Comments on: Is the focus on patient safety creating a generation of indecisive doctors who practice without confidence?

By: Anonymous

Anonymous — Thu, 26 Mar 2009 00:18:00 +0000

If a physician is practicing psychiatry, then he is in fact practicing medicine.

This shrink has never consulted Nephrology for a sodium of 134 but I have done peer review on some dodo's who are so afraid to make a judgement that they just might. I also do peer review on a lot of cases that had a commitment order executed by a non-psychiatric physician without any evidence of the slightest effort made to make a judgement about whether the patient was a actual danger and really needed hospitalisation--quite many clearly didn't. The other side of the same coin. Usually it is someone with the sneering attitude of Dr. Drackman (although I agree about the no-suicide contracts--clinically useless IMHO)

And I do see the problem getting worse on both sides of that coin over the last 10 years.

It is apparent from watching what is happening that a lot of docs just don't have the courage to act on their judgements or to even try to make them--just substituting test and turf instead.

By: Anonymous

Anonymous — Tue, 24 Mar 2009 08:45:00 +0000

With so much emphasis on “standard of care” criteria, how can you fault residents for wanting to know what that is? I hate hearing disagreements between attendings about the standard of care, because it implies that a standard exists but we don’t know what it is. Everybody wants evidence-based studies and policy statements today, because it tells us what is the minimum we must do to not be negligent, and to a lesser extent to avoid overtesting/treating to receive adequate compensation. As the standard of care has become more prominent in the legal and compensation arenas, of course physicians (especially new ones) are going to fret about the details. Residents would be much more willing to act independently if we didn’t know some attending might chastise us for “failing to meet the standard of care.” This charge doesn’t imply that you were somehow inefficient, it sounds as if you were incompetent.

By: Frank Drackman

Frank Drackman — Tue, 24 Mar 2009 05:26:00 +0000

What does a Shrink know about practicing Medicine?? These are the guys who consult Nephrology for a Sodium of 134.9, Heme/Onc for abnormal Red Cell Distribution Widths, and get their patients to sign rediculous contracts promising not to kill themselves…

By: alexa-blue

alexa-blue — Mon, 23 Mar 2009 23:50:00 +0000

Well, given that a great deal of our confidence is in practice patterns that deliver only theoretical benefit, perhaps a little circumspection is in order.

By: Anonymous

Anonymous — Mon, 23 Mar 2009 18:59:00 +0000

Of course, there is no evidence that there is such a thing as “runaway malpractice” or a “crisis” since there is no baseline for what the appropriate number of claims and/or payouts should be.

The real question should be is if all the steps taken by physicians to avoid errors actually work to reduce their risk and exposure. If no one knows that answer, why are you training physicians to act that way? Is the hesitancy and uncertainty really reducing medical errors? If not, then perhaps physicians should change their actions and their training to something that does.

By: Chuck Brooks

Chuck Brooks — Mon, 23 Mar 2009 18:41:00 +0000

Runaway malpractice is certainly a factor, no less then the second guessing by insurance carrier bureaucracies. Also, too few of the customer/patients don’t take responsibility for their own health, and neither they nor their doctors have any real appreciation, much less a compreshension, of true medical costs. Both are little more than ‘givens’ in the fractured health industry ‘complex’, and increasingly and easily ignored.
Chuck Brooks
FutureWare SCG

By: Anonymous

Anonymous — Mon, 23 Mar 2009 18:08:00 +0000

Actually, the malpractice crisis has already created a generation of indecisive physicians, who are afraid to make rapid, decisive, and life-saving decisions.