A Patient Safety Leader Speaks Out

An interview with patient safety leader Dr. Robert Wachter in the New York Times was both encouraging and dismaying. Encouraging because Dr. Wachter gets it right about what the medical system needs to do to make health care safer. Dismaying for some of the shrill and hysterical comments from physicians posted on the NYT blog in response.

Dr. Wachter, a hospitalist at UC-San Francisco, made a number of sensible points, including:

* Financial incentives need to be better aligned with safety. Instead, the incentives are mostly focused on getting paid by insurance companies. Quote:

“For instance, I can lose my hospital privileges if I fail to sign a dictated discharge summary or operative note. But if I don’t clean my hands for the next 10 years, nothing will happen to me.”

* More honesty is needed when confronting errors. Quote:

“The only way we are going to fix this problem is to become much more open and transparent. That transparency will drive us to improve and allows us to educate each other.”

* Standardizing safety routines is urgently needed. Quote:

“The chaos of everyone doing things their own way is incredibly dangerous, and it is that chaos which gets in the way of the [doctor-patient] relationship. You can make health care better, safer and less expensive while strengthening the core of the patient-doctor relationship. You can standardize certain parts of care based on clear evidence, which will free up doctors to focus on those pieces of the health care puzzle where there is no data – those issues that are uniquely human and that require judgment, expertise and empathy.”

Now for the dismaying part. If you scroll through the “Well” blog comments on Dr. Pauline Chen’s interview with Dr. Wachter, the ones with “MD” behind their name jump out for their … well, judge for yourself:

A reader who identified himself as Dr. Mark Johnson: “Wachter is attention-craving sensationist, apparently employed by NYT on their anti-doctor crusade. Is he even practicing medicine? Has he ever worked outside of academia?”

Another reader who signed as Anonymous: “It’s simple. If you don’t trust the medical system, just don’t use it. Don’t come see me when you’re in a trauma. Don’t come see me when you want an elective procedure. Just don’t come see me. It saves me the energy that I waste catering to people who hate me and distrust everything I do.”

Another one, who identified himself as Mark Davis, M.D., had a similar suggestion that patients should just move out of the country if they don’t like it.

Back to a more encouraging take:

It was good to see many, many other readers writing in with thoughtful comments and ideas about how we can improve health care for everyone. The only ones that made me wince were those that demonized lawyers who represent injured patients. Some of them have the naive idea that if lawsuits were lessened, everyone in health care would come forward with more honest confessions about their errors, which would lead to vast improvement. The fact is that even countries with very little malpractice litigation, like England, have the same problem with the culture of secrecy in medicine.

Killing the messenger who delivers the bad news won’t solve the problem.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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