You can't get it right every time - Guardian
""Most of the time, they are patients whom I think I've done all I possibly could for, so I can accept it. But there are always the others. Six months ago, I was performing a thyroid operation on a teacher my age and damaged a nerve that led to her vocal cords. This woman can no longer talk and has had to give up work. The only way I can live with myself is to try to do all I can for her and understand what I did wrong and do better next time. Being sorry is not enough."
Gawande is a general surgeon at the Brigham and Women's Hospital in Boston and assistant professor at Harvard Medical School. And he still makes mistakes. It's this uncomfortable wound that he has opened up, first in Complications - his bestselling book that was shortlisted for the National Book prize in the US and became the inspiration for the TV series Grey's Anatomy - and now in his follow-up, Better.
"What I'm interested in is failure," he says, "as it's the one area of medicine with which the professionals are often reluctant to engage because the stakes we are playing for are so high. We can fail by putting a decimal point in the wrong place and by not asking the right questions. If you ask any doctor when he or she last made a misdiagnosis, the truthful answer would always be in the last month. We get things wrong and we try to put them right. And, of course, we can fail with a slip of the hand. I once performed an emergency trachaeotomy in which I did everything wrong. I had the wrong knife, the wrong lights and I made the wrong incision. There was blood everywhere and the patient would have died if a colleague hadn't stepped in to help. It was horrific."
If his call for willingness to ruthlessly examine what goes wrong and why is not always shared by other doctors, then neither will be the second part of his prescription for demystifying failure. Mention league tables to most doctors and they start spitting blood, but Gawande is adamant that there is a value in open accountability. "You have to be careful you are comparing like with like," he says, by way of a caveat, "because otherwise the data can be meaningless. For instance, death rates for cardiac surgeons can vary hugely, depending on the age of their patients and the difficulty of the procedures they are undertaking. But we shouldn't allow this to disguise the fact that some surgeons and some hospitals get better results than others. And unless we are prepared to admit this, we'll never improve the overall success rates."
As an example, Gawande cites both the case of the paediatric team at a hospital in Cleveland, Ohio, who virtually single-handedly raised the average life expectancy of cystic fibrosis patients from three years old in 1957 to 33 in 2003, simply by providing aggressive preventive treatment before sufferers became visibly sick from it. You could argue that such successes are largely a matter of money, but Gawande disagrees. "We spend huge amounts of cash on healthcare in the US," he says, "and not all of it is very effective. Infection rates in hospitals are proof of this. Some hospitals have spent a small fortune on portable $5,000 hand-washing machines [superbugs are as rife in America as they are in Britain], but their infection rates have remained as high as before.
"The one hospital in the US that has managed to reduce infection to almost zero did so not by spending money but by analysing procedures. They asked doctors and nurses how they used the system and found that the alcohol gel dispensers were in the wrong place, the gowns they needed for the 3pm ward rounds were in the wrong place and that it was better to have a single stethoscope designated for each patient's sole use than for a doctor to carry his own from patient to patient.""
It's heart-warming to read, "This woman can no longer talk and has had to give up work. The only way I can live with myself is to try to do all I can for her and understand what I did wrong and do better next time. Being sorry is not enough." - Sadly Atul Gawande is rare among doctors in having this moral attitude. - Victims of medical error are mostly abandoned by the health professionals who have harmed them. That is certainly the norm in Britain. - See http://aboutsalt.blogspot.com/search/label/Andrea%20Carey and http://aboutsalt.blogspot.com/search/label/NHS%20Complaints
I regard the failure of doctors to tell the truth about the causes of obesity as probably the most colossal group negligence in the history of medicine.
Obesity is not caused by overeating. It is caused by fluid retention in people who are vulnerable to salt. - See Mensa article about Obesity and the Salt Connection
Lose weight by eating less salt! Go on! - Try it! - You will feel so much better!
See my website www.wildeaboutsteroids.co.uk
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Tuesday, June 12, 2007
You can't get it right every time - Guardian