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 to meet this task for either patient, physician or society). The Association of American Medical Colleges and the 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 and faculty want to do the right thing; they no longer have the time and energy to do all the right things that society is expecting of them—no human can. Something has to give, and as we see, it's 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 we will 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 and 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, M.D.
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