Is Medical Education a Systemic Root Cause of Poor Quality?
I will try to be careful with this topic, since I'm obviously not a doctor. Criticism of doctors gets thrown around pretty easily around many hospitals, too much so, I think. You sometimes hear blanket criticisms about doctors being difficult, how they don't want to participate in Lean improvements, and how they don't follow proven practices around hand hygiene and checklists. Oh, and they are sometimes called jerks and accused of throwing things at nurses (and yes, sometimes nurses act badly.)
A new report from (news story, PDF of report) Dr. Lucian Leape, a noted patient safety expert, looks at medical education, the process and system for educating doctors as a root cause. Maybe that's more productive than blaming individual docs.
Blanket statements are, of course, never true. I've never liked playing the “blame game” with doctors, since “they are difficult” is sometimes code for “they won't do what we tell them to do” (a sign of command and control thinking). I'd rather ask why they seem difficult, why they don't follow a proven process, why they are often not perceived to be team players… look for the root cause. It's usually far more complicated than the doctor being a bad person… they work within a system and they're human. Blaming docs only alienates them and that prevents us from working together for quality improvement (something I know doctors want badly).
There are two blog posts from people whose opinion is more meaningful than mine.
Dr. John Toussaint, the former CEO of ThedaCare, writes in his blog post (“Lucian Leape challenges medical educators“) that:
the shame and blame culture instilled in our medical schools is our biggest barrier to patient care improvement.
For example, the fact that professors of medicine are allowed to berate,belittle, and attack medical students in public forums is appalling. It is fundamentally disrespectful and it fosters ill will and a culture of hiding mistakes.
Yikes. As I commented on John's blog, I was never treated that way as an undergraduate engineer or in graduate school for engineering or business. But, as we always hear, medicine is different, I guess. In his response comment, John referred to the “tyrants” in medical education. As an outsider, doesn't that seem like a huge problem?
John cites the root cause factor, saying:
Lucian Leape is absolutely right in his analysis of the gigantic gap in medical education.In fact this may actually be one of the root causes of the entire healthcare cost and quality crisis.
The other key blogger, a non-physician CEO, is Paul Levy from Beth Israel Deaconess and his “Running a Hospital” blog. In the post “What does it take? (revisited),” Paul asks:
All things considered, are we in the health care professions moving fast enough to transform the delivery of care? And whatever you think about today's problems and this generation of caregivers, how about trying harder for the next?
By citing and quoting from the Leape study, I'm guessing he thinks we aren't treating the next generation any better, in terms of training and creating the right environment for patient safety?
He quotes from the Leape report:
“Despite concerted efforts by many conscientious health care organizations and health professionals to improve and implement safer practices, health care remains fundamentally unsafe,” said Lucian L. Leape, MD, Chair of the Institute and a widely renowned leader in patient safety. “The result is that patient safety still remains one of the nation's most solvable public health challenges.”
A major reason why progress has been so slow is that medical schools and teaching hospitals have not trained physicians to follow safe practices, analyze bad outcomes, and work collaboratively in teams to redesign care processes to make them safer.
If there are physicians reading, what do you think?? If you're reading as a non-physician medical professional, what are your thoughts? As a reader who is part of the general public??