Tuesday, May 1, 2012

The Importance of the Individual in Reducing System Errors

I found Atul Gawande's Better to be an extremely fascinating examination into failures and triumphs of the medical profession.  In particular, I was interested in Gawande's Afterward, in which he proposes five "suggestions for becoming a positive deviant." His first suggestion is for doctors to ask their patients unscripted questions, meaning, questions about their lives outside of the ailments that they came to the hospital for.  Gawande rationalizes that when a doctor is able to learn a memorable fact about a patient's personal life, it allows the doctor to see that patient as more of an individual, rather than an anonymous patient as a part of a routine checkup.  I think that this is an intriguing idea, but I also can't help but wonder about the bias factor when doctors engage in friendly relationships with their patients, as we explored in Groopman's book. Gawande's next suggestion is to avoid complaining, which seems like a reasonable and universal piece of advice.  He then notes that "counting something" is helpful in reducing errors such as leaving sponges in a patient during surgery.  This seems logical, and I would fully support the counting of sponges before a doctor decides to close up a patient. Next, he urges doctors to "write something," as writing can allow them to think through a problem and reflect in an alternative way.   Gawande's final piece of advice is "Change," and he urges doctors to stand up for what they believe in and not just be "another white-coated cog in the machine." These suggestions seem to stem from Gawande's personal experience, and I find it interesting that his final word in Better is how to become a more effective doctor, and not how the medical system should implement sweeping changes. He emphasizes the importance of individual people working to improve themselves as the optimal way to change the medical profession as a whole.

1 comment:

  1. I agree with your post because I think that doctors need to get more involved in the patients life, and their lifestyle habits. They need to take more time with each individual patient, as Gawande discuss, and figure out what is good in their lifestyle and what needs change. This knowledge could help a doctor solve an ailment question a lot easier and figure out a better diagnostic procedure. Additionally, I feel that asking these sorts of questions as Casey mentioned would help the patient feel more comfortable with the doctor and therefore be more willing to disclose certain information that is private that would help with the ailment in question that a patient would normally not share if they do not know somebody that well. I don't know how bias factors would play into this though, if the doctor is jut simply getting to know the patient, but still keeps a professional distance, then I see no harm in that and no bias can come from this. I too believe that the doctors should always count their instruments during and after surgery to make limited mistakes. Doctors in general, as Casey mentioned, just need to start having their own opinions and speaking up, whether it be during a surgery or about a patient because what they have to say may be life changing and it may create a turn of events for the better, or make new insight into the situation, rather than just watching as a bystander what other doctors are doing.