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> Analyzing medical death rate data over an eight-year period, Johns Hopkins patient safety experts have calculated that more than 250,000 deaths per year are d

> Analyzing medical death rate data over an eight-year period, Johns Hopkins patient safety experts have calculated that more than 250,000 deaths per year are due to medical error in the U.S. https://hub.jhu.edu/2016/05/03/medical-errors-third-leading-cause-of-death/ https://hub.jhu.edu/2016/05/03/medical-errors-third-leading-...

elliekelly 6y ago
I’ve mentioned it here before but the book “Black Box Thinking” by Matthew Syed is an interesting read in this regard. It really highlights how important it is to design a system that’s focused on error reduction (like aviation) rather than focused on allocating blame (like medicine). IIRC there’s a chapter in the book about patient safety correlating with how “friendly” the OR nurses perceive a surgeon. The implication being that if someone makes a mistake they’re more likely to fess up a nicer surgeon (who will then have the opportunity to correct the error) and more likely to cover it up or ignore if they might get chewed out for bringing it up.
- matheusmoreira 6y ago
  > It really highlights how important it is to design a system that’s focused on error reduction (like aviation) rather than focused on allocating blame (like medicine). How can we change this culture though? For some reason doctors attract insane lawsuits seeking hundreds of thousands of dollars in damages. People don't seem to be so litigious when they're against rich corporations with lots of lawyers at their disposal. If this continues, the only possible result is defensive medicine since doctors will need every bit of proof and documentation in order to prove their innocence in the event of a lawsuit.
  - deleted 6y ago
    [deleted]
  - yummypaint 6y ago
    Doing things like making sure medical staff arent forced to work while sleep deprived would go a long way to avoiding errors in the first place. Policy changes that walk the walk and substantively prioritize safety over profit can help create safety culture from the top down. Having more staff available in general can also make redundancy checks more feasible.
    - adrianN 6y ago
      It is my understanding that the error rates skyrocket when patients are handed off between medical staff. Longer shifts reduce the number of hand-offs and thereby reduce the number of errors overall, despite sleep deprivation being a source of errors in itself.
      - carlmr 6y ago
        Considering error rates due to sleep deprivation must rise at some point and the hand off error rate is probably quite constant there may be an optimal hand off. However that doesn't mean this is the global optimum. There are probably ways to reduce hand off errors, e.g. by introducing hand off check lists. Sleep deprivation errors on the other hand can only be reduced by reducing sleep deprivation, giving crystal meth to the doctor (probably unethical and unsustainable) and by general poka yoke style changes that will have benefits even when not sleep deprived. So the global optimum can probably be shifted to somewhere where the doctor is not sleep deprived and the hand off is organized. Which is also more humane towards the doctor.
        eru 6y ago
        You could probably have overlapping shifts? After eg 6h of work, don't accept any new patients, but finish treating the ones you already have, if possible.
        carlmr 6y ago
        Overlapping shifts could just be seen as a better hand-off. However I think the hand-off issues are probably the same that you have in any project. There's a lot of implicit knowledge. E.g. you've noticed patient X was breathing heavily, but you weren't sure if it meant something, if you see that again 10h later you might investigate, while for the other doctor if he started after 8h he might notice it for the first time, and have a similar wait and see approach. In this case one procedural way to make this better would be to teach doctors to write up anything unusual they notice during the day, and read this list of unusual events during hand-off to the next doctor.
  - sampo 6y ago
    > How can we change this culture though? There are articles on how the early aviation had too much pilot egos and cowboy attitude, and how the aviation industry was able to change that and reduce human errors. And how medicine should learn from them, and maybe already is. https://www.nytimes.com/2006/10/31/health/31safe.html https://www.nytimes.com/2006/10/31/health/31safe.html https://www.youtube.com/watch?v=L_oXvXtQlBA https://www.youtube.com/watch?v=L_oXvXtQlBA
    - 082349872349872 6y ago
      For "urban cowboy" attitude, compare spurs in the cockpit: https://generalaviationnews.com/2020/03/18/questions-from-the-cockpit-a-pointed-question/ https://generalaviationnews.com/2020/03/18/questions-from-th...
- ako 6y ago
  I wonder how doable it is to make medicine more like aviation? Medicine is for a large part trial and error (try this medicine and come and in one week to see if it helped), under high time pressure (general practitioners in the netherlands have 10 minutes to see a patient, including reading up on previous visits, and following up with hospital research results, etc). Even if you'd try to determine learnings from every error, and put these in protocols to instruct healthcare people to avoid same mistakes next time, would they be able to effectively use this knowledge within the 10 minutes allocated?
TheButlerian 6y ago
Covid-19 cannot get to 200 000 still and it will be one and done. Absolutely baffling that people are not outraged by the doctors killings...I guess not enough media drumming up of the number? Time to have counters on every news media with the murders?

elliekelly 6y ago

I’ve mentioned it here before but the book “Black Box Thinking” by Matthew Syed is an interesting read in this regard. It really highlights how important it is to design a system that’s focused on error reduction (like aviation) rather than focused on allocating blame (like medicine). IIRC there’s a chapter in the book about patient safety correlating with how “friendly” the OR nurses perceive a surgeon. The implication being that if someone makes a mistake they’re more likely to fess up a nicer surgeon (who will then have the opportunity to correct the error) and more likely to cover it up or ignore if they might get chewed out for bringing it up.

matheusmoreira 6y ago
> It really highlights how important it is to design a system that’s focused on error reduction (like aviation) rather than focused on allocating blame (like medicine). How can we change this culture though? For some reason doctors attract insane lawsuits seeking hundreds of thousands of dollars in damages. People don't seem to be so litigious when they're against rich corporations with lots of lawyers at their disposal. If this continues, the only possible result is defensive medicine since doctors will need every bit of proof and documentation in order to prove their innocence in the event of a lawsuit.
- deleted 6y ago
  [deleted]
- yummypaint 6y ago
  Doing things like making sure medical staff arent forced to work while sleep deprived would go a long way to avoiding errors in the first place. Policy changes that walk the walk and substantively prioritize safety over profit can help create safety culture from the top down. Having more staff available in general can also make redundancy checks more feasible.
  - adrianN 6y ago
    It is my understanding that the error rates skyrocket when patients are handed off between medical staff. Longer shifts reduce the number of hand-offs and thereby reduce the number of errors overall, despite sleep deprivation being a source of errors in itself.
    - carlmr 6y ago
      Considering error rates due to sleep deprivation must rise at some point and the hand off error rate is probably quite constant there may be an optimal hand off. However that doesn't mean this is the global optimum. There are probably ways to reduce hand off errors, e.g. by introducing hand off check lists. Sleep deprivation errors on the other hand can only be reduced by reducing sleep deprivation, giving crystal meth to the doctor (probably unethical and unsustainable) and by general poka yoke style changes that will have benefits even when not sleep deprived. So the global optimum can probably be shifted to somewhere where the doctor is not sleep deprived and the hand off is organized. Which is also more humane towards the doctor.
      - eru 6y ago
        You could probably have overlapping shifts? After eg 6h of work, don't accept any new patients, but finish treating the ones you already have, if possible.
        carlmr 6y ago
        Overlapping shifts could just be seen as a better hand-off. However I think the hand-off issues are probably the same that you have in any project. There's a lot of implicit knowledge. E.g. you've noticed patient X was breathing heavily, but you weren't sure if it meant something, if you see that again 10h later you might investigate, while for the other doctor if he started after 8h he might notice it for the first time, and have a similar wait and see approach. In this case one procedural way to make this better would be to teach doctors to write up anything unusual they notice during the day, and read this list of unusual events during hand-off to the next doctor.
- sampo 6y ago
  > How can we change this culture though? There are articles on how the early aviation had too much pilot egos and cowboy attitude, and how the aviation industry was able to change that and reduce human errors. And how medicine should learn from them, and maybe already is. https://www.nytimes.com/2006/10/31/health/31safe.html https://www.nytimes.com/2006/10/31/health/31safe.html https://www.youtube.com/watch?v=L_oXvXtQlBA https://www.youtube.com/watch?v=L_oXvXtQlBA
  - 082349872349872 6y ago
    For "urban cowboy" attitude, compare spurs in the cockpit: https://generalaviationnews.com/2020/03/18/questions-from-the-cockpit-a-pointed-question/ https://generalaviationnews.com/2020/03/18/questions-from-th...
ako 6y ago
I wonder how doable it is to make medicine more like aviation? Medicine is for a large part trial and error (try this medicine and come and in one week to see if it helped), under high time pressure (general practitioners in the netherlands have 10 minutes to see a patient, including reading up on previous visits, and following up with hospital research results, etc). Even if you'd try to determine learnings from every error, and put these in protocols to instruct healthcare people to avoid same mistakes next time, would they be able to effectively use this knowledge within the 10 minutes allocated?

TheButlerian 6y ago

Covid-19 cannot get to 200 000 still and it will be one and done. Absolutely baffling that people are not outraged by the doctors killings...I guess not enough media drumming up of the number? Time to have counters on every news media with the murders?