Charles L. Bosk’s book Forgive
and Remember: Managing Medical Failure is an in depth ethnography that
investigates the little known world of surgeons. The book differs greatly from How Doctors Think, and I think that this
example is a better way to understand how working as a medical unit may affect
the care of people admitted to a hospital. Although some may be shocked at how impersonal
they may be with their patients, I think that knowing these aspects of surgeons
can ultimately improve how surgeons perform.
Bosk takes Durkheim’s sociological approach in order to understand
the morality of an entire group. Rather than approaching each surgeon
individually, they are viewed as a collective who make mistakes and learn
together and adhere to strict social dynamics within their group. The social
interaction skills unlike Groopman’s book are not with the patients but with
one another. This may because there is a difference between diagnosing patients,
where there is forced patient-doctor interaction, and being skilled at operation,
which is helped by your surgical team. Surgeons ultimately need to listen
to each other in order to stay informed about patients and to learn. As highlighted in the section on error, rank, and
responsibility, it appears that making a technical error (like an infection
from surgery) can be more excusable than normative errors (error in assuming
role). If a normative error is made, it is a miscommunication, perhaps between attending
and house staff that is preventable, which may be why it faces more scrutiny.
As other posts mention, the solidarity of the surgeons may
come at the expense of a patient. Although I would never want to be the guinea
pig of an intern, I think that the book is correct in quoting a surgeon who
says “the way you learn as an intern is by being put on the spot and coming
through it” (53). Through reading this book, I can understand how technical
errors are seen as permissible rather than normative errors. Even in Groopman’s
book, doctors cannot be perfect on the first try, it takes years of practice to
understand how to diagnose and treat patients. However, you can try to control how the housestaff, nurses, interns, and attendings work with one another to be a better team and efficiently help patients. What I enjoy about this book is
that so much emphasis is placed on surgeons as a unit and how they operate as a
team. When the science isn’t always exact and people are unsure of the best way
to operate on a patient, the bond between a skilled attending and an inexperienced intern is a key element to success. Perhaps in changing the culture of surgical
teams, we can improve the way surgeons practice and perform.
I agree with Simone that teamwork is key when trying to create an efficient surgical environment. There are countless elements that must be considered in establishing the proper social climate to ensure success in medicine, especially surgery. In a documentary that I recently watch, a surgeon compared his performance in the operating room to "driving on an icy road for six hours straight." In such a high pressure, densely critical environment, there must be fluidity in communication. Of course, there will always be disparity in the years of experience that each doctor has, but the only way that emerging young surgeons can ever become proficient is to perform surgery. It will always be somebody's first surgery; as in any field, all great surgeons must start somewhere. But, of course, when dealing with the lives of patients, the learning experience is placed under great pressure. In my opinion, the most effective way to minimize mistakes in surgery is to make sure that there is the correct balance between the fluidity in a surgical environment and the establishment of a hierarchy. Also, I think that doctors should be eloquent in their "debate skills" (I couldn't think of another wording), meaning, in every situation, a doctor should be able to give rationale for their actions and communicate that rationale to ensure that everybody is on the same page. It is very difficult to devise a plan to implement such a system of social control. I believe that this book has brought up one of the most interesting and explicit examples of true "Sociology in Medicine."
ReplyDeleteI feel like Simone's post involves everything Bosk is trying to say about the teamwork of surgeons and its positive effects on the practice. I believe that it takes courage to be surgeon, taking on such a big responsibility is not what every person can do and they are brilliant for doing so but they are human too and it is understandable for them to make mistakes every once in a while. It sad for their mistakes to have such big effects on other people's lives, but that's one of the consequences of becoming a surgeon. Then again, two heads are better than one. Mistakes can be brought to a minimum if teamwork is at its maximum. New technological procedures are developed everyday and in medicine change is constant. It is impossible for one person to keep up with every changing aspect of surgery and medicine. That is why I think that Bosk puts so much emphasis on teamwork. He also talks about teamwork in the surgical environment. They go for hours of surgery without food and water along with the stress and pressure of the life of a human being.
ReplyDeleteApart from teamwork, I think that normative errors are unacceptable. Technical errors can happen depending on the patients condition, the doctor can do everything in his/her power but still the patient may get an infection just because his/her immune system is not as strong as it should be. But, it is easier for normative errors not to happen if the surgeon and his/her staff can keep track of the situation and communicate well.