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.
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Keywords
Medical profession, doctors, physicians, surgeons, preventable patient harm, adverse events, professional schema, medical education, psychological identity, error, Quality in Australian Health Care Study, Harvard Medical Practice Study, fatigue, medicine, professional identity, Doctor identity, medical students, cognitive dissonance, first do no harm, Hippocrates, medical ethics, shame, humiliation, self-concept, patient safety, history of patient safety in Australia
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