Johns Hopkins radiation oncology resident Kendra Harris informs us that the most common reason radiation oncologists give for not reporting medical errors is fear of getting colleagues into trouble, liability and embarrassment in front of colleagues. This was the result of a survey of 274 people from Johns Hopkins, North Shore-Long Island Jewish Health System in New York, Washington University in St. Louis, Missouri, and the University of Miami.
Whoa! Doctors who are sending the wrong amounts of radioactivity into us, or into the wrong parts of our bodies, or making other errors, are more worried about "trouble, liability and embarrassment" than about making process improvements?
Sorry, but this is just inexcusable. As you know, I'm all for working on cultural changes to create no-blame environments and just cultures, but there has to be a place for individual responsibility.
Interestingly, the physicists, dosimetrists and radiation therapists who work in the radiation oncology centers are more likely to report errors. This suggests that there is something in the system of medical education -- or in the self-selection of people who become radiation oncologists -- or both, that causes this result.
The title of Dr. Harris' paper is "Learning From Our Mistakes: A Multi-Institutional Survey of Attitudes and Practices Related to Voluntary Error and Near-Miss Reporting".
The good news, Harris says, is that few respondents reported being too busy to report or that the online tool was too complicated. "Respondents recognized that error events should be reported and that they should claim responsibility for them. The barriers we identified are not insurmountable," she added.
Good news. Right.
Barriers. Right.
Lead (as in Pb) between the ears -- instead of other grey matter -- it seems to me, is the main barrier.
From Facebook:
ReplyDeleteThis pattern is why all the great dentists/doctors get "poisoned" and thrown into a barrel equally compared to the dentists/doctors they are covering up - disgraceful when you consider how many victims it creates, like me!
Paul, you have hit the nail on the head with your observation:
ReplyDelete"Interestingly, the physicists, dosimetrists and radiation therapists who work in the radiation oncology centers are more likely to report errors. This suggests that there is something in the system of medical education -- or in the self-selection of people who become radiation oncologists -- or both, that causes this result."
I don't know why on earth people expect that doctors are somehow different from other people when it comes to admission of being wrong. Or that the fact that our errors kill people somehow would make us more likely to admit them. I don't know anyone who likes being wrong, nor finds admitting it easy. And yes, people who are selected for medical school (not just radiation oncology) probably like to be wrong much less than 'normal' people. And certainly yes, the culture of medical education very much discourages open admission of error. Ironically, the very 'individual responsibility' you cite is used as a hammer to brainwash us that we are not allowed to be wrong.
I am reminded of your famous post of Feb 13, 2009, with the 40 comments, in which you similarly called out physicians for not taking the lead in reducing error. Clearly little progress has been made since. I would suggest a system approach for investigating why, (the surface of which has been scratched by this article), might serve better to overcome those barriers, rather than, as one of your 2009 commenters put it, 'evangelism.'
nonlocal MD