- By Ian Bradley
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In my previous post, I shared my view on how CEO’s and managers discuss mistakes in their executive coaching sessions with me. I pointed out how much the discussions focused on the emotional consequences of the mistake and not the underlying cognitive process. I offered that my own profession of clinical psychology didn’t do a particularly good job either in handling mistakes. In today’s comments, I’ll examine some of the changes that are reducing medical mistakes before I present a model for us all.
Errors in medicine; torts and traps
In contrast to Psychology, there is more consistence about what interventions will cure or kill a medical patient. However, the variability in each patient’s presentation with only partial overlap with group-based diagnostic criteria makes the environment ripe for mistaking the condition and providing the wrong treatment. Even the right treatment can initiate a chain of side effects that becomes as serious as the original problem. Given this inherent complexity plus the fact medical decisions are often split-second decisions made by stressed and tired medical professionals, it is not surprising that errors occur. We have documented evidence for the magnitude of the problem; the US Institute of Medicine estimated that 44,000 to 98,000 patients succumb to medical errors each year in the US.
In my opinion, two factors mitigate against a more professional response to this error rate, the first is economic; the second, attitudinal. As long as tort lawyers seek stratospheric medical malpractice awards, there will be a financial incentive for physicians to obfuscate. Similarly, as long the professional views medical mistakes as signs of individual physician failure, then systematic and corrective exploration will be limited. Douglas Mossman has written an excellent article about this concern in the March 2009 issue of Journal of American Academy of Psychiatry and the Law where he stresses the importance of moving away from punishment to education.
In a highly readable book, How Doctors Think, Groopman gets to the heart of the issue by examining the biases, misattributions and cognitive traps that were instrumental in the series of medical misadventure narratives. Understanding the underlying thinking patterns that get a doctor in trouble can lead to corrective action. Nowhere is it better illustrated than in changes to the medical curriculum itself that teaches young minds how to think to arrive at a proper diagnosis rather than just the diagnosis.