Wachter is Right: Patient Safety is Not the Patient’s Job

Wachter's World: Can Patients Help Ensure Their Own Safety? More Importantly, Why Should They Have To?

The whole subject of asking patients and families to participate in safeguarding their own safety is something I've written about before and the idea makes me cringe. Do airlines ask me to double check that the pilot has set the flaps properly? No. Where do hospitals get the idea they can ask patients to confirm that caregivers have washed their hands or that they are bringing the right meds?

Is it probably in your interest to double check, to inspect their work? Yes, because healthcare has not proven that it can operate as reliably as patient safety or the U.S. nuclear navy (as highlighted so well in Steve Spear's book Chasing the Rabbit. Double checking the hospital's work should be considered, at best, a short-term countermeasure — a workaround. It shouldn't be considered the ultimate quality improvement solution.Dr. Bob Wachter writes about this on his outstanding blog. He's not opposed to patients and families being involved — he's just skeptical that it really helps. Where is the data? Do hyper-involved patients cause more problems than they prevent?

Read his whole post, but Wachter sums up his thoughts this way:

Patients encountering the healthcare system lack this trust [as exists with airlines], which make relaxation and passivity seem maladaptive, even suicidal. So I completely understand why patients and families would want to do whatever they can to improve their odds of emerging unscathed. I'm just not sure how well the resulting tactics work or how to apply them most effectively. Clearly, this is a testable hypothesis, and it should, in fact, be tested.

In the meantime, while we should support the efforts of patients and families to participate in their own safety when feasible, our primary focus should be on making such hyper-vigilance unnecessary. This one is our bad, not theirs.

Well said.

The patient hyper vigilance should be considered, at best, a short-term countermeasure until better systems can be put in place to protect patients and provide perfect patient care.

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