Something You Should Know - The Science of Innovation & When Doctors Make Mistakes

Episode Date: July 3, 2023

Did you know that all people with blue eyes are related to each other? That is just one of the fascinating things we explore as I begin this episode with a look at how your eyes work and how they help you navigate your world. http://www.buzzfeed.com/acuvue/impossibly-cool-facts-you-may-not-know-about-yo#.kjpwxlkvO It often seems that great new ideas and inventions come out of the blue. However, that’s not usually true. There is actually an innovation process according to Matt Ridley. Matt is a journalist, businessman and author of the book How Innovation Works: And Why It Flourishes in Freedom (https://amzn.to/2D6syWe). Matt has studied how great ideas are created, developed and accepted and he joins me to explain the process and where the next big thing is likely to come from. Doctors are human so of course they make mistakes. However, the consequences of medical mistakes can be serious and even life threatening. Some reports have said that medical errors are the third leading cause of death in America. Could that really be true? Are errors just part of the system or could most of them be prevented? Joining me to discuss this is Dr. Danielle Ofri, clinical professor of medicine at the New York University School of Medicine and practicing physician at New York’s Bellevue Hospital for more than two decades. She is author of the book When We Do Harm: A Doctor Confronts Medical Error (https://amzn.to/3hVGku9). Perhaps you have noticed that the more money you have in your wallet, the more likely you are to spend it. Actually, it is a little more complicated than that. It seems what kind of money you have in your wallet is a big factor in whether you spend it or keep it. Listen as I explain how this works and how you can use this knowledge to keep more of your own money. http://www.forbes.com/video/4061993829001/ PLEASE SUPPORT OUR SPONSORS! Keep American farming and enjoy the BEST grass-fed meat & lamb, pastured pork & chicken and wild caught-Alaskan salmon by going to https://MoinkBox.com/Yum  RIGHT NOW and get a free gift with your first order! The Dell Technologies’ Black Friday in July event has arrived with limited-quantity deals on top tech to power any passion. Save on select XPS PCs and more powered by the latest Intel® Core™ processors. Plus, get savings on select monitors and accessories, free shipping and monthly payment options with Dell Preferred Account. Save today by calling 877-ASK-DELL ! Let’s find “us” again by putting our phones down for five.  Five days, five hours, even five minutes. Join U.S. Cellular in the Phones Down For Five challenge! Find out more at https://USCellular.com/findus Learn more about your ad choices. Visit megaphone.fm/adchoices

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Download June's Journey now on Android or iOS. Today on Something You Should Know, what's the fastest reacting muscle in your body? I'll tell you which one and just how fast it is. Then, the science of innovation and where great ideas come from. I tell the story of the pill camera, which is a thing you swallow and it takes a picture of our insides for your doctor to look at. And it came about after a conversation over a garden fence between a gastroenterologist and a guided missile designer. Also today, how to keep more of your own money. And medical errors. They can have serious consequences.

But why do they happen? Most errors and bad outcomes tend to relate to some form of communication error. Are the doctors and nurses communicating appropriately? Are they communicating with the patient? Are they listening to what the patient's saying? And all of those areas are why it's so much more difficult to pin down where things go wrong. All this today on Something You Should Know. People who listen to Something You Should Know are curious about the world,

looking to hear new ideas and perspectives. So I want to tell you about a podcast that is full of new ideas and perspectives, and one I've started listening to called Intelligence Squared. It's the podcast where great minds meet. Listen in for some great talks on science, tech, politics, creativity, wellness, and a lot more. A couple of recent examples, Mustafa Suleiman, the CEO of Microsoft AI, discussing the future of technology.

That's pretty cool. And writer, podcaster, and filmmaker John Ronson, discussing the rise of conspiracies and culture wars. Intelligence Squared is the kind of podcast that gets you thinking a little more openly about the important conversations going on today. Being curious, you're probably just the type of person Intelligence Squared is meant for. Thank you. practical advice you can use in your life. Today, Something You Should Know with Mike Carruthers. Hey, welcome. Time to take your mind off whatever it is you've been thinking about and dive into some new things to think about on another episode of Something You Should Know. And we start today talking about your eyes. They are truly fascinating. And here are some things about your eyes you probably didn't

know. According to studies, defined limbal rings can make you more attractive. The limbal ring is that dark round line around your iris. And apparently you're more likely to develop a crush on somebody who shows them prominently. The eye muscle is the fastest reacting muscle in your entire body. It contracts in less than 1 100th of a second. There are approximately 7 million cones and 130 million rods in your retina that respond to light. They help you determine color and detail. Around 6,000 to 10,000 years ago, everybody had brown eyes, and then the first blue-eyed baby was born. And all blue-eyed people since then are related to

that first baby and to each other. Your eyes can see about 10 million different colors, but if you're part of that 1% of women with a rare genetic mutation, you're able to see 100 million colors. Both sides of both parents' families can all have brown eyes, yet still produce a child with blue eyes. And your eye color isn't set until you're two years old. And that is something you should know. When it comes to innovation, we live in exciting times. It seems like new ideas and improvements to existing products and services come out at a rapid rate, and often from unexpected people in unexpected places. So just how does innovation work? Where do great ideas come from?

And what's the difference between innovation and invention? These are all really good questions that can help us all better understand how great ideas grow and prosper. And one of the best people to talk on the topic is Matt Ridley. He's a journalist, writer, and businessman. He is a member of the House of Lords in the United Kingdom. And he is author of the book, How Innovation Works and Why It Flourishes in Freedom. Hey, Matt, welcome.

Thanks for having me on the show. Sure. It seems to me that when you look at innovation and where new ideas and products and services come from, that one of the things that makes it so fascinating to look at is because things often seemingly come out of the blue or they come from places that you would never expect, which I would imagine makes it also difficult to study innovation and find any kind of common thread or guiding principles on what makes innovation work. That's right. I tell the story of the pill camera, which is a thing you swallow and it takes a picture of our insides for your doctor to look at. And it came about after a conversation over a garden fence between a gastroenterologist and a guided missile designer. That's quite a nice example of a very unexpected combination of talents coming together and doing something different and interesting. Yeah, well, that's the perfect example. Two guys talking

across a fence, they come up with a great idea. But just coming up with a great idea isn't enough, right? There's also the important difference between invention and innovation in the sense that a lot of the hard work is turning a bright idea into something that's practical, affordable, and reliable and that people actually want to get hold of. What I call that innovation, essentially, is turning inventions into practical realities. And that's often neglected. People think that all you have to do is design a better mousetrap and the world will beat a path to your door. Doesn't happen that way. You've got to make that mousetrap reliable, affordable and available. But again, when you've got, you know, two guys talking across a fence and they come up with this great idea, it is so random. It is so who would have thought that it seems almost impossible, if not, frankly, pointless to try and figure out innovation.

It's not that random. I mean, after all, it happens a heck of a lot more in Silicon Valley than it does in the middle of Central Africa or somewhere like that. And a thousand years ago, it happened a lot more in the Yangtze Valley than in Silicon Valley. So there's something about certain places at certain times, the Renaissance Italy, the city-states there, ancient Greece, Victorian Britain. There's something about each of these places that they get together the critical mass where the innovations happen, they attract the right people, the people have an opportunity to share their ideas in a way that they don't in other places. There is money available. There is energy available. There is talent available to help them. So, it's non-random in that sense. It's also non-random in terms of which sectors

get innovated. So, the last 50 years have seen extraordinary changes in computing and communication but very disappointing changes in transport. And you get a feel for that if you go back to the 1950s and look at their ideas about what the 21st century would look like it's full of routine space travel supersonic flights personal jetpacks gyrocopters for all um there's very little about mobile telephones and things like that um so you know for reason, we've hit limits that make it very hard to innovate in transport. Well, we've made it more reliable and affordable, but we've not made it faster. Whereas we've made communication and computing much, much faster as well as more affordable over the last 50 years. And so there are things you can say about why that happened,

about what's going to happen. Well, there's not much you can say about what happens next, because it's also surprisingly unpredictable. Well, it is interesting that I imagine that there are new innovations in all kinds of industries and all kinds of technology. But I think when most people, when I think of innovation, I think of computers, electronics, digital innovation seems to be what I think of. And I think most people think of when they think of innovation. That's partly because digital innovation is permissionless. Whereas if you want to build a flying car, you've got to go out and get licenses from pretty well everybody. And it's you know, there's a very heavy regulatory hurdle to get over, which makes it very expensive. Whereas if you're building a new social media platform, there's really almost nothing you have to do to get permission. Is the point of talking about innovation, writing books about innovation,

to just shine a light on it that, ooh, isn't this interesting? Or is it to come up with a recipe? I'm more interested in the former. I just think innovation itself is a very interesting topic. It's the reason we are living lives of extraordinary prosperity compared to our ancestors. It's the reason we have technology and rabbits and rocks don't have technology. It's one of the huge themes of the modern world. And so I just want to understand it. But I deliberately set out to do something rather sort of bottom up here. In other words, to tell stories about innovation, about many, many different kinds of innovations, high tech ones, low tech ones, no tech ones, you know, virtual ones, and all these kind of things, and then see if there were common themes.

So to let the evidence speak for itself, rather than sort of going with a theory and try and make the evidence fit my theory. And so what are some of those common threads? When you look at different things being invented and innovated, what do you see that they have in common? There's a really interesting phenomenon called simultaneous invention, whereby the thermometer was invented by four different people independently around the same time. The light bulb was invented by 21 different people independently in the 1870s. The search engine was invented by hundreds of different people independently in the early 1990s.

And with that last example, you can see very clearly what's going on, which is not that there is some deity up there in the sky who has suddenly injected the phrase search engine into the brains of lots of different people at the same time, but that the contributing technologies that you need are ripe. They're ready to come together. In the case of the search engine, the internet has arrived. People are going to be exploring the internet. It's kind of obvious that devices that help them find what they want to look for in the internet are going to be important and possibly lucrative. Well, it's obvious in retrospect. But did anyone in the late 80s say, you know, once we've got this internet thing up and running, I'm going to make a lot of money out of search

engines? Almost nobody did that. In fact, Sergey Brin and Larry Page, the two people who made the most money out of search engines, didn't even think that's what they were doing. They thought they were cataloging the internet. They didn't realize they were inventing a search engine for a surprisingly long time. And they say that themselves. So there's a surprising, there's a phenomenon here where it looks very obvious in retrospect what comes next, but it doesn't look at all obvious what comes next when you're there in the moment looking forwards. And so from a broader perspective that you have taken, what is it you can say about innovation in general? One, it's more gradual than we think. We tend to think of it as disruptive innovation that suddenly changes the world.

Actually, if you look closely, there's a lot of hard work goes in before the disruption and a lot of hard work goes in after the disruption. It's evolutionary in the sense that there is dissent with modification. Each technology gives rise to another technology and so on. You have to go through the steps and it runs a sort of trial and error phenomenon that is very like natural selection. There are lots of ideas thrown out there. Some survive and some don't. Google Glass was a a failure google itself was a success it's serendipitous we've already touched on how you get these strange meetings of ideas that produce new ideas it's recombinant every single idea that every single technology that we have

is basically a combination of other technologies it's got this fascinating hype cycle whereby it tends to disappoint in the first few years, and then it exceeds expectations after that. So, Roy Amara was a computer scientist in Silicon Valley in the 1960s, who said a new technology exceeds expectations in the long run, but we underestimate its impact in the long run, but we overestimate its impact in the short run. And I think that's very interesting. You know, think about the internet. The first, you know, by the end of the 1990s, quite a lot of us were saying, I don't know, I'm not sure about e-commerce. It's not really that interesting. It's not quite going to work. I can't make it function. Ten years later, nobody is saying that. So there's a sort of takeoff phenomenon that is quite important.

We're talking about innovation and where it comes from. And we're talking with Matt Ridley. He's author of the book, How Innovation Works and Why It Flourishes in Freedom. Contained herein are the heresies of Rudolf Buntwine, erstwhile monk turned traveling medical investigator. Join me as I study the secrets of the divine plagues and uncover the blasphemous truth that ours is not a loving God and we are not its favored children. The heresies of Randolph Bantwine, wherever podcasts are available. Since I host a podcast, it's pretty common for me to be asked to recommend a podcast. And I tell people, if you like something you should know, you're going to like The Jordan Harbinger Show.

Every episode is a conversation with a fascinating guest. Of course, a lot of podcasts are conversations with guests, but Jordan does it better than most. Recently, he had a fascinating conversation with a British woman who was recruited and radicalized by ISIS and went to prison for three years. She now works to raise awareness on this issue. It's a great conversation. And he spoke with Dr. Sarah Hill about how taking birth control not only prevents pregnancy, it can influence a woman's partner preferences, career choices, and overall behavior due to the hormonal changes it causes.

Apple named The Jordan Harbinger Show one of the best podcasts a few years back, and in a nutshell, the show is aimed at making you a better, more informed, critical thinker. Check out The Jordan Harbinger Show. There's so much for you in this podcast. The Jordan Harbinger Show on Apple Podcasts, Spotify, or wherever you get your podcasts. So Matt, when you say that innovation has this kind of false start where people overhype it and it's a kind of a disappointment, does that tend to be typically more digital kinds of innovation? It seems like if you invent a better mousetrap, it's either

going to work or it doesn't. It's not going to get better. This is it. Well, no, I don't think you're right there because what you're talking about is the mousetrap having already been invented and someone coming along and inventing a better one. That's quite late. That's sort of mature technology. But if you think about something like genomics, okay, 20 years ago, Bill Clinton and Tony Blair did a joint press conference to announce the sequencing of the first human genome. And if you read their speeches from that day, they are extraordinarily utopian. They say this is the beginning of the end of disease. This is when we start to cure cancer. This is the most important breakthrough

in all of human history. In the long run, I think they're going to be right. But if you think about what genomics has delivered in terms of new medicines today, it's pretty disappointing. And that's not an electronic technology. Another example is airplanes. By the late 1920s, the idea that you could build planes strong enough to fly over the oceans had largely been dismissed. Everybody thought, right, well, you can build planes up to a certain size and you can use them in warfare over the trenches and you can do acrobatics in them. But frankly, we're never really going to use them much to get across the oceans, at least not with many passengers or much cargo on board. We're going to have to rely on airships for that, which is why there was a lot of airship building around 1930. It's only, you know, 20 or 30 years after that that we start to say, hang on,

we can build aluminum fuselages that enable us to fly lots of passengers across oceans. Don't you think there's some resistance to innovation that, you know, people say they like the new thing, the new shiny object, but people also say they like things just the way they are. There's even a longing for the good old days and partly I suspect because to adopt new innovation means a learning curve. You've

got to learn how to do the new thing when you you just mastered the old thing and all of this acts as kind of a pushback against innovation. Actually, there's a huge amount of opposition to many innovations, and it's often based on spurious imaginary problems that might come out of technologies. And a lot of organizations get very rich fanning the flames of this opposition. And just to ram the point home, I give the story of coffee, which was an innovation that came into Europe in the 1500s. And pretty well wherever it went, people were furiously against it. And rulers in particular kept banning it or trying to ban it. They usually failed because people liked coffee. But there were medical reasons.

You know, this was going to dry up your kidneys or something. There was commercial reasons. The wine and beer industry didn't like it. And there were social reasons. Kings didn't like coffee because people would gather in coffee houses and have animated conversations about whether kings were doing a good job. And quite often they came to the conclusion that they weren't. And Charles II of England was very explicit. Is that why he was banning coffee houses? Because he didn't like people spreading fake news in them. Now, that's all quite familiar when we look at what's happened to genetic engineering in agriculture in Europe or shale gas in Europe or nuclear power where we haven't been able to develop new nuclear technologies in the last 50 years. There's a lot of vested interests and a lot of scaremongering that holds back innovation even today.

In fact, more today, I would say, than in the past. Well, I've certainly experienced that resistance to technology and innovation myself, and I think everyone has in the case of you get a new computer or you get a new cell phone, and in no time there's a newer one that's cooler and better, and you really need to get a new one. And I think, well, this one works fine. It does everything I need it to do. I don't want to get a new one, but there is that pressure to keep up and to get a new one. And I push back and say, no, this is fine, at least for now.

Well, that's a very interesting point, because if you look at the history of the mobile telephone, everybody drastically underestimated the attraction, the importance, the commercial significance of mobile phones. I mean, there's a famous prediction from AT&T, I think it is, that there'll never be a market for more than about 4 million mobile phones in the world. Well, the date they put on that prediction, there were already 100 million in the world and climbing. So, again and again, people adopted mobile phones and threw away old ones and adopted new ones at a terrific rate until recently. And if you look at what's happening now in the mobile, the smartphone market, people are no longer changing models so fast because they're finding

that the advantages of the next model are not as great as they would like them to be, and it's just not worth the bother. And so the market projections for the number of sales of mobile phones have had to be downgraded in recent years. And this is, of course, the first time this has happened. Yeah, well, I think that's true for a lot of innovation, especially incremental innovation, because, yeah, you can make the phone a little better,

you can make the computer a little better, but you have to weigh that against the huge hassle it is. Like, if you get a new computer and you have to move everything over to the new computer and reload the programs and set all the settings for your email or whatever it is you have to do. It's a big hassle and nobody's ever figured out how to make that really easy to do. So that's a big pushback, I think, to innovation. Well, I think one of the reasons for that is because people want to keep you trapped on their own systems. I mean, I migrated from

Microsoft-based computers to Apple-based computers about 10 years ago, and I was very, very nervous about doing so. And I wasn't sure I was doing the right thing. And to start with, oh, gosh, this is confusing. But quite quickly, I found actually that I preferred the Mac- based system. It's sort of more intuitive. So it can be done, but you're right. There was a lot of, there's a big transactional hurdle there in changing. And very few people have a vested interest in making that easier for you or me to do.

One of the things that's always interested me about innovation is that you would think, well, maybe you wouldn't think, but I would think that if somebody comes up with the next big thing, that there's something special about that person or that group of people, that they'll likely come up with more next big things, but they almost never do. You know, Microsoft came out with what they came out with, but then they kind of fell behind. Apple kind of took off. And we haven't seen any big, huge, the next personal computer kind of innovation from Microsoft.

And maybe it's because they're very vested in their old big thing and want to keep that going. But it does seem to strike like lightning in terms of where it comes from. That's absolutely right. And the reason for that is because success breeds size and size breeds complacency and vested interest in the status quo and a general tendency not to be innovative. So, you know, Nokia became the biggest mobile phone company out of nowhere. But then Nokia was so invested in voice that it didn't really see the data revolution, the mobile data revolution coming, and it was blown out of the water by

basically Apple and others. And Kodak didn't invent digital photography. Actually, it did invent it. It just didn't see the point of it because it didn't want to cannibalize its own business in film. And as you say, you know, Amazon invented online retail and has been spectacularly successful

and has all sorts of devices to keep being an innovative company. And Jeff Bezos' ethos online retail and has been spectacularly successful and has all sorts of devices to keep being an innovative company. And Jeff Bezos' ethos of you have to swing a lot and miss in order to occasionally succeed is an important part of that. But there will come a time when Amazon is a great big clunky dinosaur and somebody else eats its lunch. One of the interesting things about innovation to me, and you touched on it in the beginning of our conversation, is the difference between invention and innovation. That for an innovation to really work and take hold and get people excited,

you have to sell it. Because, you know, if it's a brand new product and we've lived this long without it, you're going to have to really convince me to buy it because I really somehow need it. I haven't needed it till now. That's that's exactly right. I mean, this is the point about the difference between invention and innovation is that the the innovator knows that he's got to go out there and sell the product. And he's got to get it into a form where people want it. So where Edison was so brilliant is that he saw the need to do the hard grind of turning the pretty good prototype into the very good model. Henry Ford was the same. So these guys were innovators, not inventors. And you're right, marketing is a big part of that. And it has resulted in us missing out on some very good technologies because the inventors didn't know how to market them or sell them.

I find it so interesting, as you discussed, that we have this love-hate relationship with innovation, that we like things the way they are, we resist the new thing until we stop resisting the new thing, then we love the new thing, and then we resist the next new thing. And it's this resistance and giving in and adopting and then resisting again that is so fascinating. Matt Ridley has been my guest. He is a journalist, a writer, a businessman, a member of the House of Lords in the United Kingdom. He is author of the book, How Innovation Works and Why It Flourishes in Freedom. You'll find a link to his book at Amazon in the show notes. Thank you, Matt. Appreciate you being here.

Thank you, Michael. I've being here. Thank you, Michael. I've really enjoyed the conversation and some very good points that you've made too. Hey, everyone. Join me, Megan Rinks. And me, Melissa Demonts for Don't Blame Me, But Am I Wrong? Each week, we deliver four fun-filled shows. In Don't Blame Me, we tackle our listeners' dilemmas with hilariously honest advice. Then we have But Am I Wrong,

which is for the listeners that didn't take our advice. Plus, we share our hot takes on current events. Then tune in to see you next Tuesday for our listener poll results from But Am I Wrong. And finally, wrap up your week with Fisting Friday, where we catch up and talk all things pop culture. Listen to Don't Blame Me, But Am I Wrong on Apple Podcasts, Spotify, or wherever you get your podcasts.

New episodes every Monday, Tuesday, Thursday, and Friday. Do you love Disney? Then you are going to love our hit podcast, Disney Countdown. I'm Megan, the Magical Millennial. And I'm the Dapper Danielle. On every episode of our fun and family-friendly show, we count down our top 10 lists of all things Disney. There is nothing we don't cover. We are famous for rabbit holes, Disney-themed games, and fun facts you didn't know you needed, but you definitely need in your life. So if you're looking for a healthy dose of Disney magic, check out Disney Countdown wherever you get your podcasts. I know I've heard this statistic, and you've probably heard this too,

that medical errors are the third leading cause of death in the United States. And just on the face of it, I mean, if that's true, that's just horrible. How could that be? We supposedly have the best medical care in the world. How could the medical profession be making so many serious mistakes that it's killing more people than everything else but two other things? And then what about all the medical errors that are causing harm but not killing people? Well, that statistic may need a little further examination.

And here to do that is Dr. Danielle Ofri. She is a clinical professor of medicine at the New York University School of Medicine. She's cared for patients at New York's Bellevue Hospital for more than two decades. And she is author of the book, When We Do Harm, A Doctor Confronts Medical Error. Hey, doctor. Welcome. Thank you. It's so nice to be here. So how big a problem really are all these medical errors? It's a good question that you ask. Part of the problem is we don't know the answer to that.

So a couple of years ago, there was a big article with huge headlines about medical error being the third leading cause of death in the U.S. It was funny because I work in a very busy urban clinic. I thought, boy, if medical error is the third leading cause of death, I should see it every day, shouldn't I? But I don't, or at least I feel like I don't. So then I wonder, is it there and we miss it or are the data wrong? And partly we don't know because it's very hard to know necessarily when an error occurs and whether the error is the cause of something bad. There's no place to check off medical error on a death certificate. So we don't actually know. It's pretty common, though. Where did that number come from, then? So this study reanalyzed a couple of older studies, and they were looking at hospitalized

patients, which, as you can imagine, are not representative of all people, right? Not everyone's in the hospital, thankfully. Older patients, hospitalized patients tend to be older and sicker with many more moving parts. And one of the problems is that because you're reanalyzing someone else's data, you're relying on their judgment of whether an error occurred and whether the error actually caused the death. Imagine a patient dying of liver cancer, and they're given the wrong antibiotic, and they die. So there's been an error, and there's been a death, but did the error cause the death?

It's often very hard to tell. So it's already a judgment call, and then you're relying on someone else's judgment call. So any biases will then get magnified if you then extrapolate to 350 million people. And so we hear the sensational stories about, you know, the doctor cut off the wrong leg or, you know, these horrible medical error stories. I imagine, God, I hope that's the exception, not the rule. Are they very rare or are they, I mean, one is bad enough, but I mean, how bad is that?

Well, it depends how widely you cast the net. So catastrophic errors like cutting off the wrong leg or operating the wrong side of the brain, those are rare. It takes a lot. A lot of things have to go wrong for that kind of error to happen. They do happen, but they're not that common. However, there's lots of errors that are smaller and cause mild amounts of harm. Maybe the patient had to stay in the hospital a day longer, or maybe they had an upset stomach when they didn't need to have that. Things like that, which there may still be an error, but the consequences weren't grave.

And then there's a huge category of what we call the near miss. That is, an error has happened, but the patient did okay. Or as I like to think, the patient got lucky that day. And those errors are probably vast. We don't really know the number because who reports near misses? Very few people do. And because the patient isn't harmed, we tend to ignore them. However, that's kind of like the minefield of the future errors waiting to happen. So to me, near misses are just as important, even if there's no harm from those medical errors. Understanding that you're a physician, a practicing physician, so you're on the team, so I'm sure you have conscious or unconscious biases about this. But still, you've objectively tried to look at this problem, an important problem.

So how would you, if you could step back, how would you rate your profession, your colleagues? How well a job do they do as it relates to medical errors? That's also a tough question because there's many levels to that. So one is, what does the individual doctor or nurse do? So let's say the nurse grabs the wrong IV fluid. So that, yes, that's an error that you can say she did that and that was incorrect. But then you can look at, well, what were the reasons, what were the systems that made that error possible? Was she being given too many patients to take care of because they're short-staffed? Was the lighting poor so you can't read the labels? Do the medications look alike or sound alike? Was she being interrupted

every five minutes by people asking for ginger ale and directions to the bathroom? So even though we can rank that nurse as, boy, she's really rotten because she gave the wrong medication, you can also find the systems that made that error more likely. As a whole, as a field, I think we are finally waking up to the sheer volume of errors or care that is less than we want it to be. And that includes not just outright errors, but harms that patients receive that we don't intend for them to get, even if an error wasn't committed. That's quite a vast issue. So the profession is waking up. We're still going a little slowly and partly because we tend to want to blame the nurse or the doctor for making the mistake, as opposed to looking at the system that makes the error or bad outcome more likely to happen.

Seems like that would be the case, that the system is the problem. And, you know, I've heard the comparison that, you know, the airplane pilot, if he makes a big error and somebody dies, he dies too. So that's why there's far fewer airplane accidents than there are medical problems, because the doctor doesn't harm himself, he only harms the patient. It seems a little harsh, but I see the logic in that. But I also think there's fundamental differences between the aviation industry, between airplanes and medicine. So for one thing, all the moving parts of airplanes are moving parts. Most of the moving parts in medicine are people. And there's all kinds of people on the team.

On an airplane, there's one pilot, one co-pilot, a fixed maintenance team, and that's really it, and the flight crew. In medicine, you may have dozens of people involved in care at all different levels. There's many moving parts, and these are human beings, and they don't all necessarily come out the same. They don't show up with, you know, vasculitis diagnosis branded on their chest. They come and say, I don't feel good. We have to figure that out. So it's quite a bit different. But I think going back to your original point about the wrong leg being cut off, why that's rare, most errors and bad outcomes tend to relate to some form of communication error. So it's not like we're just checking the parts of the engine,

making sure it works, but are people communicating correctly? Are the doctors and nurses and physical therapists communicating appropriately? Are they communicating with the patient? Are they listening to what the patient's saying? And all those areas are why it's so much more difficult to pin down where things go wrong. What about the patient's responsibility in this? What role do they play in preventing medical errors? You know, medicine, it's a team sport. We hear that all the time. We tend to think of the team as the doctors and nurses and then the medical folks, the people in scrubs. But really, the team is also the patient and the patient's family and the close friends who are there with them. We're all on the same team. And even sometimes feel like

we have opposing agendas. There's really just one agenda, and that is helping the patient get better. And so the patient and family, they do have responsibilities too. So knowing your own medical history, knowing your allergies, knowing what medications you're on, that's very important. But of course, the patient's also the person who's sick. And so it's not so fair to ask of them, well, while you're suffering a 103 fever and vomiting your guts out, make sure you ask the nurse the name of every single medication that you get. So it depends on the circumstance. I think the more patients and families can be engaged and involved and know what's going on, keep a notebook, ask the questions, write down the answers, that's all for the better. But I think we can't foist it upon the patient who is pretty busy being sick or anxious,

worried, frightened, all these other things that make them maybe not at their best at that moment and much more vulnerable than usual. So the onus really is on the healthcare profession for most of it, although the more patients can be engaged and involved, the better for everyone. Where likely do things go wrong? Is it medication typically? Is it, what is it? Well, again, we don't have a good answer to that question. And one of the reasons that we don't have any kind of national database for reporting errors. So we have no way of knowing. Reporting errors is voluntary, or you get sued and then it comes to light. The other day, I detected a near-miss error that was related to the electronic medical record.

I thought, well, you know what? Let me file a patient safety report. It's important for them to know. Well, you know, I couldn't even find the page and the link. And I had to go through six different pages on the computer. I had to call the help desk, find out where to, you know, find this. Then I had to open an account with a password and a capital letter and a small letter. And at that point, I gave up. So we don't have an easy system for doing that. We don't have a requirement. We don't have a national database. So we do not know. It's a mix of those. Certainly medication errors are big,

procedural errors and communication errors. Those are, I think, where the big things are. And then overlaying that is the issue of diagnostic errors, that is getting the diagnosis wrong or having a delay in the appropriate diagnosis. But that encompasses things like communication errors, listening errors, and also, you know, medication errors, whether it's the medications the patients are on, those we are prescribing. We hear about defensive medicine, that doctors, for fear of being sued, do things, do extra tests, or do or don't do things to basically protect themselves from liability. Does that play into this? Oh, yes. Defensive medicine is an enormous problem, particularly in the United States,

which has a more litigious culture than many other countries. And some several billions of dollars are spent on unnecessary tests because, oh my gosh, the patient's got a headache. Better do a CAT scan because they might sue me. Whereas in another country, you might say, hey, listen, I don't think it's anything other than a tension headache. Let's watch it and see how it goes. And so it's not just the cost, though. Every test you do brings in its own room for error. You do a CAT scan. Maybe you give someone a contrast dye, and they might have a reaction to that. Or you do additional tests that pull up incidental findings that maybe are meaningless clinically but then cause you to do more tests.

And so we definitely – we're just adding to the pile of things going on. And certainly the more that's going on, the more chances for things to go wrong. Well, plus there's this whole umbrella problem of people interact with doctors because they're sick. Things go wrong because they're sick. It's easy to blame the doctor. You know, people die, but people are going to die. Everybody's going to die. You can't always blame and sue the doctor because they were in the hospital at the time they died. Yeah, so it points to how limited the malpractice system is for addressing error, because you have to actually prove that the error, the issue caused the death or the bad outcome, that can be very

hard to do. You know, again, people are sick. There are many things going on. A mistake might be made. It's very hard to prove that that mistake actually caused the death or the bad outcome, which is why malpractice only helps a very small sliver of patients. Other countries like Denmark are experimenting with systems that are more akin to our workers' compensation system, where you don't involve lawyers in going to court, but you simply file a claim. And if the adjudicating board sees that this is maybe less than standard of care, or you suffered some kind of harm, then you either get a settlement or you don't. And in this way, many more patients can get some kind of compensation, get their issue addressed.

The payments are smaller, but they're faster. They don't take five years. They take a few months. And also, it becomes now a database, a repository for finding out about problems that are going on. So you might see, oh, in one hospital, there are lots of claims for pressure ulcers. Boy, something's probably going on there. So it has double duty for both giving more patients some kind of restitution, but also enabling, you know, researchers to see where things are going wrong. Doctor, what about the problem that was portrayed in the podcast and the TV show, Dr. Death. So here was this doctor in Texas who was grossly incompetent

and perhaps even maliciously trying to do harm to people. And he would just move from hospital to hospital. He would get fired for his negligence and his incompetence. And then he'd get hired at another hospital and he would just move on and do more harm and do more harm. truly negligent people like that. But it's very small. The overwhelming majority of errors and adverse outcomes result from clinicians who are committed, doctors and nurses who are doing their best under challenging circumstances and maybe temporarily just miss something. But it's certainly not negligence. But there are a few. It's small. Now, the issue, though, of people covering is something else. because you can imagine, you know, a step back from that kind of, you know, true criminal behavior. Let's say a doctor's

getting older or having poor judgment or maybe off their game, not, you know, doing horrific things, but maybe not as good as they could be. Who turns that doctor and who reports that? That's very hard to do. I mean, many doctors and nurses have depression, substance issues, they're being very overworked, certainly in the wake of COVID, many, many clinicians are suffering, and it can come through in their work. And we would like our colleagues to, you know, bring those issues to the surface, because we want to help that staff in addition to protecting their patients. Do doctors, because I've had really good doctors and I've had really crappy doctors,

and by crappy I mean non-communicative, sometimes even nasty, aren't very helpful. Maybe they're good technically as a doctor, but they're lousy as a person doctor. Their bedside manner sucks, basically, I guess is what I'm saying. And I wonder why that is. If you're a doctor, why are you acting like that when you know people are sick,

they're relying on you, and you're treating them poorly? That's a great question. I bang my head against the wall all the time. The book I wrote before this one was called What Patients Say, What Doctors Hear, about the issue of communication between doctors and patients and why it's so difficult. Because you often hear, you know, so-and-so, you know, great doctor, but lousy bedside manner. But what I discovered after researching that book is that those things can't exist apart. You can't actually be a great doctor with a lousy, you know, quote, bedside manner, for which we really mean communication skills, because what the patient

is saying is the primary data from which we make all our diagnoses, all our treatment plans. And so listening, it's not just nice, it's critical to be accurate and to make the right diagnosis. Now, why are some doctors really crappy? Well, some people are probably just misanthropes and they probably shouldn't have gone into medicine. Again, it's probably a smaller percentage, but I think a lot of doctors are simply so overworked by the system. I mean, right now, you know this, everyone knows this. You go to your doctor and they're sitting in front of a computer screen battling with the electronic medical record. You know, you see them hitting the side of the computer and, you know, muttering under their breath about the help desk. And we've given

doctors and nurses more, you know, annoying work to do than they even have the time for. So it's hard to even spend time with the patient if you have 25 minutes worth of box checking to do and 10 minutes to see the patient and do everything. So a lot of doctors and nurses, I wouldn't say burned out because that puts a little bit of onus on them. I think it's more like a moral injury. They're being asked to basically cut corners because there's no way to do it without cutting corners. And that's morally corrosive. And so we use the term more of moral injury. And for many people, that becomes so difficult. It's very hard to maintain the reason you want to go into medicine, to spend time with patients and be with them. And some people, unfortunately, end up with the phenotype of kind of a grouchy, uncommunicative doctor or nurse.

And that's bad for everyone. Is being a doctor getting so difficult that it's really turning a lot of people off? Or are we facing a shortage of doctors like we are nurses or not? Well, we do have a shortage of doctors, particularly in the primary care fields. That is general internists, family doctors, pediatricians. And you might see a common theme. These are the professions that are very burdened by paperwork, are relatively lower paid on the spectrum of doctor payment,

which is certainly no doctor is starving, but definitely they're lower paid. The hours tend to be longer. I mean, compare that to some specialties like dermatology, radiology, where hours are fixed and the pay is very high because they're procedure-based. So we certainly have a shortage of primary care doctors. Try getting an appointment with an intern. This is pretty tough these days. And I think it's because, you know, partly you accrue a lot of debt as a doctor. So to go into a relatively lower paid field is maybe not so appealing when you have $300,000 worth of debt. But also the paperwork burden of the electronic medical record is really unappealing and people

don't want to do that. So I think it's really a concern that we need to think pretty clearly about. Yeah. Well, but you would think, though, that if there was a shortage, that those who did go into it would make more money because supply and demand. Well, we wish. But it's really about who sets the reimbursement for insurance companies. So if I talk to my patient about diabetes and how to take their medications, maybe, you know, Medicare will reimburse my hospital $48. But if I talk to them about how to make brown rice instead of white rice, which is really important for diabetes, and I simultaneously thread a catheter into one of their orifices, and you can pick any orifice you want, that payment goes up like tenfold. So anytime there's a procedure involved, the payments are

higher. When it's talking to your patient about how to take your medications, how to work on the lifestyle to affect your illness, that's not reimbursed. So there's no supply and demand. It's simply who was at the table when the rates were set. And you can bet that the primary care doctors were not at the table. Well, what about the idea of a primary care doctor? Because it seems like now, and I've had this experience because I moved from an HMO to Blue Cross or whatever, that I don't even have a primary care doctor because it's hard to get in to see one when you're sick.

They can see you in three months. Well, I probably won't be sick in three months. And so I just go to the urgent care. And if I need a specialist, I call a specialist. I don't even really have a primary care doctor. Yeah, that pains me to hear that. And certainly for someone young and healthy, that may work for the occasional thing that comes up.

But as patients get older and have many chronic diseases, having a primary care doctor is essential. And it's been proved to me more and more during COVID, as patients were often cut off from their doctors, how much people's care suffered from having the doctor who's known you for five years and knows the complex interplay of your different illnesses and also knows you well enough to know when something's wrong. When they come in and say, hi, something's off with this patient just by the way they're talking or the way they're walking or the way they sound. And that's so essential. Plus, there's more to

health than just taking care of your acute illnesses. There's also the idea of being well in between. So a good primary care doctor, even for a healthy person, is helping them, you know, have a healthy diet, exercise to prevent all these chronic illnesses, make sure your vaccinations are up to date, helping you through a pandemic or what have you. So it is really crucial. And you're right, we should be having many more primary care doctors. It's kind of a crime that we have more specialists than we have primary care doctors now. Right. Well, if you can't get in, even when you have one, if you can't get in to see them for eight weeks and you're sick today, you wonder why do they take on so many patients that every patient is eight weeks away from an appointment?

Well, if the insurance company reimburses $30 for a visit, in order for the company, the hospital, the practice to keep the lights on, they have to take a lot of patients on for very short visits. So that's the business model, which as you can see is crazy. We sort of have this supply and demand model for a field that really doesn't, you know, it's not toasters or microwaves or jeans. It doesn't quite work that way. And so we're trying to fit one model into something else that doesn't quite work. And that's exactly what the problem is now. Well, we started this conversation by talking about that statistic that medical errors are the third leading cause of death. And I think you've done a pretty good job of explaining that,

A, that's pretty hard to determine, and B, there's a lot more to the story than just that statistic. Dr. Danielle Ofri has been my guest. She's a clinical professor of medicine at the New York University School of Medicine, and she has cared for patients at New York's Bellevue Hospital for more than two decades. She has a book out called When We Do Harm, A Doctor Confronts Medical Error,

and you'll find a link to that book in the show notes. Thank you, Danielle. Well, thank you. It's been a pleasure. How about some advice that will help you keep more of your own money? And it all has to do with the way your brain perceives cash. This is according to Forbes.com. We know that you're more likely to spend more with a credit card than with a debit card. And you're more likely to spend more with a debit card than with a debit card, and you're more likely to spend more with a debit card than with cash.

So just by using cash instead of plastic, you will spend less money. But it gets more interesting than that. The next time you need cash, skip the ATM and go into the bank and ask for new $50 bills. Why? Because research says you're more willing

to spend older bills than newer bills, research says you're more willing to spend older bills than newer bills, and you're much more willing to spend smaller denomination bills than larger ones. So skip the plastic and stuff your wallet with new $50 or even $100 bills and see if you don't keep more of your own money. And that is something you should know. If you enjoy this podcast and would like to support it and see if you don't keep more of your own money. And that is something you should know. If you enjoy this podcast and would like to support it and help us continue to grow it and keep producing episodes that you enjoy, we ask one thing, and really only one thing of you,

and that is to spread the word. Tell a friend and ask them to listen too. I'm Mike Carruthers. Thanks for listening today to Something You Should Know. Welcome to the small town of Chinook, I'm Micah Ruthers. Thanks She suspects connections to a powerful religious group. Enter federal agent V.B. Loro, who has been investigating a local church for possible criminal activity. The pair form an unlikely partnership to catch the killer, unearthing secrets that leave Ruth torn between her duty to the law, her religious convictions, and her very own family. But something more sinister than murder

is afoot, and someone is watching Ruth. Chinook, starring Kelly Marie Tran and Sanaa Lathan. Listen to Chinook wherever you get your podcasts. Hi, I'm Jennifer, a founder of the Go Kid Go Network. At Go Kid Go, putting kids first is at the heart of every show that we produce. That's why we're so excited to introduce a brand new show to our network called The Search for the Silver Lining, a fantasy adventure series about a spirited young girl named Isla who time travels to the mythical land of Camelot. Look for The Search for the Silver Lining on Spotify, Apple, or wherever you get your podcasts.