Monday, December 7, 2015

What I Believe The Public Should Know About Clinicians

The daughter of the patient walked out of the room livid.  She was convinced that the nurse had no business taking care of patients.  She seethed as she recounted all the supposed injuries and mistakes that had occurred.  I took a deep breath and paused for a moment, trying to collect my thoughts.

The daughter didn't know that I had watched this same nurse successfully perform CPR on a man the day before, and her quick thinking was one of the factors that save his life.  She had once recognized a rare side effect of a medication, and solved a clinical mystery that had hounded doctors, hospitals, and pharmacists for months.

In my mind, she was the best that clinical medicine had to offer.  Knowledgeable, kind, intuitive.

But this trend has been escalating over the last few years.  Patients and families wagging their fingers and nodding their heads angrily in the direction of clinicians.  Doctors, nurses, and therapists have been accused of being incompetent, lazy, or downright cruel.

There is a basic loss of faith in the ability of our healthcare practitioners.

I think that the Internet plays a role.  The ability to Google one's symptoms and come up with a host of diagnoses has made the populace feel that medicine is easy.  Furthermore, the lay press and some of our own physicians and administrators decry the system as befouled by errors.  They say that we account for as much death and disability as heart disease and cancer.

While I believe that medicine requires a continuous and stringent effort to improve itself, I also think that the populace is becoming progressively fooled and brain washed.

Here is what I think the public should know:

1)People die, for the most part, because they are sick.  Yes medical errors occur (even to healthy people).  But medical errors happen more often in deathly ill, hospitalized patients, with poor prognoses to start with.  The more ill the patient, the more complicated the care.  More medicines.  More tests.  More risky procedures.  More errors.  This doesn't mean that we must not strive to do better.  But all those articles about how "hospitals kill more patients than..." are ungenuine.
2)Complications are not errors.  A small percentage of people who get colonoscopies will have the unfortunate complication of perforation.  They may even die from it.  This is expected.  Same for post surgical deep venous thrombosis.  Same for deadly side effects of medications.  There is a cost/benefit ration.  We can do our best to mitigate risk, but we can't avoid poor outcomes altogether.  It's like a reverse lottery.  The grand majority do just fine, but occasionally there is a big loser.
3)A text book presentation of a disease is very rare in clinical medicine.  It happens infrequently.
4)Physicians are some of the most highly trained individuals in society.  Our education is arduous and can span more than a decade.
5)Medicine is one of the most researched fields known to man.  Billions are spent every year improving our clinical knowledge.  Our ability to treat cancer, heart disease, and injury is far better than it was even a decade ago.  Patient safety is, and has been, at the forefront of researchers minds for years.  We are making great improvements. Think anesthesia, hospital acquired infections, and surgical check lists.
6)physicians have active and time consuming requirements for continuing medical education and board certification. Greater, I believe, than almost any profession.
7)The legal system holds physicians to a high standard and the penalties can be life altering for the involved clinician.  The grand majority of physicians are sued at least once during their career.

In summary, medical practitioners are highly trained and skilled individuals who are plugged into an incredibly regulated and researched domain of human existence.

To treat them as if they are stupid or ignorant is unkind, to say the least.