Thoughts

lorri Zipperer zipperer_info at YAHOO.COM
Tue Sep 3 16:58:24 UTC 2013


**Forwarded by Moderator**
 
akassoffmd at gmail.com writes:
 
I have been following the Email discussions with interest
and am impressed that that so many  contributors have spent much time and effort in developing their views
and impressions. The suggested approaches are well thought out and presented,
based both on individual experiences and research as well as familiarity with
the literature published in this area.
 
As someone who has just been introduced to these
discussions, I am impressed, not only by the concern so many individuals have
regarding this important problem but by the efforts that have been made to
introduce measures to address it. I do have some suggestions that I would
submit, perhaps to broaden a perspective.
 
It seems to me, based upon these discussions, that some
recognition should be given to what I believe are fundamental impediments
contributing to medical errors that have not been given warranted focus.
Regarding the general practice of medicine, gleaned in most part from discussions
that I have had with patients unhappy with their general medical care, there
seems to be an unwillingness to spend time listening to patients' complaints
and their perceptions regarding such complaints. They often sense a tone of
arrogance on the part of the physician, interpreted as a demeaning of their
knowledge and understanding and a projected attitude that the physician can
understand a problem fully even before hearing them out. This tends to close
down further discussion and conversation and leaves the patient frustrated in
their opportunity to have their history and symptoms fully explained. To the
degree that this is true, all the paradigms that may be put forth to improve
the accuracy of diagnosis will be for naught as the clues that might lead the
diagnostician to a correct diagnosis may well be missed.
 
Secondly, in this regard, in the current state of
reimbursement, with declining income and  the rising costs of practice, I sense that in many cases, there is an
effort to compensate for this by seeing more patients in a given day, allotting
less time for each visit. This sense of urgency on the part of the physician is
often portrayed by, as patients express it, as the doctor standing and moving
toward the door before the patient feels that the story has been fully told or
questions being asked. In my personal experience, this has not infrequently led
to being asked my advice about something such as a problem with a knee which,
as an ophthalmologist, I am ill equipped to answer. When I inquire as to why I
am being asked, I am inevitably told that their general physician or specialist
seemed to be in a hurry and their visit seemed to have been incomplete.
 
On another topic addressed in the on-line discussions,
that of medical teaching, my thoughts are these. Whatever the method utilized,
there are good and bad teachers. I have little doubt that the knowledge of the
teacher is less important than the ability to teach effectively. Whatever
approach is taken, it is critical that the teacher have a dedication to the
imparting, not only a body of knowledge but an system of utilizing it which
would lessen the chance of medical error. It is not only the ability of a
student to provide a differential diagnosis but an approach to enable the
student to apply a logical mental process to sorting it out, which is of critical
importance. I believe that the clinical experience , to varying degrees, is
left in the hands of practitioners who may or may not have a commitment to
teaching. They may be part of a rotation with an obligation to lead rounds but
without an appetite or skills to effectively teach. When I read polls
suggesting that a sizable percentage of individuals in private practice are
unhappy, with plans to retire early, of that they would dissuade their children
from entering the field of medicine, it speaks to me of the need to keep such
"teachers" away from students who I can only believe have chosen the
field of medicine for the best of reasons. To have enthusiasm poisoned by
individuals who are disgruntled can only influence young and impressionable physicians
in a way that will lessen intellectual stimulation and commitment that will
impact negatively in future behavior. This can only and surely perpetuate an
environment which will diminish the quality of medicine as it is practiced
(leading to errors in diagnosis and otherwise). 
 
 
Aaron Kassoff MD
Albany NY
akassoffmd at gmail.com







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