Wednesday, October 13, 2010

Culture: To Err is Medicine

Dr. Brian Goldman, host of White Coat, Black Art, spoke at the "To Err is Medicine" Town Hall in Toronto, Ontario on 12-October-2010

TORONTO, ONTARIO - The CBC Radio One medical show White Coat, Black Art held its first public Town Hall last night at the Glenn Gould Studio in Toronto, Ontario. Held in co-operation with the University of Toronto's Mini-Med School, the forum was focused on the issue of "minimizing and managing medical errors."

Having been to a number of CBC events, this one has to rank as an odd one. For one thing, Glenn Gould Studio was not even close to being filled for an evening event--normally one has to be there quite early to get in the door. Secondly, the "star"--show host Dr. Brian Goldman, entered the studio so quietly and rapidly that he was sitting down before most of the audience even noticed him, which meant no introductory applause. I guess such stealthy movement comes with the pressures of the profession.

The event was nominally for the taping of a single broadcast of White Coat, Black Art, which runs only 27 minutes. The forum went on for nearly two hours of discussion, so it will be interesting to see how the material is edited down for what will surely be at least two episodes of the program, which airs at 11 am Saturday and 11:30 am Monday on CBC Radio One nationwide and is available as a podcast.

Despite the longer-than-expected discussion, the message of the evening could really be reduced to just one sentence: Communication amongst health professionals, families, and patients needs to be improved, whether through technology or changes in culture. Everything else that came up could be considered an elaboration or sub-point of that single idea.

A clear message, expressed in one way or another by every member of the expert panel, was that every patient should have an advocate, ideally a family member, who looks out for them during any interaction with the medical system. That individual makes certain that information known to the patient actually gets to new members of the medical team, who otherwise not realize something that would affect their assessment of the situation.

The expert panel consisted of Lianne Jeffs, Dr. Barry McLellan, Pam Marshall, and Dr. Kaveh Shojania for the "To Err Is Medicine" Town Hall on 12-October-2010

One of the more entertaining sequences of the night occurred when the panelists discussed past medical mistakes in their histories. Lianne Jeffs, the Director of Nursing and Clinical Research at St. Michael's Hospital, Pam Marshall, the Executive Director of Patient Relations and Legals Affairs at The Scarborough Hospital, Dr. Barry McLellan, President and CEO of Sunnybrook Health Sciences Centre, Dr. Kaveh Shojania, Director of the University of Toronto Centre for Patient Safety, and Dr. Goldman all told stories. Marshall described her reaction to each as "verklempt," a word I hadn't heard outside of Saturday Night Live in years.

Dr. Shojania made amongst the most interesting points of the evening. He stated that doctors need to pay attention to "little voices" and red flags telling them that a situation might not be what it seemed, rather than following training that tells them to be strong and forge ahead. He noted that doctors can become "second victims" when a mistake occurs--he almost left the field as a result of the mistake he talked about. Finally, he took a firm stand against "half apologies" after a mistake occurs, supporting the relatively new legislation in Ontario that allows doctors to make a full apology without invoking legal responsibility.

There seemed concern that the audience might bring up too personal or too involved stories, but all stories were quite brief and led to precise questions. One medical student, starting a second career, asked what I thought was the best question of the whole night--why can the steel industry have a greater focus on the safety of human beings than the medical industry? A point was made that medicine has learned much about communication from the aviation industry.

A question I don't expect to find as part of the final program revolved around using foreign-trained physicians to help reduce the workload on residents and other health professionals. The two doctors were so instantly dismissive of the idea that it couldn't help but reinforce the impression that doctors are only interested in preserving their status and have no interest in doing anything about the foreign credential issue. A foreign-trained physician happened to be sitting right in front of me, and her disgust at their reaction was quite obvious.

While the discussion seemed productive, I walked away at the end of the session yesterday with one primary thought--it seems preventing medical errors is not brain surgery; there are plenty of ideas on how to do it. It would be a shame if the country had to wait for the old doctors to retire before new ideas are implemented.

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