AW: [IMPROVEDX] AW: [IMPROVEDX] AW: [IMPROVEDX] death certificates-litigation

Vic Nicholls nichollsvi2 at GMAIL.COM
Sun May 8 18:11:34 UTC 2016


Hi,

I'm not understanding how a patient acting autonomously can prevent a 
prescription/drug prescribing error, leave items in the body/operates on 
the wrong part/side during surgery, or gives directions contrary to EBM, 
ignores test results, etc. Can you explain that to me?

The context I am looking at is what can a doctor do to mitigate any 
problems on their end. If a patient screws up, then they take the blame 
for that. If they can't follow a prescription or order it filled due to 
financial issues, that is not a doctors' fault, but the patient must 
tell the doctor. If I have a hard time getting Likewise, if a doctor 
said take drug X, and needed to prescribe drug Y, I expect them to take 
the blame for that, acknowledge that and what they'll do to not do it to 
someone else.

Thanks,

Vic


On 5/8/2016 5:00 AM, Kodolitsch von, Yskert wrote:
>
> Hi Joe,
>
> you may enjoy an article that questions the cockpit metaphor for the 
> surgery suite:
>
> http://www.ncbi.nlm.nih.gov/pubmed/20106395
>
> But I admit: from all industries mentioned as models for clinical 
> safety aviation is probably most suitable, because pilots deal with 
> outer conditions (weather, airtraffic, for instance). Marc De Leval 
> pioneered this approach, and he was able to approach error 
> successfully in doing so (http://www.ncbi.nlm.nih.gov/pubmed/10733754)
>
> Nonetheless, the type of social action of pilots (at least in civil 
> aviation) is different from that of physicians. Dealing with patients 
> is not like dealing with weather because patients act autonomously. I 
> am not arguing against cross-industry innovation approaches, but I 
> point out to the limits of such approach in this specific contents.
>
> Best,
>
> Yskert
>
> *Von:*Joe's New Gmail [mailto:jgraedon at GMAIL.COM]
> *Gesendet:* Samstag, 7. Mai 2016 21:00
> *An:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Betreff:* Re: [IMPROVEDX] AW: [IMPROVEDX] AW: [IMPROVEDX] death 
> certificates-litigation
>
> Let's consider pilots for a moment.
>
> Does anyone remember a few years ago when two pilots overflew the 
> Minneapolis airport for almost an hour.
>
> They became a target of derision. They were fired.
>
> No one was injured. The flight landed safely...just late.
>
> Pilots have an amazing outcome! Very rarely is there a crash. When it 
> happens, there are headlines. It leads all news stories.
>
> Every day in America health care experiences the equivalent of 3 jumbo 
> jet crashes with NO survivors. These are preventable errors. There are 
> no headlines.
>
> Pilots report near misses and mistakes. Everyone learns from others.
>
> Health care institutions keep their sentinel events closely guarded 
> secrets.
>
> How will this change? Please do not say tort reform!
>
> Joe
>
>
> On May 7, 2016, at 1:58 PM, Robert Bell 
> <0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG 
> <mailto:0000000296e45ec4-dmarc-request at list.improvediagnosis.org>> wrote:
>
>     More good thoughts Yskert,
>
>     Maybe the expression should be "To Err Occasionally is Human."
>     Perhaps from country to country in medicine the error rate is
>     fairly standard, but in some countries there are extenuating
>     circumstances that increase it - here perhaps a lack of sleep. In
>     another country a greater fear of admitting guilt despite despite
>     little litigation. All are hindrances to occasional human error,
>     should be well understood, and dealt with. A few studies where the
>     hindrances are controlled would get the ball rolling.
>
>
>
>     Do other industries better understand the hindrances to error
>     reduction than we do?
>
>
>
>     it is sad that we still do not even know the error rates by
>     country in medicine. And also very sad, when we do nothing
>     happens, e.g. Guns. What is the hindrance there?
>
>
>
>     Rob
>
>
>     Sent from my iPad
>
>
>     On May 6, 2016, at 11:02, "Kodolitsch von, Yskert"
>     <kodolitsch at UKE.DE <mailto:kodolitsch at UKE.DE>> wrote:
>
>         An argument that support Joe´s is that in Germany litigation
>         is not such a big problem (jet), but error is.
>
>         We only can fix things when we stay authentic as physicians.
>         Physicians do not want to harm patients. That is why we fight
>         error – and truthfulness is a prerogative to succeed.
>
>         We have colleagues who had the courage to fight Ebola. We all
>         should have courage enough to fight error.
>
>         Right?
>
>         Yskert
>
>         *Von:*Joe Graedon [mailto:jgraedon at GMAIL.COM]
>         *Gesendet:* Freitag, 6. Mai 2016 17:41
>         *An:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>         <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
>         *Betreff:* Re: [IMPROVEDX] AW: [IMPROVEDX] death
>         certificates-litigation
>
>         Robert,
>
>         We have heard for years (decades) that litigation is the
>         problem. Mean, nasty, aggressive plaintiffs lawyers are what
>         prevents transparency. If we could only institute tort reform
>         and reduce the risk of litigation and large settlements, then
>         everyone could live happily ever after and report errors and
>         the system would function superbly well.
>
>         Sorry, I hate to play devil’s advocate on this, but where is
>         the evidence that would make any difference? A lot of people
>         who are severely injured as a result of medical mistakes are
>         left in limbo when tort reform prevents legal recourse.
>
>         If I am not mistaken, Tim McDonald, MD, JD, demonstrated that
>         the Seven Pillars program he initiated at the University of
>         Illinois demonstrated that transparency works and does not
>         result in outrageous settlements. If anything, it saves money.
>
>         Here is a link to our interview with him and an overview of
>         his research:
>
>         http://www.peoplespharmacy.com/2015/09/23/show-1007-coming-clean-on-medical-mistakes/
>
>
>             Seven Pillars of Transparency:
>
>         "Despite the fear, some health care institutions have found
>         that transparency with respect to errors actually reduces
>         lawsuits and generates good will. Learn about the Seven
>         Pillars approach to disclosure and remediation utilized
>         successfully at the University of Illinois. Should it be
>         adopted elsewhere?”
>
>         Joe
>
>             On May 6, 2016, at 1:05 PM, Robert Bell
>             <0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG
>             <mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>>
>             wrote:
>
>             Yskert, a real step forward. We need solutions.
>
>             Your thoughts, where appropriate, should also be extended
>             to every private doctor''s office and all other medical
>             facilities outside of hospitals. Although it could be
>             harder to do.
>
>             However, I have been recommending for years a system of
>             having at least one person assigned as a "Safety Officer"
>             in HCPs offices with periodic discussion and remedies of
>             ALL the negative events collected. Call back failures,
>             appointment problems, lost lab work, 911 calling, etc., etc.
>
>             But to my knowledge I have had no offices that have
>             recently introduced such an arrangement. But I may not
>             have heard of them. I have heard by hearsay that a very,
>             very small number of larger offices have such a system in
>             practice, but that was some years ago. Not recently.
>
>             The lack of interest I think is because no one wants
>             anything to do with errors/mistakes, or any record keeping
>             of these in case they are discoverable in future law
>             cases. Cost may be a minor problem.
>
>             And this presumably is the same reluctance that hospitals
>             have to collecting decent error data.
>
>             So this gets back to my point in this thread of can we
>             achieve ANYTHING significant without first fixing the
>             litigation issues?
>
>             Without this are we just perpetually committed to talking,
>             talking, talking but doing nothing very concrete to remedy
>             the injury and loss of life!
>
>             Rob Bell, MD
>
>             Sent from my iPad
>
>
>             On May 6, 2016, at 2:33, "Kodolitsch von, Yskert"
>             <kodolitsch at UKE.DE <mailto:kodolitsch at UKE.DE>> wrote:
>
>                 Dear Peter,
>
>                 your comment is brilliant. Quite humanistic, I would say.
>
>                 The literature on hospital management seems quite
>                 uniform in suggesting a command and control model of
>                 leadership instead (see for example all the strange
>                 articles that currently appear in the N Engl J Med;
>                 e.g.
>                 http://www.nejm.org/doi/full/10.1056/NEJMp1502312, or
>                 http://www.nejm.org/doi/full/10.1056/NEJMp1502419 ) .
>
>                 If this goes on, there will be a deadly avalanche of
>                 costs for control and external incentives that finally
>                 destroys motivated healthcare.
>
>                 Do you know any good literature that substantiates
>                 your view in healthcare leadership?
>
>                 There has to be an organizational theory framework to
>                 ground your views (beyond the usual literature on
>                 “team motivation”).
>
>                 Best from Hamburg
>
>                 Yskert von Kodolitsch
>
>                 *Von:*Elias Peter [mailto:pheski69 at GMAIL.COM]
>                 *Gesendet:* Freitag, 6. Mai 2016 01:34
>                 *An:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>                 <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
>                 *Betreff:* Re: [IMPROVEDX] death certificates
>
>                 I didn’t say reward and punishment won’t work. I said
>                 (or I tried to say) that this is too simple a phrasing
>                 to be either accurate or actionable.
>
>                 I think there is never a single simple thing that will
>                 solve a complex and multifactorial problem. But here
>                 are some ideas I would try if I were CEO of my
>                 institution and had a magic wand:
>
>                   * Essentially NO rewards to individuals based on
>                     individual metrics. (See Deming and the Red Bead
>                     Game for why. Here is a link to a talk where
>                     Berwick does a shortened but effective version:   )
>                   * Set up the rewards (salary, bonuses, parking
>                     spaces, extra time off) so they are tied to
>                     outcomes across the institution, not by
>                     individuals. If complication X goes down by Y
>                     percent, EVERYONE (janitor to CEO) gets a piece of
>                     the reward.
>                   * At least half of the items measured and tracked
>                     should be selected by a broad and open process
>                     rather than imposed.
>                   * Largely eliminate performance evaluations of
>                     individuals and replace them with performance
>                     evaluations of processes and teams.
>                   * Publish the institution’s statistics.
>                   * Set up a process where, after an error is found
>                     (with or without actual harm) the involved
>                     individuals (including patients) are told what
>                     happened, the results of the root cause analysis,
>                     and what specific things are changing to prevent a
>                     recurrence.
>                   * When someone makes a mistake and harm occurs,
>                     provide counseling and support. (I have not fully
>                     healed from some mistakes I made 3 decades ago.)
>                   * Make self-examination of processes and small tests
>                     of change for improvement a standard part of
>                     everyone’s job description, with budgeted time and
>                     support infrastructure.
>                   * Make self-examination of errors and harm a
>                     standard part of everyone’s job description, with
>                     budgeted time and support infrastructure. (E.g., a
>                     weekly meeting of clinicians and office staff to
>                     talk about things that didn’t work well and how to
>                     improve them.)
>                   * When something bad happens (from wrong side
>                     amputation to failure to notify a patient of a
>                     normal lab result) and is reported by someone
>                     involved who suggests an improvement, a thank-you
>                     note wet-signed by the CEO and included in the
>                     personnel file.
>                   * Etc.
>
>                 The overwhelming majority of people in health care are
>                 motivated (driven) by a desire to do the right thing
>                 for the right reason in the right time frame. Leverage
>                 this. Build on this commitment and the accompanying
>                 internal motivation. Avoid turning internal motivation
>                 into a materialistic economy, which is much easier to
>                 game and less likely to work.
>
>                 All my suggestions are intended to make success
>                 something measured at the highest team level possible,
>                 remove or blunt a punitive mind set, make sure metrics
>                 happen at a level where there is at least a chance
>                 that they are meaningful (they are not meaningful at
>                 the individual clinician level), and focus all the
>                 talk and energy on making things better.
>
>                 Peter
>
>                     On 2016.05.05, at 6:22 PM, Joe's New Gmail
>                     <jgraedon at GMAIL.COM <mailto:jgraedon at GMAIL.COM>>
>                     wrote:
>
>                     So Peter...how would you go about changing behavior?
>
>                     If reward and punishment won't work, what would
>                     improve the reporting process?
>
>                     Joe
>
>
>                     On May 5, 2016, at 5:04 PM, Elias Peter
>                     <pheski69 at GMAIL.COM <mailto:pheski69 at GMAIL.COM>>
>                     wrote:
>
>                         I love blunt. I’ll also be blunt.
>
>                         Without disagreeing, I would add that it is
>                         important to remember that ‘reward’ is a
>                         simple two syllable word that codes for an
>                         incredibly array of possibilities. Big, small,
>                         intrinsic, extrinsic, immediate, delayed,
>                         proportional, disproportional; these all
>                         impact the effectiveness (or
>                         counter-productivity) of rewards.
>
>                         Pilots, to my knowledge, are not rewarded
>                         *directly* for reporting errors, problems,
>                         incidents. They are ‘encouraged’ by a
>                         combination of culture, support when they do
>                         so, seeing positive results when they do so,
>                         and the knowledge that their fate is the same
>                         as the fate of the airplane.
>
>                         Let’s not think that we can create a reward
>                         system for reporting errors and thereby change
>                         the culture.
>
>                         Peter
>
>                             On 2016.05.05, at 4:35 PM, Joe Graedon
>                             <jgraedon at GMAIL.COM
>                             <mailto:jgraedon at GMAIL.COM>> wrote:
>
>                             I am a firm believer in the principles of
>                             reward and punishment. By that I mean,
>                             people, animals, and all sorts of other
>                             creatures do what gets them rewards,
>                             treats, food, toys, whatever. They also
>                             try to avoid the things that cause them
>                             distress.
>
>                             Our medical system rarely rewards health
>                             care professionals for reporting errors.
>                             If anything, physicians are punished by
>                             their employers, insurance companies and
>                             yes, malpractice lawyers, for being
>                             transparent about mistakes, especially
>                             those that lead to death.
>
>                             I only imagine we will see change if we
>                             come up with strategies to reward
>                             physicians, nurses and all others involved
>                             in health care to share mistakes the way
>                             pilots are encouraged to share close call
>                             information. We need billions of dollars
>                             in federal money (think the National
>                             Institute of Error Prevention-NIEP) to
>                             come up with solutions to diagnostic
>                             errors and treatment mistakes. And we need
>                             to punish institutions that hide their
>                             mistakes.
>
>                             Reward the behavior we wish to encourage.
>                             Punish the behavior we wish to disappear.
>
>                             Sorry to be so blunt.
>
>                             Joe
>
>                                 On May 5, 2016, at 3:57 PM, Phillip
>                                 Benton, MD, JD
>                                 <0000000697ec7b18-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG
>                                 <mailto:0000000697ec7b18-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>>
>                                 wrote:
>
>                                 Liz,
>
>                                 Is such review not essentially what
>                                 Lucien Leape and colleagues did in the
>                                 Harvard Medical Practice study (N Engl
>                                 J Med.
>                                 <http://www.ncbi.nlm.nih.gov/pubmed/?term=Leape+L%2C+Brennan+T%2C+Laird+N%2C+et+al.+The+nature+of+adverse+events+in+hospitalized>
>                                 1991 Feb 7;324(6):377-84) 25 years
>                                 ago, referenced in the IOM report /To
>                                 Err Is Human/ (1999)? The several
>                                 reviews that followed
>                                 were systematically re-reviewed by
>                                 John James just 3 years ago (J Patient
>                                 Saf.
>                                 <http://www.ncbi.nlm.nih.gov/pubmed/?term=James+JT%2C+Journal+of+Patient+safety+2013>
>                                 2013 Sep;9(3):122-8.).
>
>                                 Can we deny the problem? NO.  Can we
>                                 arrive at a consensus definition (wth
>                                 qualifiers) and ascribe an ICD code
>                                 (with modifiers)? Most probably YES if
>                                 anyone will take it on.
>
>                                 Phil Benton, MD, JD
>                                 Atlanta, GA
>
>                                 -----Original Message-----
>                                 From: Elizabeth Regan
>                                 <lizregan53 at GMAIL.COM
>                                 <mailto:lizregan53 at GMAIL.COM>>
>                                 To: IMPROVEDX
>                                 <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>                                 <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>
>                                 Sent: Thu, May 5, 2016 2:24 pm
>                                 Subject: [IMPROVEDX] death certificates
>
>                                 I would not favor adding medical error
>                                 to death certificates for a variety of
>                                 reasons but the chief one being that
>                                 it is so hard to define and while is
>                                 obvious to those who want to see
>                                 improvement, it is less obvious to
>                                 those who want to avoid the concept.
>                                 At the point where there is broader
>                                 consensus on how to identify and
>                                 reduce medical error (especially
>                                 diagnostic error) I think it will be
>                                 easier to record and track the event.
>
>                                 I believe strongly that it is critical
>                                 to do that, but we are not there yet.
>
>                                 I have just completed a project to
>                                 adjudicate cause of death in nearly a
>                                 1000 deaths for a large cohort study.
>                                 The project involves reviewing both
>                                 death certificates and medical
>                                 records. At that level of review I did
>                                 not see evidence of diagnostic error
>                                 or other errors. Now that I consider
>                                 the project in light of this
>                                 discussion - I guess that is interesting.
>
>                                 I don’t interpret this to mean that
>                                 none of those subjects experienced
>                                 error, but rather to reflect on the
>                                 invisibility of error in our record
>                                 keeping.
>
>                                 I wonder about the feasibility of
>                                 re-reviewing the data with a more
>                                 critical eye and finding more.
>                                 However, I don’t really think I would
>                                 find much.
>
>                                 Liz Regan
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>         ------------------------------------------------------------------------
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>         Universitätsklinikum Hamburg-Eppendorf; Körperschaft des
>         öffentlichen Rechts; Gerichtsstand: Hamburg | www.uke.de
>         <http://www.uke.de>
>         Vorstandsmitglieder: Prof. Dr. Burkhard Göke (Vorsitzender),
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> Moderator:David Meyers, Board Member, Society for Improving Diagnosis 
> in Medicine
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>
> ------------------------------------------------------------------------
>
> Universitätsklinikum Hamburg-Eppendorf; Körperschaft des öffentlichen 
> Rechts; Gerichtsstand: Hamburg | www.uke.de <http://www.uke.de>
> Vorstandsmitglieder: Prof. Dr. Burkhard Göke (Vorsitzender), Prof. Dr. 
> Dr. Uwe Koch-Gromus, Joachim Prölß, Rainer Schoppik
>
> ------------------------------------------------------------------------
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> SAVE PAPER - THINK BEFORE PRINTING
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> Moderator:David Meyers, Board Member, Society for Improving Diagnosis 
> in Medicine
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> To learn more about SIDM visit:
> http://www.improvediagnosis.org/ 






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine

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