Institutional self-protection motives are part of the system which affect diagnostic error

Vic Nicholls nichollsvi2 at GMAIL.COM
Mon Dec 8 00:56:34 UTC 2014

How about a 3rd option?

Sit down and talk like a human being, face to face, with the patient 
(and their family if so desired). Do a decent investigation. List the 
items that they have. Let the patient show what evidence they have.

Do a real serious investigation and come back with findings. See where 
that goes. Apologize. Find out what the patient wants - if they want $$$ 
or be involved in knowing things were set better for themselves and others.

I think the other option that would work is that with the culture of 
some groups, maybe holding the admin responsible for creating a hostile 
environment that didn't encourage doctors to work with and learn from 
their mistakes, make the admin liable and criminally liable. In some 
instances, I truly believe that putting the ADMIN on the hot seat more 
so than the doctors would be more beneficial to getting change and 
support in terms of the culture of medicine than doctors themselves.

No disrespect to any physician on here, but admin and risk managers can 
make worse blown calls than Jim Joyce or Don Denkinger ...

I actually told a ... ?? doctor helper ?? ... someone who works with 
problem doctors ... that they need to work with a particular 
admin/system first. Then they'd have less problems out of the doctors, 
less stress and Lord knows less stupidity.


On 12/1/2014 12:06 PM, Hamm, Robert M. (HSC) wrote:
> Specifically, after a mistake, the details could be 1) publicized so 
> others could learn, or 2) hidden, so this institution won't get sued.
> Here is the "Health Care Renewal" discussion of the hospital's 
> behavior after the patient's Ebola diagnosis was delayed.
> "
>       Public Relations and the Obfuscation of Management Errors -
>       Texas Health Resources Dodges its Ebola Questions
>       <>
> Not long ago, Texas Health Presbyterian hospital and its parent 
> system, Texas Health Resources (THR), were in the headlines after the 
> first patient to be diagnosed with Ebola in the US was admitted to 
> Presbyterian.  The hospital arguably flubbed the initial diagnosis of 
> this patient.  He was later admitted, very sick, and then quickly 
> died.  Two of the nurses caring for him in turn were infected with 
> Ebola, but survived, mainly in the case of specialized infectious 
> disease units in other hospitals.  Many questions remained about the 
> events at Presbyterian, whose answers might inform management of 
> future Ebola patients, or patients with other novel infections.  Yet 
> instead of answering them, THR has apparently loosed its dogs of 
> public relations to obfuscate the issues, apparently to make its 
> management look less bad.  The generic managers of health care 
> organizations use numerous tools, including well funded PR 
> departments, to advance their interests.  In this case, the interests 
> of generic management appear to conflict with those of public health.  
> Yet so far the generic managers seem to be winning.  True health care 
> reform would enable leadership of health care organizations by people 
> who actually understand the health care context, and would be 
> accountable to put patients' and the public's health ahead of 
> self-interest.
> Link: 
> <>"
> Robert M. Hamm
> Clinical Decision Making Program
> Department of Family and Preventive Medicine
> University of Oklahoma Health Sciences Center
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