About nine months ago one of my friends, Frits, went to his family doctor because he was worried. A number of times he had felt dizzy when playing football, and sometimes felt a pressure in his chest. The doctor calmed him down – it couldn’t be anything serious. After all Frits had a very healthy life-style – did a lot of sports, was pretty young, drank almost no alcohol and ate healthily, his blood pressure was fine and he didn’t carry a spare ounce. The following Saturday he dropped dead with a heart attack on the football field.
Happily two members of his team managed to resuscitate him so that the next day in the hospital he could open his eyes and soothe his family doctor who was almost in tears. “We all make mistakes,’’ Frits told him.
Frits’ response is the chief reason why politicians, big educational institutions, directors of housing corporations, bank directors and many others are so jealous of medics: the image of and understanding shown to the medical profession seems to be indestructible. In this jealousy a very painful figure plays a part – the annual 3,148 cases of death in this country caused by medical mistakes. That is more than the (single) attack on the World Trade Centre in New York.
Medics are lucky, but… some are worried about a change of feeling and fear that they could be denigrated like bankers. I don’t think this is inevitable, but it certainly isn’t impossible. And it depends on you yourself – however much the media juggles with facts or goes to extremes.
Therefore – what must you do to prevent a negative image developing? In the first place DON”T do what everyone does when they are confronted with problems due to tunnel vision (that’s what they call it these days) – dig yourself in your mental wrongness. You do that when you stay caught up in one or more of the following sort of thoughts:
- “But the medical position of the Netherlands in the international ranking is really good!”
- “You should think about how much has changed in the last ten years!”
- “We are constantly working on improvement!”
All three arguments can be useful, but they are not sufficient. Critics immediately reply with something like: other people doing even worse doesn’t interest anyone, and what has changed or is changing even less – too late, too little, too slow”
But if the arguments can be countered so easily aren’t we fighting a lost battle? No, because there are effective actions:
- Improve what you do and regularly inform the public of your efforts and results.
- Make – as a medical institution (not per doctor) – your results transparent. Comparisons with other countries as part of this are fine.
- Make it clear what, as a profession, you understand by ‘human error’, ‘professional misconduct’ (for the ethics committee) and what you see as criminal actions (such as operating while drunk or fighting).
- Among colleagues do not keep your mouth shut about unprofessional or criminal conduct. This is always due to anxiety, misplaced feelings of solidarity with colleagues or your own interest (I’ll keep quiet about your mistakes if you’ll keep quiet about mine).
- Make it clear to the public that if ordinary human error is punished then nobody will dare to confess such errors, so that learning from them can’t take place, BUT DO THIS IN COMBINATION WITH THE EARLIER POINTS, otherwise the argument sounds like blackmail.
A combination then, of improvement, openness about errors made, defend your position with passion and in a friendly but clear manner do your thing
Someone who did this in a brilliant way was the cardiologist and member of the management of the Order of Medical Specialists Marcel Daniëls, in the TV programme Buitenhof on 3rd March this year, (fragment on 33.40). It is difficult to imagine a better advocate of the public importance of the medical profession. Great to see – and more than anything – a relief!
A blog by Frank Geene