Do No Harm or If a Doctor Does the Need to Admit to Conduct That Injures
Hippocrates insisted that “The physician must . . . have two special objects in view with regard to disease, namely, to do good or to do no harm.” It is with the faith that their physicians will “do good” or at least “do no harm” that patients seek out medical care. Recent studies have indicated that physicians are poorly trained in matters of patient safety and practice in an environment that often work against the wellbeing of those seeking their expertise.
A recent study by the National Patient Safety Foundation noted that medical schools today focus principally on providing students with the knowledge and skills they need for the technical practice of medicine, but often pay inadequate attention to teaching how student how they as physicians can promote patient safety. Medical schools’ focus on technical medicine rather than patient safety, combined with a traditional approach to teaching which fosters humiliation and fear, has led to a crisis in patient care, which is only beginning to be adequately addressed.
The Culture of Fear
The medical community has recently lavished a great deal of attention on the subject of patient safety. To promote patient safety, many hospitals have implemented checklists to ensure that healthcare providers are not inadvertently omitting important safety steps or procedures. People who repeatedly perform the same procedure do not have to consciously think about the procedure because they have performed it so many times it becomes second nature. This, however, is where mistakes occur because people unconsciously omit important safety steps that can lead to injury. Typically, the person is not conscious of missing the step. To prevent this, airline pilots have adopted checklists in flying a plane to ensure that the pilot never inadvertently omits an important safety step. Noted Harvard surgeon Atul Gawanda has written a book, The Checklist Manifesto, which discusses how checklists can be used in healthcare to save lives and promote patient safety.
Medical schools, which should work to instill patient safety-conscious behavior in physicians, have traditionally exhibited a startling lack of attention to teaching the next generation of caregivers what they need to know to keep patients safe. The Joint Commission Journal on Quality and Patient Safety recently reported that a majority of medical residents have never written up an incident report. Only 85 medical schools require that students take a course in patient safety in comparison with 125 that require a course in cultural diversity and 100 that require a course in biological/chemical terrorism. Researchers have found that even those hospitals and medical schools that stress the importance of patient safety tend to neglect teaching such basic skills as how to fill out an incident report.
Even when residents and physicians are aware of the procedures necessary to report a mistake, many are reluctant to actually report them. Dr. Lucian Leape, a leading expert in patient safety at the Harvard School of Public Health who chaired the National Patient Safety Foundation study, noted recently in the New York Times that, “young doctors are being educated in a toxic culture.” Physicians report that they often fail to report medical mistakes to avoid the risk of being viewed as troublemakers, naïve, and incompetent. It is problematic for both health care providers and patients that residents and physicians are so concerned with their image and what damaging that image might do to their careers that they feel they cannot speak up when mistakes are made. Unfortunately, too few doctors are willing to admit when medical malpractice has occurred. Moreover, many physicians are reluctant to become expert for the patient and testify that another physician was negligent. Moreover, the leading experts in medicine are often too willing to come forward in the defense of a physician, but are unwilling to come forward to criticize a physician on behalf of a patient.
Effects and Possible Solutions
When physicians fail to admit that their conduct has injured a patient, they compromise patient care and safety and impede the progress of healthcare. Not only is the patient left without a full understanding of the reasons for her injury, doctors are unable to learn from each other’s human error in order to prevent similar conduct from occurring in the future. This lack of disclosing medical negligence has undoubtedly contributed to the repetition of such conduct by others. Studies suggest that if patient safety was made a greater priority, up to two million patients a year would avoid hospital-acquired infections, and hundreds of thousands of people would be spared from medication errors made every year in U.S. hospitals.
The National Patient Safety Foundation study outlines twelve recommendations for improving patient safety through better training in medical schools and opening more channels of communication between doctors in order to better report and address prevention of conduct that reduces patient safety. The study’s first recommendation epitomizes the necessary institutional and cultural shift that needs to occur for the benefit of patients everywhere: “Medical schools and teaching hospitals should place the highest priority on creating learning cultures that emphasize patient safety, model professionalism, enhance collaborative behavior, encourage transparency and value the individual learner.”
For Further Reference
If you or someone you care are about has been injured as result of a preventable medical error, please seek the counsel of a trial attorney with experience representing patients in medical malpractice cases.
Date: June 29, 2014