As I pointed out in a recent post, resilient medical systems are ones that have cross-checks built into them so that they can catch mistakes that are made in the system, such as giving the wrong medication or continuing a medication for too long. Cross-checks usually involve asking questions--the right questions. As the article by Price in the January 2010 Monitor on Psychology points out, questions can be too general and too generic. Asking someone if they’re sure about something isn’t as good as asking them a specific question, such as, “I didn’t know about combining X and Y” when referring to adding another medication to the patient’s treatment.
Another point made in this article is that physicians often use rules of thumb and shortcuts to make a diagnosis and start a course of treatment. This generally works, but sometimes it doesn’t. Sometimes physicians get caught in “mental ruts” and ignore contrary evidence. Critical thinking and thinking outside the box is often what is required to make an accurate diagnosis. Dr. David Woods, a psychologist, believes that many errors in medical systems can be prevented by fostering a climate where seeking advice and second opinions is encouraged, not ridiculed. Openly discussing treatment plans and diagnoses is a good process. Clinical audits and mortality reviews can help assist the providers and the system in being more resilient.
Details provided to a physician by a patient may at times be misleading. For example, a young woman may complain of pain in her lower ribs since she fell during a skiing accident 3 months ago. The physician might make a wrong initial diagnosis of trauma, but in reality the young woman is suffering from non-Hodgkins lymphoma. Both can cause pain in her lower ribs, and one or both need to be ruled out as part of the assessment process. For more information on this topic, refer to Michael Price’s article, “The Antidote to Medical Errors” in the January 2010 issue of Monitor on Psychology, published by the American Psychological Association.
Ron Breazeale, Ph.D.
Author, Duct Tape Isn't Enough