Can we redefine the physician ? From ‘doing things to people’ to ‘doing things for people’

Medical system, like any other enterprise, happens to be run by humans. But why do mistakes by doctors seem so outrageous to other people? Are doctors supposed to be perfect? The usual refrain – Why not? People trust you with their lives! Wait a second, we are not the only ones dealing with lives. How about the airlines industry. With them it is more like 300 lives depending on 2 pilots. Why is there a double standard when it comes to medical error!

True, we all know how to deal with the mistakes in our personal lives. The universal remedy for mistake is communication. Acknowledge, talk about it, forgive and best of all learn from it. Can we say the same when it comes to medical practice? I’m afraid no. Institute of Medicine pegs the number of deaths attributed to medical errors in U.S. at just under 100,000 every year. And that number almost certainly is a conservative estimate given that its a taboo subject within the discipline. Imagine the corresponding number in the developing world. The thought is disturbing.

I love that nothing scares a general surgeon

Does the problem lie in the social construct of medicine? Looks likely. We don’t come out of medical school thinking “ok I’ll try my best to avoid mistakes”. Its not allowed, even if implicitly. You need confidence to start and sustain the job and accept the psychological burden of taking another person’s life into your hands. It’s part of the prerogatives you earn in medical school.

“We send each one of them out into the world with the admonition, be perfect. Never ever, ever make a mistake, but you worry about the details, about how that’s going to happen.” That’s quoted from Brian Goldman’s thought-provoking TED Talk lecture titled, “Doctors make mistakes. Can we talk about it.” In this video, Brian talks about the culture of denial in medicine – the denial of errors and the toll it takes on the physician himself in addition to the patient. He does an excellent job of letting the audience peer inside a doctor’s emotional life with regards to mistakes and errors. “And we have this idea that if we drive the people who make mistakes out of medicine, what will we be left with, but a safe system.” (Here’s some unbelievable statistics from U.S. “Facts About Physician Depression and Suicide”)

In his fascinating book “The Youngest Science“, Lewis Thomas (1913-1993) provides a compelling narrative of “what medicine was, and what it has become; its evolution from hand-holding to scientific care; its complete transformation from an art of comforting to the hard core science of healing”. Healing at the cost of dehumanizing. This is a thought provoking must-read both for patients and doctors. “As a medical intern in 1937. Back then medicine was cheap but ineffective. The main benefits of hospitals were warmth, food, shelter and attention from nurses. Doctors and medicine made hardly any difference.”

Fast-forward a few decades, we find ourselves immersed in a world of incredible complexity. 4000 surgical procedures, 6000 licensed drugs and cures for nearly all of the imaginable illnesses. Yet we are far from satisfied. Perhaps we can learn from a best practice in airlines industry. It has an inbuilt system where pilots voluntarily report critical incidents, be it a near-miss mid-air collision, a simple human error or just a machine failure. The reporting is anonymous; guaranteed against any penal action. Best of all, no one can trace back the error to the reporting pilot. That’s the first step in quality assurance. We cannot correct what we don’t know or are unwilling to admit..

There’s no doubting the admirable medical science. However, we still have to deal with the flaws. As humans we will make mistakes. Is it possible to make a back up for the inevitable errors that will occur? Can we just update our culture accordingly? Better still, can we move over from “too-much medicine” to “patient-centered medicine”? Only time will tell.

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