Patient safety progress slowed by arrogance of physicians

Despite a decade-long effort to improve patient safety, little progress has been made.

One big obstacle is arrogant physicians who are not held accountable for their actions, says Dr. Peter Pronovost, the quality & safety research group medical director at Johns Hopkins University's Center for Innovations in Quality Patient Care, in a July 14 article published in the Journal of the American Medical Association.

One personal example Pronovost shares is of a surgeon who made it clear he was not to be questioned. Although the patient had classic signs of a latex allergy, the surgeon refused to change gloves until Pronovost threatened to call a higher authority.

Other examples he describes include physicians who don't accept that they are fallible. They believe they have all the answers, dismiss team input, or respond aggressively when questioned.

Physicians, he notes, are "overconfident about the quality of care they provide, believing things will go right rather than wrong...thinking they alone have sufficient knowledge and skills to provide care."

In a healthcare culture that often looks the other way, rather than speaking up about actions that might harm a patient, it's clear that a lack of accountability is a key challenge. The U.S. healthcare culture doesn't yet back questioning physician behavior. And that can harm patients.

"Too often, neither physicians nor hospital leaders hold themselves accountable for patient outcomes," Pronovost writes. Hospital administrators say their patients are too sick and that central line-associated bloodstream infections are inevitable, although they are not. That many hospital CLABSI infection rates are higher than the national average suggests doctors and hospital administrators feel no accountability for them, Pronovost adds.
 
To learn more:
- read Pronovost's article in JAMA (subscription required)

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