How often to you hear "Do you Remember?"

[Lysinee]

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http://www.ted.com/talks/brian_goldman_doctors_make_mistakes_can_we_talk_about_that.html

I found an interesting video on how every doctor makes mistakes. I was wondering how often does an EM physician hear the 3 words, "Do you remember" (7:20 and 11:24)? Basically, you release a patient and s/he later returns in a life threatening condition.

For people who viewed the entire video, any opinions.

 

[MD13]

http://www.ted.com/talks/brian_goldman_doctors_make_mistakes_can_we_talk_about_that.html

I found an interesting video on how every doctor makes mistakes. I was wondering how often does an EM physician hear the 3 words, "Do you remember" (7:20 and 11:24)? Basically, you release a patient and s/he later returns in a life threatening condition.

For people who viewed the entire video, any opinions.

Great video - phenomenal speaker who makes great points. I'd recommend it to anyone.

He didn't talk much about the reasons for having this culture, however (not a fault of his talk--his focus wasn't on this). But moving forward, I think it's important to recognize the reason for this culture so it can change.

Unfortunately, having such openness about these mistakes is often perceived as a huge liability. The era of malpractice and litigiousness of our society makes this very difficult. Despite this, however, in med school we are taught to always own up to your mistakes, but I think that after medical school you get a very different perspective. The horror stories about physicians getting sued and doctors losing their licenses are pervasive and do tend to affect one's mindset.

So overall, I agree with everything he has said and think that a culture change DOES need to occur, but this too needs to be coupled with certain policy changes on the malpractice side of things (read tort reform) in order to promote this culture change and transform it from a few individuals speaking out, to an entire culture of physicians changing the way they look at their mistakes from acts of shame to acts of learning.

 

[deleted109597]

19:29 is not terribly long, but at the same time, longer than most of us have except on casual days.

Two points I would like to make of it. First, yes, it is admirable to try and change the system. QI/QA/M&M should be about learning from the mistakes, not about ostracizing those that made them (unless they did it purposefully). However, we are in a system where this is hard to do. There is a point where admitting mistakes does increase your risk of litigation. Being forthcoming to people does decrease litigation some, but if you're learning from it, you need to be able to do so in a manner which does not set you up for penalty, or you simply go back to not admitting mistakes to begin with.
Secondly, even though we know we aren't perfect, every meeting I've ever been to talks about the strive for perfection. Yes, we should try not to make mistakes, but we do not need to be compared to the airlines. I often don't have a choice about whether I can fly the plane or not. Once it is there, I have to fly it, regardless of the lack of wings/fuel/actively on fire/being shot at by anti-aircraft fire. The ED is not elective. CMS dings us for less than 100% on measures that don't actually help people. They do however, encourage people to lie about patients that they don't meet the measures on, or encourage strange bureaucratic decisions about silly things such as giving all patients with cough, sputum, and fever PO avelox in the lobby after blood cultures.


The fact that this guy feels this way and practices in Canada makes me wonder at what he would go through in a highly litiginous state.

 

[WilcoWorld]

Yes, we should try not to make mistakes, but we do not need to be compared to the airlines. I often don't have a choice about whether I can fly the plane or not. Once it is there, I have to fly it, regardless of the lack of wings/fuel/actively on fire/being shot at by anti-aircraft fire. The ED is not elective.

That is a very important distinction that is not often enough made.

 

[Lysinee]

Interesting answers, thanks.