Danielle Ofri

This was an interesting book to have picked up after reading Brené Brown’s The Gifts of Imperfection; both books touch on the ideas of guilt and shame being different feelings. Guilt is feeling bad about something you did; shame is feeling that you are a bad person. This book is also a precursor to If I Betray These Words, by Wendy Dean and Simon Talbot, which talks about moral injury in medicine and the challenge that physicians face in maintaining empathy reserves in the modern (American) health-care system. Ofri’s experience anchors the book, and the narrative is propelled along by strategically weaving in Julia’s story throughout the book. I appreciate Ofri’s frankness in dealing with her own biases and mistakes, and her desire to always do better. That said, the sense I got from these stories is that there is still a great deal of ableism in particular in medicine; the story near the beginning about a man with necrotic ulcers who ended up having to have both his legs amputated made me aghast at how the doctors considered him to appear inhuman. It wasn’t until the man’s wife came in and talked about him as a person that the doctors looked at him differently.

If you’re the sort of person who likes medical memoirs or medicine-related non-fiction, you might like this book.… (altro)

This book is all about conversation, a key diagnostic tool whose value is often not appreciated. The medical system revolves around efficiency and quality indicators and tests that have quantitative values attached to them, but it is in open-ended questions and active listening that the real work happens. Dr. Ofri showcases this with examples from her own practice and from others around the world about the power of conversation to save money (not ordering expensive, unnecessary tests), make connections, and even stave off lawsuits in situations of medical error. As always, Dr. Ofri writes movingly and honestly—she is not afraid to hold up events from her own past and examine her biases in order to improve and grow.

I think this book would pair nicely with with Kathryn Mannix’s book Listen: How to Find the Words for Tender Conversations.… (altro)

Full disclosure: Danielle Ofri accepted my short story "5 Star Hotel" for inclusion in the literary magazine she edits, the Bellevue Literary Review a few years ago. She was a terrific editor to work with.

This is a rambling, passionate, sometimes utterly harrowing examination of errors in medical care. I've worked in healthcare for thirty years, and can attest to the truth of what she observes in the ongoing effort to provide the right care to the right person for the right reason at the right time. The patient safety mission - to its credit - is data-driven, trying to focus on figuring out what went wrong, and then checking to see if improvement efforts actually had an effect. Not so much to its credit, the data measured is often punctuated with $, and tends to ignore how human beings (and doctors, nurses, and patients ARE human beings!) function, emotionally and neurologically. Health care trumpets how well it followed the aviation industry model of aspiring to zero errors, but as Ofri astutely points out: airplanes of a given model are machines, with the same dials, gauges, and levers, so once a pilot masters one, he or she can master the others. In medicine, every "pilot" (doctor) and every single individual "plane" (patient) is different, so one-size most definitely does NOT fit-all. She exudes frustration with the holy grail of the electronic medical record (EMR): a system originally designed to track every single item or activity that can be billed for does not translate well into a system of tracking health, disease, and the continuum of care, leading to workarounds, copy/paste shortcuts, hasty box-clicking, and profane outbursts. She is critical of the ever-shifting attention span of the quality-tracking people, and I've seen it myself first hand. A few years ago, every search of the literature I was asked to do was about catheter-associated bloodstream infections (CLABSIs) for a task force. There were inservices, posters, training sessions, newsletter features, etc. There was some improvement, so yay! And it was on to catheter-associated urinary tract infections (CAUTIs). And then on to healthcare-associated pressure injuries. And a month or so ago, a new task force is announced: we're back to CLABSIs as the numbers inched up again when the spotlight moved on.

Ofri also examines the effect of workload and staffing on errors. She describes an environment that sounds like sheer madness: lone physicians struggling to care for 40 patients at once, scheduling screwups, nurse shortages, EMR downtime, emergency admissions, overflowing waiting rooms, green interns, exhausted residents, and absolutely no time to THINK. She is a champion of nurses, extolling their value above rubies. One thing she does not address much is the high level of practitioner burnout - overburdened staff who are simply fed up, depressed, and angry, and how this might affect the care they give - or don't. The horrific case report of Jay, a 39-year-old man who goes into a septic spiral after a leukemia diagnosis, demonstrates a level of staff disconnection and indifference that makes me wonder about the basic emotional status of the clinicians involved.

I'm not quite sure who this book is intended for. It is lucidly written enough for lay people; yet it delves into the nitty-gritty of quality / performance improvement, checklists, etc., that may cause their eyes to glaze over. And while I stocked my hospital's medical library with books by Pronovost, Gawande, et al., (sometimes even at an administrator's request), they were rarely touched by anyone. Victoria Sweet's book [b: Slow Medicine|33670464|Slow Medicine The Way to Healing|Victoria Sweet|https://i.gr-assets.com/images/S/compressed.photo.goodreads.com/books/1498884844l/33670464._SY75_.jpg|54542084] relates an appalling episode of her father's inappropriate care in a hospital where she had previously been invited to speak to the medical staff. Her message of connection to patients obviously dissipated as the door closed behind her. So while I will certainly add Ofri's book to the shelves where I work, I am not hopeful anyone will read it.

A couple minor things my copy-editing eye tripped on: even spell-check should have caught the several references to the medical chart as a "chronical."(p. 84) And a line about how the questions of interns force their supervising attendings to explain their reasoning, confusing "dissemble" with "disassemble" turns the sentence on its head entirely (p. 127).

Important information, to be sure, including suggestions for patients and families about keeping notes, asking questions (and which ones), and resources for assistance. Ofri sees patients, teaches, writes books and columns, edits a journal, has teenaged kids AND plays the cello. Her driven, high-intensity persona is apparent in this book, which can be exclamatory, sometimes flippant, sometimes darkly funny. I hope she's not heading for burnout - we need her.… (altro)

Medicine, wherever it is practiced, involves heavy things that are not for the faint of heart. Outcomes sometimes involve death, and errors are not always (or often) easy to spot. Poor outcomes can haunt doctors and nurses both professionally and personally – almost as much as they can haunt the families of patients. Nonetheless, in the United States, no comprehensive system exists to monitor medical errors. As Ofri details in this well-written and timely book, this situation neither provides justice to the needs of patients and their families nor allows the medical system to learn from its mistakes.

This book probes two medical cases that were particularly error-filled. One involved a patient with leukemia, a form of cancer, and the other involved a patient whose case was clearly mismanaged at several points. Errors accumulated in each case, and each was met with silence and obfuscation by the medical establishment. At the outset, positive outcomes were not guaranteed, but compounding errors guaranteed horrific outcomes involving death. Families of both patients sought corrective measures for the causative systemic problems, but despite noble intentions and proper efforts, neither family were successful.

Ofri holds the Danish medical system as an example. In this small country, parliament passed a Patient Safety Act of 2005 to set up a system that judges and potentially compensates patients for negative outcomes. Gone were the excesses of legal case and drama of the courtroom; also gone were the huge settlements for hyperbolic cases. In its place was something more equitable and more enlightened. Instead of requiring excessive, provable harm like death or permanent disability, the Danish system just required preponderance of the evidence for more mundane claims.

The author rightly questions whether such a system could ever succeed in the United States. For one, we are more brashly capitalistic and individualistic than Denmark. Further, our country is much larger and more diverse. We also have a long and deep suspicion of centralized medical data collection. But the Danish system simply seems fairer and more just to both parties. In it, the doctor-patient relationship never transforms into an adversarial duel filled with legal tactics. Medicine at its best aims to be humane; doesn’t this system better fit that ethos?

This work can find an obvious home among American healthcare workers, whether doctors, hospital administrators, or nurses. Particularly those with patient contact should attend to Ofri’s clear message. Policymakers and administrators of public health might also want to give this one a read because of obvious import into government. Ofri’s call may yet be a bit early for legislation to be passed, but my experiences concur that it needs to be heard. It deserves to be on the radar for public health advocates once the challenges of COVID dissipate. I’m glad that I found and read this book.… (altro)