Recently read two books by physicians with different angles on the same topic: how doctors make mistakes. Jerome Groopman is an oncologist who writes in how Doctors Think about the prejudices, biases, and cognitive errors that result in missed diagnoses. Doctors make mistakes when they dislike their patients, when they like patients to much, when they fail to listen to patients enough; when they see the common and miss the unusual, when they are in love with their own expertise. Groopman focuses on the personal and interpersonal, the nuances the doctor-patient relationship and the thought processes in the doctor’s mind.
Atul Gawande is a surgeon who focuses in Better on system problems and process solutions; methods for mass immunization, saving the lives of wounded soldiers, combatting hospital infection, and extending the lives of cystic fibrosis patients. The two doctors advocate different paths to improvement; Gawande encourages increased measurement, system improvement, and standardization; Groopman encourages personal reflection and better communication with patients, and is distrustful (with evidence) of computer-aided protocols that lead doctors to override their better judgment.
While the two physicians have different takes on how to reduce mistakes, they seem both to be a part of an underlying shift in how doctors respond to mistakes. A desire to maintain authority and prevent liability discouraged doctors from acknowledging mistakes. The newer mindset sees that analyzing mistakes with a focus on learning rather than blame can help prevent more errors.
Both doctors criticize the impact of “managed care” on the quality of medicine. Groopman writes about how doctors are encouraged to rush, eliminating doctor-patient relationships, and how drug company perks affect doctors’ judgement. Gawande describes how insurance-company protocols are designed to reduce reimbursement rather than to improve care. Incentives in the US health care system for quality, cost, and accountability are not complementary. We keep paying more and get better technology but not on the whole better care.