Getting Something Accomplished

robert bell rmsbell200 at YAHOO.COM
Tue Jun 27 01:19:17 UTC 2017


Getting Something Accomplished

 

It is a few years since I was an academic and involved in clinical research and practice. So I am hoping that the comments made here are on target. I would welcome thoughts to correct anything and improve the arguments, which are an expansion to an article published nearly two years ago by Bell, R. Inside Medical Liability, 3rd Quarter 2015 entitled Errors in Medicine  - Do Something Now.

At the outset, let me say that we all should be very appreciative of Mark Graber and his SIDM colleagues in moving the ball to where it currently is - an amazing effort.

Slowness in Medicine

Medicine seems to me, in general, to make progress very slowly. 

§  Stethoscope. This was introduced 201 years ago and yet today we do not know how accurate it is with differing hearing losses, patient differences, user expertise, and the various diagnostic situations for which it is used. One could ask, overall is the stethoscope one of the biggest contributors to diagnostic error? How difficult would it be to clarify the accuracy of the stethoscope in various situations?  https://en.wikipedia.org/wiki/Stethoscope <https://en.wikipedia.org/wiki/Stethoscope> Would it be valuable to test the stethoscope for accuracy? Has this not been done because the stethoscope's status symbol protects it? If that is so, does it address a major flaw in our thinking that compromises our dedication to patients

§  Introduction of new ideas. New ideas seem to take so long to become established. I remember it taking some 10 years for antibiotics to be introduced and widely used in the US for the treatment of peptic ulcers after the discovery by Barry Marshall and Robin Warren of helicobacter pylori as the cause. https://en.wikipedia.org/wiki/Barry_Marshall <https://en.wikipedia.org/wiki/Barry_Marshall>
§  Guidelines Witness the number of Guidelines there are for so many conditions. Could not some of these be reduced with co-operation so that there is greater standardization? And that standardization being focused on what is best for the patient.

§  Specialty Societies These seem to take a long time to issue pronouncements and recommendations. I would be interested to learn how many of these and also the Societies dedicated to Errors in Medicine (including diagnostic) use time related goals to advance their agendas.

§  Publications - Medical publications I am told take longer to publish than the other scientific disciplines (who more frequently use open source publications). There are many reasons, but this overall delay in publication inhibits both diagnostic progress and patient treatments.

§  Etc., etc.

The time wasted in these delays is not completely lost and one can list benefits to waiting. But in the area of errors in medicine it would seem that time is of the essence and that saving some of the 100,000+ lives and injuries should be a very important goal.

Time Related Goals

 President Kennedy told Congress that it would be good to put a man on the moon and return him to earth within the 1960s. About 8 years later that happened


 There are a lot of articles on the Internet relating to the value of time related goals. Here is one:


https://wikispaces.psu.edu/display/PSYCH484/6.+Goal+Setting+Theory <https://wikispaces.psu.edu/display/PSYCH484/6.+Goal+Setting+Theory>
 This detailed article says, “…goal-setting theory has been the most researched, utilized, and established theory of work motivation in the field of industrial and organizational psychology (Pennsylvania State University World Campus [PSU WC], 2015, L. 6).”


 So the question is, would more time related goals speed up research in medicine? Would they help in the area of Errors in Medicine (including diagnostic errors) and our movement towards making medicine safer?


 In achieving Goals it would seem that time related ones have value but are more likely to succeed if the organization's culture enthusiastically supports them and that the responsible persons undertaking the tasks are more often wage earning.


 What To Do?

 So what can be done? And some of the suggestions here may already be ongoing: 

§  Triage the main problems in terms of frequency and difficulty in achieving.

§  Expand consortiums.

§  Think way out of the box and take a few chances.

§  Develop realistic time related goals and try to stay on target.

§  Collaborate with other societies involved in Errors in Medicine. Share responsibilities. Agree on dates for completion of projects.

§  Focus on the accuracy and improve the tests we currently use to make our diagnoses. This before we concern ourselves about other considerations such as biases, etc.

§  Publish successes both national and international, particularly studies that show lives saved and injuries prevented.

§  Get several hospitals that are at the top of the accepted list for medical standards to collectively publish specific Have them participate in clinical studies focused on one issue. Publish the results.

§  Research takes money and time – approvals, grants, etc. Consider establishing a Foundation to support the research.

§  Publish books that focus on litigation errors and their prevention. Get specialty societies involved. Consider establishing a publishing endeavor.

§  Encourage faster publication. Consider more open source publications.

§  Consider establishing a pilot initiative to get consensus guideline collaboration with several specialty societies that benefits patients. Publish the results.

Conclusion

We should be grateful for the progress already made. Things in medicine move slowly. Is it is incumbent upon us to try and speed things up for the benefit of patients using all things available to us? If the Holy Grail is figures and statistics for all errors in medicine, and that cannot be immediately achieved, then focus on things that can be accomplished. Clinical studies, publications, recommendations/statements, consensus guidelines, collaborations, etc., etc. should all be possible. And would realistic Time Related Goals help?


 Robert M. Bell, MD. Ph.C.

rmsbell200 at yahoo.com
 





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


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