Is “Treadmill” Medicine Safe?

The great doctor speed up continues, and at the same time there is an increasing recognition that diagnostic error is a major patient safety issue. One recent study suggests that “diagnostic errors affect at least 1 in 20 US adults.”

What is the relationship between the speed up and errors? A recent article in JAMA addressing the problem of diagnostic error in the primary care setting concluded that:

 “Most process breakdowns were related to the clinical encounter, wherein practitioners are almost always pressed for time to make decisions. With the current emphasis on patient-centered medical homes that facilitate team-based care, patients might be able to access or interact with their practitioners more effectively. However, these new models of care might not produce the level of cognitive support needed for gathering and/or interpreting a patient’s key signs and symptoms effectively and safely.”

The correlation between “process breakdowns” and time remains, in our opinion, understudied. According to a recent Modern Heath article titled “Physicians blame patient ‘treadmill’ for missed calls”, the Institute of Medicine plans to issue a report this year on the problem of diagnostic error.

Indeed the relationship between “treadmill” style medicine and patient safety must be at the heart of any conversation about diagnostic error in the clinic environment.

A doctor who studied the issue at Maine medical center concludes:

“’Just about every time you talk to clinicians involved in diagnostic errors, it seems like time and volume is an issue,’ said Dr. Robert Trowbridge, an internal medicine physician who teaches clinical reasoning at Maine Medical Center. “

While some call for more technology and better use of EMR’s and others call for a greater patient engagement in preventing diagnostic error, it is clear to us at Doctors Council that any real solution must also address all the front-line “on the ground” conditions in the clinics that can interfere with the clinical encounter. This often means chronic understaffing, poor or out dated EMRs, a constant push for speedup, doctor burnout and lengthy waiting times for translation services.

It is becoming increasing clear that these issues can no longer be dismissed as only provider concerns but are indeed at the center of any conversation about patient safety.