This morning, when I woke up, I called a good friend and colleague to find out about a project we are working on. Before I could even broach the subject, she told me she’d just had a terrible morning. Why, I asked. She’d just gone to see her gynecologist and went in an hour early for her appointment to get some blood work done. The secretary told her to come in at 8 am to do the blood draw. She dutifully arrived only to be told that, in fact, the person who does the blood draws only comes in at nine. Glitch number one.
But that was okay, she was told, because the health care system was updating its computers and introducing all sorts of electronic wizardry (healthcare information technology (HIT) — the kind the Patient Protection and Affordable Care Act (PPACA) has supported and which promises to protect patients from all manner of frightening medical errors and injuries. Because she was early for her appointment with the doctor, she could take the time to fill out a bunch of forms that would provide critical information that would be entered into the computer and would help physicians and nurses etc make better judgments. (Obviously, I added the nurses here because no one in health care would ever talk about anyone on the team other than physicians). Fine, my colleague thought, I’ll be glad to fill out all your forms. Read more >>
There’s a lot of talk today about including patients as members of the healthcare team.This is supposed to help avoid medical errors and injuries and make patient care more about the health of the patient rather than the convenience of their caregivers or the financial well-being of the institutions which care for them.
There’s a lot of talk about including patients in their own care but what about action?In my experience as both patient and observer, there’s not enough in this regard.Take the issue of medication errors.In my experience, doctors and nurses don’t take enough time to thoroughly go over details about the medications they are giving and how they should be taken. Here are just two examples – one from my own experience.
Nursing has been infected with smilitis. Go into any hospital, and check the pictures on the walls. Hospitals often use pictures of nurses to promote the institution. Trouble is, the nurses are always smiling. Doctors look serious, with serious looks on their face, because they know something serious. Nurses, on the other hand, are used to convey an impression of coziness and comfort. Although patients actually find comfort in the fact that the people who are taking care of them actually KNOW what they are doing, hospitals and a lot of nursing organizations seem to ignore this and focus on the sentimental value of the nurse.
Check out nursing websites and what you often find are hearts and smiles. Like for example, Johnson and Johnson’s Campaign for Nursing’s Future. Smiling nurses greet you on every page.
Liberals don’t care about controlling healthcare costs. Or so we just learned from Dr. Ezekiel Emanuel, a well-known oncologist, former presidential advisor on health care policy, now employed as vice provost and professor at the University of Pennsylvania, and still the brother of Rahm, a fellow Obama White House alum who now rules Chicago.
Emanuel (the doctor, not the mayor) made this blatantly false accusation in a Jan 22 New York Times opinion piece. In his article, entitled “What We Give Up for Health Care,” he stitches together a complete straw man – in the form of “liberals” (who knew America still had any?) who are so concerned about securing universal health coverage that they fail to grapple with the problem of medical cost inflation and thus end up depriving other government programs of needed funding. Read more >>
As I think about patient safety and teamwork , I have been reading a lot about how other high reliability, safety-critical industries have achieved better performance in these areas than health care.One of the reasons that high reliability industries are safe is because they recognize that safety is a function of teamwork and that teamwork is not possible with the recognition of a very specific kind of group cognition – what cognitive anthropologist Edwin Hutchins calls “distributed cognition.”In his work on aircraft carriers and aviation for his book, Cognition in the Wild, Hutchins laid out a theory of distributed cognition that is crucial to our understanding of how genuine teamwork functions in complex endeavors. Read more >>