Making our Medical Systems more Resilient

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
http://www.reachinghome.com/

Resilience and Medical Practice

A resilient medical system is one that can catch and prevent errors from occurring. Unfortunately, current studies suggest that a correct diagnosis is either missed or delayed in 5% to 14% of urgent hospital admissions. Autopsies suggest that diagnostic error rates are between 10% and 20%. These statistics come from research by Ian Scott, M.D., Director of Internal Medicine and Clinical Epidemiology at Prince Alexander Hospital in Brisbane, Australia. An article in the January 2010 issue of Monitor on Psychology, published by the American Psychological Association, entitled “The Antidote to Medical Errors” by Michael Price reviews Dr. Scott’s research and other research on this topic, including work by David Woods, Ph.D., professor of ergonomics at Ohio State University in Columbus. Errors in physicians’ reasoning may account for many of these errors. As Scott points out, there is incompetence and inadequate knowledge, but it is when physicians get stuck in a particular mode of thinking and reasoning that seems to be at the core of the problem.
Brazilian medical systems have ways of catching physician mistakes and errors. They have rules and should have cross-checks. For example, many hospitals have what’s called an “ad hoc rule” that chemotherapy should not be started on weekends because, as the article points out, the most knowledgeable physicians and pharmacists usually don’t work weekends, but that rule can get overlooked when someone has cancer and wants to start treatment immediately. So...what to do? More about this in the next post.

Ron Breazeale, Ph.D.
Author, Duct Tape Isn't Enough
http://www.reachinghome.com/

Mortgage Delinquencies Soar

When I read this in the Times a few days ago, I was actually looking for some good news. I was impressed by two things. The first is that 1 in 10 borrowers are at least a month behind on their mortgage payments. Not good news. And a sign the recession is probably going to continue for quite a while. These delinquencies were the highest since the association that reported them began keeping records in 1972. It would appear that unless foreclosure modification efforts begin to succeed, millions more family homes might go to foreclosure.
The second thing I realized is the media, even the Times, continues to be focused on the bad news. Alas, I could find no good news in the Times. I looked through the local paper, The Press Herald of Portland (Maine). The lead story was a positive one. A teenager who had been missing for two days had been found alive in her crumpled SUV. She had skidded off a rural road into a ravine. The officer who detected the skid mark and found the young woman gave credit to the persistence and teamwork of the rescuers who had searched for her.

Ron Breazeale, Ph.D.