What happened to that public outcry of the 1980s? As I have previously written, hospital-related medical errors are considered the third leading cause of death (after heart disease and cancer) in America and the root cause is not individuals, but systems (Study Meta-analysis of studies published in The Journal of Patient Safety, September 2013).
We now need to examine our healthcare systems, as these ongoing studies have concluded: “Medical errors are not caused by ‘bad people’ but in general are caused by ‘good people’ working in bad healthcare systems that must be made safer” (https://www.scribeamerica.com/blog/medical-errors-causes-solutions/).
Meanwhile, these good people are trying harder to improve their individual approaches to care. I read an editorial in JAMA (Journal of American Medical Association) June 12, 2018, entitled The Art of Constructive Worrying. Hats off to those providers trying to do a better job because they “worry” about their patients!
Do you get bogged down in trying to make everything perfect? Perfection is not realistic; mistakes do happen and they are hard to admit. In the health field, it is even harder for providers to admit to a mistake. Put yourself in the shoes of a doctor or nurse who makes a medical error; that error may result in a medical condition that negatively impacts a patient’s life. Doctors and nurses are sometimes haunted by their decisions and spend many wakeful nights second-guessing their actions. When perfection becomes our expectation, a toxic outcome results: we avoid admitting mistakes. If we don’t admit a mistake, it only compounds the issue, as we are unlikely to learn from the mistake.
When working alone, one also worries alone. This can become consuming and distracting. Overall this is destructive. When healthcare providers collaborate, they are more likely to carry out “constructive worrying.” According to that editorial in the June 12, 2018 JAMA, constructive worrying can turn around how a person looks at the situation and helps the individual to focus on corrective action and being more attentive to details. Over time the benefits of constructive worrying result in fewer errors and/or errors of less magnitude.
In the training of nurses and doctors, the culture of making mistakes needs to be more transparent. Team-based care is a helpful solution. It basically means that providers work collaboratively in their approach to caring for a patient. Instead of working alone, providers “put their heads together” in treating their patients. In addition to reducing mistakes, this approach changes the culture because the team members are openly discussing their strategies of care and learning from each other.
On the receiving end of the mistake (the patient), an apology “gets us to a better place” (http://www.perfectapology.com/medical-errors.html). However, there is a reluctance to apologize, especially in the world of medicine. In addition to the concerns about malpractice claims and one’s professional reputation, there are feelings of shame and guilt. In this stressful situation, it becomes difficult to communicate, and many people lack the skills to do so. But the absence of an apology compounds the problems of medical errors because there is a major disruption of patient trust in the doctor-patient or nurse-patient relationship. An apology can restore that relationship.
Although doctors and nurses are concerned about the legal liability, it was discovered that apologies lead to the less lawsuits and increased respect by the community (As Doug Wojcieszak writes about in his book, Sorry Works!). In the 1980s, the debate about disclosing medical errors erupted in the U.S. There was a push for research to address patient safety, new laws were developed to protect patients, and there was an overall strong demand by the public for full disclosure of medical errors. In 2000, the outcome of this public outcry was the publication by the Institute of Medicine (IOM) called To Err is Human. In summary, this publication broke the silence surrounding medical errors and their consequences. It became a national agenda to promote patient safety and reduce medical errors.
As we begin to accept our imperfections, the culture of medical practice will change. The approach to training will transform, followed by the way doctors and nurses practice. The code of ethics – do no harm– must be honored, but let’s hope admitting to mistakes will become easier, followed by an apology. Now that the individual providers are addressing this, let’s make the same demands on those people designing our healthcare systems.
An apology is a childhood lesson that somehow seems to lose its way in the grown-up world!
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