Clinical Risk Management

 I will be reviewing clinical risk management.

All investigations and interventions are targeted to a specific patient so at each step it is very important that the patient be properly and correctly identified.

The standard procedure is to confirm the patient's name and date of birth. However, it is not unusual for multiple patients to appear with the same or similar names. This then necessitates an additional identifier which can be problematic.

Telephone numbers are convenient but in these times people often do not know their telephone numbers and even if they do the records may not match because numbers can change quite frequently.

Another acceptable identifier is the patient's address. These tend to change infrequently for people past their 20s. Again records may not match but asking about previous addresses is very likely to end with a match and allow for updating the patient's demographic details.

Next of kin would be the final acceptable identifier. There may be similar problems with getting a match but these are easily solved.

Having properly identified the patient, the next step is to assign the right provider.  This is something of a catch-22 situation because in order to do so one must first properly frame the patient's problem. Such problem definition is of necessity iterative. The most acute severe non-emergent problems need to be assessed by the most experienced generalist available. Emergencies require anyone and everyone immediately available to act to maintain life. Acute mild problems do not generally present for treatment.

Acute problems are generally dealt with by providers who are not familiar with the patient. Such lack of familiarity represents an information risk.

Killing me with kindness

My most fervent prayer for as long as I can remember has always been "Protect me from the kindness of strangers!"

There is a natural tendency to forgive others if they act with good intentions rather than malice if the consequences are not too negative. That line of "too negative" is however very blurry and severely contingent.

We desire a society made up of Good Samaritans. Over the long term, cooperation and kindness remain strategic champions.

The general, however, does not always apply to the particular and there are always, always outliers.

Beneficence is an outstanding moral principle, but it can never be considered to supercede autonomy. And I am always wary of those who claim to be proponents of the general good. Saints are extreme outliers.

Labelling as pathological those perspectives that do not agree with one's own especially from a position of power and/or authority is extremely dangerous as it leads to a monochromatic, dysfunctional society.