This news just in: I am not a perfect physician. I thought I was, but I am not. When I take care of patients I sometimes make mistakes, do the wrong thing, forget to do the right thing, or don’t do everything I should.
You can tell me I’m a bad physician, make me hate myself, boil me in malpractice oil, send me back to medical school for the rest of my life, and I still will not practice perfect medicine. To increase my odds of doing that I need help, but not just any help; I need my patients’ help to get it right more of the time.
In fact, as a physician I don’t just need your help with that; I need you to see that as your job as a patient. You can say that’s putting the burden of my inadequate performance unfairly on your shoulders, and call the Board of Medicine to report a quack ducking his responsibility, but I don’t care about that. What I do care about is my patients, enough to tell them I’m not perfect, and that it is their job to help me take better care of them.
I don’t need that help because I am an idiot or don’t give two leeches about providing excellent care. I need it because even being smarter than Bill Gates and more passionate about people than Dr. Jesus O. Nazareth cannot make me perfect in the practice of medicine. I wish that was all it took, and in the days when my new physician ego was big enough to be carried in a dump truck I thought brains and passion were plenty, but they haven’t been enough yet and never will be, for me or for any physician.
Here’s an example of this reality. Consider two numbers: 92 and 70 (letter grades A- and C-); in August two years ago I passed my national medical board recertification tests with a score higher than 92 percent of the other physicians taking it. What a smart guy, eh? That winter only about 70 percent of my patients who should have gotten a flu shot actually got one.
Now, to be fair to me, some of my patients forgot to get their shots, some told me I could stick my own flu shot because they believe the myth that the flu shot can cause the flu, but in some cases I just plain forgot to tell the patients to get it. I hate not giving the care I should, I don’t want my patients to get sick unnecessarily, I got that great score on my medical board exam, and I still forgot.
Other physicians also forget sometimes. Several years ago a brilliant transplant surgeon at Duke University did not make sure the blood type of the donor heart and lungs he transplanted into a 15-year-old girl matched her blood type, and she died when the donor organs were rejected by her immune system. On some days what physicians forget means nothing, and on others it means everything.
In a typical day taking care of patients I make more than a hundred medical decisions, have to remember several hundred things, and cannot remember everything I should. Sometimes the problem is not that I forget to do something, it’s that – hold on to your coffee cup, Margaret – I don’t know everything there is to know about everything in medical care. Computers help me do better with my inadequate memory and knowledge, but are not enough. I need you.
This is the job you have to do; help me remember to do some important things in your care, including the following:
1. Ask me if I cleaned my hands before I take care of you, and remind me to clean them again when I finish. In fact, ask every physician, nurse or therapist taking care of you anywhere to do the same thing. Some of us will be insulted, many will be embarrassed, but if anyone complains just remind them that we need reminding because study after study has found that, on average, health care professionals only clean their hands about 60 percent of the times they should. That would be no big deal, but those unclean hands are a major cause of patients getting infections passed to them from other patients.
2. If we give you a prescription check that prescription before you leave the office; do you really need this medicine, is it the right medicine at the right dose, do you know why you should take it and what side effects to watch for, and can you read the handwriting? If the answer is no to any of those, or you are not sure, ask your physician to clarify before you leave the office.
3. If you are in the hospital ask your physician about your risk for developing a blood clot in your legs and-or lungs. If that risk is high, ask if your physician has ordered preventive treatment to reduce that risk. Those blood clots kill about 300,000 patients each year in American hospitals, and some clots could be prevented if physicians ordered preventive treatment.
4. Ask us each year about what preventive tests a patient your age and gender should have.
5. Ask what the goals should be for care of any chronic conditions you have, e.g.: your target blood pressure if you are hypertensive, and your target blood sugars and Hemoglobin A1c if you are diabetic. If you have not reached those goals, ask how you and your physician are going to get you there.
I wish this was not necessary, because no physician wants to admit they cannot get the job done right all of the time. The simple and important truth is, however, that we cannot. We need great nurses, pharmacists and other health care team members, computer systems, best practice guidelines and patients, all looking over our shoulders and helping us provide the care we want for our patients. A physician doing this alone is a safety net with large holes.
You and I can argue about whose responsibility the job is, but in the end only one of us will be harmed if it does not get done, and that would be you, the patient. I may end up sued and ridden with guilt if I screw up, but you will be harmed. It’s the same reason I tell my daughters that in the end, birth control is mostly their job, not the guy’s; in principle men and women are equally responsible for birth control, but in 18 years of medical practice I have never seen a pregnant guy.
If your physician does not like sharing the job of giving the right care safely, get another physician, because the best physicians know they make mistakes. That is, after all, part of what makes them human beings and not robots with stethoscopes.
Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region.