Amy Reinert amy.reinert at GMAIL.COM
Tue Dec 8 13:20:27 UTC 2015

You raise some interesting questions here, Rob.

In response to your question about one thing that could be done right now
that could save lives or reduce injuries caused by errors in medicine, I
suggest that taking responsibility for individual patients under the
doctor's care seems to be something that has fallen by the wayside as
medical care delivery becomes increasingly systems oriented and

I see several clients in my practice who have serious chronic illnesses and
are in various stages of diagnosis and treatment. One theme that I have
picked up from them is that there is a great deal of frustration that they
get handed off to one specialist or another, then referred back to primary
care, and out to specialists again, but with all this bouncing around,
nobody really takes charge of the case and commits to finding the correct
diagnosis and appropriate treatment. This seems particularly true for
patients with autoimmune diseases. I am not suggesting that each physician
isn't doing their best, but rather, that the patients are suffering because
the PCP refers the patient out as necessary, but the specialists keep a
narrow focus only on their area of interest. Care then becomes piecemeal,
lots of communication errors and failures occur between medical offices,
necessary tests are not conducted, or tests are unnecessarily repeated. One
of my clients used the analogy that his care was like paying good money for
concert tickets to hear a beautiful piece of music, but the conductor
wasn't there, so the music is reduced to cacophony. Another client arrived
at her session one day in tears, because an accurate diagnosis had been
made for her two years previously, but there was a communication error and
so she never got the call from the doctor or the nurse, never received
prescription information, and therefore continued her diagnostic quest for
another 24 months. She learned this through a strange set of circumstances
that people of faith might describe as Divine intervention. She spent a lot
of time grieving two years of her life where she might have been feeling
better and more able to participate in her own life. Interestingly, in that
two year quest, nobody else picked up the correct diagnosis.

My guess would be that each doctor perhaps does feel that they are being
responsible for the patient without realizing what is being left
unaddressed because nobody is keeping an eye on the big picture of the
patient's condition. I remember that PCP's used to do this. Perhaps they
are still supposed to?

Systems and procedure policies are intended to reduce human error and
increase efficiency. Unfortunately, they also tend to provide a practical
shield from individual responsibility (I say practical because it might
seem safe to practice medicine behind the systems and policies, but the
doctor can still get sued). When service to the systems and policies
becomes greater than service to the patient, an element of humanity is
removed from the process. It seems to me that a great many of the problems
in diagnostic accuracy result from this. I don't think anyone does this
intentionally. It is the nature of the beast.

All the best,
Amy Ruzicka, Ph.D.

On Saturday, December 5, 2015, robert bell <
0000000296e45ec4-dmarc-request at> wrote:

> *Questions *
> Do those working in the Medical industry ask enough questions?
> Would asking more  questions lead to creativity, and that then lead to
> solutions, and finally to saving more lives and injury from errors in
> medicine?
> Are we making enough progress with Errors in Medicine?
> What is the one thing, that we could do right now, that would save some
> lives or reduce injuries caused by errors in medicine?
> Robert Bell, M.D. Ph.C.
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