Problems in Practice Unrelated to Medical Knowledge

Abstract

The physician who reviews his practice continually will serve his patients well, but good health care requires more than medical knowledge. At every step, extrinsic phenomena, errors, and omissions may adversely affect medical practice despite the physician’s superb knowledge. “The best performance is built upon sound information,” said George Miller, “but sound information is no assurance that it will occur.” John Williamson found, for example, that highly informed physicians often did not respond to an unmistakably abnormal laboratory report.² About two-thirds of the abnormal results of three routine screening tests (urinalysis, fasting blood glucose, and hemoglobin) elicited no response from the physicians in his study, even after they attended a specially designed continuing education workshop and received reminders about the problem. The simple device of obscuring the abnormal findings on the laboratory report with a piece of removable fluorescent tape, however, significantly improved the response.

If anything can go wrong, it will.

Murphy’s Law¹

Murphy was an optimist.

O’Toole’s commentary on Murphy’s Law¹