My husband and I often watch TedTalks on our Apple TV. About a month ago, they had a very interesting speaker by the name of Atul Gawande. He is an author and surgeon and his talk was about the many issues that plague the medical community, particularly the occurrences of incomplete and inadequate care. He discusses the attitudes amongst the physician community and how certain ideals of perfection can impact behaviors.

I thought that his talk echoed some of the same concepts discussed in the medical errors chapter (pp. 160- 161) of Managing Ethically. In this chapter Dr. Morreim discusses the legal and ethical imperatives in dealing with medical errors. He notes that the healthcare culture views doctors as error-proof gods and this is similar to Gawande’s perspective in the TedTalk. Gawande also acknowledges that the physician community places in emphasis on being a “cowboy”—kind of like the “answering to no one” mentality—and how this attitude belittles the importance of rules and structure.

What I find to be very interesting is how this attitude can prevent physicians and medical staff in general from taking the ethical high road in situations. If doctors are held up to a standard of perfection, I would think that they would be much more likely to hide their errors or downplay them so that they save face in front of their superiors and colleagues. This is damaging not only to the patient who may be harmed as a result, but it also does not allow for the improvement in systems due to fear of judgment or repercussions.  

Perhaps these attitudes are the reason why public records of physician errors are so controversial. In a culture where perfection is the standard, any doctor would be fearful of losing patients because of this information going public.

I think that there are several ways to help deal with this problem. Firstly, healthcare managers need to be intentional about creating a culture of teamwork. Doctors do not do their jobs alone. They rely on nurses, other physicians and a full staff of people to help them succeed in caring for patients. The healthcare environment should place more emphasis on teams and less on individuals. Certainly, there are times when individuals need to be praised or held accountable for their actions, but all around a culture that focuses more on teamwork could be helpful.

Additionally, managers need to create a safe environment for error reporting.  The staff should feel comfortable reporting errors without fear of being punished or judged. The more employees share in this area the more a hospital can improve in their systems.

Finally, I like the suggestion that Gawande makes in his TedTalk video: checklists. There are a variety of strategies that can be used for reducing medical errors, but Gawande notes that even in surgery using checklists decreased complication rates by 35% and death rates by 47% in hospitals that implemented the technique. He agrees that overcoming physician attitudes around checklists will be a challenge, but the outcomes of this idea appear to be promising.

I’m sure that there are many more ways to reduce errors in hospitals, but a key aspect of that is to create a culture where people feel comfortable admitting that they made a mistake.

The Ted Talk Video is below.