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MEDICINE CREATED AN EXPECTATION OF PERFECTION
Medicine Is A Field Where A Mistake Can Kill Someone
A Medical Mistake Is Treated As One Provider's Fault
An American Report On Medical Error Described The Opposite
Its Committee Argued That The Systems Failed Rather Than The People
A BMJ Editorial The Next Year Turned To The Clinician
Its Author Called The Doctor Who Errs The Second Victim
This Part Covers The Report The Editorial And What Training Does
THIS NEWSLETTER IS FOR INFORMATIONAL PURPOSES ONLY. NOTHING IN THIS CONTENT CONSTITUTES MEDICAL, PSYCHOLOGICAL, OR PROFESSIONAL ADVICE. ALWAYS CONSULT A QUALIFIED HEALTHCARE PROFESSIONAL BEFORE MAKING ANY HEALTH RELATED DECISIONS.
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OKAY BACK FROM THE WARD 🩺
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THE REPORT AND ITS ESTIMATE 📄
The Institute Of Medicine Published To Err Is Human In 1999
Its Subtitle Is Building A Safer Health System
The Estimate In It Came From Two Studies Of Hospital Admissions
One Used New York Data From 1984
The Other Used Colorado And Utah Data From 1992
Both Counted Injuries Caused By Medical Management
The Rates Were 2.9 And 3.7 Percent
That Committee Extrapolated To American Hospital Admissions In 1997
There Were Over 33.6 Million Admissions That Year
The Result Implies At Least 44,000 Deaths A Year
98,000 Is The Upper End Of The Same Implication
Both Numbers Are Extrapolations Rather Than Counts
The Setting Is Hospitals And Not Health Care As A Whole
Public Views Of Medical Error Also Appear In That Report
Most People View A Medical Mistake As An Individual Provider Issue
The Report Contrasts That With A Failure In The Delivery Process
Some Cases May Stem From Incompetent Or Impaired Providers
The Committee Believed Many Could Likely Have Been Avoided
That Report States The Problem Is Not Bad People In Health Care
Good People Are Working In Bad Systems That Need To Be Made Safer
Legitimate Liability Concerns Discourage Reporting Of Errors
Most Errors And Safety Issues Go Undetected And Unreported
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THE SECOND VICTIM 🩹
Albert Wu Published An Editorial In The BMJ In March 2000
Its Title Names The Doctor As The Second Victim
A Second Line Reads The Doctor Who Makes The Mistake Needs Help Too
Wu Wrote That There Is No Place For Mistakes In Modern Medicine
He Named Technological Wonders And The Apparent Precision Of Tests
Those Innovations Created An Expectation Of Perfection
Patients Need To Consider Their Doctors Infallible
Wu Wrote That Patients Colluded With Doctors To Deny Error
Hospitals React To Every Error As An Anomaly
The Solution Is To Ferret Out And Blame An Individual
A Promise Follows That It Will Never Happen Again
Wu Called That Approach Paradoxical
It Diverted Attention From The Improvements That Could Decrease Errors
Patients Are The First Victims Of Medical Mistakes
Doctors Are Wounded By The Same Errors
Wu Called Them The Second Victims
He Described The Sickening Realisation Of Making A Bad Mistake
The Event Replays Itself Over And Over In A Doctor's Mind
Unconditional Sympathy And Support Are Rarely Forthcoming
Reassurance From Colleagues Is Often Grudging Or Qualified
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PERFECTIONISM INSIDE TRAINING 🎓
A Cohort Study Followed Medical Students From Start To Finish
It Ran At The University Of Queensland In Australia
The Programme Is A Four Year Graduate Entry MD Degree
Its Annual Intake Is Approximately 480 Students
About 65 Percent Of Each Cohort Are Domestic Australians
Students Completed Surveys In First Year And Again In Fourth Year
154 Individuals Completed Both
The Study Measured Concern Over Mistakes As One Perfectionism Score
A Separate Score Measured High Standards
Concern Over Mistakes Was Already Elevated At Baseline
It Increased Again By The Final Year
High Standards Did Not Change
Resilience And Calling Both Decreased Over The Same Period
Ambiguity Tolerance Declined As Well
Baseline Personality Did Not Explain The Increases
The Authors Put That In The Title Of The Paper
An Expectation Of Perfection Is Not The Same As A High Standard
Four Years Of Training Moved One Of Those And Not The Other
