tag:blogger.com,1999:blog-32053362.post4101121456933941548..comments2024-03-26T00:25:34.026-04:00Comments on Not Running a Hospital: Just a bit off, Dr. GuptaPaul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger10125tag:blogger.com,1999:blog-32053362.post-1773287726981414922012-08-03T16:53:16.151-04:002012-08-03T16:53:16.151-04:00I do agree that M&M is not the best venue to m...I do agree that M&M is not the best venue to make system-wide safety changes, but it provides insight into complications, some of which result from the actions/inactions of individuals, and others due to a system problem.<br /><br />Surgical M&M was historically to put trainees under the microscope, to underscore the type of responsibility involved when one operates on other people. <br /><br />M&M can devolve into a less valuable experience as described above. But when done right, it is an important venue for continued learning and improving outcomes. Complications can be debated and dissected, and new protocols adopted to prevent similar future outcomes. With the current trends toward diluted residency experiences and more care provided by non-physicians, we should strive to maintain high-quality M&M conferences.Thomas Panehttp://www.bsurgmed.wordpress.comnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-55125296051592074702012-08-03T12:59:22.031-04:002012-08-03T12:59:22.031-04:00I think that the main problem is that there's ...I think that the main problem is that there's an assumption that we are perfect until we fail - and that failure is evidence that we will fail again.<br /><br />Practicing medicine requires trust - trust that your images are from the right patient, trust that the meds you're giving are correct, trust that the lab result is from your patient and not some other person. When that trust is compromised, most people lose faith in a person permanently. This extends to departments as well - it only takes one or two mistakes in lab results before providers become very suspicious of the lab (despite the fact that millions of tests are done correctly each year). Ironically, Dr. Gupta's article has the same "just trust me, we've got it handled" language that is used to instill trust in patients.<br /><br />The change in thinking that needs to happen is in looking at mistakes as system problems. It's also important to recognize that anyone could make a mistake. An M&M that allowed for a real evaluation of an event and called for systems change would go a long way toward accomplishing this goal. But from what I'm hearing here, that's not what those are about.clsmtnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-75333672415621756152012-08-03T12:15:46.757-04:002012-08-03T12:15:46.757-04:00Patients are told to report medical device adverse...Patients are told to report medical device adverse events to the FDA which approves most implanted devices without clinical testing, no warranty, no post market national registry, no voting patient representation on advisory panels and no judicial patient protections to counteract federal judicial entitlements by the medical device industry. Surgeons seem tone-deaf to patient concerns or are defensive when it is clear that an implanted device fails(metal on metal hips, surgical mesh, ICD leads). The system is a failure.Joleen Chambershttps://www.blogger.com/profile/16287810963418348672noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-20815644381076027122012-08-03T09:15:30.366-04:002012-08-03T09:15:30.366-04:00I'm wondering (and not snarkily) if the underl...I'm wondering (and not snarkily) if the underlying issue here is that part of our medical culture, at least in the US (I don't know about elsewhere), is the unwitting assumption that medicine is not like other sciences - somehow above science - so that there's no need to look elsewhere for useful methods.<br /><br />That would be ironic because of course the same people talk about science and the scientific method, and disparage those who they believe aren't good at science.<br /><br />Again, I don't mean that in an insulting way: I'm really looking for objective insights. I mean, you gotta be academically strong to become an MD - so what's the disconnect? It's gotta be a cultural malfunction, because nothing but culture resists change so firmly.e-Patient Davehttps://www.blogger.com/profile/16381434866099596466noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-31328740320953530682012-08-03T08:32:54.440-04:002012-08-03T08:32:54.440-04:00From Facebook:
Agreed. While Dr. Gupta brings lig...From Facebook:<br /><br />Agreed. While Dr. Gupta brings light to an important issue, the solution he offers is severely lacking as seen by years of M&M conferences.AMSA PharmFree Fellownoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-40951850222438926842012-08-03T08:22:31.179-04:002012-08-03T08:22:31.179-04:00Another aspect of Dr. Gupta's solution is that...Another aspect of Dr. Gupta's solution is that it largely only addresses errors of commission - that is, things done when they should not have been done. As has been shown by many investigators (including Kahneman and Tversky), we as humans value losses more than gains. Because of this we are more apt to see the harm arising from our actions and miss the harm from our inactions - be it beta blockers in AMI or handwashing. The dramatic, uncommon, possibly unpredictable events as articulated in M&Ms drain our attention and create a huge opportunity cost for recreating care delivery that would benefit many more people.Jimnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-82152784877031363802012-08-03T08:03:16.474-04:002012-08-03T08:03:16.474-04:00The M&M (as it still is done in many places) i...The M&M (as it still is done in many places) is an old boys club that loves to finger point especially at other services or departments. I remember one case at my hospital where surgery at their M&M blamed anesthesia, anesthesia blamed internal medicine, and internal medicine blamed surgery at their M&M. The only group who saw it correctly was nursing who blamed all three services because each could have done better.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-17447301810220561572012-08-03T07:51:20.979-04:002012-08-03T07:51:20.979-04:00I had read that essay yesterday and had EXACTLY th...I had read that essay yesterday and had EXACTLY the same reaction as you.<br /><br />Not only are M and M conferences everything you say, but many hospitals are dropping them, and most of the time they do not result in anything but recriminations rather than systemic change.<br /><br />But beyond that, to have them be the only solution he offers to the MASSIVE dimensions of the problem was just plain bewildering.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-91734603597012396182012-08-03T07:34:43.387-04:002012-08-03T07:34:43.387-04:00You are so RIGHT!! He serves those in the insuran...You are so RIGHT!! He serves those in the insurance who want to keep charging but not spending --obviously, all will be available to the Haves who think like Gupta.Georgenoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-78952033949334463462012-08-03T07:21:43.675-04:002012-08-03T07:21:43.675-04:00Very, very much on target.Very, very much on target.Marknoreply@blogger.com