(After multiple technical errors and a faulty wireless connection…many
attempts later)
As some people have mentioned already in their posts, it seems
absurd that doctors would ignore results and refuse to use simple devices like
checklists to save patients’ lives.
This part of the
article reminded me of Gawande’s section in Better about handwashing. He
tells the story of the Viennese obstetrician Ignac Semmelweis who in 1847 figured
out a way to reduce the leading cause of death from childbirth, childbed fever
(puerperal fever). In hospitals, the maternal death rate was 20%, whereas for
home births it was only 1%. With proper handwashing procedures, he got the rate
in his ward to fall to 1%. However, colleagues were offended by the claim that they
were the cause of these deaths and he in turn "took calls for proof as a
personal insult" (16). On both sides, there seems to be an overly large
problem of ego. His colleagues were offended by his theory and he was offended
by their disbelief; a fairly absurd reason to endanger the lives of patients.
In Gawande’s account of the modern-day implementation of proper
handwashing protocols, some similar problems arise. However, the solution of "finding
solutions from insiders" (25) and looking for instances of "positive
deviance" (25) seemed to be one possible solution to the problem of ego.
When the hospital implemented this program, "it was the first time those
people had been heard, the first time they had a chance to innovate for
themselves" (26). This idea of innovating for themselves and change from
within seems to help avoid the problem of ego to some extent. Having to worry
about whether doctors will be personally offended and noncompliant when trying
to save patients’ lives is seems to imply a much larger problem amongst those
who pursue the medical profession today.
Also, for more interesting thoughts from Gawande: http://www.newyorker.com/online/blogs/newsdesk/2011/05/atul-gawande-harvard-medical-school-commencement-address.html
The idea that doctors would choose not to follow proven protocol does seem absurd if the checklist that they follow is proven to save lives. I think the problem is that some doctors may be opposed to following what they view as time consuming steps if there are not results of importance. The example of hand washing that Gawande gives in the book, when the 70% compliance with hand washing began in an American hospital, the practice didn’t change the infection rates, thus making it harder for doctors to want to follow a time consuming rule. Maybe what needs to be done isn’t an outside regulation, but something that comes from the doctors themselves and seems like a team strategy rather than removed regulation. This isn’t only a problem within the medical community, but all closed communities. Gawande’s example of nutritionist Sternin and his anti-starvation program demonstrated that interventions from the outside work best when focusing on “positive deviance” from the norm (25). When village women in Vietnam followed examples of how mothers of well-fed children nourished their kin, the ideas spread. This parallels to doctors and following check-lists. It isn’t so much of an ego and a natural instinct to follow a procedure demanded from within a person’s social group, not outside of it.
ReplyDeleteI thought it was also interesting in Gawande's chapter On Washing Hands when he talked about the young engineer who came into the hospital and "didn't ask, 'Why don't you wash your hands?' He asked, 'Why can't you?'" I thought this was a good example of how framing questions differently can have a huge impact on how people react to you. Because of the way the engineer reframed the question he found that doctors, nurses, and other health care workers weren't necessarily choosing to not wash their hands because they didn't care, but because they felt that they did not physically have time. The engineer also took blame out of the equation and instead focused on how to fix the problem. I think that a lot of problems in medicine could be better dealt with if we weren't always trying to find someone to pin the blame on. For instance, I recently read a book where a medical anthropologist suggested doing away with the term "compliance" entirely in medicine because it implies moral homogeny and also because instead of looking for ways to effectively change people's behavior it looks for ways to coerce them into acting in the way which has been deemed best by someone other than them.
ReplyDelete