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Thursday, October 4, 2012

Modern Medical Ritual

You've got to hand it to medical science - its always moving forward - they've discovered the checklist!

From this link: 

"Which hip is being repaired? Is this the right anesthesia? Do we have all the right surgery tools?

Answering such basic questions from surgery checklists — and involving everyone as a team, even patients — saved lives in Veterans Affairs hospitals, according to one of the most rigorous studies of patient safety in the operating room.

Surgery deaths dropped 18 percent on average over three years in the 74 VA hospitals that used the strategy during the study. Surgery team members all created checklists and discussed them in briefings before, during and after surgery. "

What's not said here is that surgery teams without checklists killed more people with easily preventable mistakes than those with checklists.

Its astonishing that these articles don't outrage people.

What, you're a doctor, one of the most highly educated and trained professionals in the world, and you run your surgical practice without the benefit of a simple checklist?

After all, soccer mom has a checklist when little Johnny goes to camp.  You and I take one to the grocery store.  Why doesn't her surgeon have one?

Read a little further and you'll find this: 

"Teamwork problems are ubiquitous in health care but in operating rooms, they're so problematic because ORs are so hierarchical. They're full of ritual and for so many years it's been the surgeon (who) dictates," Pronovost said.

The VA's program began in 2003 and over time has been adopted at virtually all of its 130 surgery centers. Before sedation, patients identify themselves and the reason for their surgery, hear the checklists being read off, and can speak up if something doesn't sound right. The idea is to give everyone in the operating room an equal voice in helping ensure patient safety."

Ritual? Really?

You mean like this?

It's good to see that all that money we're spending on new health care laws has a good foundation in history.  

Imagine if we simply passed a health care law that required surgeons to use a checklist like the one described in the article.  Imagine a world the patient or a nurse know more about what's going on than the surgeon - like person who's being operated on (no - my left arm!).

I have experience with this.  Several years ago I broke my left wrist.  A trip to the ER left me with an appointment to see a specialist who had to do surgery.

After some consultation the surgeon and I agreed to have him put a metal bracket in and re-set the break.

The morning of the surgery sees me in the giant bullpen of "out patients for surgery" with many dozen of people where there.  Once I am called into the OR prep area I am installed in a bed and set up with IV's and other things.

I joke I need a red marker to write "NO" in big letters on my arm.

No one laughs.

Then someone says "don't do that! Don't write on your arm!"

Eventually the surgeon comes in.  He checks me over a bit and then takes my broken arm and writes mysteriously on it (doctor scrawl I suppose).

"What's that for?" I ask.

"So we operate on the right arm." he says.

"But my left arm is broken" I joke.

He didn't laugh either.

I've read up on this a bit - one day in the Borders - and its not just the VA hospital, either:

"Jauhar feels responsible when he botches the blood pressure check on a patient who later dies during an aortic dissection and when he misses the high blood sodium level of a man who then suffers irreversible brain damage."

Ah!  Medical science also has its own idea of responsibility as well. No doctor ever causes a problem - they merely misidentify or miss characterize one.

Read the part in the book where they handle failures.

I guess that's why they call it practicing medicine.

I'll have to keep all this in mind.

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