Patient safety requires changing the culture of medicine

Patient safety has become more pronounced in hospitals today. But for the movement to have its full impact, doctors have to buy into it wholeheartedly.

And that’s where the progress is slower.

In her recent New York Times column, surgeon Pauline Chen discusses the “culture of fear” that pervades medical training. She cites a report from the Lucian Leape Institute of the National Patient Safety Foundation, which concluded that newly graduated residents go into the real world with little formal training in patient safety.

In fact, not much has changed over the years:

“Young doctors are being educated in a toxic culture,” said Dr. Lucian L. Leape, a leading patient safety expert at the Harvard School of Public Health who was chairman of the report’s committee. “The current environment is hierarchical, stressful for the individual, driven by the fee-for-service payment system and humiliating, all of which works against improving patient safety.”

Changing the medical culture begins early on in training. And that means that cash-strapped medical schools and residency programs need to find the funds and physician leadership to take charge — not easy to do when there are so many other competing interests.

It could be something as simple as teaching a resident to fill out an incident report; something, I admit, I was never taught during residency. If we want to create a “culture of safety” at our hospitals, physicians need to take the lead by instilling concrete methods to do so in their students and trainees who can then pass on those lessons when they become attending doctors.

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  • Dr. Mary Johnson

    Residents go into the real world without training in a whole lot of things.

    “It could be something as simple as teaching a resident to fill out an incident report.”

    O puhlease. That’s hardly a simple thing to do in many places – particularly if the “incident” involves another doctor.

    What happens when that resident gets fired for filling out the report – or intervening to stop the incident – because the “cash-strapped” institution training him/her wants to protect its bottom line by keeping a lid on the medical ugly?

    I’ve lost count of the local “journalists” who’ve sneered and spit at my story (as they refused to tell it to the clueless masses) because my case is not “relevent” to the problems of today.

    And they could not be more ignorant or the way things really are – or more wrong.

  • BobBapaso

    Yes, we need changes is culture for a lot of reasons, not fully delineated here. Patient safety would be helped most by placing first emphasis on prevention rather than on handling crisis. And by using check lists. All medical students should take a few flying lessons to get them used to them, and eliminate the stigma:

    “You used a checklist to do a simple appendectomy?”

    “Yes, and I also use one for all my takeoffs and landings.”

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