What Do the Five I’ve Stages of Death and Dying Have to do With Patient Safety – Part 5

Depression:

            This section can be short and to the point. Having exhausted all ability to deny the problem or to explain away the findings, I felt overwhelmed and a bit sad. If, as it seems, intelligent, well intended, and hard working people can still collectively be participants in a system with such problematic outcomes, what solutions can possibly be developed? 

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:

1. Institute of Medicine, To Err is Human: Building A Safer Health System (Washington, D.C.: National Academies Press, 1999
2. 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
3. National Committee for Quality Assurance, State of Health Care Quality 2004 (Washington, D.C.: NCQA, Sept 2004
4. 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
5. 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)
6. 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
7. 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