Why Do Doctors Fail? - Hurricanes Vs. Ice Cubes

“Too often”, said  President John F. Kennedy, “we enjoy the comfort of opinion without the discomfort of
thought”

Dr. Gawande has been a great inspiration for me these past couple of years.  As a brilliant surgeon and doctor he has had great insight into medicine, it's current and past problems and often asks and addresses many difficult AND UNCOMFORTABLE questions.

Since I have arrived in 2014 in the Chapala Lakeside area, the local WEB BOARDs have been a resource for many NEWCOMERS and SEASONED resident/EXPATS in the LAKESIDE REGION as well as to those who may be thinking of writing a new chapter in their lives by moving to the CHAPALA LAKESIDE.

I have also noticed many virtually anonymous criticisms (more so than recommendations) of professionals, especially healthcare providers.  Ideally this site would function like a site we have NOB called Angie's List: http://www.angieslist.com  But as Dr. Gawande states that we often don't know how to utilize this information.

I highly recommend that you take the time and either listen to this short lecture or read it. He answer's questions from a patient and a other healthcare providers as well.  I think that this will really help patients and healthcare providers alike.

Here are some excerpts and  I've included the links to the audio(podcast) and the transcript from the lecture which is from the BBC.

[b]EDITH RICHMAN: My name is Edith Richman and I’m originally from New York and have
had very similar experiences that you’ve talked about. How do I know when I go to a doctor that
he has good diagnostic skills to determine what I need in medicine?

ATUL GAWANDE: You can’t right now. Even when we needed to find doctors for my own
son, for my wife, for other people in our family, you ask around co… to colleagues, you find out
about reputation. You very rarely have much data to go on. Now it’s starting to change. You can
go online these days and look up whether your doctor has been arrested under any kind of
criminal prosecution and whether they have an active licence. Alright, it’s a useful bar. You
know you can go also now and find out if there are any kind of patient complaints, but I never
know what to make of people who are simply cranky and any more than I know what to do with
all the people complaining about the hotels that I look at online. And so you know we’re kind of
in between those worlds without a real adequate window in.

EDITH RICHMAN: Well I have rejected a lot of what doctors have told me and, you know
what, I was right.

SUE LAWLEY: I mean this is the depressing message that’s coming across here really. We’ve
been taught not to trust our politicians and our bankers, and now you’re saying we can’t trust our
doctors.

ATUL GAWANDE: Here’s the reality. You are far better off putting yourselves in the hands of
a medical profession than not. You know we’ve had a century of incredible progress; we’ve
added many years to people’s lives and even more quality and productivity to people’s lives.
And yet there is a wide variation in the results that people get. It’s not that that kid in Maine
couldn’t trust their doctor; it’s they didn’t have a system that could assure that that child in
Maine had the same chances that my son had.
[/b]


LINK TO THE AUDIO

LINK TO WRITTEN TRANSCRIPT

That's great Santiago, I have come late to reading this post. I wonder if this was in response to all those posts in April on some of the horror stories we experienced here? If yes, than I am curious to know what, as a medical health professional, is your advice when dealing with unscrupulous emergency care providers, or worse, really poor emergency care service such as we have experienced here at Lakeside. If you are really interested in helping out then why not PM me and we can start a real conversation about how to fix things.

Semalu wrote:That's great Santiago,  I have come late to reading this post. I wonder if this was in response to all those posts in April on some of the horror stories we experienced here? If yes, than I am curious to know what, as a medical health professional, is your advice when dealing with unscrupulous emergency care providers, or worse, really poor emergency care service such as we have experienced here at Lakeside. If you are really interested in helping out then why not PM me and we can start a real conversation about how to fix things.

too bad-most of my emergency care was satisfactory or better. who is unscrupulous in emergency care? why "fix" things by pm with one doctor who you may or may not know. why not tell us how you plan to fix things?

Unscrupulous?  How about having a specialist selected by the emergency care clinic charge more than ten times the charges posted on the wall for "specialist" treatment?

Follow up:  Can't get a factura from said specialist by normal means:  Namely, requesting it multiple times.

You figure out what's going on.

Let's please stick to the topic. I sympathize with your concern about FACTURAS but FACTURAS are an administrative issue.

Anyway, I hope that the lecture Dr. Gawande gives helps shed light on "WHY DOCTOR'S FAIL".

Please listen to or read the lecture. That is the topic of this posting.

Yes, administratively any professional(including doctors) are supposed to give Facturas(Official Invoices) when asked for them according to the law. If you are having trouble getting one then call PROFECO or have an attorney help you obtain one. That's another topic.

Chapalamed wrote:Please listen to or read the lecture. That is the topic of this posting.

Yes, administratively any professional(including doctors) are supposed to give Facturas(Official Invoices) when asked for them according to the law.   If you are having trouble getting one then call PROFECO or have an attorney help you obtain one.  That's another topic.

I have read the entire lecture you posted. Much of it is about the concerns all patients have when they encounter illness.
I particularly agree with his point of view about the lack of transparency concerning what goes on behind the scenes.
For instance, how many primary care physicians actually report the adverse effects of a drug prescribed when a patient experiences them? I'm guessing not enough.

yes gringall you had an unseemly experience which was totally disgusting as i recall but what is semalu talking about. outside of the emerg issue,what actually is a primary care doctor? it seems one does not need such a doc here as one has direct access to any specialists one requires. a gp[some call themselves primary care physicians now] is really only necessary for what they do "general" practitioning. and some of that[parasites] one can get stough from the farmacia. i did read some of the link by the way. i am not interested in medical treatment for me like NOB or the uk. been there done that now i am here and have found it redundant..

This is a tough subject to debate as the experiences are all over the place. e.g., the clinic where gringal had the bad experience has treated and doctored my family for 20-30 years, and we don't have one complaint. Never had a problem with the Cruz Roja, the few times that we had to haul someone there or use their ambulance service or x-ray service.
Anyone can hit a snag in medical services, anywhere, anytime. You just never know.

Maybe Semalu will recount her own recent horrendous medical treatment experience.  Those who've never been misdiagnosed, given unnecessary surgery or been thoroughly reamed on some level are very fortunate indeed.
Sometimes the patient has to "just say no" to the treatment or surgery proposed, but it's amazing how verbally abusive a few docs can be when their judgment is questioned.

My husband and I have been to the local Clinic for emergencies before and were always treated competently by the doctors on call, at very reasonable cost. No complaints then.

As Slainte pointed out, you just never know.  Worst of all, if you're bleeding or broken, you have no choice but to trust the doc wherever you go, at least up to a point.

I don't want this thread to turn into recounts of people's positive or negative experiences and why the prefer this doc vs that doc.

There have been so many other posts/threads that do that.

My purpose for posting this LECTURE is to promote awareness and perhaps for those who read or listen to the lecture gain some understanding of what doctors deal with on a day-to-day basis and "WHY THEY (at times) FAIL".


(5.31) ATUL GAWANDE: Every family has its pivotal medical moments. Ours is a family …
One of ours was in July 1995 when my son Walker then was just 11 days old. He had difficulty
taking his feedings, he couldn’t hold anything down, and we took him to the paediatrician. The
paediatrician put her stethoscope on his chest, listened for a moment, and then looked at us and
said, “There’s something wrong with his heart” and we needed to take him to the hospital right
away.
I think there are millions of moments like this one that occur every day: a human being coming
to another human being with their body or their mind’s troubles and looking for their assistance.
And that is the central act of medicine – that moment when another human being turns to another
human being for help.
(6.35) And it always struck me how small and limited and improbable that moment is. We have
13 different organ systems and at the latest count we’ve identified more than 60,000 ways that
they can go awry. The body is scarily intricate, unfathomable, hard to read. We are these hidden
beings inside this fleshy sack of skin and we’ve spent thousands of years trying to understand
what’s been going on inside. So the story of medicine to me is the story of how we deal with the
incompleteness of our knowledge and the fallibility of our skills.

Science is concerned with universalities, universal truths, laws of how the body or the world
behaves. Application, however, is concerned with the particularities, and the test is how the
universalities apply to the particularities. Do the general ideas about the sounds the paediatrician
heard in my son’s chest, do those general ideas correspond with the unique particularities of
Walker?

So then the interesting question is how do we cope? Now it’s not that it’s impossible to predict
anything. Some things are completely predictable and they gave the example of a random ice
cube in a fire. An ice cube is so simple and so like all the other ice cubes that you can have
complete assurance that you put it in the fire, it will melt. The everyday question for us,
however, is are human beings more like hurricanes or are we more like ice cubes?

Would someone please summarize the message. I read it all, but must be missing the point. In an ideal world, of course the transparency would exist and the training would be better, but I doubt this will happen in any of our lifetimes.
It is in the best interest of the professionals to cover their errors, especially in a lawsuit-happy world.

AGAIN, this is from the lecture and related to the "TRANSPARENCY" issue:

"In some ways I think you know turning on the cameras inside our world is more treacherous at
times. There’s a reason that Gorovitz and MacIntyre labelled the kind of failures we have
“ineptitude”. There’s a sense that there’s some shame or guilt to the fact that we don’t get it right
all the time. And exposing it can make people more angry than exposing the fact that we’re
simply ignorant about certain ideas and, therefore, we’ve blocked many of these efforts to try to
provide some transparency to what’s going on. The audiotapes are often not allowed, the video
recorders are turned off. We have no black box for what happens in our operating rooms or in
our clinics. The data when we have it is often locked up. You can’t know, even though we have
the information, which hospitals have a better complication rate in certain kinds of operations
than others. There’s a fear of misuse, a fear of injustice in doing it, in exposing it.

But arguably there are lives at stake from not opening up the doors and I think we also will miss
out on the chance that what we get to find can often be miraculous.

.................. And the key question we have to ask ourselves is how are we going to make it possible
for others to have that, how do we fulfill our duty to make it possible for others? And the only
way I can see is by removing the veil around what happens in that procedure room, in that clinic,
in that office or that hospital. Only by making what has been invisible visible. This is why I
write, this is why we do the science we do – because this is how we understand - and that to me
is the key to the future of medicine. Thank you."