The problems in the medical industry are due to an obsolete professional culture

(written by lawrence krubner, however indented passages are often quotes). You can contact lawrence at: lawrence@krubner.com, or follow me on Twitter.

I enjoyed reading this interview with James Bagian.

How does the healthcare industry compare to engineering and aeronautics when it comes to dealing with human error?

Not favorably. Much of my background is in what’s called high-reliability industries—the ones that operate under conditions of high hazard yet seldom have a bad event—and people in those fields tend to have a systems perspective. We’re not terribly interested in what some individual did. We want to know what led up to a bad event and what changes we need to make to reduce the likelihood of that event ever happening again.

When I got into healthcare, I felt like I’d stepped into an entirely different world. It was all about, “Let’s figure out who screwed up and blame them and punish them and explain to them why they’re stupid.” To me, it’s almost like whistling past the grave. When we demonize the person associated with a bad event, it makes us feel better. It’s like saying, “We’re not stupid so it won’t happen to us.” Whereas in fact it could happen to us tomorrow.

Why do you think healthcare lags so far behind in this respect?

For one thing, in healthcare there’s tons of variation, in both biology and behavior, so physicians are rightly skeptical of the cookie-cutter approach. They think you have to tailor everything to the individual. There’s some truth to that, but the tailoring should be based on what helps the patient, not on your own personal preference.

And then, too, medicine is much older than these other fields, eons old, and for most of that time there wasn’t PubMed or the AMA or what have you. It was all about the expertise of the individual practitioner. It’s a short step from there to assuming that problems in medicine stem from problematic individuals. That’s why we have this whole “train and blame” mentality in medical culture; someone makes a mistake, you train them not to do it anymore, and then you punish them if it happens again. I think we’ve ridden that horse about as far as we can.

That suggests that the biggest obstacle to reducing medical error is medical culture, rather than our understanding of the human body or the quality of the available technologies and treatments.

It’s all those things, but first and foremost, yes, it’s cultural. But I should say before we go any further that I don’t usually use the term “error.” For starters, it distracts people from the real goal, which isn’t reducing error but reducing harm. And it also feeds into precisely the cultural problem we’re discussing. It has a punitive feel, and it suggests that the right answer was available at the time, which isn’t always the case.

Post external references

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    http://www.slate.com/blogs/blogs/thewrongstuff/archive/2010/06/28/risky-business-james-bagian-nasa-astronaut-turned-patient-safety-expert-on-being-wrong.aspx
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