Physician Health

A Culture of Safety and “Doctor as God”

Posted in patient safety, Physician Health on April 12th, 2013 by MMS – Comments Off on 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 Opinions expressed here are his own, and do not necessarily reflect those of the Massachusetts Medical Society or Physician Health Services.

Doing No Harm: Physicians Should Just Say No to the Medical Use of Marijuana

Posted in Medical Marijuana, Physician Health on April 9th, 2013 by MMS – 5 Comments

By Steve Adelman, MD

As an addiction psychiatrist, I have seen marijuana do far more harm than good. So with the medical use of marijuana in Massachusetts now legal under state law, what should physicians do?

Last week, I attended a chilling presentation from Dr. Kevin Hill, an addiction psychiatrist at McLean Hospital, at a meeting of the Massachusetts chapter of the American Society of Addiction Medicine on the topic “Medical Marijuana: What is the Proper Role of the Addiction Physician?”

As we all know, the people of Massachusetts have spoken: last November, 63% of the voters endorsed Question 3, “The Medical Use of Marijuana.”

Since that time, the Department of Public Health has been scurrying to operationalize the so-called medical use of cannabis in the Commonwealth. The community of physicians has been scratching its collective head and wondering, “What in the world are we going to do about patient requests to become certified to purchase, or grow, so-called medical marijuana?”

I use the terms “so-called” and “medical marijuana” together, because there is scant scientific evidence to support the use of marijuana as a medication.

The US Food and Drug Administration has yet to approve any “smokable” medications. The Drug Enforcement Agency classifies marijuana as a Schedule 1 substance. Schedule 1 substances are defined by the DEA “as drugs with no currently accepted medical use and a high potential for abuse. Schedule 1 drugs are the most dangerous drugs of all the drug schedules with potentially severe psychological or physical dependence.”

Many users of marijuana become addicted, suffering withdrawal symptoms when they attempt to stop, and experiencing a variety of impairments as a result of chronic use. They continue using because they feel worse when they don’t use. Frequent use of marijuana by young people may impede the development of the brain (which continues until the mid 20s), interfering with education and work performance.

I am not taking a position on the legalization of marijuana, but I am taking a position against the medicalization of marijuana. I strongly believe that it is misguided. Although small numbers of individuals with intractable, debilitating medical conditions may derive some benefit from the use of marijuana “when all else fails,” so-called medical marijuana laws open up a floodgate to entrepreneurs who will profit from the sale of this valuable addictive substance.

All patients with certificates who are covered by MassHealth or by Social Security Disability Insurance (SSDI) will have the option of growing their own. There will be massive amounts of diversion to non-patients, and the price of marijuana will drop. The health and well-being of the greater public will be jeopardized for the relief of a few, and for the profit of the unscrupulous.

Physicians who have taken a pledge to “do no harm” should simply steer clear of the emerging Massachusetts medical marijuana debacle and “just say no.”  As physicians contending with the increasing demands of a complex and unevenly funded healthcare system, we should focus our attention on providing evidence-based care to patients, and sidestep getting involved in a social movement that is medical in name only.

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