It is rare to pick up an article or a book on patient safety without seeing reference to “medical error” as the cause of patient harm. System theorists have attempted to convince health care professionals for more than a decade that simple explanations for adverse events in complex adaptive systems such as health care are discordant. However, articles and books with the fundamental tenet that “patient safety” and provider error are synonymous continue to be published. If such a theory were true, then the path to safer care would lead directly through improving the error proneness of individual practitioners, and this book by John Mary Meagher would be of interest to the reader.
In the preface, Meagher makes clear where he stands on the issue of patient harm, error and individual responsibility:
About four years earlier than the Institute [of Medicine1]’s report, one of my mistakes jolted me to research the nature of error. I searched for the causes of my errors in the system, the staff, and the patients. But I found that the cause was myself.
The basic premise of this book is the ability to trace the source of diagnostic misadventures to how doctors think, with the conclusion that physicians are overly reliant on what Meagher refers to as the primitive or reptilian part of the human brain. Meagher hypothesizes that this part of the brain is prone to 3 fundamental problem attitudes: apathy, haste and egoism. Added to these faults are traditional factors such as fatigue and stress. Once the case is made for the cause of misdiagnosis, Meagher’s prescription is for physicians to enhance their brain activity using the NewMind response. This involves monitoring for heightened “reptilian attachment”; if present, its cause(s) must be identified and specific antidotes applied. Meagher offers some reasons why doctors make diagnostic errors; however, the theoretical construct underlying the NewMind response lacks robust references and justification. Whereas James Reason mused “we cannot change the human condition, but we can change the conditions under which humans work,”2 Meagher asserts that there must be a change in how doctors think. In summary, he believes the problem is with the individual; thus, that is where the solution must also lie. In contrast, a system-focused approach would examine ways to support physicians in the challenges they face rather than simply suggest that they work (and think) differently, harder or better.