Patient harm and medical error as threats to the Doctor Identity - a new lens for improving patient safety?

Abstract

Preventable patient harm and medical error occur frequently in health care. Despite the apparent widespread commitment to the “First do no harm” aphorism in medicine, it has proved difficult to get prompt, effective and sustained action to detect and prevent these. The existence of preventable patient harm and medical error has been well established over the past 50 years and its high frequency has been confirmed in many international studies over the past two decades.

The thesis used a secondary source research methodology across a wide range of disciplines that have looked at medical error, preventable harm and doctor behaviour to explore possible explanations for these phenomena. The thesis concludes that there is an alternative plausible explanation for why action on identification and action on these issues by doctors, as leaders in health care, have been so slow and inconsistent. The thesis provides evidence in support of three hypotheses that form part of this explanation. Hypothesis 1: the occurrence of patient harm and medical error can be perceived psychologically by a doctor as a fundamental threat to his or her identity; Hypothesis 2: a serious threat to identity causes a range of psychological defences, often rooted in the biological responses of the brain to threats to existence, and these defences can make it hard for a doctor to recognise, identify or accept the risk of patient harm; Hypothesis 3: elements of the Doctor Identity deny ordinary human psychological responses and physical limitations, and thus promote unrealistic self or group perceptions. This creates risks to both doctors and patients. Many of these risks may be avoidable through modifying these perceptions and developing more realistic self-and professional schemas.

The thesis concludes that these hypotheses provide potential new ways to address the issues, and reduce harm caused to both patients and doctors.