Monday, July 27, 2015

"This is bad for academic medicine"

When the history of the patient safety movement is told, it will be appropriate that the Association of American Medical Colleges* will be left out.  The recalcitrance of this organization in acknowledging patient safety problems was legendary for the first decade of this century. The AAMC's leadership not only refused to acknowledge the depth of patient harm but also precluded use of the organization's arms in working on the issue.

For example, when an AAMC committee was to be established in the mid-2000's on patient quality and safety issues, the leadership insisted that the word "safety" be omitted from the committee's name and charter.

For example, when people would submit articles on patient safety to the AAMC's main journal, Academic Medicine, they would be summarily refused, refused even the courtesy of peer review.  The authors were told that patient safety was not an issue of public concern and therefore did not warrant space in the journal.

For example, at sessions with the world's experts on patient safety and doctor education (like Don Berwick and Lucian Leape), high officials from AAMC would reiterate their belief that hospitals did not have a patient safety problem.

Things finally changed in 2010, when a new CEO arrived.  In an article, he and the organization's president addressed the issue:

In order to develop a health care culture of safety that leads to clinical improvements, an unprecedented collaboration between medical schools and their partnering health systems is required, according to Drs. Kirch and Boysen. They identify five factors critical to the success of a culture shift: leadership from the top, student involvement, a focus on safety during residency training, health information technology, and teamwork among health professionals. “When combined with a growing investment in comparative effectiveness research, these factors will help physicians improve care at the bedside,” the authors write.

I suppose better late than never, but think about the societal loss caused by the absence of the major academic medical organization from this issue for so long--notwithstanding important findings by the Institutes of Medicine on the topic.

Perhaps the AAMC leadership reflected the views of its membership.  I recall, when I was emphasizing patient harm on this blog and posting clinical outcome data, the Chair of the Partners Healthcare System called the Chair of our system and said, "Can you get Paul to stop publishing those numbers.  This is bad for academic medicine."

Or perhaps the membership took direction from the AAMC leadership, who, after all, were highly regarded in the profession.  Either way, the lack of action on and attention to patient safety was a significant failure and led to the slow inclusion of patient safety curricula in America's medical schools. Let's consider, therefore, that the AAMC contributed for years to the delay in addressing the large number of preventable deaths and harm in America's hospitals.


* As noted in its materials: The Association of American Medical Colleges is a not-for-profit association representing all 144 accredited U.S. and 17 accredited Canadian medical schools; nearly 400 major teaching hospitals and health systems, including 51 Department of Veterans Affairs medical centers; and nearly 90 academic and scientific societies. Through these institutions and organizations, the AAMC represents 148,000 faculty members, 83,000 medical students, and 115,000 resident physicians.


nonlocal MD said...

This is just another illustration of the complete dereliction of duty on the part of our profession's leadership for the past decades - and now we complain we are over regulated and persecuted. Sadly, we have made a mockery of our Hippocratic oaths in such arenas as giving out opiates like candy (directly linked to the current heroin epidemic), overusing untested medical devices in the name of money, acceding to uninformed parents on vaccines, giving antibiotics to anyone who asks for them, etc etc. It is time for real self examination on the part of AAMC, the AMA, specialty societies and all individual physicians. We could do so much better.

Brian Klepper said...

I'm glad to see this. It is hardly cynical to be honest about reality. Associations and societies notoriously avoid political risk, including on issues that are precisely what they should be weighing in on. I experienced the same recalcitrance by the primary care societies on the politics of the RUC, which had systematically devalued primary care and over-valued specialty care. The same is true for business health groups that are more in thrall to their "vendor partners" contributions than their members' interests. Everyone aspires to integrity, the courage of convictions and being mission-driven, just so long as they doesn't get in the way of the money.

Carole said...

Wow, when I read this I viewed it as something positive, seems like I'm always missing the bigger picture. I'm just someone because of a negative medical experience trying to repair my trust in the medical system and its professionals again. Part of my healing had to be finding a CEO or a former CEO of a hospital with integrity, morals and a true advocate for patient safety, unless I've missed something again that's what I thought I found here with Mr. Levy. Everything I have read seems to be about changes in the right direction, what more can I ask for. (sadly thought everything is about money, as much as I wished that wasn't so ) that will never change !

Anonymous said...

Mr. Levy,

As a harmed patient, and one who keeps getting that way thanks to attitudes like the above, I am so very grateful for what you are doing. Thank you for keeping this up. It might be too late for me, but it isn't for others.

The major healthcare corporation in my area has done everything they can to keep from getting the story out how one of their surgeons is on a recording id'ing me and talking about false things in the records. I'm grateful for this exposure.

It needs to be done.

e-Patient Dave deBronkart said...

Agreed, but what brings this up now? Maybe I missed something but all I notice in the post is 2010.

Last year I gave a plenary at the 100th annual meeting of the National Board of Medical Examiners, about the changing patient-provider relationship and what the IOM called "patient needs and perspectives." Someone (I wish I knew who) came rushing up and said "The dean of every medical school in America needs to hear this." Shortly after I was invited to do a "Thought Leader" talk at AAMC's annual meeting that November. 150 people showed up at 8 a.m. Sunday morning (that's when those sessions are) and gave the talk a standing ovation. And I've been unable to get a response out of anyone at AAMC since. (The woman who invited me, Carol Aschenbrenner, retired and nobody since has been interested.)

Carole said...

Was that comment meant for me? Because I'm in total agreement with you, have been since I started. I have left a comment on the wrong post before, by the time I realized it,it was to late and felt it would make it worse if I explained myself, so I just let it be. I'm sorry if I messed up again! But know I feel just like you do, that's why I have mentioned I love how you speak your mind and look forward to reading more. You as a harmed patient upsets me, and I want what's going to give you peace of mind again. Just like what I want for myself.

Carole said...

Mr. Levy,
It's important to me that you understand because of who you are and what you obviously believe in and stand for is why in spite of me at times not having a clear understanding that all the topics eventually end up having one to do with the other, adding several different points of views to make it interesting, plus all the difference in opinions. I was totally confused for awhile, not easy to admit but It would seem foolish if I didn't. Me being afraid of asking a dumb question didn't help either so I just went for what I thought I understood. Sometimes embarrassed when I realized I didn't understand after all and I put it out there I wanted to give up and go away, however because no one called me out and made me feel little or insignificant ( your followers are not just super smart they're kind and dignified people as well ) I braved it out because I care and want to be part of learning and knowing about the positive changes coming. Because of awesome men like you !

Paul Levy said...

Thanks, Carole. We're all learning here! You are right that I have wonderful readers.

Mark Graban said...

It's a shame that many "leaders" would rather stick their heads in the sand or intentionally keep others in the dark about the reality of the problems that exist in healthcare. Quite an indictment of AAMC.

Carole said...

"Can you get Paul to stop publishing those numbers," (that statement stood out to me) that wasn't just a good thing to read it was a great
Thing to read!