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To: d:oug who wrote (15250)	8/27/2002 8:51:27 PM
From: d:oug	Read Replies (1) \| Respond to of 80994

[medicine] how many mistakes should be tolerated... . Subj: UPCLOSE: Dr. Atul Gawande From: listeditor@abcnews.go.com (UpClose) . MS. MARTIN: "Has anyone ever died under your care? DR. GAWANDE: Absolutely. There are deaths in surgery--I've seen dozens of deaths in my short time as a doctor, and I'll see hundreds over the course of my career, and some of them will come as a result of my failures. MS. MARTIN: Is there anyone, in particular, you can tell us about? DR. GAWANDE: I did have a patient who was really doing very well, and the next thing I knew--I was speaking to him in the morning. We were talking about getting him ready to get home in the next couple of days after an operation. Two hours later...he was pulseless and not breathing, and people had already started CPR, and something terrible had gone wrong. I thought I traced it down to being a drug that he'd been given incorrectly, and I chewed out the physician who had given it to him...I'm reluctant to talk about it. It was very hard for me to write about errors that I, myself, have made, partly because my ego is involved, and I don't want to look like a bad doctor, partly because you don't want to put something on paper that is going to come back to haunt you in a lawsuit and be twisted into the worst-possible morality tale that says that all you are is nothing but a bad doctor." . --Dr. Atul Gawande, Chief Surgical Resident, Brigham & Women's Hospital . You've heard all the horror stories about the long hours medical residents work and the ensuing mistakes from fatigue and inexperience. We saw all that firsthand some years ago when a young resident courageously allowed our cameras to watch him working 36 straight hours at a major Midwest hospital. Inevitably, we witnessed the young doctor make potentially fatal mistakes as his face became etched with exhaustion. It's part of an ongoing debate in medicine - how much should hospitals depend on overworked residents to train them in the ways of medicine and provide cheap labor for an increasingly squeezed health care system? . But there's a question in medicine that gets very little attention. Regardless of a doctor's experience, how many mistakes should be tolerated, and is there any way the system can be improved to prevent them? It's something Dr. Atul Gawande has given a lot of thought to, and he has had the courage to write down his observations in a series of articles for The New Yorker Magazine, which led to his new book, "Complications." . The son of two doctors, Gawande is pulling back the curtain to allow those of us outside the medical profession in. The picture is not always pretty and the questions not always those the medical establishment wants asked. Why not have computerized prescriptions instead of the chicken scrawl variety where decimal points can be moved and may cause serious harm to the patient? And why does the doctor's child getter better care than the trucker's child? . Tonight, UpClose, Dr. Atul Gawande. Michel Martin introduces us to a doctor posing all the right questions - but will the medical establishment provide the right answers? . Richard Harris Senior Producer Nightline UpClose