"你犯了一个错误"--通过极端的自主性和对患者的关注来克服手术病理错误。

IF 3.2 Q2 PATHOLOGY Head & Neck Pathology Pub Date : 2024-10-15 DOI:10.1007/s12105-024-01706-6
James S Lewis
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引用次数: 0

摘要

我们的医学目标是零失误,但现实是,失误是医疗实践中不幸的一部分。手术病理是一种特殊情况,诊断的 "底线 "在病理报告的最终诊断中直截了当地呈现给所有人。一旦诊断有误,尤其是给患者带来严重的不良后果时,对患者、医疗服务提供者、病理学家和医疗保健系统造成的身体、精神和情感影响可能极其严重。头颈外科病理学是一个重大诊断错误率一般的亚专科领域,但有可能对患者造成严重的负面影响。研究表明,头颈部手术的重大错误率在 1%到 7%之间。那么,作为病理学家,当我们出现严重诊断错误时,该如何应对和处理呢?通过二十多年的亲身经历,我们得出了一个来之不易的答案,那就是要有极强的主人翁精神,以病人的需求为中心,用威廉-梅奥(William J. Mayo)的话来说,就是要把病人的 "需求放在第一位"。作为病理学家,我们以及与我们共事的临床医生所受到的情感影响也应得到承认和管理。本文将对这些错误情景进行彻底、公开的审查,并特别关注诊断错误,为您提供实用指南,帮助您在今后的工作中尽力 "纠正错误"。
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"So You Made a Mistake" - The Path Forward Through Surgical Pathology Errors by Extreme Ownership and a Focus on the Patient.

Our goal for medicine is to make zero mistakes, yet the reality is that mistakes are an unfortunate part of medical practice. And when it comes to surgical pathology, it is a special case where the diagnostic "bottom line" is provided starkly and directly for all to see in the final diagnosis of the pathology report. When this diagnosis is wrong, particularly when it has serious adverse consequences for the patient, the resulting physical, mental, and emotional effects on patient, provider, pathologist, and health care system can be extremely serious. Head and neck surgical pathology, based on large second review-type studies, is a subspecialty area with average rates of major diagnostic error, but with potential for severely negative impacts on patients. Studies have shown between 1% and 7% major error rates for head and neck practice. How then, as the pathologist, can we react to and manage things when we have made a serious diagnostic mistake? Through personal experience over more than two decades, the hard-won answer is through extreme ownership and a focus on the needs of the patients, who, in the words of William J. Mayo, should have their "needs come first". The emotional impact on us as pathologists and on the clinicians we work with should also be acknowledged and managed. This article will serve as a thorough and open examination of these mistake scenarios and, focusing specifically on diagnostic errors, serve as a practical guide for what you can do, moving forward, to "make things right" to the best of your ability.

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来源期刊
CiteScore
5.70
自引率
9.50%
发文量
99
期刊介绍: Head & Neck Pathology presents scholarly papers, reviews and symposia that cover the spectrum of human surgical pathology within the anatomic zones of the oral cavity, sinonasal tract, larynx, hypopharynx, salivary gland, ear and temporal bone, and neck. The journal publishes rapid developments in new diagnostic criteria, intraoperative consultation, immunohistochemical studies, molecular techniques, genetic analyses, diagnostic aids, experimental pathology, cytology, radiographic imaging, and application of uniform terminology to allow practitioners to continue to maintain and expand their knowledge in the subspecialty of head and neck pathology. Coverage of practical application to daily clinical practice is supported with proceedings and symposia from international societies and academies devoted to this field. Single-blind peer review The journal follows a single-blind review procedure, where the reviewers are aware of the names and affiliations of the authors, but the reviewer reports provided to authors are anonymous. Single-blind peer review is the traditional model of peer review that many reviewers are comfortable with, and it facilitates a dispassionate critique of a manuscript.
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