Doctor, Patient Accountability

NY Times’ columnist Maureen Dowd wrote a column this morning that was both disturbing and sobering. In order to illustrate her point, Dowd writes about her brother’s death in the ICU. He was hospitalized with pneumonia and then contracted four other infections in the hospital. Dowd asked a young doctor how her brother could have contracted the infections. He responded matter-of-factly by saying they could have originated from any source including his necktie which had just brushed against Dowd’s brother. When Ms. Dowd asked him the obvious question “Why then are you wearing a tie?” The doctor shrugged and left without answering her.
The story describes two preventable medical errors. First, infections acquired in hospitals are quite common and also preventable. Second, the lack of communication between the doctor and a member of the patient’s family. The latter is also preventable if the healthcare culture were to change. In the column, Dowd describes her feelings poignantly,
“I saw infractions of the rules in the I.C.U. where Michael died, but I never called out anyone. I was too busy trying to ingratiate myself with the doctors, nurses and orderlies, irrationally hoping that they’d treat my brother better if they liked us.”
Dowd interviewed Dr. Peter Pronovost of Johns Hopkins Hospital who addressed both medical errors. According to Pronovost, hospital acquired infections are preventable if doctors follow established protocols and checklists. In addition, Pronovost believes the medical culture has to change so that patients and their families feel free to challenge a doctor. Pronovost notes, “There’s no doubt that it’s really difficult to question physicians,” Dr. Pronovost says. “It’s hard even for me when my wife or my kids are ill. Many clinicians aren’t the most welcoming. They give verbal or nonverbal clues to say, ‘Hey, I have the answer.’ We just need to change the culture. The patient really is the North Star.”
We are far from a culture where “the patient is the North Star”. Perhaps Dowd’s column is a step in the right direction. As doctors often say, diagnosing the problem is half the battle in curing the disease.