by Zoe Kiren Deol, MD, FACS
This morning, I am sitting in front of my computer, drinking my coffee, and chatting with a good friend from my surgical residency days named Chris. Chris is helping me with a humanitarian project that I am currently working on. I am designing solar and wind powered units that can run a small surgical clinic in a remote area, or in areas of disaster relief. As Chris and I talk, I see the devastating updates on the situation in Haiti flash up on my muted TV. This injects a sense of urgency through my veins resulting in a rush of adrenaline. If anyone can help me accomplish this task, it is Chris.
Chris has a long history of humanitarian work, spanning back to his years as a surgical resident in metro-Detroit. During his research year, Chris spent time in the Sudan in Africa. Since then, he has continued his efforts with various organizations including the world renowned “Doctors Without Borders” (Médecins sans Frontières). To this day, I can clearly remember Chris’ presentation of his African trip to our hospital. The point that stuck me the most was his comparison of what constituted a crisis in the US vs. what constituted a crisis in the Sudan.
In a typical hospital in the United States, we have whole committees created to analyze and improve the single action of putting up a patient’s bed rails during transport. In fact, I believe some of us were “written-up” for omitting this critical detail during our surgical training. Chris calmly pointed out that, in the Sudan, they did not have any side rails on their beds, and no one ever fell out. Their typical crisis was losing power … mid operation … in the dark. Yet, they always managed to make do with whatever they had. Their outcomes were also surprisingly good. With so very few doctors, and so many patients, they were able to provide quality care in a remote area of Africa.
As a resident, I could not understand why our medical system had become so bogged down with red tape that it had literally hog-tied itself. After years in private practice, and some of my own work overseas, I have a much different perspective. The critical difference between operating in the US and operating …… almost anywhere else in the world, is what I call “defensive practicing”.
While Chris was in the Sudan, all of his thoughts were focused on helping his patient. Back in the US, your thoughts are dragged away from the patient, and steered towards avoiding a lawsuit. This unfortunate reality has evolved as our country has progressed. While I do believe that accountability is a necessary part of quality control, I also believe that it can be taken it to the point of absurdity.
I am going to date myself with this next reference, but does anyone remember an episode of Star Trek (the original one with Leonard Nimoy and William Shatner) where Captain Kirk visits planet Earth many years into our future?
Captain Kirk “beams” down to earth and immediately notices that everyone on the street is walking along side a second person wearing a business suit and carrying a brief case. As the Captain walks along, trying to figure out the reason for this odd spectacle, he bumps into someone. Captain Kirk reflexly apologizes. A gasp goes up from other passersby, and the “injured” person’s companion (in the suit) pops open his brief case and hands Captain Kirk a paper to sign, stating his responsibility over the “incident”.
We later come to learn that the show is foreshadowing a time on planet earth where our society has become so litigious that every person is accompanied by a lawyer whose sole responsibility is to fend off a lawsuit from everyone else.
Now, I am not a Trekkie (in fact I had to Google that word to figure out how to spell it…). Yes ….. I Googled! But that episode slowly emerged from the depths of my brain somewhere as I progressed from medical school, through residency, and into private practice. I guess the question I will leave you with is this: Are we there yet?
What's your take? E-mail firstname.lastname@example.org
Dr. Deol is a self-employed, board-certified general surgeon.