Dr. Brian Goldman is right.
We expect a level of perfection from our doctors, nurses, surgeons and care providers that we do not demand of our heroes, our friends, our families or ourselves. We demand this level of perfection because the stakes in medicine are the highest of any field -- outcomes of medical decisions hold our very lives in the balance.
It is precisely this inconsistent recognition of the human condition that has created our broken health care system. The all-consuming fear of losing loved ones makes us believe that the fragile human condition does not apply to those with the knowledge to save us. A deep understanding of that same fragility forces us to trust our doctors -- to believe that they can fix us when all else in the world has failed us.
I am always surprised when people say someone is a good doctor. To me, that phrase just means that they visited a doctor and were made well. It is uncomfortable and unsettling -- even terrifying -- to admit that our doctors are merely human -- that they, like us, are fallible and prone to bias.
They too must learn empirically, learning through experience and moving forward to become better at what they do. A well-trained, experienced physician can, by instinct, identify problems that younger ones can't catch -- even with the newest methods and latest technologies. And it is this combination of instinct and expertise that holds the key to providing better care.
We must acknowledge that our health care system is composed of people -- it doesn't just take care of people. Those people -- our cardiologists, nurse practitioners, X-ray technicians, and surgeons -- work better when they work together.
Working together doesn't just mean being polite in the halls and handing over scalpels. It means supporting one another, communicating honestly about difficulties, sharing breakthroughs to adopt better practices, and truly dedicating ourselves to a culture of medicine that follows the same advice it dispenses.
Yes, this is certainly easier said than done. But as daunting as the task may seem, we aren't heading into the dark alone. It's been done before. We aren't the first people to face this challenge.
The airline industry understands how to learn from its mistakes; it has a firm grasp of best practices for accident avoidance. Pilots, aeronautical engineers and flight attendants develop those practices from examining data about past plane crashes.
Regardless of scale, total damage or mortality, federal investigations reveal the exact series of events that precipitate each crash and provide a methodical account of what went wrong. Crashes are not shameful moments swept under an emotional rug; they're teachable moments that are examined, diagnosed and learned from.
I understand that airplanes and arteries are vastly different systems. I'm not trying to equate a plane crash with a botched diagnosis -- what's important here is the approach to error. The airline industry has understood, internalized and implemented a system that recognizes human and mechanical failures as important lessons and opportunities for improvement.
The Collaborative Chronic Care Network (C3N) is a project that catalyzes improved patient care. Chronic illness management is driven by the same lessons that Dr. Goldman and the airline industry have brought to light. Dr. Richard Colletti, a C3N collaborator, explains that "the care that a patient gets is not just dependent on how good the doctor is or how much the doctor cares. The care is dependent on the system that the doctor works in."
Dr. Colletti sees medicine as an ongoing learning process, where patients and care providers actively help each other find solutions on the journey to wellness. This openness makes collecting empirical medical knowledge less of a Herculean effort -- it encourages and even facilitates data and care collaboration among networks of doctors.
C3N implements this approach with real action and systemic change.
They note, "By combining large data registries and making them accessible and interactive, it drives action and innovation to create a more reliable and accountable care delivery system for children and their families dealing with chronic gastrointestinal diseases. And with an open-source framework, the project is developing a means to overcome barriers that involve concerns about intellectual property, data sharing and privacy, and medicolegal liability."
Perhaps, then, a new generation of doctors can eliminate the culture of walled gardens. More and more, we hear experts discuss the same kinds of shame addressed by Dr. Goldman -- the healthy shame that can be dealt with, and the unhealthy shame that shakes you to your core and drives change. Transparency in the doctor's office and a culture that accepts and learns from its mistakes should be a priority for medicine.This system is not just a great idea or an interesting experiment; it is a thriving solution that's changing the lives of patients everywhere. Dr. Colletti has reported that, because of the C3N methodology and practices, 10 percent more children with Crohn's disease are now in remission.
*I'm working with Cincinnati Children's Hospital to bring the C3N to Cystic Fibrosis and improve our outcomes too!
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