Primum Non Nocere
No. 2, 2004
Medical Boards seek out and study fac¬
tors and parameters that affect the deliv¬
ery of health care, both positive and neg¬
ative. One human factor that is accepted
as a significant negative factor is the lack
of introspection. Introspection is
defined as the contemplation of one’s
own thoughts, feelings, actions, and sen¬
sations. In a broader sense, and in this
context, it is self-examination, which
should continue throughout the career of
die provider, just as continuing medical education should become
an integral part of the physician’s life. When any provider fails to
admit or understand, or simply ignores, the human condition of
imperfection, no effort will be made to improve and to “do it bet¬
ter” the next time — no progress or advance will be achieved.
In the field of aviation, there is a particular aircraft, and a very
good one, that is known as the “flying casket” because physicians,
and surgeons in particular, have developed a reputation, deserved
or not, for crashing the aircraft in almost unbelievable situations
and ways. Flight instructors believe that they have identified a
distinct pattern here. So well biown is this sad reputation that
professional pilots and flight instructors cringe and roll their eyes
when the words “pilot” and “surgeon” are said in the same sen¬
tence.
Some years ago, there was a well-known, talented, and respect¬
ed surgeon that learned to fly. This surgeon’s remarkable ability
in his chosen career was unquestioned, and his personal contri¬
butions to the field of medicine were widely recognized as enor¬
mous. Albeit brilliant, this surgeon also had a persona that was
interpreted by most of those who knew him as arrogant. The
time came when he chose to fly an aircraft that was beyond his
experience level in weather conditions that were far beyond his
skill level. On that occasion, he was briefed by the weather serv¬
ice and was told that flying into the prevailing poor weather con¬
ditions under visual flight rules was not advised. He paid no
attention, and his medical brilliance did him no good from that
point on — or down. The flight lasted less titan four minutes and
abruptly ended a distinguished career. Despite crashing into a
congested area, very fortunately he did not kill anyone he had so
thoughtlessly — and arrogantly — placed at risk on the ground.
Two generally unrelated groups, medical regulators and flight
instructors, have collectively reached the same independent con¬
clusion regarding behavior patterns and safety: confidence, the
state or quality of being certain, is an asset; arrogance, the state
of self-assumption and presumption, is a detriment. It is a recur¬
ring theme and pattern in medicine and aviation. The story of
the prominent surgeon whose flight lasted less than four minutes,
which is based on a report from the National Transportation
Safety Board database, illustrates a particularly tragic intersection
of die two.
I believe many professional medical societies and other health
care groups and organizations recognize the potential danger that
can result from arrogance and a lack of introspection, and I blow
some have published statements warning of the serious problems
those personal weaknesses can cause. All groups and organiza¬
tions in die field of health care should address such issues, and
every person involved in health care should encourage and sup¬
port the process.
At the same time, while we know the physician that always
reports perfect results and the pilot that always reports perfect
flights share serious and sometimes fatal flaws, that both are dan¬
gerous to others and to themselves, it’s important to remember
that neither is common.
Stephen M. Herring, MD
In This Issue of the FORUM
Item Page
President’s Message:
Introspection anti Saftty . 1
‘Stephen M. Herring, MD
NO Severe Acute Respiratory Syndrome
(SARS) Response Plan . 2
•Kadiv Dai! RN, MEd, and Debbie Crane
Using Information Technology to Improve
Patient Care and Communication:
A Practical Guide — Part 2 . 3
•Marjorie A. Sarinsky, MA, MBA
Item Page
Fondly , Carolyn: Letters to a Young Physician
Published on die Board’s Web site . 11
•Staff Item
North Carolina’s Allied Health Care Professionals . 12
•Robin Hunter-Buskey, PA-C
Review:
Patient-Centered Care . 15
•E.K. Fretwell, PhD
Board Actions:
2/2004-4/2004
. 17
Board Calendar . 24
Change of Address Form . 24
