Check-mark medicine

When the diagnosis is lack of human attention.

In the Times:

Hospital accreditation committees now audit charts for
outdated abbreviations and proper signing of notes. Electronic
prescription systems are rapidly becoming the norm. Pay-for-performance
interventions by insurers promise to reward those who make the grade
and to refuse payment to those whose treatments cause complications
like hospital-acquired infections…

None of these interventions, however well meant, address a
fundamental problem that is emerging in modern medicine: a change in
focus from treating the patient toward satisfying the system. The
effects of focusing physicians’ attention on benchmarks and check boxes
are not, I think, to the patient’s advantage.

This is a very good analysis. The doctor’s personal experiences make it even better.

A close family member was recently hospitalized after
nearly collapsing at home. He was promptly checked in, and an
electrocardiogram was done within 15 minutes. He was given a bar-coded
armband, his pain level was assessed, blood was drawn, X-rays and
stress tests were performed, and he was discharged 24 hours later with
a revised medication list after being offered a pneumonia vaccine and
an opportunity to fill out a living will.

The only problem was an utter lack of human attention. An emergency
room physician admitted him to a hospital service that rapidly
evaluates patients for potential heart attacks. No one noted the blood
tests that suggested severe dehydration or took enough history to
figure out why he might be fatigued…

As a profession, we are paying attention to the details of medical
errors — to ambiguous chart abbreviations, to vaccination practices and
hand-washing and many other important, or at least quantifiable,

But as we bustle from one well-documented chart to the next, no one
is counting whether we are still paying attention to the human beings.
No one is counting whether we admit that the best source of
information, the best protection from medical error, the best
opportunity to make a difference — that all of these things have been
here all along.

The answers are with the patients, and we must remember the unquantifiable value of asking the right questions.

Excellent diagnosis, doctor.


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