Accountability in Medical Practice or Building safer Health system to improve patient Safety What We (Have Not) Learned?

Accountability in Medical Practice or Building safer Health system to improve patient Safety . Creating Safety Systems in Health Care Organizations \A Comprehensive Approach to Improving Patient Safety)……lessons What We (Have Not) Learned? Theme - To ERR is HUMAN ? To what extent it is acceptable in Medical Practice; Errors do happen’ which one realizes when you or your dear one is the victim. Prevention is Better than Cure- The Time is Now: 'Culture of Safety' Key to Preventing Errors. Error in medical practice is not uncommon and may cause harm to patient, doctor and the hospital. An average of one million people annually in the U.S. dies due to potentially preventable in-hospital medical errors, (comparable to having three jumbo jets filled with people crash every other day). Do Doctors Kill More People Than Airline Pilots? Pilots use untiringly checklists every time to reduce adverse effects. Doctors Don't. In an Era of clinical accountability in healthcare –we need to work together and shift our perception from the blame game to greater accountability says Dr Fiaz Fazili ------------------------------------------------------------------------------------------------------------------------------------ “A patient died due to alleged negligence of doctors at the Casualty Ward of the ……hospital …”- (Greater Kashmir 28 June 2011). “Ventilator Sparks Fire; A 55-year-old patient, who was being revived with electric shocks at the……., lost his life after a short circuit caused his stretcher burst into flames. The agitated family members alleged that the doctors were careless…(media reports ). News like this often make headlines in the media, but what's often over looked are the simple safety practices in everyday Healthcare that make a difference in patient’s lives. Are Medical malpractice allegations just a media hype or harsh reality? Do Patient‘s die due to ‘negligence’ of docs? Nearly one million people in the U.S. die each year as a result of potentially avoidable medical errors, making this one of the leading killers in the U.S" with numbers far greater than fatalities attributed to automobile accidents, breast cancer and AIDS. TO ERR IS HUMAN.- Is it acceptable in health care, if yes to what extent? GMC Srinagar is celebration golden celebrations--– What we did /din’t learnt from past mistakes? Medical professionals undergo rigorous academic and residency training. When a patient has a medical complaint, is experiencing symptoms, or is about to have surgery, they place an enormous amount of trust in their doctor. Patients have a reasonable expectation that their doctor will follow the standard of care, make correct decisions, and react quickly in the event of an emergency. When something goes wrong, patients are often left wondering how such a mistake happened. The late Dr Tom Chalmers, a distinguished medical researcher, once asked why doctors kill more people than airline pilots. The odds of getting harm or dying in hospital as a result of human error are 33,000 times greater than the risk of harm or dying in an air crash - an extraordinary figure. Dr Chalmers came up with a number of reasons for this apparent discrepancy - such as the requirement that pilots take time off for sleep, undergo random breath-testing, perform pre flight check list and that their skills are tested every six months. Pilots Uses Checklists evertime to reduce adverse effects. Doctors Don't. But he saved his harshest comment until last: 'If doctors died with their patients, they'd take a great deal more care’. Strong words. How valid are they? When we think of medical malpractice, we often think of a certain type of case: a doctor amputates the wrong leg of a patient or leaves a medical sponge behind in a patient's abdominal cavity. The mere fact that a patient dies in a hospital should not lead to the presumption that the death occurred due to the negligence of the doctor. However, there are much more subtle ways that a doctor can be negligent in his or her treatment of a patient. There are people who think that this happens only to those who are going through surgeries or serious medical procedures. Sadly, harm or wrongful deaths do occur due to medical errors of different assortment like machinery malfunctioning or carelessness in high dependency units like CCU;ICU:MICU; Dialysis units or while prescribing or dispensing the medication. Arrogance, Abuse, Kickback-driven medicine unholy nexus between pharmaceuticals Promoting unnecessary procedures and lab exams for reasons of self-interest or monetary gain, ,Bait and switch(You do a little research, meet and agree to a surgery by a certain physician, once under anesthesia, the person actually performing the surgery is much less experienced, or this may even be their first surgery, or first surgery of this type. Sometimes the surgeon you thought was performing is in attendance supervising. Your life threatening surgery is being used as training and you are left with a resident under no supervision) are not un-common patient complaints in mal practice cases . Doctors are expected to be among the most dedicated workforce in any industry. As such, they are not prime candidates for public sympathy when they falter in their duties and responsibilities. Regardless of their experience, motivation, or vigilance, medical personnel do make mistakes. The problem is not bad people exclusively; the problem is that the system needs to be made safer and accountable. Patients aren't as safe as they should be. How can it be made safer, requires the political will and recognition above the striking issues of emoluments, practicing or non practicing ,working hours .How quickly you get treated them that matters, but how safely? Prevention is better than Cure. Medical practice carries lot of misperception and mistrust, we need to resist the siren call of, “ Blame Someone”,or nothing will ever get better. People expect a lot from the medical profession, when they put their lives in these hands. Each time we go to a medical practitioner, we more or less expect to receive reasonable care. At the very least, we think that our health care providers will offer us with care that won't harm us. But the brutal fact is that, sometimes medical professionals make very serious mistakes that do cause a fatal and wrongful death to a human life. Patients and their family members have right to inquire, so we the Professionals shouldn’t get intimidated on their concerns. Medical error is an undeniable problem and can be devastating. We need to understand why medical errors occur, what factors produce them, and how to reduce them. Errors happen not just because of, errors in inference and interpretation perception and judgment, lack of skill or knowledge but for attitude/behavioral reasons also. The reality of medical errors is that they are seldom due to carelessness or negligence. More commonly, errors are caused by faulty systems, lack of standards and policy and procedures, no annual CME accreditation, no auditing(accountability). The basic flaw in our healthcare systems is in its design and organization which affects implementation of proper health care delivery. Preventing Medical Errors Requires "Culture of Safety" . Pilots are taught to use a pre-flight checklist, an ingeniously simple approach, double checked tirelessly by co-pilot. In medicine too, we have sequential steps of prioritized assessment procedures in order of importance with mnemonic ABCDE’S, and/ pre intervention checklists to minimize errors, unfortunately often ignored or forgotten. Influenced by airline industry the WHO launched a check list ((time out) in Operation room before any intervention….patient mortality rates were cut nearly in half and complications fell by more than a third.(NEJM). Most of the hospital administrators and practioners rage at the suggestion that they don't take patient safety seriously enough. Often, we blame 'the system' for causing errors - the lack of manpower that leaves exhausted and inexperienced staff without supervision - but errors can happen even in ideal circumstances. Safe hospitals and Safe staff recognize their errors; go back to the safety standards accept changes on feedback and works in a cohesive team. Not everyone accepts change easily. Where do our premier health institutes stand specifically on the most pressing issues of safety and standards? The hospital that admits to nothing generally has the most to hide. Doctors, if wary of accountability or litigation, take safety seriously and mistakes shall not be buried - along with the patients. To improvise on health care the existing concept and the process of accountability in health care needs to be fundamentally redefined or restructured towards "Culture of Safety” by creating safety systems in Health Care organizations. The Time is Now, without any name, shame or blame - -with a philosophy of-- How can we do better ? (Dr Fiaz Fazili is a Research Analyst and Quality assurance coordinator- specialized in medical credentialing, primary source verification, according to the standards of joint commission international.)