Rules of Thumb for Better Health Care: When Instinct Can Guide You in the Right Direction

Dear Readers,

Rules of thumb are quick shortcuts to decision making.  Often we can’t explain them.  It’s just a “gut feeling.” Sometimes when we’re trying to be really logical and rational so that we make the “right” decision, we discount our gut feelings and ignore quick rules of thumb.  But rules of thumb can be quite valuable in health care.  In this newsletter, we will talk about a few quick rules that can serve you well in getting the best care for you and your family.  And we will explain the logic behind them, so that it becomes clear they’re grounded in good sense.
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Rule One: Avoid Superior Doctors

A superior doctor is not necessarily a better doctor, but he sure thinks so. We all know people in various walks of life who are “legends in their own minds,” but in health care, a self-centered, superior doctor can be downright dangerous to your health. Here’s why.

Teamwork is absolutely critical to high quality health care. The technology nowadays is so complex, and the treatments likewise so intricate, that any individual patient’s care can require the skills of  nurses, technicians and therapists, not to mention doctors from numerous specialties.  A well functioning team requires mutual respect and regard for all team members, and close communications too.

When one of those team members acts superior to the others, the team no longer functions well.

A nurse, for example, who has had her head bitten off on one occasion is going to be reluctant later to speak up when she sees something that seems wrong.  That propagates error, and error propagates injury.

So when you see a doctor demeaning or insulting a nurse or another care giver, especially in the presence of others, steer clear! That doctor is dangerous to your health.

And don’t just take my word for it.  Nurse Theresa Brown wrote a column about this in the New York Times (punningly titled “Physician, Heel Thyself”), and several letter writers, including a hospital CEO, wrote into the Times to endorse the importance of this simple rule of thumb.

A Rule of Thumb for Scheduling Surgery

You can’t schedule an emergency, but many hospital stays for surgery are non-emergency and can be scheduled. Rule of thumb: Avoid Thursdays, Fridays and nights.  Also avoid any time right before your surgeon’s vacation.

 Why? If you are operated on close to a weekend, that means the critical early days of your recovery — when the bad stuff like blood clots, infections and other avoidable complications often happen — are going to be under the domain of the weekend staff at the hospital.   There will be fewer bodies to pay attention to you, and more important, they are often second stringers: Less experienced staff have less seniority and therefore lose out when scheduling time off.

 Nights are a similar problem. And if the staff runs short at night, they often try to scrape by until morning rather than getting backup staff out of bed.    That can be bad for your health.

 You wouldn’t think nighttime surgery would be common. But I have a client who was told to show up at midnight for induced labor childbirth at a northern Virginia hospital.  The labor and delivery unit grew exceptionally busy, and she was neglected, with tragic results.

 As for vacations, my totally unscientific personal experience tells me that malpractice events happen more commonly when the surgeon goes out of town right after the procedure.  The person who knows best what happened during the surgery is not around, and the substitutes have less of a personal, emotional commitment to your welfare.

 The point is the same as avoiding weekends: You want the first string team on your case.

More Reading on Rules of Thumb

You probably have heard of best-selling author Malcolm Gladwell, but what about Gerd Gigerenzer?  He wrote a book that Gladwell used as a prime source for his “Blink.”  I just finished Gigerenzer’s book, Gut Feelings: The Intelligence of the Unconscious.  I highly recommend it for anyone interested in the science behind instinctive, rule-of-thumb decision-making.

Another book of Gigerenzer’s, Calculated Risks, was an important source for the discussion of medical statistics in my book, The Life You Save: Nine Steps to Finding the Best Medical Care — and Avoiding the Worst.

 Gigerenzer is a psychologist and the director of the Max Planck Institute for Human Development in Berlin.

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To your continued health!

Sincerely,
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Patrick Malone
Patrick Malone & Associates