Do the right thing, but …
With physicians, especially academic faculty, pressed at every corner for time because of increasing demands and declining reimbursement, patient-safety advocates must figure out ways to provide the time/financial incentives to make this happen. That is not being cynical or mercenary; that simply reflects the declining economics for every player in the provider chain these days (“Textbook revision,” March 15, p. 14).
Physicians/hospitals will only take this seriously when it affects revenue either negatively or positively, and not a minute earlier.
A patient-safety focus will have to supplant an extant “priority” unless there is more revenue directed toward this arena. We operate in a zero-sum game in medicine these days; there is no excess capacity, slack, etc. (And the tort system is woefully inadequate). The Association of American Medical Colleges/Joint Commission simply can’t layer more expectations onto an increasingly underfunded healthcare and medical-training system being asked to perpetually do more with less (and capitalize major health information technology expenses currently).
Physicians/faculty want to do the right thing, but they no longer have the time and energy to do all the right things that society is expecting of them. Something has to give, and as we see, its patient safety in this case.
For those who no longer see patients on a daily basis for their livelihood to exhort for patient safety from bully pulpits invites ennui and cynicism even among the most idealistic of clinicians. You must find the dollars, you must make hard choices, and you must supplant other extant priorities. To elevate patient safety in an era of declining budgets, what will you sacrifice?
And please don’t dismiss this rhetorically by labeling this line of reasoning as false or a Hobson’s choice until you return to working 60 hours a week seeing patients on a production-line practice or are willing to meet me in the operating room at 6 a.m. to discuss your ideas.
Everyone wants more patient safety. Who wouldn’t? The question is how will we pay for it, and what will we re-prioritize to give it the
attention it needs? Be specific about what you would do instead of advocating “patient safety” in a sterile academic vacuum.
Medical students all start out reasonably compassionate and concerned about patient safety. It’s the system of practice that grinds them down/distracts them. This is not a teaching or role-model issue. Fundamentally, it’s like all things in medicine: a time and money matrix. How do we solve that in this era? J.D. White