And yet, he writes that, “I had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled. This is a lesson all physicians and hospital administrators should learn. When nursing is not optimal, patient care is never good. “
Relman’s ignorance about the work of the largest profession in healthcare – people with whom physicians work day in and day out– is not due to the fact that he’s an nonagenarian – an elderly physician whose attitudes will soon be a thing of the past. The chief resident who couldn’t figure out what nurses contribute to patient care was in his early 30’s. Many of the medical students and physicians-in-training who don’t consult nurses about patients before they enter the patient’s room are also 20 or 30 somethings. And the majority of physicians who still yell at nurses when they are woken in the middle of the night or who, studies reveal, abuse or disrespect RNs aren’t all old fogies.
Nor is the problem of physician’s misunderstanding of the role of non-physician players on the healthcare stage limited to RNs. Nutritionists, physical and occupational therapists, social workers, pharmacists all complain that physicians fail to understand the contributions they can bring to patient care and underestimate their knowledge, skill and expertise. The language of contemporary medicine reflects the extent to which physicians have been programmed (I use this word advisedly) to disregard and devalue their non-physician colleagues. In the 19th century, a noted physician described nurses as follows, “There is no proper duty which the nurse has to perform, even to the placing of a pillow, which does not or may not involve a principle, and a principle which can only properly be met by one who has had the advantage of medical instruction. It is a fundamental and dangerous error to maintain that any system of nursing has sources of knowledge not derived from the profession.”
Things have not changed much in the ensuing 150 years. In the contemporary medical lexicon many non-MD health professionals are called “mid-level” providers or “allied health professionals” – allied to medicine that is. As “mid-levels” or “allied”s, nurses, for example, are routinely described as “physician-extenders” or as “the doctor’s eyes and ears” or sometimes even “hands and feet.”
Whether they are depicted as upper or lower extremities, this Adam’s rib view of the nurse and other non-MDs promotes the notion that there is only one mindful professional in the healthcare workplace – the physician. Almost everyone else, it seems, is a mindless automaton who is attached by some invisible line to the physician’s brain since they don’t seem to have one of their own. This conception of mindful and mindless work has, in fact, contaminated all of health care. Nurses commonly refer to nursing aides and assistants as nurse extenders. PTs have their own set of extenders as do pharmacists and many other health professionals.
This practice ignores the fact that many different kinds of health care workers have knowledge and skill, which they, in fact, mobilize not only to assist the physician but to save lives and enhance the quality of patient care. (Consider for example, the fate of the patient who has the best brain surgeon but whose RN is so over-worked he fails to notice the signs of a blood clot, or who contracts a hospital super bug because the housekeeper didn’t have time to adequately clean the room.)
All over the country, hospitals and healthcare professional schools are implementing programs to teach healthcare professionals and other workers to function collaboratively, as members of an inter-professional team. Problem is, in most of these programs, physicians remain the captains of the ship and leaders of the team. How, one wonders, can they lead effectively if they have no idea what their crew members are doing?
In a Sunday New York Times Week in Review opinion piece internist Sandeep Jauhar poses the dilemma that occurs, in his mind at least, of what happens “When Doctors Need to Lie.” (my italics) In it he discusses the virtues of medical paternalism, which he believes, is necessary in certain instances, which he goes on to describe. Jauhar discusses the case of Jamaican patient who needed a heart transplant. The patient’s father insisted his son could not tolerate learning of his diagnosis and treatment recommendation and begged him to simply tell his son that all would be well if he did what the doctor recommended. Jauhar uses this incident to argue that medical paternalism is necessary and that despite our concern for patient autonomy, “there is still a place for old-fashioned paternalism in medicine.” Read more >>
This month has not been a good one for the largest profession in healthcare — nursing. Two reports have once again ratified what nurses have been complaining about for years. That is the fact that cuts in nursing care and poor working conditions impact patient health. When patient care suffers nurses, not the systems that decide to cut back on their services, get blamed. Once again, in too many settings, nurses are asked to nurse against odds that are stacked against them as much of what I wrote almost ten years ago, in my book –Nursing Against the Odds — keeps happening over and over again. The bad news about nursing appeared this month in two articles in British Medical Journals. One was in the BMJ and the other in Quality and Safety in Health Care another BMJ publication. Read more >>