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Are Physicians Still Responsible For Mistakes In Healthcare?

Wed, 07/17/2013 - 9:30am
James C. Salwitz, MD

Who is responsible for mistakes in healthcare?  Who should take credit for success or blame for failure?  Most families, patients and obviously the courts, hold the doctor responsible.  It seems to me this is reasonable; it is the obligation physicians assume and which society returns with empowerment and respect.  However, is this changing because of the Internet and big data?

In 2013, most patients have spent hours on the Internet investigating their medical complaints, before they walk in a doctor’s front door.  Rather than having sole faith in their doctor’s advice and knowledge, they work to become minor experts in their illness.  Patients frequently have tests, diagnosis and treatment in mind (or printed in hand), before the physician even opens their chart.  Does this mean that the balance of responsibility for medical care is shifting toward the patient?  In the future when a mistake happens will we say, “well, she deserved that, she didn’t take the time to look it up on WebMD?”

Both players in this relationship have strengths and weaknesses.  The doctor has years of experience, which can help predict medical futures. They have formal training, the ability to incorporate myriad unrelated conditions, cultivated medical judgment to detect subtle change and the emotional objectivity to make tough recommendations while communicating in a compassionate manner.  Yet physicians have limited time for each case, carry a tendency toward tunnel vision based on preconceived notions which can corrupt differential diagnoses, may have finite “patience” for each patient’s peculiarities and of course in the end are simply human, with all that creature’s colorful flaws.

Relative to the needs of an individual or family, the Internet is a source of massive information, which is infinite in quality, quantity, and patience.  It can connect with experts from anywhere giving up-to-date answers at any moment.  It has no single bias and as a whole is immune to tunnel vision.  On the other hand, the Internet has no ability to focus or tune answers for a specific individual, but must rely on searches from patients who are biased, medically naïve, frightened, and ill.  Patient online investigations often yield bad data, either because the website is unreliable or because the patient does not ask the correct questions.  Hundreds of patients have come to my office having done exhaustive research on the wrong disease. Finally, the Internet has no built in screen to identify high quality sites verses snake oil salesman, who simply had a good web designer.

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