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Wellness in the Headlines
(Don's Report to the World)
"There Is Glory In A Great Mistake"
The title of this essay is taken from a line in Imperfection by Nathalia Crane. I thought of Crane's sentiments the other day while reading about a great conflict in our medical system between a malpractice "Sword of Damocles" looming over all doctors (and other health care workers) and the unfortunate and unchangeable fact of imperfectability. The latter is also called mistakes, errors and human fallibility.
Atul Gawande, a surgeon, wrote a book entitled 'Complications: A Surgeon's Notes on an Imperfect Science. One of the three parts is devoted to ''Fallibility.'' Anyone who has or expects to have an encounter with the medical system (try getting out of this life before having several) should read at least this section of Dr. Gawande's work. Under "Fallibility," the good doctor explains that physicians, like everyone else, must make mistakes as part of the process of learning the trade. As you might recall when learning your trade, this learning involves not just making mistakes but benefiting from the lessons gained in doing so. No matter how expensive the medical school, or fabulous the quality of instruction, or how great the quality controls in the hospitals and wherever else practice takes place (yes, even doctors must practice, though contrary to popular opinion, practice does NOT make perfect -- just better), human fallibility will prevail. Dr. Gawande wisely notes that perfection "runs counter to the categorical truth, vouched for by the experience of millenniums and confirmed by the foremost thinkers of every age, that human beings are fallible." Just so. Someone please tell the lawyers and, more important, the jurors.
When doctors make mistakes, whether during initial training or after their graduation (both is more likely), one word that applies is "mistakes." Yet, another word is more likely --"malpractice." This becomes expensive for all, including the patient on whose body the mistake was made. Furthermore, some patients, as Dr. Gawande explains, are more likely to be the object of physician mistakes than others, such as the poor. This is due to the fact that poor folks are most likely to encounter doctors in training, in free clinics or medical schools. However, nobody is safe from medical mistakes, and some mistakes are more non-excusable than others. Yet, they all hurt.
Gawande's point is that a terrible dilemma exists for which there really is no solution, sort of like the situation in the Middle East! As Gawande put it referring to the tort liability system, ''we want perfection without practice, yet everyone is harmed if no one is trained for the future.'' Hard to quarrel with that.
One of the reasons there is a conflict in the medical arena between what is possible (reducing the number of mistakes) and what is impossible (perfection) is that society is beset with slogans that defy common sense. In the business world, for example, a recent buzzword among management gurus is ''zero mistakes.'' In school drug policy, there is "zero tolerance." In religion, there is that zany idea of "fearing a loving God?" Huh? Even in wellness, we sometimes go too far, as in the phrase "high level wellness!" Wellness IS a high level of well-being -- how high can you go, anyway? What's the opposite? Low level worseness?
Dr. Gawande cites models from other industries that can be used to lower the incidence and severity of mistakes, and that could bring some controls to skyrocketing medical malpractice suits. Unlike the business world, however, medicine does not deal in fixed products, but rather with unpredictable, perplexing, intricate and idiosyncratic subjects -- and the variables with humans are never easily controlled. Dr. Gawande holds that medical practice ''may well be more complex than just about any other field of human endeavor.''
Apologizing for an error is strongly discouraged in the medical system, for while a confession of error to your defense lawyer or priest is privileged and cannot be used against you, the same is not true when a doctor apologizes to a patient (or the patient's family) for an error made that caused problems. Yet, some experts recommend a greater degree of honesty and frankness as a balm for the public's confidence in the profession. Such candor seems unlikely. Most doctors favor putting a spin on all situations, especially those that turn out poorly. Most seek to avoid any acknowledgment of error. It calls to mind the famous remark of Marshal Foch in 1915 during the Great War, who supposedly explained a dire battlefield situation caused by all manner of screw-ups with, "My center front is in disarray, both my flanks are turning to the rear and the situation is excellent -- I attack!"
So, if your doctor removes a toe instead of a tooth or otherwise makes a perfectly human mistake, try to be patient with him or her. Nobody's perfect. You can, after all, always look on the bright side of life.
Be well -- that's your best bet.
Domain: mentalSubdomain: factual knowledge
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