Today’s medicine is like a double edged sword, it can benefit but also harm
In the last article, I wrote the story of Richie Williams and his doctor Dr Lee. Richie was wrongly injected vincristine intrathecally (in the spinal space). Richie lost his life. Dr. Lee committed suicide later. Both were the victims of medical accidents. The first victim was the patient and the relatives and the second victim was the doctor and other healthcare professionals.
Let us analyse the sequence of events. Why did such an error occur? Behind such incidences we always find the people involved. But why did these people make such an error? The science of patient safety states three main factors: the human factor, the system factor and, above all, the factor of the complex healthcare system.
Today’s medicine: a double-edged sword
When we see a picture of a doctor in the 18th century, we see a doctor with few things such as stethoscope, torch and a small bag of medicines. And we typically see a doctor holding the patient’s hand with empathy. Now let us imagine a picture of today’s doctor. What do we see? Big hospitals or clinics, nurses fluttering around in hurry, huge machines and then the doctor who is examining the patient using some device or gadget or reading some reports or looking at a computer screen. In fact, we can’t imagine today’s doctor working without reports, gadgets and the help of others.
With limited knowledge of human body and resources, practice of medicine was relatively easy. There were no specialists and many diseases had no cure. Patients also had fewer expectations from the doctors. Thus, medical practice was simple, individualistic and personalized. But was it as effective? Let us take an example of treatment of low birth weight premature babies. In the past, in order to maintain the body temperature of premature babies, the doctor would keep these babies in “thermocol” boxes or wrapped in the cotton sheets. Now compare that with today’s incubators which intelligently regulate the baby’s body temperature. Much more efficient! Isn’t it? Although thermocol or cotton could not control temperature as effectively, it could not cause great harm either. Incubators may have saved millions of lives by perfectly regulating the temperature, but if something goes wrong with the machine or an error or mistake takes place in handling it, imagine what will happen? We do hear such dreadful incidences once in a while. Take an example of cancer and its treatment. We now have excellent medicines that can kill cancer cells with precision. But what if the dose of such a potent medicine is given in excess? The medicine will cause more harm than cure. Conclusion: Today’s medicine is like a double edged sword, it can benefit but also harm!
De-centralized & de-personalized
The explosion of medical knowledge has led to specialization and super specialization. Today, patients need to go to various doctors along with visits to a dietician, physiotherapist, counsellor, an optometrist etc. While undergoing a surgery, the patients usually know the surgeon and may be the assisting doctors or anesthetists. However, there are many more people who are involved in the process indirectly. The people, who sterilize the operation theatre, maintain the machines and equipment, nurses, and the list goes on and on.
It is estimated that behind one single surgery there is an involvement of at least 139 people (right from the hospital architect to the surgeon). All these people involved in the patient’s care will be primarily experts of their own domain of work and may not be fully aware of the patient and the problems. In busy and large hospitals a situation may be that all the people involved in the care may not even know each other! As a result, today’s healthcare is not only ‘de-centralized’ but also depersonalized. It is expected that all these people, who may not even know each other, work as a team in a synchronized manner with efficiency and effectiveness. But more the people, more difficult become the task of communication. Thus, we can conclude that healthcare delivery is beyond the scope of one person. Even avoiding mishaps is beyond the scope of one person. Thus, finding a solution is surely difficult but not impossible.
A complex problem
Basically, healthcare systems and medical science deals with a machine called ‘human body’. This ‘machine’ is not fully understood yet. On top of it, in medical practice, ‘imperfect’ human beings are treating another set of ‘imperfect’ human beings. Humans may be similar in body structure, but their minds, complaints, expectations, response to treatments – everything can be different. Some diseases bring in rapid deterioration and some reside in the body for years, but cause no trouble and no symptoms. Thus, ‘lack of complete comprehension’ is also one more challenge.
So, is there a solution to this complex problem? Or should we simply accept these problems as inevitable and sit quiet? There are many industries in this world which are equally complicated and can be potentially hazardous too. Electricity, nuclear power, chemical production, airline services – all these business are complicated, highly technical, and technology dependent. In these industries also there are different people working in different positions and unconnected to one another. Take an example of the airline services: right from buying a ticket, to getting the boarding pass, to luggage check-in, security check, getting passengers and luggage in the air craft, to arranging food in the aircraft, engineering of the aircraft, and managing directions – there are completely different departments. And yet, the process happens with precision, efficiency. The possibility of accidents in the airlines is considered to be one in ten thousand. But possibility of an accident or mishap in healthcare is as high as 1:10 or 1:100!
So, how has the airline industry become so safe? Well consolidated airline industry has been seriously implementing the science of safety for almost more than 60 years. This learning need to be implemented in the healthcare industry to make it safer and predictable. So we are going to focus on the science of safety in the next few articles. Till that time do share your thoughts by visiting the website www.patientsafetyalliance.in