Explain why or why not the perspective of the patient is the most important determinant as to whether an adverse event has occurred.
Even with precise calculations, effective protocol,
methodology and practice, adverse or undesirable events are unavoidable. With
the fluidity and ever-changing scene in health care, casualties spring up from
time to time within health care and usually many factors and individuals are
involved. It is important to weigh carefully and determine the precise misstep,
or area in which the event took place in order to avoid future mishaps. Patient
perspective is undeniably an important part of this process and something to be
considered as the patient is usually at the center of the setting; however, it
is in the opinion of this student that the patient perspective, although very
important, is not the best determinant as to whether an adverse event has
occurred.
For example, outcomes may not always meet the expectations
of patients even though they may be considered positive from a clinical
perspective. The patient experience is subjective and therefore not always the
best determinant of a medical error. Patients, in general, may lack the ability
to decipher an event as a positive one if the results are not significant in
their production of change, or positive change; albeit positive from a clinical
aspect. Procedures may be followed precisely to quality standards; however, a
patient generally lacks the knowledge or understanding of hospital or facility
protocol, for this reason, an undesirable event or outcome may be perceived
when in fact there is none.
Likewise, there are always risks with any medical procedure.
Potential risks are always discussed with patients prior to treatment in
preparation for a best and worse case scenario. Some risks are minimal, while
others are adverse. Patients can be sensitive and emotional when it comes to
their health and may view the occurrence of a small risk as much more adverse
than it truly is. With this being said, I personally feel the voice of the
patient is not something to be taken lightly or ignored. The patient voice is
an important part to maintaining and improving quality standards for the
overall benefit of the community, but not always the best resource for
determining an adverse event.
When determining if a medical error has occurred it is
important to rely on facts and empirical evidence in culmination with the patients voice. It is important to
investigate all avenues leading up to the event in question to identify if and
where an error has occurred. Adverse events are usually a combination of latent
failure (less apparent errors) in areas such as organization, training, or poor
design, and active errors (errors which are immediately apparent leading up to
the event). The comparison and intensive investigation of evidence will ensure
the efficacy and efficiency of all medical protocol and procedures.
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