Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Do we blame the system?
- Graham Neale, Imperial College, St Marys Hospital, W2 1NY (7 April 2008)
-
outdated view of medicine
- Mark F Lambert (9 April 2008)
-
Reign of Blame
- Hugh Mann (10 April 2008)
|
|
|||
|
Graham Neale, Visiting professor Clinical Safety Research Unit, Imperial College, St Marys Hospital, W2 1NY
Send response to journal:
|
The article by Professor Christakis criticising the systems approach to medical error appears to document a personal view that is not backed up by published evidence. Regrettably he starts by plucking a figure from the sky - "iatrogenic deaths certainly exceed 50,000 per year in the United States placing them among the top ten killers." There is no good published data on the number of medical interventions that kill. The available data concern adverse events in healthcare that contribute to a shortening of life - often in sick elderly patients. Accumulated data on dreadful events that kill, such as intra-thecal injections of vincristine, are lacking Moreover, all clinicians are well aware of the human factors underlying adverse events, as was discussed more than a decade ago by a leading authority on the nature of human error(1). I am no sociologist but do doctors really "take the blame because the flip side of blame is credit" In fact although the medical profession as a whole has been slow to face up to the issues(2) there have been big changes since the publication of key documents on both sides of the Atlantic(3,4). I believe that most clinicians will find it difficult to accept that they need to focus on the "old-fashioned virtue of personal responsibility." This is a key part of medical education across the world. However, there is a need for better support for patients when things go wrong and, in the UK, we still await the enactment of the NHS Redress Bill(5) that passed through parliament 18 months ago. 1. Reason J. Understanding adverse events: human factors. Qual Saf Health Care 1995; 4: 80-9. 2. Neale G. The problem of engaging hospital doctors in promoting safety and quality in clinical care. JRSH 2007; 127: 87-94. 3. Kohn L, Corrigan J, Donaldson ME. To err is human. 1999 National Academy Press, Washington DC. 4. Donaldson L. Building a safer NHS for patients. 2001. www.doh.gov.uk/buildsafenhs. 5. NHS Redress Bill 2006. www.commonsleader.gov.uk/output/Page990 Competing interests: None declared |
|||
|
|
|||
|
Mark F Lambert, public health physician NHS Institute, Coventry House, University of Warwick Campus, Coventry CV4 7AL
Send response to journal:
|
It is hard to disagree with Christakis (1) that good doctoring and good care are important. But his analysis of medical practice is based on an outdated model. Providing good safe care is complex, and does rely on effient interaction of people and systems. Doctors (and other health care professionals) may well balk at the industrial metaphor for their practice, but the alternative, which Christakis seems to favour, of doctor as lone conqueror of disease is equally inadequate. Credit or blame are equally inappropriate when they are undeserved. All those responsible deserve a slice, whether they lead, determine treatments, or play are part in implementing them. And yes, we should hold doctors, managers, nurses, policy makers and pharmacists to high standards for their decisions and actions. But holding anyone up as a superhero can only end in disappointment. Nicholas A Christakis. Don’t just blame the system. BMJ 2008; 336: 747 Competing interests: None declared |
|||
|
|
|||
|
Hugh Mann, Physician Eagle Rock, MO 65641 USA
Send response to journal:
|
Education credits the teacher Competing interests: None declared |
|||