Medical errors are estimated to be the third leading cause of death in America’s hospitals. Though some of these errors are beyond physician control, many are the direct result of physician action and inaction. I spend a lot of time thinking about how to reduce these errors and I (like many of my peers) lose sleep over the mistakes I witness.
When you ask patients what quality is most important in a physician, they often answer, “empathy.” I think that’s close, but not quite right. I know many “nice” and “supportive” doctors who have poor clinical judgment. When it comes to excellent care quality, one personality trait stands out to me – something that we don’t spend much time thinking about:
A physician with a curious mind doesn’t necessarily know all the answers. He may not be the “smartest” graduate of his medical school. But he is a great detective, and doesn’t rest until problems are solved. This particular quality isn’t nurtured in a system that rewards partial work ups, rapid patient turnover, and rushed documentation. But some doctors retain their intellectual curiosity about their patients – and to the extent that they do, I believe they can significantly reduce medical errors.
Many of the preventable adverse events I have witnessed (outside of procedure-based errors) began with warning signs that were ignored. Examples include abnormal lab tests that were not followed up in a timely manner, medication side effects that went unrecognized, copy errors in drug lists, and subtle changes in the physical exam that were presumed insignificant. All of these signs trigger the curious mind to seek out answers in time to head off problems before they evolve into real dangers.
Of course, there are other qualities that make a physician excellent – wisdom, experience, kindness, and a grounding in evidence-based practice come to mind. But without an engaged mind fueled by genuine curiosity, it’s hard to retain the vigilance required for continued good outcomes.
Curiosity may have killed a cat or two, but I’ve seen it save a large number of patients!
Last week I scribbled about the future of the social health community. This week I’m in Australia speaking about screaming babies, practical parenting, and social media — such divergent things.
I’ve listened to author Tim Sanders suggest that a person needs to stick to just one thing or folks will be confused about who you really ARE – your “brand” will get fuzzy. I’m not sure. While having a niche is important, it’s not everything.
Case in point: Steven B. Johnson is one of this generation’s most talented nonfiction authors. By day he oversees his social startup outside.in. By night he travels the globe speaking about his bestselling books, among them Ghostmaps and The Invention of Air. In his free time you’ll find him writing cover features for Time magazine.
And then there’s Daniel Pink, former speechwriter for Al Gore and peripatetic bestselling author, speaker, and thinker. Manga, motivation, videos on travel tips — nothing is outside his realm it seems.
Two remarkable people defined more by their curiosity and thinking than the imposed confines of a tangible niche — and it works for them. I’m guessing that Johnson and Pink don’t spend a lot of time fashioning their look. They just “do” — and do it well. Perhaps that’s how I’d like to be seen.
*This blog post was originally published at 33 Charts*
As we move towards EMR’s, the ability to know who has looked at the medical record may get more and more people in trouble. While we are all curious about our friends, neighbors, and celebrities (local or global), it is important to respect each others privacy. This local Arkansas story shows the importance of this respect.
Hospital emergency room coordinator Candida Griffin, patient account representative Sarah Elizabeth Miller and Dr. Jay Holland, a family doctor who worked part time at the hospital, each face up to a year in prison and $50,000 fine if convicted of the misdemeanor charge.
I would hope that all three of the people listed above would have “known better.” When this story broke earlier this week, the staff in the OR and I had a nice discussion on who gets HIPAA training and how much each get.
I think as part of their punishment, they and perhaps the facility (St Vincent Health System) should have to do refresher courses on HIPAA privacy rules.
The hospital said in November that it fired up to six people for looking at Pressly’s records after a routine patient-privacy audit showed that as many as eight people gained access to them.
It was not immediately clear whether others fired from the hospital would face charges. U.S. Attorney Jane Duke declined to comment about the charges Tuesday.
With paper charts, there isn’t a trail proving you or I accessed the chart without need to do so. With EMR’s there is but this trail is not fool-proof. If I haven’t logged off and you look over my shoulder, then ….
If you haven’t logged off and I ask for a quick look at patient 007’s lab work and you do me a “favor” of checking quickly. See, not perfect. No harm was intended and patient 007’s info may never be “leaked” to the press, but someone who perhaps had no need to access it did so.
My circulating nurse in the OR during the discussion revealed that she had heard a lot of talk about the Ann Pressly case which she admits she should not have. She didn’t access the chart. She was working in another hospital’s ER. It was the police and EMT’s doing the talking. There is no trail to “prove” those violations of patient privacy trust.
We need to be more careful in discussing patients and cases. We still need to be able to discuss difficult or unusual cases, but this can be done without breaking a patient’s trust or privacy. Names and identifiers don’t have to be used when stumped by a rash or odd presentation.
Dr Holland had no malicious intent, just curiosity. Be careful.
Arkansas Democrat Gazette article Doctor, ex-hospital employees charged over Pressly records (subscription required) written by Linda Satter
3 charged with getting TV anchor’s medical records by Jon Gambrell (no subscription required)
*This blog post was originally published at Suture for a Living*