When the team of otolaryngologists from Children’s Hospital in Boston, including Drs. David Roberson and Rahul Shah, among others, investigated the classification of errors and physician responses to errors as it is germane to otolaryngology, they provided a great service to their fellow specialists. As the team emphasized, and was mentioned in Part 1 of this two-part series (see ENToday, November 2006), when it comes to provider-related errors, otolaryngology is different from other specialties only in some ways.1-6 That’s why patient safety programs need to be driven by practitioners at the sharp end of the system, at the point of care, not by a [general] patient safety committee, said David Eibling, MD, a physician in the Veterans Affairs (VA) system and a professor of otolaryngology-head and neck surgery at the University of Pittsburgh, because they are not able to see the unique problems of each individual specialty, and moreover, you don’t know where your own problems are unless you count them.
Explore this issue:December 2006
Before the publication of To Err is Human,7 the now famous report of the Institute of Medicine that started the patient safety ball rolling at turbo speed, the most frequent subject of patient safety publications was medical malpractice. Since its release in 2000, the most frequently addressed topic has been organizational culture, and growing data substantiate that the way in which communication is handled within that culture is a vital factor in litigation and patient satisfaction.5
Pitfalls and Land Mines
Are there any particular areas where otolaryngologists are more at risk for errors than other physicians? For any physician, medical knowledge and technical skill, or even patient-doctor relationship skills, are not the biggest areas for risk, said Nancy Elder, MD, Associate Professor of Family Medicine at the University of Cincinnati, who has studied extensively the topic of errors in medicine. Sometimes the risks lie not so much with the physician himself or herself; it’s the communication before and after the exam or operation, or the providers’ office processes and systems. The patient doesn’t have to just communicate with the physician, Dr. Elder said. The patient also has to communicate with whoever answers the telephone, the front desk, the nurse-and a lot of errors are happening in these areas that physicians are not even aware of.