January 16th, 2011 by DavedeBronkart in Health Policy, Opinion
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From the Medscape Medical Ethics article entitled “‘Some Worms Are Best Left In The Can’: Should You Hide Medical Errors?“:
Consequences aside, from a strictly ethical perspective, if a patient doesn’t realize that his physician made a mistake, should the physician fess up?
Before you jump to conclusions (as I did), look at the article’s three parts. It’s about a survey. The title is on the inflammatory side; the article is a window into physicians’ views. The introduction continues:
Evidence of the complex prisms through which physicians view these issues was apparent in the replies to four questions asked in Medscape’s exclusive ethics survey. More than 10,000 physicians responded to the survey in 2010.
Subheads:
— Mistakes that don’t harm patients. “Are there times when it’s acceptable to cover up or avoid revealing a mistake if that mistake would not cause harm to the patient?” Sixty percent said “no;” the others split between “yes” and “it depends.”
- I personally can understand this note from a survey respondent: “If there is a mistake that would have no medical effect but would cause extreme, uncalled-for anxiety, then yes,” especially since I know people (some elders, some young) who would indeed freak out, out of proportion. But, that’s a big judgment call.
- I have a harder time accepting this comment: “Why shake the patient’s trust in the doctor for something that is irrelevant?” Irrelevant is a big judgment call, and I’d be really concerned about the natural human tendency to minimize the probable impact of a mistake — especially if a provider thinks it’s all about maintaining a patient’s trust, even when the topic is their own error.
— Mistakes that might harm patients. Ninety five percent said “no;” some still said “yes!” One commented: “If the mistake has not progressed to harmfulness, then it’s essentially a non-issue. Treatment correction takes place and you move on.” Another says if there hasn’t been harm yet, “I think a ‘wait and see’ approach is okay.” Read more »
*This blog post was originally published at e-Patients.net*
January 14th, 2011 by Elaine Schattner, M.D. in Opinion
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An online friend, colleague, and outspoken patient advocate, Trisha Torrey, has an ongoing e-vote about whether people prefer to be called a “patient,” a “consumer,” a “customer,” or some other noun to describe a person who receives healthcare.
My vote is: PATIENT. Here’s why:
Providing medical care is or should be unlike other commercial transactions. The doctor, or other person who gives medical treatment, has a special professional and moral obligation to help the person who’s receiving his or her treatment. This responsibility — to heal, honestly and to the best of one’s ability — overrides any other commitments, or conflicts, between the two. The term “patient” constantly reminds the doctor of the specialness of the relationship. If a person with illness or medical need became a consumer like any other, the relationship — and the doctor’s obligation — would be lessened.
Some might argue that the term “patient” somehow demeans the healthcare receiver. But I don’t agree: From the practicing physician’s perspective, it’s a privilege to have someone trust you with their health, especially if they’re seriously ill. In this context, the term “patient” can reflect a physician’s respect for the person’s integrity, humanity and needs.
*This blog post was originally published at Medical Lessons*
January 14th, 2011 by RyanDuBosar in Health Policy, Research
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Far more primary care doctors report detailed referrals than do specialists report receiving them. The same applies in reverse. Specialists report returning quality consultations, while primary care physicians report receiving them far less often.
Researchers reported in Archives of Internal Medicine that perceptions of communication regarding referrals and consultations differed widely. While 69.3 percent of primary care physicians reported “always” or “most of the time” sending a patient’s history and the reason for the consultation to specialists, only 34.8 percent of specialists said they “always” or “most of the time” received the information. And, while 80.6 percent of specialists said they “always” or “most of the time” send consultation results to the referring physicians, only 62.2 percent of primary care physicians said they received it.
So where are the reports going? Read more »
*This blog post was originally published at ACP Internist*
January 12th, 2011 by Bryan Vartabedian, M.D. in Better Health Network, Opinion
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I can’t say that I enjoy the patient encounter as much when it involves a translator. There’s just something about communicating through a third party that changes the experience. But there are some things you can do as a provider to bridge the language gap:
Look. Even thought the translator is doing the talking, look at the patient just as if you are asking the question yourself. There’s a tendency to let the translator act as a surrogate with respect to eye contact and visual feedback.
Smile. A smile doesn’t need translation. It conveys very clearly that have a sincere interest in making a connection.
Touch. I never leave the exam room without some type of sincere physical contact. A firm handshake or a hand on the shoulder go a long way in closing the language barrier.
Say something funny. Patients don’t expect jokes to come through a translator. And there’s nothing better than watching a silly, lighthearted remark make its way into another language. It’s powerful and fun.
It’s important to think about how we can recreate the elements of a one-on-one dialog. What do you do to make a connection beyond spoken language?
*This blog post was originally published at 33 Charts*
January 5th, 2011 by Elaine Schattner, M.D. in Better Health Network, Health Tips, News, Opinion, Research
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Three recent stories lead me to my opening topic for the year: The value of open-mindedness. This characteristic — a state of receptiveness to new ideas — affects how we perceive and process information. It’s a quality I look for in my doctors, and which I admire especially in older people.
Piece #1 — On the brain’s maturity, flexibility and “cognitive fitness”
For the first piece, I’ll note a Dec 31 op-ed piece that appeared in the New York Times: This Year, Change Your Mind, by Dr. Oliver Sacks, the neurologist and author. In this thoughtful essay, he considers the adult brain’s “mysterious and extraordinary” power to adapt and grow: “I have seen hundreds of patients with various deficits — strokes, Parkinson’s and even dementia — learn to do things in new ways, whether consciously or unconsciously, to work around those deficits.”
With appropriate and very-real respect, I question Sacks’ objectivity on this subject — he’s referred some of the most outstanding (i.e. exceptional) neurological cases in the world. And so it may be that his careful reports are perfectly valid but not representative; for most of us, the adult brain’s capacity to establish new circuitry for language learning or music appreciation may be limited. What his stories do show is that unimaginably strange things happen in our brains, at least occasionally. And maybe we should just accept that and take notes (as he does so carefully), and keep an open mind. Read more »
*This blog post was originally published at Medical Lessons*
