Sunday, July 15, 2012

The Need to Blame the Doctor, not the System

Maureen Dowd wrote a thoughtful and thought-provoking article in the New York Times this morning entitled "The Boy Who Wanted to Fly". I had read about the incident in a twitter-linked article earlier in the week and my heart ached for everyone involved--the boy, the parents, the pediatrician, the ER docs and the staff treating him at the hospital. I know from professional experience how gut-wrenching this outcome is to the doctors and staff involved. As a parent I prefer not to imagine what the personal experience would be. It was hard enough to have stood beside friends as they moved through it.

Many of the comments below the article demonize the physicians involved in the care of this boy. That is an easy thing to do and seems to be a particularly American way of approaching a problem--find someone to blame and sue them. Unfortunately, this will do nothing to fix what is an increasingly common problem in our healthcare system today.

I don't know the specifics of what happened in this case. On the surface of it, the article and remarks about it emphasize many of the issues of our broken healthcare system. The comments engendered begin with 'hard-hearted doctors" and "sue the jerks". Perhaps the most thoughtful was the comment by Infectious Disease specialist Dr. Jonathan Rosenthal who said: "The average physician will never see a case of florid Group A Streptococcal septic shock such as this one in her entire career. One of the reasons these rare cases can be so lethal is that is can be enormously difficult to pick them out from among 10000 cases of viral illness in a Pediatric ER. Herculean efforts are made every day not to miss early sepsis. We can learn from cases like this but not if we are distracted by looking for the person to blame. This poor child was seen by a number of physicians - were they all incompetent?"

As a primary care physician some of my thoughts are: How busy was the pediatrician? How busy was the ER? Did they have the time and experience to pick up on those "soft signs" of sepsis that Sully Sullenberger alluded to? As an aviation safety expert he understands the importance of fixing the SYSTEM that is causing the problem, rather than placing blame on the individuals involved.

Patients live in a world where physicians are pushed to see more and more of them to pay the bills; where technology substitutes for stopping and really "seeing" a patient as more than a disease state; where the patient is seen only as a dollar sign by the healthcare administrators, insurance executives, employers, lawyers and politicians who crowd into the examining room as if they had a sacred right to be there; and where time, the most important commodity for good patient care, is stripped from those on the front lines because it is not valued highly by their own peers.

This case should be a rallying cry for patients (and we are all patients) to fix a badly broken, fragmented healthcare system where volume and technology substitute for care. Since this involves a political fix from a system equally broken and fragmented, a fix that must involve compromise from both sides of the aisle, I fear for the future health of my patients and my profession.


  1. Where exactly does the 'rarity' exist? In the diagnosis of Strep or the occurrence of septic shock?
    I'm a school nurse and had three cases this year of Strep in leg wounds.
    Two occurred after insect bites and a third was after a minor abrasion from a skateboarding accident.
    None evolved into sepsis but when I saw these wounds, I knew something was seriously wrong and made immediate medical referrals. I wrote down my observations and concerns and made sure the parents gave that info to the examining doctors.
    All 3 were successfully treated but 2 required wide excisions and ongoing wound debridement.
    Although I have over 30 years experience in nursing, I never saw wounds like this. Any observations??

    1. My interpretation of Dr. Rosenberger's remark is that he was discussing the occurrence of septic shock from the strep. I see strep infections all the time as well but in my more than 25 years of clinical practice after residency I have never seen a streptococcal septicemia from a wound infection. It is thankfully rare.