Arrogant Complacence in Medical Practice and Institutions Kills Thousands of People Annually ─ Self-Regulation Is Not the Answer

© 2010 Peter Free

 

20 July 2010

 

We’re better than you, so you won’t mind when we carelessly kill or maim you

 

Our culture places medicine and its practitioners on a undeserved pedestal.   As a result, arrogance among physicians/surgeons and medical institutions is endemic.

 

Arrogance is not a desirable personal or institutional trait in a profession that is ethically bound to care about achieving good medical outcomes.  Conceit, complacence, and patient-directed deafness go hand in hand.

 

This is not a trivial problem

 

For at least ten years, our society has known that errors in medicine and health care kill ridiculous numbers of people.

 

Forty-four thousand to 98,000 die annually in hospitals due to preventable mistakes.  Perhaps another 99,000 die of hospital-associated infections.  And many thousands more succumb to diagnostic missteps or the failure to treat in accordance with established guidelines.

 

These mortality estimates are only for hospital-related incidents.  The numbers associated with profession-wide medical errors, carelessness, and incompetence are probably appalling.

 

A proxy measure for quality-of-care problems ─ central line-associated bloodstream infections

 

Peter Pronovost, writing in JAMA, states that central line-associated bloodstream infections are the only relatively well-studied aspects of patient safety.

 

His review of central-line infections illustrates the medical profession’s resistance to implementing procedures that have been proven to dramatically reduce infection rates and the mortality associated with them.

 

In short, central line-associated bloodstream infections serve as a simple graphic for the medical field’s inability to police itself.

 

Proving the case regarding hospital complacence

 

Thirty-one thousand patients die each year from central line-associated bloodstream infections.

 

The Department of Health and Human Services has designed a quantifiable program to reduce this by half over the next three years.  But only 23 states have a better than twenty percent hospital participation in the HHS plan.  And only 5 states have better than seventy percent hospital participation.

 

Worse, these numbers are actually lower than they appear to be because the participants often do not provide all the HHS-required data.

 

Pronovost finds the low participation numbers perplexing because intensive care units in some large academic hospitals have almost eliminated central line-associated bloodstream infections.

 

Proving that the “Arrogance Pedestal” is an obstacle to practicing good medicine

 

Nurses are reluctant to tell physicians when the deviate from the checklist that guides infection-preventing central line placement.

 

[T]his view of not questioning physicians is pervasive.

 

Too often, neither physicians nor hospital leaders hold themselves accountable for patient outcomes.

 

Moreover, many physicians have not accepted that fallibilities are part of the human condition.

 

[A]utonomy become arrogance when actions are mindless and not mindful, when something is done simply because a physician demands it, when a clinician does not learn from mistakes, and when experimentation occurs without a clear rationale or testable hypothesis. . . . When placing a catheter, reliability and not autonomy is needed.

 

© 2010 Peter J. Pronovost, MD, PhD, Learning Accountability for Patient Outcomes, JAMA 304(2): 204-205 (14 July 2010).

 

Dr. Provonost’s conclusion is simple

 

[H]ealth care professionals must be accountable for training physicians to accept that they are fallible.

 

Ultimately, physicians must be held accountable for their clinical behaviors, and health care leaders accountable for patient outcomes.

 

© 2010 Peter J. Pronovost, MD, PhD, Learning Accountability for Patient Outcomes, JAMA 304(2): 204-205 (14 July 2010).

 

Citations

 

Centers for Disease Control, National Healthcare Safety Network ─ First State-Specific Healthcare-Associated Infections Summary Data Report: January – June 2009 (2010).

 

Committee on Quality of Healthcare in America, Institute of Medicine, Linda T. Kohn et al. (editors), To Err Is Human: Building a Safer Health System (National Academies Press, 2000).

 

Peter J. Pronovost, MD, PhD, Learning Accountability for Patient Outcomes, JAMA 304(2): 204-205 (14 July 2010).

 

R. Monina Klevins et al., Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002, Public Health Reports 122(2): 160-166 (March-April 2007).