It’s Called Medical Practice, not Medical Perfect

TL;DR — The point is: Hiding is unsustainable. Transparency is coming.

After Mark Cuban became a billionaire and bought the Dallas Mavericks, he wrote this:

In basketball you have to shoot 50 percent. If you make an extra 10 shots per hundred, you are an All-Star. In baseball you have to get a hit 30 percent of the time. If you get an extra 10 hits per hundred at bats, you are on the cover of every magazine, lead off every SportsCenter and make the Hall of Fame. In business, the odds are a little different. You don’t have to break the Mendoza Line (hitting .200). In fact, it doesn’t matter how many times you strike out. In business, to be a success, you only have to be right once.
All he does is Win, Win, Win no matter what

And every doctor turns green with envy… Because that doesn’t describe our business. (And as Dr. Gupta says in Episode #3: “”Medicine is like any other business.”) In our line of work, the pressure is to be spot-on 100% of the time. No excuses.

Any deviation from “adherence to best practice” is potential grounds for being sued. 10% of every doctor’s paycheck goes straight to pay for malpractice insurance (and that was before Obamacare even passed).

There’s no room for risk. No room to experiment. No room for highly-skilled and over-educated physicians to challenge the status quo. Even “evidence-based medicine” ignores the results we don’t like to admit.

Check out his TED Talk. Both of them.

Face it: we don’t know how to handle them when we do make mistakes. In hospitals. In clinics. In the operating room. We usually glaze over them and talk about “complications” — on grand rounds, with colleagues, even to the family. Admitting weakness is not an option.

One surgeon put it like this:

How we treat ourselves when such situations occur is reflected in how the system treats us. It is little wonder then that this translates into a culture of medicine that is equally harsh, punishing and blaming — even if it professes not to be! The professional bodies put their reputation over and above the humanity of the people they are in charge of teaching and regulating. They set curriculums devoid of care for the people they are supposedly training to care for others, and then wonder why there is a lack of compassion in the profession, when it has been absent from the culture of how the regulating bodies treat their subjects, how doctors treat doctors, how senior doctors treat junior doctors and how all grades of doctor treat medical students. And so the cycle continues.

I don’t have the answer [yet]. But I have stories.

I haven’t even finished my first year of medical school, but I’ve seen verbal abuse. I’ve seen administrators glare each other down. I’ve seen 3 deans quit from the same department in the same month.

So here are some more realistic numbers:

  • 50%. A dean of Harvard Medical School once said: “Half of what we are going to teach you is wrong, and half of it is right. Our problem is that we don’t know which half is which.” That was back when epistemological modesty AKA intellectual humility was in fashion. Professors still say know that today, but they can’t say it.
  • 25%. One-fourth of cases that get referred to the Cleveland Clinic have a wrong diagnosis. (Of course, the CC doesn’t publish stats on how often their own doctors get the diagnosis wrong. But they’re really good at pointing fingers.)
  • 1%. One out of 100 people admitted to a hospital this year will die — not from illness, from a blatant human MISTAKE. (Jargon calls them “preventable medical errors”.)

Something has to change. Patients deserve better.

Because when we don’t fix our own problems, we just pass them down the line.

As they say in AA meetings, the first step to recovery is admitting you have a problem you can’t control. (Don’t ask me how I know what goes on in AA meetings.)

But now I’m just ranting.

The point is: Hiding is unsustainable. Transparency is coming.

We discuss this shocking new trend in healthcare on Episode #5 of The Ultimate Doctor podcast. Check out my discussion with the founder of Sano Surgery: “I’m in the transparency business.”

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