11 ms·

I don't see why the the anesthesiologist should not be held liable in this case (and possibly the hospital). In my opinion, it would be very reasonable for them

I don't see why the the anesthesiologist should not be held liable in this case (and possibly the hospital). In my opinion, it would be very reasonable for them both to pay a significant penalty. These abnormally low (and capped) penalties make it easier for those who should not be doing this work to keep showing up every day. I understand that we don't want to scare people in health care out of the field, but those who are clearly inept certainly should be afraid to keep working.

wvenable 11y ago
Most of the problems are systemic. Most people are probably not "clearly inept". You probably make dozens of mistakes in a week but, just by the nature of your job, nobody dies. Procedures, policies, and even technology should exist to prevent and mitigate mistakes because humans are deeply flawed. Unfortunately the fact that the situation is life-and-death with huge liabilities that there really isn't significant effort to improve things. It's legally safer to continue practices that mostly work but are already standard than try something new.
- noonespecial 11y ago
  Another industry faced systemic life-and-death problems like this. Air travel. They use extensive checklists that they run like human computers before every flight, from the smallest cessna to the largest airbus. My mom, the NP, says doctors, as a group are too proud to ever use lists like that. She asked me how the "pride issue" was dealt with among pilots. I suggested that when it comes to airplanes, prideful pilots have a way of sorting themselves out one way or another. Source: I'm a timid GA pilot who actually shouted "I'm a leaf on the wind" at my plane during my first solo...
  - wvenable 11y ago
    I'd argue that there so many differences between air travel and medicine that it's not a useful comparison. A single passenger doesn't even interact with a Pilot, as just one example.
    - TillE 11y ago
      It's not difficult to see how the concept of following strict procedures and double-checking your work might be adapted to medicine. There's really no use in arguing about an analogy. Focus on the point.
      - wvenable 11y ago
        It sort of implies that there aren't strict procedures and double-checking in medicine. But there are. The problem is that medicine is more complicated with more people involved. You can't just say "hey, look in Engineering we can build bridges on time and under budget, why can't you do that with software?" The same issue here.
        EliRivers 11y ago
        I understand the evidence indicates that checklists in medicine can make a significant improvement. http://www.who.int/patientsafety/implementation/checklists/background/en/ http://www.who.int/patientsafety/implementation/checklists/b... "This study revealed an overall significant reduction in mortality and morbidity after implementation of the checklist."
  - tomkinstinch 11y ago
    There is a push to use 'pilot' checklists in medicine as tools for reducing human error! Harvard surgeon Atul Gawande wrote a book on it: http://atulgawande.com/book/the-checklist-manifesto/ http://atulgawande.com/book/the-checklist-manifesto/ http://www.amazon.com/Checklist-Manifesto-How-Things-Right/dp/0805091742 http://www.amazon.com/Checklist-Manifesto-How-Things-Right/d...
  - matwood 11y ago
    Interesting. I sat in on a few surgeries years ago when I thinking about going pre-med and I saw many checklists. There were counts of instruments used, rags used, checking and double checking all through the surgery. Maybe it was only these 2 older surgeons who did this, but it seemed pretty useful. I distinctly remember having a hanging shoe rack like thing where each rag used was put to make counting easy. The count was off at the end of one of the surgeries so they went through it again, and it turned out one of the slots had 2 rags.
    - schoen 11y ago
      I was just in a hospital lab and saw a very prominent checklist on the wall for use with some procedures (but not what I was there for, so I didn't see whether they used the checklist in practice).
    - digler999 11y ago
      counting the instruments/sponges is not the kind of checklist they are referring to. They mean "I'm going to do an appendectomy: sterile instruments [X], wash hands[X], open instrument pack [X], apply iodine solution [X], make 4cm abdominal incision [X]....
  - strictnein 11y ago
    My father was a private pilot. Owned a plane (1996(?) Mooney Bravo, it really moved), so we flew around quite a bit. If I got in a small plane, and the guy I was flying with wasn't going through his checklist, I would get out.
  - CreRecombinase 11y ago
    The issue is that medicine is not air travel. For example, if an airplane doesn't pass safety checks that plane doesn't fly. What is the equivalent in the ER? Furthermore, because of the way planes are engineered, (and because of the stringent safety standards), it is rarely the case that a mechanic has to make repairs on an already compromised vehicle, and even in that scenario most systems are designed to fail independently of other systems (i.e the fact that the electrical system is on the fritz doesn't change the way you inspect the propeller). In the medical realm, all of the systems interact. Reducing blood pressure may put undue stress on the kidneys, etc, so any hypothetical flow-chart is going to get really complicated really fast. The issue is partially pride, but it's also that it's not obvious that blindly adding checklists makes sense in every scenario.
    - rpedela 11y ago
      I don't know if checklists can be used in every medical scenario, but they do have a significant positive effect in surgery [1]. 1. http://www.nytimes.com/2009/01/20/health/20surgery.html?_r=0 http://www.nytimes.com/2009/01/20/health/20surgery.html?_r=0
      - nefitty 11y ago
        I think checklists can be used in literally almost any scenario. They can prevent basic errors from occurring, and can save time on unnecessary redundancy. I'm not sure what the process would be for a medical procedure but it could be 1. Admit patient 2. Consult about problem 3. Decide effective treatment 4. Perform and run through checklist of that treatment. Each step would have it's own checklist that follows the patient and that can be seen and reviewed by other caregivers. Checklists have made my life easier. For example, I got in to work today and if I hadn't made a checklist of my daily procedure I might be stuck on HN all day, but just looking over today's tasks I know what my first step and final steps look like so I can begin immediately upon entering the building. If I make a mistake I won't kill anyone, but if my life is in someone's hands I'd very much hope that they are running through a checklist built around the priority of keeping me alive first, and making me healthy second.
    - 11y ago
  - shimon 11y ago
    The sorting out is exactly the problem. A mistake in an aircraft, combined with some bad luck, leads to a crash. Everyone knows what that is and it triggers a government review. In medicine, most mistakes are not obvious. A doctor who makes 5 or 10 times as many mistakes as average might be known to a few colleagues as "that guy who probably shouldn't have his license", but the vast majority of those won't even lead to malpractice cases, let alone clear-cut malpractice verdicts. That said, we should be engaged in understanding and judging these cases, and figure out how to properly attribute deaths to preventable medical errors. It will be messy but the status quo is a large-scale ongoing disaster.
    - lisper 11y ago
      > A mistake in an aircraft, combined with some bad luck, leads to a crash. Not always. You can actually push your luck pretty hard in an airplane and get away with it 99% of the time. There are pilots out there who are accidents waiting to happen.
      - jleader 11y ago
        Example where the pilots involved pushed their luck until that 1% chance finally killed them (and their passengers): http://fearoflanding.com/accidents/accident-reports/how-to-drop-a-gulfstream-iv-into-a-ravine-habitual-noncompliance/ http://fearoflanding.com/accidents/accident-reports/how-to-d...
      - jandrese 11y ago
        The point is that there is almost never a single cause for any accident. It is almost always due to a confluence of multiple events. This should be expected. Engineers can be reasonably expected to think of the contingencies related to the system they are actively working on, but generally work under the assumption that the rest of the device is functioning normally. A nonfatal error in a normal situation can become fatal when combined with two or three other nonfatal conditions.
  - brazzledazzle 11y ago
    You'd think with the embarrassing history (as a profession) of being too prideful to do things like wash their hands there would be a bit more humility.
  - robohamburger 11y ago
    This seems like a really good idea. Otherwise brilliant and highly trained humans make mistakes. Any process or plan that requires everything going perfect as the only acceptable outcome seems like a terrible one.
  - marcosdumay 11y ago
    Air travel also does not overwork their professionals as a rule, and have a clear policy of liability waving from parties that did not practice negligence or willful malpractice (just like the GP is asking for). On the other hand, any accident carries a huge cost that companies can not wave away, because it is not set by tribunals. I really don't know what factor it the most relevant here.
  - grahamburger 11y ago
    Do you think that the air travel industry's roots in the military is a significant factor? I would guess so but I have no experience to back it up, just curious. (I'm asking this on the assumption that the US air travel industry has significant military roots, which I think is true but could be wrong?)
    - eru 11y ago
      If that is a factor, looking at how the military does medicine might be instructive.
  - maxcan 11y ago
    I'm a timid GA pilot too and you're absolutely right. Another big differentiator is the way accidents and liability is managed. When a pilot makes a mistake, they file an ASRS report and instead of being disciplined or hit with a huge legal liability they can be open and transparent while NASA and the FAA work to mitigate those accidents from happening in the future. Unfortunately, no such system exists in healthcare. Physicians and hospitals have every incentive to cover up mistakes and hope they don't reoccur instead of reporting them and ensuring that they dont.
    - ska 11y ago
      This can't be overstated. I'm not sure the risk profile in medicine is similar enough to expect the same magnitude of improvement that aviation got. I am sure, however, that the systematic way of viewing errors as an opportunity for improvement and transparent evaluation, rather than an opportunity for blame throwing and obfuscation, was absolutely key to the success of ASRS and related. The key takeaway isn't a checklist system, it it is the report and reviewing that arrived at what is on the checklist, and why.
      - maxcan 11y ago
        Exactly. The checklist is actually a product of the solution - transparent reporting and rigorous analysis of those reports. Unfortunately, the healthcare system is basically cargo-culting checklists without putting in place the underlying processes to get to the "right" checklist. Or perhaps a solution that is even better for healthcare than checklists.
        sokoloff 11y ago
        There's significant argument in aviation community about how checklists should be designed as well. I personally don't think an 8-page checklist (6 pages for normals) to fly a Piper Cherokee or Cessna 172 is the safest approach or most sensible operational tool. Many pilots seem to agree and make up their own checklists that they actually use with only the "killer items" and I think that probably increases safety; certainly it increases safety over the 8 page checklist that stays in the map pocket for the whole flight. Why doesn't the factory do that? Well, if they remove something from a checklist and a pilot comes to grief, they're thinking of how it will look in a courtroom. "No charge to add something to the list..." You'd probably enjoy reading Checklist Manifesto by Dr Atul Gawande: http://amzn.to/1ZlTjoJ http://amzn.to/1ZlTjoJ I read it years ago, but I seem to recall he did cover some of the processes and social aspects of checklist usage.
  - greedo 11y ago
    There are old pilots, and bold pilots, but not too many old, bold pilots...
- Joof 11y ago
  They are certainly over worked and probably sleep deprived. I'd love it if they staffed more people...
- calinet6 11y ago
  There is significant effort to improve things in the right way, it's via a systemic approach called Lean Healthcare (that takes into account processes, statistics, culture, leadership, and management), and you can check out leaders like Mark Graban for more information. http://www.leanblog.org/ http://www.leanblog.org/ https://twitter.com/markgraban https://twitter.com/markgraban Fun fact: the current battle is that Lean has roots in Toyota's production system (which is mainly centered around the tenets of 'respect for people' and 'continuous improvement'), and certain recent opinion pieces have cited poorly-implemented Lean efforts as making hospitals more like production lines and dehumanizing healthcare. No True Scotsman, but still, it's a hard fight to change the whole system of care to be based in working systems of people and quality improvement, and any link in the chain missing can make the outcome fall.
thfuran 11y ago
Not being held monetarily liable for damages doesn't necessarily mean you still have a job.
- dllthomas 11y ago
  But the risk of being held monetarily liable for damages might mean people stop doing work they shouldn't before damage is done. Of course, this relies on people correctly assessing their likelihood of making a mistake.
- nickff 11y ago
  Statistics on patient outcomes are rarely even tracked at hospitals. Even the administrators don't know which surgeons have the most complications, and the bad doctors are at least an order of magnitude worse than the good ones according to some studies which have attempted to track outcomes.
  - slumberlust 11y ago
    That's just not true. You will have a hard time keeping and finding a job if you can't adequately explain any open malpractice suits.
    - nickff 11y ago
      Many patients have adverse outcomes which do not result in malpractice suits; one example of a surgical issue that should be tracked is artificial joint replacement surgery. There are many people who are put under the knife multiple times due to surgical errors.
forgetsusername 11y ago
>I understand that we don't want to scare people in health care out of the field, but those who are clearly inept certainly should be afraid to keep working. Actually, it doesn't seem like you do understand. Mistakes happen. Do you make them? Are you "inept"? Should you be fired or should your company face massive financial consequences for them, regardless of negligence? It's absurd.
- emodendroket 11y ago
  There is significant variance in how many mistakes different doctors make, though.
- cmiles74 11y ago
  I make mistakes all of the time and most of the time I don't even think about it. But there are times where I understand that I am doing something that, if I make an error, would have a significant negative effect on others. At those times I check and double-check my work and I strive to avoid making an error. I may even have someone check my work, just to be sure. In my opinion, this is difference that prevents be from being "inept". As others have mentioned, checklists help in this regard. I am sure that there are other ways to mitigate the negative effects if a mistake is made. These certainly should be embraced and used extensively. If I make a mistake, people lose data; if the anesthesiologist makes an error, there is much much more at stake. In regards to this particular story, I am having a very hard time with the attitude of "well, even an anesthesiologist makes a mistake". Unlike many situations in a hospital where something like a checklist would make a big difference, there are already procedures in place that need to be followed to minimize and in many cases prevent just this kind of error. In my opinion, it does not sound like those procedures were followed.
ArtDev 11y ago
An anesthesiologist in the US is the highest paid profession, period. They earn more than surgeons. They should be responsible and liable for their mistakes.
- deleted 11y ago
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- samstave 11y ago
  My family friend was top cardiologist in the Bay Area... His grandson became an anesthesiologist - and he paid his grandsons medical school bills with the edict for him to pay it forward. The kid graduated at ~22 with an initial base salary of $350k --- I work in health tech. I designed and built many of the Bay Area hospitals you might be familiar with. I can't even break 200k
  - ams6110 11y ago
    He completed a 4-year undergraduate degree, medical school, and residency by age 22?
    - samstave 11y ago
      Hmm, that was my recollection - but I could be wrong. I knew he was quite young though... so that number may be inaccurate. My brother, for example, had to do the following: EDUCATION 1988 Bachelor of Science, Biology, U.S. Air Force Academy, Colorado Springs, Colo. 1992 Doctor of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md. 1995 Family Practice Residency (Staff Physician), David Grant Medical Center, Travis AFB, Calif. 1996 Aerospace Medicine Primary Course (Flight Surgeon Wings), U.S. Air Force School of Aerospace Medicine, Brooks Air Force Base, Texas 2001 Air Command and Staff College, by correspondence 2006 Air War College, by correspondence 2008 Occupational Medicine Residency and Master of Science, Environmental Health, University of Cincinnati, Cincinnati
forrestthewoods 11y ago
Tragedy of the commons. Literally every doctor will make a mistake that kills someone. Every one. Every doctor will kill someone. And every mistake that causes someone to die will have been preventable. An eye for an eye leaves the whole world blind. Harsh punishment for the inevitable doesn't result in positive outcomes. Quite the opposite. It leads to death and suffering. I strongly, strongly recommend reading this: http://www.newstatesman.com/2014/05/how-mistakes-can-save-lives http://www.newstatesman.com/2014/05/how-mistakes-can-save-li...
- dragonwriter 11y ago
  There is a big difference between "malpractice" and "mistakes". A mistake that occurs despite the exercise of the degree of care expected in the profession is not malpractice.
  - forrestthewoods 11y ago
    But yet our current system of malpractice is directly responsible for inhibiting systems that would help prevent mistakes.
calinet6 11y ago
The problems are not inept individuals, nor will scaring people out of the field improve conditions. More than likely, the fear of recourse causes more error and malpractice than the errors themselves. Think for a moment: why are commercial airplanes so safe? Why when an airplane crashes is it so rarely "pilot error?" And why, when it really is pilot error, does the pilot not get blamed? It is because of profound realizations in the design of the air travel system that veered toward systemic control of air traffic and its safety, rather than individual pilot accountability. I will say unequivocally and factually: our health care would be orders of magnitude safer and higher quality if we treated it in exactly the same way.
- CaptSpify 11y ago
  In my experience, in an unrelated field, most human errors are actually a cumulation of other systematic errors. Pilots are responsible for safety, sure, but there are multiple checks in case the pilot suddenly passes out (or stops paying attention, or whatever). Control towers, copilots, etc. I know nothing of anesthesiology, but it seems to me that a doctor shouldn't be a single point-of-failure. If he is, it seems like that should fall under systematic-errors.
  - solipsism 11y ago
    What a great point. Raver kids have quick and easy litmus tests they can use to make sure the illegal drugs they're taking are the ones they expect to be taking. If it turns blue, you take it. If it doesn't, you don't. It seems the procedure for injecting medicine into your spine should have at least as much fail-safety built in.
    - dawnerd 11y ago
      In cases of wrong medication, I wonder if its a mislabeling or someone just not reading? Maybe a doctor writing the wrong thing down?
      - crpatino 11y ago
rms_returns 11y ago
Giving incorrect medicine is borderline to criminal negligence. If this had happened in India, the said doctor's license to practice would have been revoked. I'm astounded how come a developed country like USA can tolerate this!
mbrameld 11y ago
Because the solution isn't to punish people who make mistakes, it's to improve processes to the point where mistakes are unable (or it at least takes more than a single doctor misreading a drug or miscalculating a dosage amount) to occur.
PhasmaFelis 11y ago
Hmm. I think it's pretty well-known that medical personnel tend to be overworked and stressed out. Is that perhaps because there's a shortage of qualified personnel? If so, and if people are pushed out of the industry because they made a mistake while stressed and sleep-deprived because there aren't enough people in the industry, it seems that that could lead to a continuing decline in the quality of care.
deleted 11y ago
[deleted]

wvenable 11y ago

Most of the problems are systemic. Most people are probably not "clearly inept". You probably make dozens of mistakes in a week but, just by the nature of your job, nobody dies. Procedures, policies, and even technology should exist to prevent and mitigate mistakes because humans are deeply flawed. Unfortunately the fact that the situation is life-and-death with huge liabilities that there really isn't significant effort to improve things. It's legally safer to continue practices that mostly work but are already standard than try something new.

noonespecial 11y ago
Another industry faced systemic life-and-death problems like this. Air travel. They use extensive checklists that they run like human computers before every flight, from the smallest cessna to the largest airbus. My mom, the NP, says doctors, as a group are too proud to ever use lists like that. She asked me how the "pride issue" was dealt with among pilots. I suggested that when it comes to airplanes, prideful pilots have a way of sorting themselves out one way or another. Source: I'm a timid GA pilot who actually shouted "I'm a leaf on the wind" at my plane during my first solo...
- wvenable 11y ago
  I'd argue that there so many differences between air travel and medicine that it's not a useful comparison. A single passenger doesn't even interact with a Pilot, as just one example.
  - TillE 11y ago
    It's not difficult to see how the concept of following strict procedures and double-checking your work might be adapted to medicine. There's really no use in arguing about an analogy. Focus on the point.
    - wvenable 11y ago
      It sort of implies that there aren't strict procedures and double-checking in medicine. But there are. The problem is that medicine is more complicated with more people involved. You can't just say "hey, look in Engineering we can build bridges on time and under budget, why can't you do that with software?" The same issue here.
      - EliRivers 11y ago
        I understand the evidence indicates that checklists in medicine can make a significant improvement. http://www.who.int/patientsafety/implementation/checklists/background/en/ http://www.who.int/patientsafety/implementation/checklists/b... "This study revealed an overall significant reduction in mortality and morbidity after implementation of the checklist."
- tomkinstinch 11y ago
  There is a push to use 'pilot' checklists in medicine as tools for reducing human error! Harvard surgeon Atul Gawande wrote a book on it: http://atulgawande.com/book/the-checklist-manifesto/ http://atulgawande.com/book/the-checklist-manifesto/ http://www.amazon.com/Checklist-Manifesto-How-Things-Right/dp/0805091742 http://www.amazon.com/Checklist-Manifesto-How-Things-Right/d...
- matwood 11y ago
  Interesting. I sat in on a few surgeries years ago when I thinking about going pre-med and I saw many checklists. There were counts of instruments used, rags used, checking and double checking all through the surgery. Maybe it was only these 2 older surgeons who did this, but it seemed pretty useful. I distinctly remember having a hanging shoe rack like thing where each rag used was put to make counting easy. The count was off at the end of one of the surgeries so they went through it again, and it turned out one of the slots had 2 rags.
  - schoen 11y ago
    I was just in a hospital lab and saw a very prominent checklist on the wall for use with some procedures (but not what I was there for, so I didn't see whether they used the checklist in practice).
  - digler999 11y ago
    counting the instruments/sponges is not the kind of checklist they are referring to. They mean "I'm going to do an appendectomy: sterile instruments [X], wash hands[X], open instrument pack [X], apply iodine solution [X], make 4cm abdominal incision [X]....
- strictnein 11y ago
  My father was a private pilot. Owned a plane (1996(?) Mooney Bravo, it really moved), so we flew around quite a bit. If I got in a small plane, and the guy I was flying with wasn't going through his checklist, I would get out.
- CreRecombinase 11y ago
  The issue is that medicine is not air travel. For example, if an airplane doesn't pass safety checks that plane doesn't fly. What is the equivalent in the ER? Furthermore, because of the way planes are engineered, (and because of the stringent safety standards), it is rarely the case that a mechanic has to make repairs on an already compromised vehicle, and even in that scenario most systems are designed to fail independently of other systems (i.e the fact that the electrical system is on the fritz doesn't change the way you inspect the propeller). In the medical realm, all of the systems interact. Reducing blood pressure may put undue stress on the kidneys, etc, so any hypothetical flow-chart is going to get really complicated really fast. The issue is partially pride, but it's also that it's not obvious that blindly adding checklists makes sense in every scenario.
  - rpedela 11y ago
    I don't know if checklists can be used in every medical scenario, but they do have a significant positive effect in surgery [1]. 1. http://www.nytimes.com/2009/01/20/health/20surgery.html?_r=0 http://www.nytimes.com/2009/01/20/health/20surgery.html?_r=0
    - nefitty 11y ago
      I think checklists can be used in literally almost any scenario. They can prevent basic errors from occurring, and can save time on unnecessary redundancy. I'm not sure what the process would be for a medical procedure but it could be 1. Admit patient 2. Consult about problem 3. Decide effective treatment 4. Perform and run through checklist of that treatment. Each step would have it's own checklist that follows the patient and that can be seen and reviewed by other caregivers. Checklists have made my life easier. For example, I got in to work today and if I hadn't made a checklist of my daily procedure I might be stuck on HN all day, but just looking over today's tasks I know what my first step and final steps look like so I can begin immediately upon entering the building. If I make a mistake I won't kill anyone, but if my life is in someone's hands I'd very much hope that they are running through a checklist built around the priority of keeping me alive first, and making me healthy second.
  - 11y ago
- shimon 11y ago
  The sorting out is exactly the problem. A mistake in an aircraft, combined with some bad luck, leads to a crash. Everyone knows what that is and it triggers a government review. In medicine, most mistakes are not obvious. A doctor who makes 5 or 10 times as many mistakes as average might be known to a few colleagues as "that guy who probably shouldn't have his license", but the vast majority of those won't even lead to malpractice cases, let alone clear-cut malpractice verdicts. That said, we should be engaged in understanding and judging these cases, and figure out how to properly attribute deaths to preventable medical errors. It will be messy but the status quo is a large-scale ongoing disaster.
  - lisper 11y ago
    > A mistake in an aircraft, combined with some bad luck, leads to a crash. Not always. You can actually push your luck pretty hard in an airplane and get away with it 99% of the time. There are pilots out there who are accidents waiting to happen.
    - jleader 11y ago
      Example where the pilots involved pushed their luck until that 1% chance finally killed them (and their passengers): http://fearoflanding.com/accidents/accident-reports/how-to-drop-a-gulfstream-iv-into-a-ravine-habitual-noncompliance/ http://fearoflanding.com/accidents/accident-reports/how-to-d...
    - jandrese 11y ago
      The point is that there is almost never a single cause for any accident. It is almost always due to a confluence of multiple events. This should be expected. Engineers can be reasonably expected to think of the contingencies related to the system they are actively working on, but generally work under the assumption that the rest of the device is functioning normally. A nonfatal error in a normal situation can become fatal when combined with two or three other nonfatal conditions.
- brazzledazzle 11y ago
  You'd think with the embarrassing history (as a profession) of being too prideful to do things like wash their hands there would be a bit more humility.
- robohamburger 11y ago
  This seems like a really good idea. Otherwise brilliant and highly trained humans make mistakes. Any process or plan that requires everything going perfect as the only acceptable outcome seems like a terrible one.
- marcosdumay 11y ago
  Air travel also does not overwork their professionals as a rule, and have a clear policy of liability waving from parties that did not practice negligence or willful malpractice (just like the GP is asking for). On the other hand, any accident carries a huge cost that companies can not wave away, because it is not set by tribunals. I really don't know what factor it the most relevant here.
- grahamburger 11y ago
  Do you think that the air travel industry's roots in the military is a significant factor? I would guess so but I have no experience to back it up, just curious. (I'm asking this on the assumption that the US air travel industry has significant military roots, which I think is true but could be wrong?)
  - eru 11y ago
    If that is a factor, looking at how the military does medicine might be instructive.
- maxcan 11y ago
  I'm a timid GA pilot too and you're absolutely right. Another big differentiator is the way accidents and liability is managed. When a pilot makes a mistake, they file an ASRS report and instead of being disciplined or hit with a huge legal liability they can be open and transparent while NASA and the FAA work to mitigate those accidents from happening in the future. Unfortunately, no such system exists in healthcare. Physicians and hospitals have every incentive to cover up mistakes and hope they don't reoccur instead of reporting them and ensuring that they dont.
  - ska 11y ago
    This can't be overstated. I'm not sure the risk profile in medicine is similar enough to expect the same magnitude of improvement that aviation got. I am sure, however, that the systematic way of viewing errors as an opportunity for improvement and transparent evaluation, rather than an opportunity for blame throwing and obfuscation, was absolutely key to the success of ASRS and related. The key takeaway isn't a checklist system, it it is the report and reviewing that arrived at what is on the checklist, and why.
    - maxcan 11y ago
      Exactly. The checklist is actually a product of the solution - transparent reporting and rigorous analysis of those reports. Unfortunately, the healthcare system is basically cargo-culting checklists without putting in place the underlying processes to get to the "right" checklist. Or perhaps a solution that is even better for healthcare than checklists.
      - sokoloff 11y ago
        There's significant argument in aviation community about how checklists should be designed as well. I personally don't think an 8-page checklist (6 pages for normals) to fly a Piper Cherokee or Cessna 172 is the safest approach or most sensible operational tool. Many pilots seem to agree and make up their own checklists that they actually use with only the "killer items" and I think that probably increases safety; certainly it increases safety over the 8 page checklist that stays in the map pocket for the whole flight. Why doesn't the factory do that? Well, if they remove something from a checklist and a pilot comes to grief, they're thinking of how it will look in a courtroom. "No charge to add something to the list..." You'd probably enjoy reading Checklist Manifesto by Dr Atul Gawande: http://amzn.to/1ZlTjoJ http://amzn.to/1ZlTjoJ I read it years ago, but I seem to recall he did cover some of the processes and social aspects of checklist usage.
- greedo 11y ago
  There are old pilots, and bold pilots, but not too many old, bold pilots...
Joof 11y ago
They are certainly over worked and probably sleep deprived. I'd love it if they staffed more people...
calinet6 11y ago
There is significant effort to improve things in the right way, it's via a systemic approach called Lean Healthcare (that takes into account processes, statistics, culture, leadership, and management), and you can check out leaders like Mark Graban for more information. http://www.leanblog.org/ http://www.leanblog.org/ https://twitter.com/markgraban https://twitter.com/markgraban Fun fact: the current battle is that Lean has roots in Toyota's production system (which is mainly centered around the tenets of 'respect for people' and 'continuous improvement'), and certain recent opinion pieces have cited poorly-implemented Lean efforts as making hospitals more like production lines and dehumanizing healthcare. No True Scotsman, but still, it's a hard fight to change the whole system of care to be based in working systems of people and quality improvement, and any link in the chain missing can make the outcome fall.

thfuran 11y ago

Not being held monetarily liable for damages doesn't necessarily mean you still have a job.

dllthomas 11y ago
But the risk of being held monetarily liable for damages might mean people stop doing work they shouldn't before damage is done. Of course, this relies on people correctly assessing their likelihood of making a mistake.
nickff 11y ago
Statistics on patient outcomes are rarely even tracked at hospitals. Even the administrators don't know which surgeons have the most complications, and the bad doctors are at least an order of magnitude worse than the good ones according to some studies which have attempted to track outcomes.
- slumberlust 11y ago
  That's just not true. You will have a hard time keeping and finding a job if you can't adequately explain any open malpractice suits.
  - nickff 11y ago
    Many patients have adverse outcomes which do not result in malpractice suits; one example of a surgical issue that should be tracked is artificial joint replacement surgery. There are many people who are put under the knife multiple times due to surgical errors.

forgetsusername 11y ago

>I understand that we don't want to scare people in health care out of the field, but those who are clearly inept certainly should be afraid to keep working. Actually, it doesn't seem like you do understand. Mistakes happen. Do you make them? Are you "inept"? Should you be fired or should your company face massive financial consequences for them, regardless of negligence? It's absurd.

emodendroket 11y ago
There is significant variance in how many mistakes different doctors make, though.
cmiles74 11y ago
I make mistakes all of the time and most of the time I don't even think about it. But there are times where I understand that I am doing something that, if I make an error, would have a significant negative effect on others. At those times I check and double-check my work and I strive to avoid making an error. I may even have someone check my work, just to be sure. In my opinion, this is difference that prevents be from being "inept". As others have mentioned, checklists help in this regard. I am sure that there are other ways to mitigate the negative effects if a mistake is made. These certainly should be embraced and used extensively. If I make a mistake, people lose data; if the anesthesiologist makes an error, there is much much more at stake. In regards to this particular story, I am having a very hard time with the attitude of "well, even an anesthesiologist makes a mistake". Unlike many situations in a hospital where something like a checklist would make a big difference, there are already procedures in place that need to be followed to minimize and in many cases prevent just this kind of error. In my opinion, it does not sound like those procedures were followed.

ArtDev 11y ago

An anesthesiologist in the US is the highest paid profession, period. They earn more than surgeons. They should be responsible and liable for their mistakes.

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samstave 11y ago
My family friend was top cardiologist in the Bay Area... His grandson became an anesthesiologist - and he paid his grandsons medical school bills with the edict for him to pay it forward. The kid graduated at ~22 with an initial base salary of $350k --- I work in health tech. I designed and built many of the Bay Area hospitals you might be familiar with. I can't even break 200k
- ams6110 11y ago
  He completed a 4-year undergraduate degree, medical school, and residency by age 22?
  - samstave 11y ago
    Hmm, that was my recollection - but I could be wrong. I knew he was quite young though... so that number may be inaccurate. My brother, for example, had to do the following: EDUCATION 1988 Bachelor of Science, Biology, U.S. Air Force Academy, Colorado Springs, Colo. 1992 Doctor of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md. 1995 Family Practice Residency (Staff Physician), David Grant Medical Center, Travis AFB, Calif. 1996 Aerospace Medicine Primary Course (Flight Surgeon Wings), U.S. Air Force School of Aerospace Medicine, Brooks Air Force Base, Texas 2001 Air Command and Staff College, by correspondence 2006 Air War College, by correspondence 2008 Occupational Medicine Residency and Master of Science, Environmental Health, University of Cincinnati, Cincinnati

forrestthewoods 11y ago

Tragedy of the commons. Literally every doctor will make a mistake that kills someone. Every one. Every doctor will kill someone. And every mistake that causes someone to die will have been preventable. An eye for an eye leaves the whole world blind. Harsh punishment for the inevitable doesn't result in positive outcomes. Quite the opposite. It leads to death and suffering. I strongly, strongly recommend reading this: http://www.newstatesman.com/2014/05/how-mistakes-can-save-lives http://www.newstatesman.com/2014/05/how-mistakes-can-save-li...

dragonwriter 11y ago
There is a big difference between "malpractice" and "mistakes". A mistake that occurs despite the exercise of the degree of care expected in the profession is not malpractice.
- forrestthewoods 11y ago
  But yet our current system of malpractice is directly responsible for inhibiting systems that would help prevent mistakes.

calinet6 11y ago

The problems are not inept individuals, nor will scaring people out of the field improve conditions. More than likely, the fear of recourse causes more error and malpractice than the errors themselves. Think for a moment: why are commercial airplanes so safe? Why when an airplane crashes is it so rarely "pilot error?" And why, when it really is pilot error, does the pilot not get blamed? It is because of profound realizations in the design of the air travel system that veered toward systemic control of air traffic and its safety, rather than individual pilot accountability. I will say unequivocally and factually: our health care would be orders of magnitude safer and higher quality if we treated it in exactly the same way.

CaptSpify 11y ago
In my experience, in an unrelated field, most human errors are actually a cumulation of other systematic errors. Pilots are responsible for safety, sure, but there are multiple checks in case the pilot suddenly passes out (or stops paying attention, or whatever). Control towers, copilots, etc. I know nothing of anesthesiology, but it seems to me that a doctor shouldn't be a single point-of-failure. If he is, it seems like that should fall under systematic-errors.
- solipsism 11y ago
  What a great point. Raver kids have quick and easy litmus tests they can use to make sure the illegal drugs they're taking are the ones they expect to be taking. If it turns blue, you take it. If it doesn't, you don't. It seems the procedure for injecting medicine into your spine should have at least as much fail-safety built in.
  - dawnerd 11y ago
    In cases of wrong medication, I wonder if its a mislabeling or someone just not reading? Maybe a doctor writing the wrong thing down?
    - crpatino 11y ago

rms_returns 11y ago

Giving incorrect medicine is borderline to criminal negligence. If this had happened in India, the said doctor's license to practice would have been revoked. I'm astounded how come a developed country like USA can tolerate this!

mbrameld 11y ago

Because the solution isn't to punish people who make mistakes, it's to improve processes to the point where mistakes are unable (or it at least takes more than a single doctor misreading a drug or miscalculating a dosage amount) to occur.

PhasmaFelis 11y ago

Hmm. I think it's pretty well-known that medical personnel tend to be overworked and stressed out. Is that perhaps because there's a shortage of qualified personnel? If so, and if people are pushed out of the industry because they made a mistake while stressed and sleep-deprived because there aren't enough people in the industry, it seems that that could lead to a continuing decline in the quality of care.

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