Doctors Frequently Make the Wrong Diagnosis



A new study finds that internists make the correct diagnosis in only 55 percent of simple illnesses, and in just 6 percent of complex cases.


 

DOCTORS FREQUENTLY MAKE THE WRONG DIAGNOSIS

When we see our doctor because we are sick, most of us expect that we will leave his or her office with a reasonably accurate diagnosis, and the appropriate treatment recommendations for our illness.  However, a newly published clinical research study suggests that these expectations might be rather unrealistic, particularly if we are suffering from an illness that requires a reasonably complex evaluation by our physician.  This new clinical study appears in the current issue of JAMA Internal Medicine.

In this study, 118 general internists were recruited from throughout the United States.  All of these physicians were asked to provide a diagnosis for 4 previously validated patient scenarios, including both straightforward and complex clinical cases.  These doctors were asked to provide their diagnoses after reading the histories, physical examination findings, general diagnostic testing results, and disease-specific testing results for each of these 4 cases.

The results of this clinical study were not exactly reassuring to prospective patients….   The 118 participating internists came up with the correct diagnosis for only 55 percent of the straightforward cases.  When it came to making the correct diagnosis for the more challenging patient scenarios, the physician-volunteers in this study correctly diagnosed only 6 percent of the more complex clinical cases!  Moreover, the doctors who participated in this web-based clinical study appeared to have little insight into their diagnostic shortcomings, as their very high level of confidence in their diagnoses was similar for both the straightforward cases and the more complex cases.   This latter finding led the study’s authors to question whether or not physicians who are dealing with complex patient cases realize how likely their diagnosis is to be wrong.  (If a physician is unaware that his or her diagnosis is very likely to be wrong, then they may miss an opportunity to perform a more in-depth evaluation of their patient.)

While this is a small pilot study, its findings are nonetheless quite disturbing.  It suggests a simultaneous lack of diagnostic accuracy and over-confidence on the part of at least some physicians when it comes to evaluating patients, arriving at a correct diagnosis, and (hence) prescribing the correct treatment.  Whether or not the findings of this small study can be generalized to all internists (or to all doctors in the United States) is not clear.  However, the disconcerting findings of this clinical study should serve as a red flag to physician residency training programs and physician certification boards.  Meanwhile, becoming an educated healthcare consumer, and asking your physician to explain his or her assessment to you, may be just what the doctor ordered!

 

For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my bestselling book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-MillionVroman’s Bookstore, and other fine bookstores!

Within one week of publication, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books. Within three months of publication, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.com Top 100 New Book Releases in Cancer” list.

 

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According to recent Bureau of Labor Statistics, the unemployment rate for veterans who served on active duty between September 2001 and December 2011 is more than 12 percent.  A new website, Veterans in Healthcare, seeks to connect veterans with potential employers.  If you are a veteran who works in the healthcare field, or if you are an employer who is looking for physicians, advanced practice professionals, nurses, corpsmen/medics, or other healthcare professionals, then please take a look at Veterans in Healthcare. As a retired veteran of the U.S. Army, I would also like to personally urge you to hire a veteran whenever possible.


Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


 

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  Over the past 12 months, 3.5 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious readers.  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 


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New Study: Medication Errors Linked to Half of All Prescriptions








 

A new study shows that despite increased efforts by hospitals and pharmacists, half of all new prescriptions, on average, contain at least one error.


 

NEW STUDY: MEDICATION ERRORS LINKED TO HALF OF ALL PRESCRIPTIONS

The prestigious Institute of Medicine estimates that at least 1.5 million medication-related cases of injury or illness, also known as adverse drug events (ADEs), occur each year in the United States, and that, on average, hospitalized patients can expect to experience at least one medication error per day.  Because of this very large number of ADEs, and their potential to cause serious harm to patients, several strategies for reducing ADEs have been recommended, including improved communication between doctors, pharmacists and patients; the use of electronic medical records and “e-prescriptions” that incorporate medication screening software; and improved drug labeling and packaging practices.

Despite these recommended strategies for reducing ADEs, a newly published prospective, randomized, controlled clinical research study suggests that even more effective strategies need to be identified, and implemented, if we are to significantly reduce ADEs caused by medication errors.  This new clinical study appears in the current issue of the Annals of Internal Medicine.

In this new study, two large teaching hospitals in the United States randomized patients being discharged after admission for heart-related illnesses into one of two groups.  One group, the “control” group, had their discharge medications prescribed and monitored in the usual manner.  The other group, the “intervention” group, had their discharge medications managed using an enhanced approach to medication prescribing and monitoring, including having a pharmacist directly review patients’ preadmission and discharge medications, one-to-one patient counseling by a pharmacist regarding their medications while patients were still in the hospital, the provision of extra counseling and assistance for patients with literacy challenges, and individual patient follow-up by telephone after their discharge from the hospital.  All patients in the intervention group were provided these enhanced services for 30 days from the date of their discharge by these two well known academic medical centers.

The results of this important prospective clinical study were, unfortunately, rather discouraging.  Among the 851 volunteers who participated in this study, 432, or 51 percent, experienced one or more clinically significant medication-related errors, 23 percent of which were assessed to be serious errors, and 2 percent of which were considered to be life-threatening errors.  Regarding ADEs, specifically, 30 percent of the patients in this study were confirmed to have experienced an adverse physical reaction or complication associated with their medications, while another 30 percent experienced abnormal symptoms or side effects that were deemed to be “potential” ADEs.  When the researchers compared the two groups of patient volunteers in this study, they found that the intervention group patients, who had received extra medication prescribing and monitoring safeguards, had the same incidence of overall medication errors and confirmed ADEs as the control group patients, unfortunately.

The findings of this clinical study are, needless to say, very disappointing.  Despite the best efforts of these two large teaching hospitals in taking multiple extra measures to drive down the number of medication errors and ADEs, these enhanced efforts appeared to have had no significant beneficial effects.  Indeed, half of the patients participating in this clinical research study experienced one or more medication errors, and proactive health-literacy-directed and pharmacist-delivered interventions appeared to have no impact on this very high incidence of medication-related errors.  (You can also bet that the incidence of medication errors and ADEs are likely to be much higher in many hospitals and pharmacies that are not closely following their patients within a rigorous prospective clinical research study, such as this study.)

The findings of this important prospective clinical study strongly suggest that currently available recommendations for addressing the ongoing high rate of medication-related errors and ADEs are likely to be inadequate, particularly for patients who are transitioning from the hospital to home.  This study’s results also indicate that additional new strategies need to be quickly identified and implemented.  At this time, I urge all patients to proactively review both their current and new prescriptions with their health care providers, and with their pharmacists, in an effort to detect potentially serious medication-related errors before they can cause any ADEs.  Moreover, every one of us who take medications (including vitamins and supplements) should carry an updated list of all medications, and a list of any allergies or sensitivities to medications, with us at all times.



At this time, more than 8 percent of Americans are unemployed.  According to the Bureau of Labor Statistics, however, the unemployment rate for veterans who served on active duty between September 2001 and December 2011 is now more than 12 percent.  A new website, Veterans in Healthcare, seeks to connect veterans with potential employers.  If you are a veteran who works in the healthcare field, or if you are an employer who is looking for physicians, advanced practice professionals, nurses, corpsmen/medics, or other healthcare professionals, then please take a look at Veterans in Healthcare. As a retired veteran of the U.S. Army, I urge you to hire a veteran whenever possible.


For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my bestselling book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-MillionVroman’s Bookstore, and other fine bookstores!

Within one week of publication, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books. Within three months of publication, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list.





Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


 

Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


 

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  (More than 1.3 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious people who visited Weekly Health Update in 2011!)  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 













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Epidemic of Alcohol Abuse Among Surgeons





A new study indicates that chronic alcohol abuse among surgeons is far more common than among the general population.


 

 

EPIDEMIC OF ALCOHOL ABUSE AMONG SURGEONS

In a previous column (Surgeon Performance and Alcohol), I reviewed a clinical research study that revealed just how significantly alcohol intake degrades surgical skills among surgeons, even well into the day following alcohol intake.  In another recent column, I examined a study that revealed a disturbingly high rate of burnout and depression among American surgeons (Surgeon Burnout and Depression).  This week, I will present a newly published clinical study that, once again, raises serious concerns about the health and wellbeing of many surgeons in the United States.

In a study that appears in the current issue of the Archives of Surgery, more than 7,000 surgeons in the United States agreed to participate in a confidential assessment of alcohol abuse and alcohol dependence among members of the American College of Surgeons.  Validated surveys and tests were administered to these surgeon-volunteers, and the resulting data was analyzed.

Based upon the results of the Alcohol Use Disorders Identification Test, 15 percent of the responding surgeons, overall, were identified as meeting the criteria for either chronic alcohol abuse or alcohol dependence.  Further evaluation of the data collected in this study revealed that 14 percent of the participating male surgeons met the criteria for chronic abuse of alcohol or alcohol dependency, while 26 percent of the corresponding female surgeons met these same worrisome criteria.  Moreover, surgeons who reported having committed a major medical or surgical error within the previous 3 months were 45 percent more likely to abuse alcohol, or to be dependent upon alcohol, when compared to surgeons who did not report any recent errors.  Similarly, surgeons who reported feeling burned out in their professional lives were 25 percent more likely to be problem drinkers when compared to surgeons who did not report professional burnout.  Finally, surgeons who reported symptoms consistent with depression were nearly 50 percent more likely to abuse alcohol than surgeons who did not report feeling depressed.

Interestingly, surgeons were less likely to have alcohol abuse and dependency problems if they were older, male, or had children.  (Approximately 11 percent of adult males in the general population are thought to have chronic alcohol abuse problems, while only about 5 percent of adult females in the general population appear to abuse alcohol on a regular basis.)

The findings of this study, once again, indicate a disturbingly high rate of substance abuse among American surgeons; and this is the first study to show that female surgeons, unlike women in the general population, are twice as likely as their male counterparts to regularly abuse alcohol.  Taken together with previous studies showing very high rates of depression and career burnout among surgeons in the United States, the findings of this latest study are rather worrisome.  (Previous studies have also linked an increased likelihood of medical and surgical errors to surgeons who are depressed, and who abuse alcohol and other drugs.)

I should also note that only 29 percent of the surgeons who were contacted agreed to participate in this confidential study.  Because this participation rate is much lower than what is typically seen in most survey-based research studies, it raises the important question as to whether or not the rate of alcohol abuse and alcohol dependency might actually be considerably higher among surgeons, in general, than what is reflected in this study.  Indeed, most statistics experts believe that a very common reason for nonparticipation in survey-based studies is a reluctance to divulge negative information about oneself.  Moreover, even people who elect to participate in survey-based studies often “fudge” their responses in ways that tend to underestimate their bad habits and other self-perceived shortcomings.  Therefore, it is entirely possible that the incidence of chronic alcohol abuse and alcohol dependency among surgeons may be even higher than what was reported in this study….

 

As I have observed in previous columns, surgeons who abuse alcohol, or other drugs, are more likely to be associated with medical errors and worse patient outcomes.  However, the stigma of reporting oneself as having an alcohol, or other drug, problem is so great in the medical profession that impaired surgeons (as with other physicians) are generally extremely reluctant to admit that they have an alcohol or drug problem.  Most medical boards still require physicians to indicate whether or not they have a history of drug or alcohol abuse on licensure applications, and the medical profession, in general, still seems to be in a state of denial regarding the unusually high incidence of drug and alcohol abuse among physicians when compared to the general public.  It also goes without saying that the potential consequences of being operated upon by an impaired surgeon can be catastrophic to both patients and their loved ones, and, therefore, the still prevailing “head in the sand” approach to identifying, and rehabilitating, impaired physicians would not appear to serve the public interest very well, in my view.

 

While the vast majority of surgeons are passionately devoted to providing the best possible care to their patients, and would therefore not engage in personal behaviors that might potentially endanger their patients, it is becoming increasingly clear that a sizable percentage of surgeons in the United States are seriously impaired by burnout, depression and other mental health illnesses, and by alcohol and drug abuse.  Therefore, a better system of screening out surgical trainees who are predisposed to these serious health problems should be considered, while, at the same time, medical authorities at the state and federal levels should make it easier, and less threatening, for currently impaired physicians and surgeons to reach out for help without fearing that they will be punished or professionally sanctioned as a result.  I, therefore, applaud the American College of Surgeons for sponsoring and publishing this important study as a preliminary step forward in this direction.


 

For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my bestselling book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-MillionVroman’s Bookstore, and other fine bookstores!

Within one week of publication, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books. Within three months of publication, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list.


Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


For a lighthearted perspective on Dr. Wascher, please click on the following YouTube link:

Texas Blues Jam


I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  (More than 1.3 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious people who visited Weekly Health Update in 2011!)  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 








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Surgeon Performance Impaired After Drinking Alcohol the Day Before Surgery

Welcome to Weekly Health Update


“A critical weekly review of important new research findings for health-conscious readers”



 

SURGEON PERFORMANCE IMPAIRED AFTER DRINKING ALCOHOL THE DAY BEFORE SURGERY

Surgeons, like pilots, are held to a very high standard of conduct when it comes to alcohol and drug use. Unlike pilots, however, there are no rules barring surgeons from having a few beers, or other alcoholic drinks, on the day or evening before they enter the operating room to perform surgery.

While most surgeons drink alcohol responsibly, some surgeons (like people in any other profession) may occasionally have a few more drinks the day or evening before they report for duty than might be considered prudent. When a surgeon has a few more alcoholic drinks than they might have planned on the day before they are scheduled to perform surgery, most will undoubtedly assume that “sleeping it off” overnight will leave them fresh and in tip-top shape to wield the scalpel in the operating room on the next morning. However, a newly published clinical research study suggests otherwise….

A newly published prospective, randomized clinical study, which appears in the latest issue of the Archives of Surgery, included two groups of study volunteers. A total of 8 expert laparoscopic surgeons were included in one group, while the other group consisted of 16 university science students. All 24 participants were trained to use a computer-based laparoscopic surgery training device that is routinely utilized to train new surgeons in laparoscopic surgery skills. The science students were then divided into two groups. The “control” group abstained from alcohol for the 24-hour period prior to being tested on their laparoscopic skills, while the other half of the students (the “experimental group”) were allowed to drink alcohol freely until they felt themselves to be “intoxicated.” The 8 expert laparoscopic surgeons were all permitted to drink alcoholic beverages “until intoxicated.” The following day, all 24 study volunteers were tested on the laparoscopic training device at 9:00 AM, 1:00 PM, and 4:00 PM. All study participants also underwent breathalyzer testing to measure their blood alcohol level, and only one of the volunteers had a blood alcohol level above the legal limit (for driving) of 0.1 percent at 9:00 on the morning after their drinking binge.

Among the science students, performance deteriorated in all of the tested laparoscopic surgery skills among those who had consumed alcohol on the day prior to testing (when compared to the “control group” of students). The outcome was not any better for the expert laparoscopic surgeons, either. These experienced surgeons, all of whom consumed multiple alcoholic drinks on the day before testing, showed significant deterioration in the time that it took them to perform specific laparoscopic surgery skills, as well as a significant deterioration in their coordination and in the number of technical errors that they made. Moreover, this significant deterioration in surgical performance was still detectable at 4:00 PM on the day after these study volunteers had consumed multiple alcoholic beverages, and despite blood alcohol levels well below the legal limit for driving.

As previous research with airline pilots has shown, alcohol consumption within 24 hours of performing critical tasks can cause significant cognitive and physical impairment, even when blood alcohol levels are zero, or near zero. The findings of this clinical study of surgeons came to similar conclusions, and these findings suggest that surgeons should avoid the consumption of multiple alcoholic drinks within 24 hours of entering the operating room.

For a complete evidence-based discussion about how to live an evidence-based cancer prevention lifestyle, order your copy of my new book, A Cancer Prevention Guide for the Human Race For the price of a cheeseburger, fries, and a shake, you can purchase this landmark new book, in both paperback and e-book formats, and begin living an evidence-based cancer prevention lifestyle today!

For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my new book, A Cancer Prevention Guide for the Human Race,” from Amazon, Barnes & Noble, Books-A-Million, Vroman’s Bookstore, and other fine bookstores!

On Thanksgiving Day, 2010, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books! On Christmas Day, 2010, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list!


Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity



Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author



For a different perspective on Dr. Wascher, please click on the following YouTube link:

Texas Blues Jam



I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit this premier global health information website every month. (More than 1.2 million health-conscious people visited Weekly Health Update in 2010!) As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.





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The Silent Epidemic of Surgeon Burnout and Depression

 

Welcome to Weekly Health Update



“A critical weekly review of important new research findings for health-conscious readers”


THE SILENT EPIDEMIC OF SURGEON

BURNOUT AND DEPRESSION

Here in the United States, we face momentous, and as yet unclear, changes in the delivery of health care.  Approximately 46 million Americans lack any health insurance at this time, and tens of millions of others have grossly inadequate health insurance.  Therefore, many millions of Americans are just one major illness away from a financial catastrophe.

In addition to the huge dilemma of how we go about making health care more efficient and more affordable for everyone, the United States, like most countries around the world, is in the midst of a dramatic shift in the average age of its population.  As the graying of America continues (not to mention the ongoing epidemic of obesity across all age ranges, as well), the growing need for high quality, comprehensive health care will continue to present major challenges to our health care system here, and in many other countries around the world.

When I graduated from medical school in 1988, health care experts were predicting a huge surplus of physicians in this country, and in response to this concern, medical schools around the United States began cutting back their class sizes, and a de facto moratorium on opening new medical schools was initiated.  Fast forward to 2010, and it has since become apparent that these dire predictions of an impending physician glut were absolutely incorrect.  As our population grows older, and more diverse, the demand for physicians is increasingly in danger of outstripping the projected supply of doctors, including surgeons.

Aging patients have a higher incidence of illnesses and injuries that require the expertise of surgeons, and general surgeons in particular.  Broadly trained and experienced general surgeons are the primary care doctors, and the workhorses, of the surgical world, and they manage an astonishing array of diseases and injuries.  Unfortunately, and for a variety of reasons, comprehensive general surgeons are slowly withering in numbers, while the demand for their skills only continues to increase.  Generational attitude shifts among recently graduating physicians have seen young new doctors gravitate towards less demanding “boutique” specialties, and away from the more challenging surgical specialties (like general surgery).  Even among those young doctors who still elect to pursue residency training in general surgery, more than two-thirds will go on to train and practice in more restricted subspecialty surgery areas.  (Disclaimer:  As a surgical oncologist, I am one of those subspecialty surgeons.  However, I still include a great deal of general surgery care in my practice, and I continue to take general surgery call in our medical center.)  Another factor that discourages potential general surgeons is the enormous debt load that most newly minted doctors graduate from medical school with, and the resultant pressure that they feel to train in specialties that do not require the additional 5 to 10 years of training that general surgeons must complete.  (Increasingly, new medical school graduates are, instead, seeking out specialties that are more financially lucrative, and require shorter durations of residency training, than general surgery.) 

Yet another adverse factor that has harmed the recruitment of new general surgeons is the ongoing and progressive fragmentation of traditional general surgery practice into other subspecialty domains.   For young doctors who are attracted to the diverse and clinically challenging sort of surgical practice that has historically made general surgery a highly desirable profession, the increasing practice restrictions imposed upon general surgeons have removed a major incentive to undergo the many years of training necessary to become a comprehensive general surgeon

Against the backdrop of these and other pressures that continue to dwindle the ranks of broadly trained and practicing general surgeons (as well as other critical core surgical specialists), the issue of surgeon burnout has only recently started to receive its due attention.  The comprehensive practice of general surgery, and other demanding surgical specialties, can be grueling and exhausting, particularly in the private practice setting where declining reimbursements compel surgeons to work ever longer hours to maintain their income and lifestyle.  (Future threatened cuts in reimbursements to surgeons will likely only further exacerbate surgeon workload problems, and eventual surgeon shortages, as new health care reform initiatives begin to roll out in the coming years.)

A newly published research study, which appears in the current issue of the Journal of the American College of Surgeons, reveals a very disturbing picture of burnout, exhaustion, and depression among surgeons, and the potentially adverse consequences of distressed surgeons on patient outcomes.

In this study, nearly 8,000 surgeon members of the American College of Surgeons responded to a detailed survey, which included self-assessments of their practice details, a validated depression screening tool, and validated assessments of both burnout and overall quality of life.  The results of these surgeon surveys were, in a word, depressing.

Among the surgeons who reported working less than 60 hours per week, 30 percent described themselves as burned-out with their profession.  Among surgeons who worked 60 to 80 hours per week, 44 percent felt burned-out, and among those surgeons who put more than 80 hours per week, 50 percent experienced significant feelings of burnout.  In addition to the number of hours spent in clinical practice per week, the number of nights spent performing overnight surgery call was a highly significant predictor of surgeon burnout.  These two surgeon workload factors were also highly statistically significantly linked to clinical depression, difficulties in finding a reasonable home-work balance, and increased conflicts at both home and at work.  Additionally, the rates of both personal emotional exhaustion and feelings of depersonalization towards patients were directly associated with working more than 80 hours per week, and with performing 2 or more night calls per week.

Excessive hours spent in clinical practice, as well as performing 2 or more overnight calls per week, also correlated with a significant increase in the number of self-reported medical and surgical errors committed by exhausted and burned-out surgeons.  Nearly 11 percent of surgeons who worked more than 80 hours per week admitted to committing medical or surgical errors, compared to about 7 percent of surgeons who worked less than 60 hours per week.

Surgeons who either worked more than 80 hours per week, or who took more than 2 night calls per week, were also significantly more likely to express regret regarding their choice of specialty, and more likely to indicate that they would not choose to become surgeons if they had an opportunity to choose their specialty all over again.

The results of this survey of surgeons across the United States have been generally confirmed by other similar studies, recently.  These disturbing findings, as reported by surgeons themselves, paints a picture of a large population of highly essential physician specialists who are, increasingly, feeling burned-out, depressed, emotionally exhausted, regretful of their career choices, and progressively more prone to both depersonalizing their relationships with their patients and to committing more medical and surgical errors.  In short, my chosen profession appears to be a profession that is, frankly, approaching a state of crisis.

Because of these enormous (and growing) pressures and stresses that are being experienced by many surgeons, including general surgeons, many public health experts are viewing the current and future surgical workforce with considerable consternation.  As more and more surgeons hang up their white coats and put away their scalpels early in their careers, and as more and more newly graduated doctors shy away from the more demanding surgical specialties, our country appears to be headed for a potentially catastrophic mismatch between the demands of an aging population for surgical care and the diminishing pool of physicians who are willing to shoulder the heavy responsibilities, and significant stresses, of surgical practice.

It is my hope that the governmental agencies responsible for implementing current and future health reforms will pay close attention to this study, and others like it.  If hard-working surgeons cannot sustain reasonable income levels (against the decades of grueling training required, and the hundreds of thousands of dollars in educational loans that most young doctors acquire) without working themselves into a state of exhaustion, burnout, and divorce, the ranks of general surgeons, and other core surgical specialists, will continue to become thinner and thinner.  Ultimately, if things do not change, and soon, you and I might find it difficult to obtain access to high quality surgical care, particularly for emergency illnesses and injuries…. 

 

 

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Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author


For a different perspective on Dr. Wascher, please click on the following YouTube link: 

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I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit this premier global health information website every month.  (As of 9/16/2010, more than 1,000,000 health-conscious people have logged onto Weekly Health Update so far this year!)  As always, I enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 

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Physician Error

 

Welcome to Weekly Health Update


“A critical weekly review of important new research findings for health-conscious readers”


PHYSICIAN ERROR

Ah ne’er so dire a Thirst of Glory boast,
Nor in the Critick let the Man be lost!
Good-Nature and Good-Sense must ever join;
To err is human, to forgive divine.

Alexander Pope (1688-1744)

 

According to the prestigious Institute of Medicine, between 50,000 and 100,000 patient deaths are caused each year in the United States by negligence on the part of doctors, nurses, and other health care providers.  Nearly 1,000,000 patient injuries per year are also attributed to human error in the delivery of health care.

The presumptive causes underlying negligence in patient care are multiple and varied, and continue to be the subject of much debate among patient safety experts.  However, virtually all such experts agree that largely preventable human errors account for the vast majority of patient injuries and deaths associated with negligent patient care.

In the operating room, where I spend much of my time, as a cancer surgeon, we have adopted patient safety “check lists” inspired by the airline industry, and which are designed to reduce the possibility of errors during surgery.  At our institution, the patient’s identity (and the surgical procedure to be performed) is confirmed, twice, by everyone in the operating room before an incision is made.  Towards the end of the surgical procedure, an additional “debriefing” is performed, and the surgeon reviews the procedures that he or she has just performed.  The operating room nurse also confirms that all sponges, needles, and instruments have been accounted for, in an effort to reduce the possibility that any of these foreign bodies will be left within the patient.

 

One important aspect of physician error is that of errors in diagnosis.  In a newly published clinical study, which appears in the current issue of the journal Pediatrics, 1,362 pediatricians at three major academic medical centers, and 109 affiliated clinics, were invited to anonymously complete an Internet-based survey regarding their self-perceived frequency of diagnostic errors.  These doctors included experienced academic pediatricians, experienced community-based pediatricians, and resident doctors who were training to become pediatricians.  Altogether, 53 percent of the queried pediatricians agreed to complete the anonymous survey. 

More than half (54 percent) of these responding doctors indicated that they made significant diagnostic errors at least one or two times per month.  Not surprisingly, the resident doctors in training acknowledged the highest number of diagnostic errors, with 77 percent of these trainees admitting to at least one or two significant diagnostic errors per month.

Based upon their anonymous responses, nearly half (45 percent) of these 726 pediatricians believed that one or more of their diagnostic errors had harmed patients at least once or twice per year. 

When asked to analyze the underlying causes for their errors, these doctors cited the following explanations:  failure to gather adequate patient history information, inadequate physical examination, inadequate review of the patient’s chart, and inadequate coordination of care and communication among the providers involved (“inadequate teamwork”). 

Specific examples of diagnostic errors cited by these pediatricians included viral illnesses being misdiagnosed as bacterial infections, misdiagnosis of medication side effects, misdiagnosis of psychiatric disorders, and misdiagnosis of appendicitis. 

When asked to offer solutions to common diagnostic errors, these pediatricians most commonly recommended the implementation of electronic health records, as well as closer patient follow-up.

(It is important to note that, in view of the human tendency to “under-report” personal failures, it is very likely that the true incidence of significant diagnostic errors is actually considerably higher than what these pediatricians have self-reported in this study.)

 

In a perfect world, we physicians would never make the wrong diagnosis, or miss a diagnosis altogether, or miss an adverse reaction to medications or other treatments.  We would never prescribe the wrong medication or perform the wrong operation; and we would never, through acts of either commission or omission, perform anything less than a perfect surgical operation.  Unfortunately, the practice of Medicine, as with all human endeavors, will never become a “zero error” profession.  However, all of us, both patients and physicians (and physicians are patients, as well), certainly would agree that every effort must be made to drive preventable patient care errors down as close to “zero” as is humanly possible. 

While it is unlikely that human error can ever be completely eliminated, in Medicine or in any other profession, the findings of this important study are significant, and point to areas where substantial improvements in the delivery of health care can be achieved by physicians and other health care providers (and, I might add, by patients as well). 

 

Look for the imminent publication of my new landmark evidence-based book, “A Cancer Prevention Guide for the Human Race,” in August of this year. 



Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author


For a different perspective on Dr. Wascher, please click on the following YouTube link: 

http://www.youtube.com/watch?v=7-Tdv7XW0qg



I and the staff of Weekly Health Update would like to take this opportunity to thank the more than 100,000 new and returning readers who visit our premier global health information website every month.  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.



 

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