Trust in a Medical Setting. Hauppauge, NY: Novinka Books, Nova Science Publishers, 2006.

Experience dealing with a host of difficult to impossible situations may help others in their encounters with these difficult and distrusting patients. These individuals may make up a small per cent of patients and family members, probably less than 2 per cent, but take up 90 per cent of energy in coping with day-to-day conflicts that arise from their behavior. Difficulties managing distrustful patients and family members must be dealt with on the spot, and they don’t go away.
Examples come from office experiences or wards, including situations that keep doctors and nurses and therapists awake at night, aggravate waking hours and poison leisure, that is, empirical, based upon experience and observation alone without science or theory. To survive an outrageous patient or relative requires resourcefulness, patience and imagination. Street wisdom learned the hard way is what I present, and without a guide or mentor to soften the bewilderment and sense of failure and frustration that accompanies these individuals. We seldom talk about these difficult, distrustful and sometimes threatening individuals amongst ourselves; rather we suffer and endure them silently, by ourselves. The problem is timeless as recorded in the world’s literature.
Out of the wreckage of human behavior comes valued experience leading to maneuvers and tactics of survival that are appropriate to almost all aspects and settings of human interaction including day-to-day medical care.

Links:
http://www.novapublishers.com
richardsmithmd.com

It’s just math. 98,000 deaths per year (the IOM number) = 1,885 deaths per week, which would be more than 1 jumbo jet per week.

Once the media repeats something enough perception becomes reality. I just like whining about it though.

This happens at first in every profession — we do at first what’s cheap and easy regardless of whether its particularly useful. I have long experience in computer programming — one of the first performance (productivity) metrics for programmers was “source lines of code per hour”. The metric does not take into account the difficulty of the problem at hand. In medical terms, the SLOC metric isn’t acuity-adjusted.

What bad metrics do is motivate improved metrics. Quality metrics will also help to figure out what we mean by “quality”. Personally I think we’re misusing the term “quality”. Pirsig was right about quality — to attempt to define it is to destroy it. We need other language.

> the number of medical errors is [...]
> based on a model

Right. Models are not evidence. Notwithstanding, we’re going to spend trillions to stop man-made (or is that model-made?) global warming. Nary a peep is heard from so-called scientists because it would stop the gravy-train they’re all jumping on. Sound at all familiar?

I do not mean to argue that we should not monitor process compliance or that we shouldn’t try to link process variation to outcome variation. We should expect compliance. But it is also true that non-compliance observed along with a poor outcome does not imply causality.

t

Take wrong site surgery as one medical error and try to find its error rate. Not easy. There is an article which has this error rate and is quite interesting – Kwaan MR, Studdert DM, Zinner MJ, Gawande AA Incidence, patterns, and prevention of wrong-site surgery. Arch Surg. 2006;141:353-7; discussion 357-8. This is the same Gawande who writes for The New Yorker.

Perhaps I had too much faith to begin with. Had I been more questioning I might not have taken the drug that began the whole mess, given for borderline hypertension; I didn’t really think it necessary, as I was undergoing severe stress at the time and figured it would resolve once things had calmed down. But I trusted my doctor. I don’t blame him for not knowing I’d have the reaction–there was no way to know. But I did quickly lose trust in his practice as they dismissed my chest pain as panic, and then in the cardiology team as with the best of intentions they bungled my case time and again.

To this day no one will tell me what happened to me. I’ve had to dig it up with my own research. No one on my medical team believed what I found out about beta blockers and my situation until the week of unstable angina that ended with my cardiac arrest. Now they believe me. It’s amazing how dying focuses one’s medical team.

I sympathize with doctors under siege by malpractice cases and reports like the one you describe. My uncle is a doctor who was unfairly sued.

But.

As long as the medical profession insists on putting itself above the rest of society, above question and reproach, it only encourages a high level of faith that can only be disappointed in the end.

- when ur treated like a puppet
(compare ur last restaurant experience with trip to high-priest doc)

- when that bowl of jello will end up costing $75.67
(1000% markup is not a business model its robbery, see Costco 15% markup on all generics including drugs)

- when credentialing is not open
(cartel-style artificial scarcity)

- when wait times r sooo Soviet bread-line
(thats the cartel again)

- when informatics and microfluidics are emerging
(diy health…. dont be fooled into thinking any biology major doc has intuition about what a false positive vs true negative really means- when surveyed most think chances of having a disease is just the accuracy of the lab test itself- so go engineered patient/consumer empowerment)

-when McClinics and overseas health are emerging
(now i just want an insurance package targeted at a market segment, say small business, that will tie it all together with low deductibles… there are a few offerings in Europe- i’m sure underwriters will pick up the risk state-side soon enough)

-when “save the children” really means collect the rent

-when u dream of the day that docs are treated no different than detectives, engineers, teachers… ie the rest of society that works hard, responds to market forces, contributes to meeting of minds, and takes on risk/innovate if they desire greater rewards.

chow

Lay people don’t realize the complexity of care nowadays, and the often unrealistic expectations of family.