Forgive
and Remember Charles
Bosk discusses the reasons so many medical mistakes are made in hospitals throughout
the U.S. Some 98,000 people a year die in the U.s. due to preventable error or
misdiagnosis and many live only to have to deal with and pay for additional
medical complications. Bosk discusses the roles residents and learning staff
have in these errors. I am left wondering how these mistakes could be
minimized. Of course experienced doctors could provide more supervision during
the learning process, but the first few years of a doctor’s career are just
that, a learning process. Without having a hands on experience and learning
semi- independently how would these learning health care providers ever really
learn? Bosk describes the level of observation and guidance attending provide their
young staff and how mistakes are often corrected before things get worse.
So long
as you learn, there doesn’t seem to be too much trouble that follows a medical
mistake, unless rank is crossed. Bosk’s description of the different types of mistakes
which are reasonable and simply not allowed; his description made me think of hospitals
as being somewhat military like in how it is run. There are four types of error
which he claims occur: technical,
judgmental, normative, and quasi-normative. Those in which a medical
provider does no respect rank are seen as the gravest. As long as one admits
ones mistakes to ones superior and submits to an inferior role, punishments
seem to be minimal.
One of the most disturbing aspects Bosk
mentioned was relocation as a punishment. It isn’t exactly a punishment to
poorly qualified or trained doctors, so much as a way to prevent these low
quality professional from reflecting on their superiors. You don’t just remove
a pedophile from one church to save it’s good name, he is removed from the
order itself, and so it should be with doctors, in my opinion. Careless providers
should not simply be moved to hospitals which
expect less and in which patients may be less able to advocate for
themselves, the expectations of doctors should just be standardized everywhere.
Doctors should all be good practitioners.
"Forgive and Remember" emphasizes that a hospital setting is filled with learning opportunities that the wiser employees choose to study and understand. The lesson I took away from the experience of reading this book was that there are predetermined relationships that are designed to run a successful hospital. When this design is tampered with, mistakes are more likely to occur. I assumed that as long as someone in the medical profession was handed a diploma as a sign that they were ready to enter the workforce, mistakes would be far and few between. The mistakes that occur because of social and technological factors are actually more frequent and more overlooked. As vulnerable patients, we looks to doctors and nurses as the knowledgable end-all- be-all, however, as the book points out "there are many decisions which surgeons are forced to make in the absence of scientifically established criteria. Great uncertainty surrounds much medical behavior." The assumption that doctors are supposed to make life changing decisions correctly in a matter of seconds every time is too unrealistic especially if we consider that doctors have lives of their own they have to tend to. When doctors act too human by having their emotions about a patient, fellow doctors and nurses, and opinion of the situation influence their behavior, the foolproof system becomes shaken. The only cure I can come up with in order to protect the hospital from further mistakes is to create robotic doctors that are trained in medical school how to think about a situation, be on the same page as everyone else, and also properly improvise when technology fails. Sounds easy enough.
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