Burnout Tied to Twofold Higher Risk for Medical Errors
Doctors who reported at least one major symptom of burnout were more than twice as likely to report a major medical error within the previous 3 months, according to a new study published online [DOI: 10.1016/j.mayocp.2018.05.014] [DX] today in Mayo Clinic Proceedings.
The study is based on a cross-sectional, observational survey, which precludes conclusions about causality or the association's directionality. But "it is conceptually likely that the two are reciprocal," write Daniel Tawfik, MD, MS, an instructor of pediatric critical care medicine at the Stanford University School of Medicine in Palo Alto, California, and colleagues. [...] The medical errors question asked, "Are you concerned you have made any major medical errors in the last 3 months?" This wording, the authors explain, "is intended to identify recent events internalized as a major medical error; events identified in this way have been found to have a high correlation with actual medical errors."
[...] The findings are not only not surprising but actually gratifying to Michael Hicks, MD, executive vice president for clinical affairs at the University of North Texas Health Science Center in Fort Worth, because they provide quantitative data to support long-time observations. "The problem we have with American healthcare, probably global healthcare, is frequently the system is designed for optimal circumstances. The environment makes the assumption that everything is going to occur correctly and that people are playing at the top of their game," Hicks told Medscape Medical News.
(Score: 5, Interesting) by RS3 on Wednesday July 11 2018, @04:55PM (1 child)
For sure this, but also everyone outside of the healthcare system. There's a prevailing assumption that you go to Dr. or hospital and it's 100% magic. But yet we all know of, or certainly hear of cases where someone gets much worse or dies, when the disease seemed so average and treatable. Most diseases, and each of us, are (maybe widely) different, need differing specific care, medications, therapies, etc. Yes, computers are doing a better and better job of tracking the details, but it's in its infancy. They have a very long way to go. I'm seeing mistakes being made entering info into the computers, but it's very difficult to correct or remove bad info. (My mom's quite ill and I'm the primary medical care coordinator, and I did it for my dad 6 years ago, who would be dead many times over if not for me.)
The bottom line is that you really have to do a ton of research if you're ever quite ill. And you might not be able to at that point, so hopefully you have an advocate. There's a growing profession for medical care management, patient advocate, "nurse navigator", etc. Hence, AI...
(Score: 0) by Anonymous Coward on Thursday July 12 2018, @02:46AM
A neighbor of mine went in to the hospital earlier this year. They just treated the obvious problem (kidney failure) racking up a bill reportedly in the ballpark of a million dollars. When they "figured out" the root problem, some kind of gall balder problem, it was too late and she died shortly afterwards. I'm assuming the bill will go to her son. Some percent of it was covered by insurance, and I'm told some government assistance might pay a bit, but it sounds like they are pretty much fucked.
(Score: 5, Insightful) by Thexalon on Wednesday July 11 2018, @04:58PM (6 children)
Nope, that's not it at all. The problem with American healthcare at least is that the doctors are controlled by businesspeople, often with zero medical training or experience, whose messages to doctors are, as they always are from management to peons:
1. Work harder. And by "harder", I mean "longer hours for the same pay".
2. Keep costs as low as possible, no matter what.
3. Increase sales (in this case, billable services) as much as possible, no matter what.
That's driving everything that hospitals and clinics are doing around the country. Even doctors who want to do the right thing find they can't.
It's always cheaper to demand that either the intern 70 hours into their shift or the slightly senile 67-year-old make decisions regardless of their own condition and ability to make those decisions well. So that's what they do and will continue to do until malpractice lawsuit costs are high enough to discourage it.
The only thing that stops a bad guy with a compiler is a good guy with a compiler.
(Score: 4, Insightful) by crafoo on Wednesday July 11 2018, @05:13PM (3 children)
This is the story across nearly all major corporations as well. MBAs control the business and theyre fucking idiots. It's disastrous in a typical company where people are designing and building widgets. I can only imagine it's just as destructive a way to run a hospital, with much more dire consequences. Consequences that actually matter.
But, don't you know, only high-pressure jobs like administrator, management, and HR need big bonuses, balanced work-life, and regular retreats, team building, and screw-off-for-a-week conferences to attend. People who actually know how to do something belong in the god damned trenches getting ground into dust, where they belong. And be grateful for it.
(Score: 3, Interesting) by RS3 on Wednesday July 11 2018, @05:35PM (2 children)
You both write very well and convincingly, but do you have direct experience? Your points are valid, but I'll tell you that Medicare dictates a huge proportion of medical rules and payment eligibility. And not just for Medicare patients, but for the whole system. And the sad thing is they're not even MBAs, they're worse, if you can imagine such a thing.
I've seen some pressure from drug companies: Dr. will recommend a very expensive drug when (literally) good old aspirin is actually better. They'll let me make that choice. Sometimes the very expensive drug is the only thing available, and it does amazing things.
My grandfather was involved in healthcare in the 1930s-1950s and my mom remembers him saying that healthcare would be ruined when health insurance became a thing. The problem is simple economics: the supply, and control, of money.
Medicare attempts to correct for the profiteering but it only goes so far and is very poorly implemented.
Wouldn't it be wonderful if someone wanted to make a drug because it was a Good Thing to do, rather than an investment?
(Score: 2) by Thexalon on Wednesday July 11 2018, @07:11PM (1 child)
Not direct, but one of my sisters is an EMT, RN, and now MD. Nothing I wrote would disagree with her experience.
Health care is a field in which some kind of spreading out of risk makes a lot of sense: You never know when you'll need a doctor, really, beyond routine checkups. If you aren't going to do private for-profit insurance, then you're going to need to do a public system a la the UK's NHS. The only other alternatives are to either throw everybody who gets sick into bankruptcy (a.k.a. what the US is doing now), or have a health care system that basically consists of a pistol and some bullets to put sick people out of their misery.
The only thing that stops a bad guy with a compiler is a good guy with a compiler.
(Score: 0) by Anonymous Coward on Thursday July 12 2018, @01:12AM
Well-qualifed doctors should be able to make the first shot do the job, so the MBAs will remove any more than one bullet for optimal cost efficiency.
In the unfortunate case that the doctor misses, the MBAs assure us that blood loss will soon enough resolve the situation as per hospital policy.
(Score: 2) by Runaway1956 on Thursday July 12 2018, @01:02AM
Medical malpractice suits will become history, soon enough. Maybe not in his first term, but certainly in his second. Trump is all about cutting red tape, remember? The businessman is always right, and in case of any dispute between businessmen, the bigger businessman is righter.
(Score: 0) by Anonymous Coward on Thursday July 12 2018, @02:56PM
And yet when we tried to change this, it was fought by people who focused on "gubbmint coming between me and my doctor" completely ignoring that it was replacing MBAs coming between you and your doctor. At least I get to vote for parts of the government.
(Score: 2) by c0lo on Wednesday July 11 2018, @11:54PM (1 child)
I mean, look, who in their right mind would go to a doctor nicknamed "Burnout"?
https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford
(Score: 0) by Anonymous Coward on Thursday July 12 2018, @12:40AM
Better than Dr. Rubout
(Score: 4, Interesting) by Runaway1956 on Thursday July 12 2018, @01:16AM (1 child)
The hours are ridiculous, or worse than ridiculous. The young doctor works for twenty hours, or more, gets a short nap of a couple hours, and he's back on his feet for another 20 hours or more. Day after day, week after week.
You really can't appreciate that, unless you've been in comparable situations. You can't understand how your perceptions begin to betray you. Memory can fuzz. Simple things can become complicated, and complicated things can become overly simple. Fatigue really screws a person up. And, this screwed up zombie is routinely making decisions that mean life or death for his patients.
Funny that the US has gone overboard on ensuring that truck drivers don't drive while fatigued, but no one ever hears about measure taken to combat doctor fatigue.
(Score: 0) by Anonymous Coward on Thursday July 12 2018, @04:00AM
I know how I get when I've had enough.
With all our technology and mechanization, I find it hard to believe anyone in this modern society needs to be pushed that hard.
When I was in the workforce, I saw it slowly change from meaningful work, to the busywork of filling out countless minutiae. Example... an income tax form for the average working laborer. I question why anyone making less than $50K/year should be paying any tax at all, when those are the people who are spending that money right back into the economy.