It’s also trivially easy to describe cases where a doctor could have made an “error” not matter what they do. It’s always easy to look back and say what should have been done.
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Replying to @JHowardBrainMD @gorskon
um .. yes … but.. I sense that you are heading off down the wrong path. Medical errors are not "something the clinician did wrong" but a deviation from the desired outcome, and far more about the process than the person The doc is just one element of one dimension of causationpic.twitter.com/MhOEpKlOzT
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I mean I’ve had patients die. It was never the desired outcome.
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Replying to @JHowardBrainMD @gorskon
Right, so re VoC. The value-based care aspect of quality is that you as physician and your patient are a team, and you will jointly agree health outcomes that are to be the measure of care quality. High quality = meeting pt health goals Low quality = not meeting them
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And to my point that, at times, an "error" can be made no matter what.pic.twitter.com/DrKzKdfH5m
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Replying to @JHowardBrainMD @gorskon
Yes! and 3. You assessed the pt as not needing opioids, they became dysregulated later at home due to pain, and suicided We could have a really long discussion here on whether a bad outcome is necessarily a medical error, but that maybe distracts from more likely error modes /2
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For example - pt got the wrong medication - wrong concentration - wrong dose - wrong frequency - drug-drug interaction There are a lot of near misses, and far too many injuries or deaths from preventable errors
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No one would deny those are preventable errors. I just don’t think 20% of Americans die because they were given the wrong med in the hospital. Or the wrong patient was operated on.
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Replying to @JHowardBrainMD @gorskon
Neither do I But until a revised estimate comes along that is better, I will tolerate the number 3 on the whiteboard. In the meantime, I will focus on the practical level of patient journey
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Lord knows quacks use this number as a marketing tool.pic.twitter.com/hg2K64uPTI
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Constantly, continually, and unrelentingly.
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Replying to @gorskon @JHowardBrainMD
and you think denouncing Makary but having no replacement makes that any better?
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One need not have a better number to criticize someone elses.
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