Medical Mistakes: The Patient as "Whistleblower" Reporting to the Government

The United States federal government in an attempt to prevent medical mistakes is considering a pilot program which will analyze these mistakes by doctors, pharmacists and hospitals. Medical mistakes not only can unnecessarily harm patients but end up costing everyone including the government money.  The interesting part of the program is that it  will be the patient (or, I suppose, also the patient's family) who will be the "whistleblowers" and notify the government of a suspected mistake.  To get an idea about the program read about it in a recent article in the  New York Times from which a few extracts follow. 

                                                      

  For each incident, the government wants to know “what happened; details of the event; when, where, whether there was harm; the type of harm; contributing factors; and whether the patient reported the event and to whom.”The questionnaire asks why the mistake happened and lists possible reasons:¶ “A doctor, nurse or other health care provider did not communicate well with the patient or the patient’s family.”¶ “A health care provider didn’t respect the patient’s race, language or culture.”¶ “A health care provider didn’t seem to care about the patient.”¶ “A health care provider was too busy.”¶ “A health care provider didn’t spend enough time with the patient.”¶ “Health care providers failed to work together.”¶ “Health care providers were not aware of care received someplace else.”A caution as noted in the article from an official of the American Academy of Orthopedic Surgeons:“However, patients may mischaracterize an outcome as an adverse event or complication because they lack specific medical knowledge.“For instance, a patient may say, ‘I had an infection after surgery’ because the wound was red. But most red wounds are not infected. Or a patient says, ‘My hip dislocated’ because it made a popping sound. But that’s a normal sensation after hip replacement surgery.” [Thus] it was important to match the patients’ reports with information in medical records.

                                                                                         

What do you think about you becoming the "whistleblower" to notify the government when you suspect your doctor made a mistake?  ..Maurice.

Graphic: From Google Images and modified by me with ArtRage

Doctors Maintaining "Clinical Distance": A Patient Value or None

The doctor looks at the patient who

Sits restlessly, coughs and is not smiling

The doctor's first thought

"Why is this patient coughing?"

Instead of

"This patient appears uncomfortable,

What can I do or say to relieve the discomfort?"

+++

What I have just described is a simple example of the professional behavior or perhaps misbehavior of maintaining "clinical distance".  It is the mindset of a technician to immediately look at the anatomy and pathology of the patient's symptoms rather than to look at the patient. Shouldn't the doctor's first interest be the observation and consideration of the patient as a whole human person who comes for consultation because of a personal problem and attempt to understand how the patient is feeling? But the fear of being contaminated by the patient's "feeling" may be more in the mind of the doctor than being exposed to whatever bacteria or viruses the patient is bearing and has become the basis for maintaining "clinical distance"; not measured in meters but in pain, in sorrow, in anxiety and fear.

But, shouldn't, at first, the doctor be more than a technician in the diagnosis and treatment of illness?  Shouldn't the doctor at first find and express some signs and acts of partnership with the patient's worries with responses of sympathy ("I care") and/or empathy ("I understand")?

In the current rush of medical practice where time is limited to attend to each patient and the fear by doctors of "becoming too emotionally involved" (contaminated), it is considered a wise practice to maintain that "clinical distance".  But is "clinical distance" really what makes a good medical professional? Does it provide a way to maintain physicians in less emotional distress, fatigue and more time to diagnose and treat and thus is of benefit and value to the patient?

On the other hand, maybe it is the basis of why some patients are dissatisfied with their doctors in many ways. Perhaps, we medical school teachers should more strongly emphasize to the students something more than the creation of a differential diagnosis list as the doctor-patient relationship begins and strive to shorten that "clinical distance". 

What is your opinion about maintaining vs shortening "clinical distance"?  Should the following be the doctor's first thought?

+++

The doctor looks at the patient who

Sits restlessly, coughs and is not smiling

The doctor's first thought

"This patient appears uncomfortable,

What can I do or say to relieve the discomfort?"

..Maurice.