Denial:
I do not want to trivialize how devastating it is to receive a diagnosis of a terminal illness and it may be a sad testimony of how much of my life is identified by my profession that the IOM report seemed to so disturb my world. However, when the report was first released my initial reaction was one of disbelief. I could not accept that the many brilliant people I work with every day were causing these errors, and I certainly did not see this in myself. Further, as other physicians have recently related to me, I did not feel like this number represented what I saw in my practice. It seemed impossible that people could be dying at this rate and that it would not be obvious to all physicians that it was happening. Certainly, we have all made mistakes, but in my experience they resulted in minor or no injury. While most physicians have heard about the cases in which a wrong body part had been removed, these were isolated events and could not possibly add up to the numbers cited. After consideration of the IOM findings, I determined that the results were inaccurate and planted my head firmly in the sand.
Table 1: Kubler-Ross’ five stages of dying
In her 1969 book, On Death and Dying [On Death & Dying, (Simon & Schuster/Touchstone), 1969] Swiss-born psychiatrist Elizabeth Kubler-Ross outlined the five stages of grief of someone who is dying:
• Denial and isolation: “This is not happening to me.”
• Anger: “How dare God do this to me.”
• Bargaining: “Just let me live to see my son graduate.”
• Depression: “I can’t bear to face going through this, putting my family through this.”
• Acceptance: “I’m ready, I don’t want to struggle anymore.”
References:
- Institute of Medicine, To Err is Human: Building A Safer Health System (Washington, D.C.: National Academies Press, 1999
- McGlynn EA, Asch SM, Adams J, et al.: The Quality of Health Care Delivered in the United States. N Eng J Med 2003; 348:2635-45
- National Committee for Quality Assurance, State of Health Care Quality 2004 (Washington, D.C.: NCQA, Sept 2004
- Bernstein, S.J., E.A. McGlynn, A.L. Siu, et al., “The Appropriateness of Hysterectomy. A Comparison of Care in Seven Health Plans. Health Maintenance Organization Quality of Care Consortium,” Journal of the American Medical Association 269(18):2398-402, May 12, 1993
- Wennberg JE, Cooper MM, eds., The Quality of Medical Care in the United States: A Report on the Medicare Program, The Dartmouth Atlas of Health Care 1999 (Chicago: American Health Association Press, 1999)
- Fisher ES, et al.: Associations among hospital capacity, utilization, and mortality of US Medicare beneficiaries, controlling for sociodemographic factors. Health service Research 2000; 34:1351-1362
- Jha AK, Li Z, Orav EJ, et al.: Care in U.S. Hospitals – The Hospital Quality Alliance Program. N Eng J Med 2005; 353:265-74