A Culture of Safety and “Doctor as God”

By Steve Adelman, MD

Brigham and Women’s Hospital in Boston, one of the nation’s best, has become a leader in yet another area: Creating a culture of safety that improves patient care by helping physicians and other health care personnel view medical errors as learning opportunities.  The Boston Globe reported on the initiative in a front page article earlier this week.

Most often, preventable medical errors stem from imperfect and flawed systems and workflows, and are not a result of a single individual’s bad judgment or poor care decision. The growing culture of safety at the Brigham emphasizes fixing the system, not on disciplining the individual whose mistake was a consequence of a flawed workflow.

The culture of safety is actually a counterculture. It runs counter to a deeply embedded culture that puts physicians on pedestals – let’s call that culture the “Doctor as God” culture. In the “Doctor as God” culture, some members of the public, not to mention goodly numbers of our patients, family members and friends, imbue us with super-human powers.

In fact, countless physicians work wonders every day. We help enormous numbers of people – with our technical ability to fix most medical problems, with our listening skills, and with our ability, above all, to relieve suffering by interacting in helpful ways with our patients and their families. One of the unfortunate pitfalls of medical practice is that some physicians buy into the “Doctor as God” culture themselves. It’s one thing to understand that patients in distress sometimes put you on a high pedestal because doing so helps them to get through a very difficult and stressful situation.

But when the doctor loses his or her humility and begins to feel that he or she belongs on a pedestal, that’s when things can start to get funny. Believing that you can do or say no wrong is dangerous. It can cause friction with colleagues, co-workers and patients, and may contribute to bad medical decision-making that leads to medical errors.

So let’s own and acknowledge the fact that each and every physician is human; even the greatest of healers. Let’s pursue our calling with an attitude of competence, compassion and humility. And let’s enthusiastically embrace the culture of safety that strives to perfect systems of care for the betterment of all.

Dr. Adelman is director of Physician Health Services, Inc., a corporation of the Massachusetts Medical Society. For more information, visit www.physicianhealth.org. Opinions expressed here are his own, and do not necessarily reflect those of the Massachusetts Medical Society or Physician Health Services.

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