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.