Another Story of Silencing in Medicine

rounds.600Another dispatch from the front lines of patient safety. Several weeks ago, I spoke at a teaching hospital about the difficulties that medical staff encounter when they try to protect patients. I encouraged medical staff to speak up to protect patients, while acknowledging that the environment in which they practice does not – in spite of all protestations to the contrary –encourage such action. After the lecture was over, a striking young woman in her mid-twenties approached me. She asked if she could talk to me to tell me a story about which, she confessed, she feels totally ashamed. Of course, I said. (She asked me not to identify her, or her school, or even the region of the country where she is studying. For the purposes of this blog post, I am going to call her “Carla,” although that is not her name.)

“Carla” explained that she is a fourth year medical student and was, at the time of this incident, a third year student. She was going into her first clinical rotation, which just happened to be in surgery. She and a team of interns, a resident and senior resident … Continue reading

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