Monday, June 6, 2011

[2/2] Finding someone (or something) to blame.

In my other post, I talked about blame and finger pointing and why they are bad ideas on a philosophical level.  But does that mean fingers shouldn't be pointed?  Am I saying that people who make mistakes should get off without any repercussions?  No.  But I think it needs to be done in a productive way - I like to focus more on the end goal.

As doctors - you need to be hyper-aware of your mistakes.  The best way to describe it is "For everyone to whom much is given, of him shall much be required." -- Luke 12:48.  (Before people get confused, no I'm not Christian).  The "popular" way to interpret this is "to those whom much is given, much is expected".

Much is given to doctors: in many cases it is people's lives.  Thus (understandably) much is expected.  The only way doctors can hope to live up to these expectation is by being very aware of any mistakes that happen, realizing the root cause, fixing it, and making sure it doesn't happen again.  This is very important in the medical field because the question of mistakes happening is not an 'if', but a "when'.  I am not an idealist, so I understand that the steps I mentioned aren't always possible in every case.  For that to be possible, we'd need to understand how everything works... and we are far from that.  Medicine is called an art for a reason.

But this doesn't mean you don't try.

You don't point fingers at the doctor.  You talk to them - about what happened and about how to prevent it in the future.  As part of this process, the doctor has to own his/her mistake.  It's the only way they can improve.

As a side note - here's a good article about why mistakes are a very important part of the learning process. The only issue is that in medicine, mistakes are usually very, very costly.

Bottom line: the doctor, nurse, any healthcare worker (really anyone) who "points" at the doctor to blame him/her should do it in the spirit of trying to improve healthcare.  Not in the spirit of trying to find incompetence.  I'd like to think that most healthcare workers are pretty competent.  Or maybe that's just my naivety?

As patients - (this will be from the perspective of a healthcare worker more so than as a patient) as much as doctors try to help patients with health issues, at the end of the day it is up to the patient to meet us half way (usually it's more like 75% of the way).  Doctors cannot help patients who don't want to help themselves.

So ask yourself what you are trying to accomplish.  Blaming the patient is bad for quite a few reasons (the focus of my other post).  In my view, the main reason it's bad is because it doesn't encourage them to fix the situation.  If your job is to help people (and if you missed that in the job description, let me clarify: that is your job), healthcare workers need to find a better way.

Step 1 of that better way is to have an open and honest conversation about repercussions.  "I'm concerned about your LDL levels and triglycerides being so high because it really increases your chances of having major heart problems.  And there's a good chances they'll occur earlier rather than later in life".

Step 2 is working with the patient to figure out how they can fix the issue.  I'd love to have a one-size-fits-all approach to patients.  Take the issue of healthy nutrition / lifestyle for example: if we could just hand them a card that says "do xyz and abc, and you'll do great!" - that really would be great.  Problem is: it won't work for everyone.  As time consuming as it is, we have to work with patients - ask them how their lifestyle / diet is right now and what they would be willing to change (which usually means what causes the least inconvenience).  No one is going to massively change their lives.  This is especially true for preventative measures - few healthy people will take warnings seriously because... well.. they think they are healthy now so they'll be fine forever!

Bottom line: don't blame.
(1) Tell them you are concerned and what the consequences are
(2) ask them what their current situation is
(3) suggest (or refer to someone who can suggest) changes that wouldn't perturb their current situation too much.

Repeat as necessary.

These are just my opinions - a doe eyed first year med student.  I'm sure people have more advise on the matter (especially the more seasoned veterans - aka real doctors) - and if you do, leave a comment or two!

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