What I suggest is that if you have a friend or relative visiting you, they should bring a "flip chart" -- the old fashioned 2 x 3 foot pad of paper -- and write down in huge letters the most important details of the case. Ask the doctor to help you fill it in.
Case in point: requiring everyone in the operating room to say their name, specialty and reason for the operation (and their part in it).
You might ask why the above is necessary?
Well:
- everyone is wearing a mask, cap and possibly glasses which makes them hard to recognize
- the patient is often draped in such a way that you can't tell who they are
- many Operating Rooms(ORs) look the same
- there are apparently COUNTLESS stories of medical personnel going into the wrong OR and not realizing until the surgery has started
Another fascinating point about checklists since the OP article mentions doctors vs nurses: checklists give nurses the power to challenge doctors. e.g. "Dr, I believe the next step on the checklist we agreed on is to do X".
If you have no checklist, the Dr can just say "No, we don't need that, I know what I'm doing. Shut up, Nurse!" (this is a real example from the book btw).
He also has an article comparing the Cheesecake Factory to health care that I also highly recommend [1]
Over the years I hear a lot of their pain points, and EMR's are consistently very painful for my boomer parents who are not tech savvy (my understanding is that it's not an age thing, though).
I have personal experience with pt. 8: Doctors know who's good, they just won't tell you. When I had a meniscectomy with poor results, none of the orthopedists I visited after the surgery would comment even lightly on the appropriateness of that procedure given my symptoms and MRI. This isn't different to other professions, where you generally have nothing to gain from badmouthing colleagues, but its incredibly painful that thousands of people are prevented from good care because of this meritocratic breakdown.
As a totally separate point-- this format of shadowing notes in incredibly compelling! I've been shadowing chemistry and biology wet-labs lately, and I wonder if making similar writeups would be interesting to others?
Once it’s done, it’s done, that’s the medical reality you’re living in: it strikes me like saying “oh man if you had driven a sturdier car, then this crash might have hurt you less, wouldn’t that have been better?”
In medicine especially, who can truly know the counterfactual?
In my own work, when I’ve gossiped about somebody else’s decision-making or work product, I’ve often gone on to be humbled by learning that the other person had more context or different information than I did while judging in self-assured retrospect.
As far as “prevented from good care”—isn’t the alternative frequently no care at all? The Very Best surgeon still can only do the same number of surgeries.
Professional boards set minimum standards, and they run out practitioners who fall below. Even your bad doctor washed his hands and sterilized his tools: in that sense it’s still “good care” compared to yesteryear’s barber’s chair, rusty saw, shot of whiskey, and leather belt to bite on.
Not to get off on a whole thing. I appreciate your perspective and your strong written voice, and I’d definitely be interested in your shadowing write-ups!
Once, in a situation when we really wanted an opinion from a nurse who wouldn't give one, we finally asked, "If it was your daughter, what would you do?" With no hesitation, she told us exactly what she would do. She just couldn't tell us what we should do.
That phrasing has proven to be useful a time or two since then...
https://www.hospitalmedicine.org/about-shm/what-is-a-hospita...