Pharris Livingston
Professor Emerson
IDMD 101
26 October 2023
Unnecessary Medical Intervention and Treatment Errors
The topic was introduced to the class through three sources. The first was “When Evidence Says No, But Doctors Say Yes” by David Epstein. In this paper, Epstein describes the extremely prevalent yet relatively unknown issue of physicians performing medical interventions or prescribing drugs that have been proven to be harmful, ineffective, or inferior to other treatments.
The second source was “Medical Error, Malpractice And Complications: A Moral Geography” by David M. Zientek. This passage explains how recent research has shown that medicine has put a major emphasis on preventing system errors but not so much on actual human error. This could pose an unintended negative consequence of shifting attention from individual moral agency in untoward incidents. The third source was not referenced in the class discussion, and, for this reason, I see no utility in summarizing it.
I kicked off the discussion with a current healthcare conundrum that was introduced by Epstein. The question was as follows, “What do you believe is the correct balance between strict FDA Drug approval that ensures drug efficacy and safety and more casual FDA approval that allows patients to receive drugs sooner?” This question was met with a notable silence that I take as a good representation of the difficult decision that this question poses. The first comment made explained that it was difficult to hold any other view except supporting strict FDA approval because Epstein was so against loose FDA regulations. The class concluded that it came back to an argument about personal freedom. The individuals that supported loose FDA regulation did so on the grounds that if a patient decided that they were willing to bear the responsibility of any negative side effects of a drug, then they had the right to receive the drug. This argument was opposed three different ways. The first argued that because we would not fully understand the long-term side effects of drugs that are not well tested, they could have negative side effects that outweigh the benefit. I can agree with this point but not because the future negative side effects could outweigh the benefits. I can agree because this would mean that the patients would be incapable of providing informed consent as being informed of possible long-term effects would be impossible. This would mean that patients would be incapable of accurately deciding if they were willing to bear the responsibility of the negative side effects of experimental drugs when there is no way to know the severity of those side effects. The second was that loose regulations could jeopardize physician credibility because they would be the ones to prescribe treatments and, therefore, could share in the culpability of future complications. This point was quickly dismissed by the idea that physicians would not be held responsible, the patients would. I agree with this rebuttal. The last point argued that doctors are a beacon of authority and experts in their discipline; therefore, patients could not just receive a drug if they were willing to take a risk. The overall response to this point was that this denies patients the autonomy to make decisions about their own health. This was the end of this exchange as the issue came back to the core discussion, and everyone made their own conclusions based on what they valued more: personal autonomy or physician expertise.
My next question was asked as follows, “In the 2nd article by Zientek, it is stated that a healthy hospital environment encourages its physicians to speak up regarding their own mistakes so that further mistakes can be avoided. How do you believe that hospitals can foster this environment considering physicians are incentivized to keep their mistakes to themselves?” The class’ first reaction to this question was the suggestion that a hospital environment was largely dictated by respected authority figures; therefore, if they accepted accountability for their actions, then the whole hospital would. This argument was strongly supported by a student who admitted that there was a moment when working at a pharmacy where he or she thought they might have made a mistake, but because they respected their manager, was entirely open to discussing the error. After some investigating, it turned out that they were not at fault and the problem was fixed. I fully agree with the class regarding this discussion. Leading by example is an important aspect of any authority position, so if a certain environment is desired in hospitals, it is the responsibility of the hospital leaders to establish norms.
As this discussion reached a consensus I asked my third question based on a hypothetical described by Zientek. The question went as follows, “Zientek describes an anecdote in which a nurse accidentally hangs the wrong IV bag, but as a result of being overworked and bags not being clearly labeled. How much of the blame of this error do you believe lies with the nurse versus the system that perpetuated the error?” The first few points basically placed the entirety of the blame on the hospital system, which was supported by the fact that the bags were not labeled well. Initially, I did not subscribe to this idea. Even though the system definitely shares in the blame, the nurse did make a mistake. He or she should be checking the labels to IV bags carefully enough to avoid any kind of error; therefore, the nurse also shares culpability. I maintain this belief, but I fully agree with the idea that healthcare workers are people too. So, hospitals are obligated to help minimize mistakes. Poorly labeled IV bags are unacceptable. The class then began to discuss the reason that the nurse was overworked: a shortage of healthcare workers. The reasons the class listed for this shortage was the mistreatment of healthcare workers, the cost of education, and a lack of medical school and residency opportunities. This led Dr. Emerson to ask, “If overworked nurses are a systematic error, how do you fix systemic issues?” One student explained that if the entire staff of hospitals maintained accountability, then preventable action could be taken against systematic errors. This would be more effective than increased funding because these issues could not be solved by financial means. I do agree that money would not solve most medical systematic errors, but I also do not believe that money was ever even considered for a solution considering that hospitals have the money to solve problems if it is deemed necessary.
I had many takeaways from this discussion. The first was the idea that when deciding between strict and loose FDA drug regulations, the discussion comes down to one’s beliefs regarding the importance of personal autonomy or physician expertise. When debating this in the future, these two values should be the focus of the discussion. My second takeaway was that in order to foster an environment of accountability in medicine, it is the responsibility of authority figures to encourage accountability through example. My final takeaway was that hospitals are obligated to maintain systems that minimize gross error in the treatment of their patients, and if systematic error is involved in a mistake, the blame lies entirely with the system.
Works Cited
Epstein, David. “When Evidence Says No, but Doctors Say Yes.” ProPublica, Feb. 2017, www.propublica.org/article/when-evidence-says-no-but-doctors-say-yes. Accessed 10 October 2023.
Zientek, David M. “Medical Error, Malpractice and Complications: A Moral Geography.” HEC Forum, vol. 22, no. 2, 18 May 2010, pp. 145–157, https://doi.org/10.1007/s10730-010-9130-9. Accessed 10 October 2023.