Hard Facts: Med

Yet more wisdom from Hard Facts:

Bloodletting was used routinely until 1836 when French physician Pierre Louis conducted one of the first clinical trials in medicine.  Louis compared pneumonia patients whom he treated with aggressive bloodletting and those he treated without it.  Louis found that bloodletting was linked to far more deaths. … George Washington, the first president of the United States, … died two days after a doctor treated his sore throat by draining almost five pints of blood.  … A remarkably high percentage of medical decisions still reflect the often-obsolete practices that a doctor learned in medical school, the ingrained traditions of a hospital or region. (p.13) …

What she thought was a straightforward study of how leader and coworker relationships influence errors in eight nursing units. … [She was] flabbergasted when nurse questionnaires showed that the units with the best leadership and best coworker relationships reported making 10 times more errors than the worst. … Better units reported more errors because people felt psychologically safe to do so. …

Nurses whom doctors and administrators saw as most talented unwittingly caused the same mistakes to happen over and over.  These “ideal” nurses quietly adjust to inadequate materials without complaint, silently correct others’ mistakes without confronting error-makers, create the impression that they never fail, and find waits to quietly do the job without questioning flawed practices.  These nurses get sterling evaluations, but their silence and ability disguise and work around problems undermine orgainzational learning.  (pp105,106)

Clearly most med errors are not reported, and docs reward nurses more for covering doc asses than for improving patient outcomes.

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  • http://www.nancybuttons.com Nancy Lebovitz

    Sidelight on bloodletting: There’s a bit in Jane Jacobs about bloodletting being more aggressive in the colonies than it was in Europe– in Europe there were more “common sense” limits on how much blood could be taken.

  • http://www.rationalmechanisms.com Richard Silliker

    Sounds like leadership is lacking, The people in charge have loyalty to their bosses instead of to themselves. Where is this robust intuition that is needed to lead?

    Change the context to adjust the symmetry or live with the problem.

  • lemmy caution

    That book looks good. I have ordered it from amazon.

  • Captain Oblivious

    So I’ve always wondered if bloodletting could be an effective treatment for high blood pressure…

    (I bet you’re all glad I’m not a doctor!)

    • Lauren

      actually, blood letting is an accepted therapy for some medical issues ie, hemachromatosis a striking common inherited disorder whereby the body holds on to more iron that it should leading to liver failure among other things.

      More to the point, it makes sense that getting rid of plasma volume is a way to combat congestive heart failure or even myocardial infarction. Doctors do it nowadays via pharmacologic methods such as diuretics (“water pill” lasix) or venodilators (nitroglycerin). It is obviously was used inappropriately, but bloodletting didn’t become in-fashion for nothing.

      I understand that the point of this review is to highlight medical errors, but this particular example seems a bit out of place.

  • Helix

    Here is an account of the bloodletting that almost certainly contributed to Washington’s death:

    http://xnet.kp.org/permanentejournal/spring04/time.html

  • tom

    Expecting true contrarianity, I hoped for a defense of bloodletting.