With the crash of the Asiana 777, we’re hearing a lot about cockpit culture and how communication across a hierarchy sometimes fails, even when the very lives of the folks communicating (or failing to do so) are on the line. This isn’t a new concept, and isn’t unique to aviation. Many parallels have been drawn between aviation communication and healthcare team communications, especially when real or perceived hierarchies exist.
Given the inadequacies in care for discharged patients — a well-documented and common problem — is it any wonder that so many bounce back to hospitals after they’re sent home? Medicare, the government’s health care program for seniors, has trained its sights on the issue and is focused on trying to reduce the number of seniors readmitted to hospitals shortly after being sent home.
The idea that printed human intervertebral discs might be used in the near future seems especially exciting, because this procedure could impact so many people with the condition who struggle to find a treatment that reduces their pain.
When we tolerate a culture of disrespect, we aren’t just being insensitive, or obtuse, or lazy, or enabling. We’re in fact violating the first commandment of medicine. How can we stand idly by when our casual acceptance of disrespect is causing the same harm to our patients as medication errors, surgical mistakes, handoff lapses, and missed lab results?
Decisions in medicine are supposed to rest on concrete observations and hard evidence. Often, hard evidence does not exist or when it does, it isn’t used. Why is this? Concrete observations, too, are increasingly missed as we stare at computer screens longer and patients less. Yet we persist. Why? This is our reality now, our evolving medical world.
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?
Patients do need the power to complain about bad doctors and, trust me, there are some bad doctors out there. That being said, the other way for patients to get some retribution is to stop seeing that doctor. Word of mouth will spread, like any other business, and that doctor’s business goes under.
On June 10, 2013 a 32-year-old pregnant woman was reported to have died after having an ovary removed instead of her inflamed appendix. As the infected appendix festered, she became septic and succumbed to multiple organ failure. This tragedy occurred in the UK in late 2011, but has just come to light. How could this have happened?
If human head transplants actually took place, imagine the sort of life a recipient would have with a familiar body but an unfamiliar mind. Scratch that, it is probably more accurate to say the mind would be familiar. Either way, the best words to describe the whole idea of a human head transplant are “unnatural” and “fascinating.”
Watching the training of medical students this last month, I am appreciative of the skills and scholarship of many of their teaching attendings, but also am noticing that there is a difference between a physician who has spent his or her time entirely at an academic medical institution and a good community physician.
I am a classic “late adopter.” I get around to trying gizmos and new products long after they have been released. I’m not a Luddite exactly, but I do need to be convinced that a new device or product will benefit my patient and make surgery simpler before I embrace it. I guess the main problem is my pervasive skepticism of “new stuff.” I don’t need one colleague to tell me some innovation is great – I need FIVE colleagues to tell me.
While not all hospitals have the resources to support a development team, hospitals need at least to demand better solutions. Administrators need to stop looking at EMRs as off-the-shelf solutions and meaningful use as a checkbox item. Only then can we leverage the power of technology to improve patient care.
The historian sorts and organizes the past, identifying the important and meaningful events from the trivial, and then interprets the story in order to explain the circumstances of the present. That, I agree, is my task. It is my job to make sense of the events told by the patient and his family. It is my job to create a record of his prior health so that our team move forward and safely develop a plan to help him.
For several years now, healthcare experts have been issuing warnings about an impending severe shortfall of primary care physicians. Policy makers have suggested that nurse practitioners, nurses who have completed graduate-level studies and up to 700 additional hours of supervised clinical work, could fill the gap.
A study analyzed data from 31 hospitals that participated in patient satisfaction surveys, the CMS Surgical Care Improvement Project (SCIP), and employee safety attitudes questionnaires. They found that patient satisfaction did not correlate at all with the rates of hospital compliance with SCIP process measures nor the opinions of employees about the culture of the institution for half the categories questioned.