How admitting mistakes may improve medicine

This summer I will visit Danielle Ofri in New York. Dr. Ofri is physician at Bellevue Hospital, professor at New York University School of Medicine and editor-in-chief of the Bellevue Literary Review.

At TEDMED 2014 she discussed her experience as a medical trainee when she overlooked a patient’s intracranial bleed.

Ofri notes that the number of decisions which doctors must make every day means that there will always be errors. However, the culture in medical centers is to not to disclose errors. Ofri suggests that the culture needs to change and physicians should accept that mistakes happen and initiate processes to improve. Errors should be used to benefit patients.

“The sheer number of decisions a physician must make every day—diagnosis, prognosis, treatment guidelines, medications, side effects and interactions, to name a few—means it’s nearly impossible to be perfect all the time”

“A certain percentage will always fall short—these are part of our native behavioral flora”. “To think of them as foreign is to misunderstand the nature of error. If we can accept that errors are indigenous to the behavioral biome, then our goal is not some impossible expectation of sanitizing away all medical error, but rather to gather this collective ecology and shift it in our patients’ favor.”

“If we hear from the titans of medicine that errors are a reality in medicine — we might be able to redefine our definition of perfection. Patients are ill-served by an impossible ideal of perfection that gives patients unrealistic expectations and keeps doctors and nurses from coming forward with errors because of shame.”

In her book What Doctors Feel: How Emotions Affect the Practice of Medicine she tells anecdotes from her training to give the reader a feel for what it was like to be in an extremely stressful situation with time pressure, conflicting duties, lack of sleep, life-or-death responsibilities, the highest expectations, and the impossibility of both getting everything done and doing each thing well.

Doctors are often accused of being unfeeling technicians who treat their patients like cases of disease rather than people. Medical students are taught in medical school to remain detached, not get too close to patients, and not show our emotions. That attitude was epitomized in William Osler’s essay Aequanimitas. But doctors have feelings like anyone else, and no one is only rational. A patient might reasonably say “I don’t give a damn how my doctor feels as long as she gets me better,” but emotions affect everything we do, influencing clinical decisions and patient outcomes.

Please, also read her blog about medical errors and the culture of shame.

In 1927 Francis Peabody wrote:

One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.

Danielle Ofri is clearly ‘a Peabody clinician but after reading her books and hear her speak in all kind of interviews and conferences on the internet, I think she also embodies some of ‘the Osler doctor’. An ideal mix, I would say. I really look forward to meet her in person this summer to talk about the importance of Patient-Doctor communication.

Sources: Ama Wire, New York Times, TED, Science Based Medicine, and @danielleofri

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