While the code of silence and cloak of secrecy around patient survival and recovery remains the norm in most of the country, there are ways you can increase the chances that you will get better care, according to Makary, a surgeon at Johns Hopkins Hospital in Baltimore and a professor at Johns Hopkins School of Public Health.
How Hospitals Can Stop Killing So Many Patients
If you don't know if your doctor is competent for the kind of care you appear to need, ask one or two medical professionals at the hospital to give their personal recommendation of a doctor in that field. Start with these websites: Vitals. Has your doctor's hospital adopted a system for nurses to independently monitor infections? If so, the quality of care and follow-up will probably be much better.
When the children of doctors apply to medical school: Language, culture and values.
Hospitals, like functioning democracies, depend on transparence and check and balances. The Association of periOperative Registered Nurses are strong backers of this approach and can be experienced, real time guardians of our healthcare, when given the power to independently enforce and verify that patient safety systems are followed. We need to support them in securing this role in more hospitals. As individuals we have little power over healthcare reform. When we ask, collectively and publically, for national standards of accountability we can hasten hospital reform.
Makery worked with Atul Gawande in ardently advocating The Checklist approach that requires doctors, like pilots, to follow specific steps and permits, even requires, the rest of the medical team in attendance to speak up if they do not. Faster than most hospitals, in even informing their workers about the Checklist Manifesto approach, Twitter and Square founder, Jack Dorsey gives a copy of the book to everyone he hires. After all, our lives may well be at stake.
Does the hospital where your doctor practices have a system of tracking patient-outcomes that is available to the public and easy to understand? Consider this the new checklist, this time for hospitals:. Gross errors such as leaving an instrument in a patient, or performing the wrong operation, or other gross errors that should never happen.
Safety-Culture Scores. Hospital administrators ask medical staff three questions in a survey that is made public and is a highly accurate way to assess safety:.
Report the number of patients with a particular medical condition and how many of each type of surgery do they perform each year. The shocking truth is that some prestigious, large hospitals have four to five times the complication rates of other hospitals in the same city. Of course a national standard for such public dashboards will have an effect similar to when, despite initial resistance, all football players were required to wear helmets. Professional cultures are also sustained through tacit processes of mimesis, or imitation of superiors. Medical students experience much uncertainty and anxiety—about the new jargon they must quickly become familiar with, about the limitations of their own knowledge and skills, about the limitations of current medical knowledge, about how to attract the limited attention of superiors [19, 20] while avoiding humiliation from them, about how to manage enormous drains on their time and energy, and about how to conduct themselves given the numerous conflicting expectations of their new environment .
Such imitation is not always deliberate. They can inadvertently pick up attitudes, such as detachment from or cynicism towards patients, from peers and mentors [26, 27]. Habituation also involves the cultivation of new tastes—for instance, derogatory humor towards certain kinds of patients—that may have seemed alien or offensive prior to medical school , as well as new dispositions, i.
These processes of cultural transmission are of ethical concern when they have harmful consequences. If—as research suggests [43, 44]—students believe that their personal values about empathy or other aspects of moral life are at odds with those held by their peers and superiors, their moral commitments may be further weakened.
The Wislang Case : IAMRA and those "attitudes"
This can become a self-fulfilling prophecy when they, in turn, discourage others from developing or expressing those values . The duration and significance of this ethical decline is unclear. Scholars have long recognized that the professional culture of medical students is not the same as that of practicing physicians . While some suggest that this erosion is temporary and situational and declines towards graduation , others argue that it is long-lasting .
Other questions have been raised as well—for instance, about the validity of reported changes in empathy  or of survey measures due to changes over time in how the same students interpret the same survey questions . Given the association between physician empathy and clinical competence [48, 49], the long-term ethical effects of structural and cultural aspects of professional socialization merit continued study—out of concern for the well-being of both physicians and patients. Abbott A. Grusky D. Foundations of a neo-Durkheimian class analysis. In: Wright EO, ed. Approaches to Class Analysis.
Bourdieu P. Homo Academicus. Collier P, trans. Hall P. Interprofessional teamwork: professional cultures as barriers. J Interprof Care. Hafferty FW. Professionalism and the socialization of medical students.
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Bourdieu P, Nice R. Outline of a Theory of Practice. Is there hardening of the heart during medical school? Which experiences in the hidden curriculum teach students about professionalism? Learning the art of doctoring: use of critical incident reports. Harvard Student BMJ. AMA J Ethics.