When Giving the Benefit of the Doubt Isn’t a Good Thing

By Blog

In most hospital situations, there is no continuity. No one knows everything about a patient. Instead, we each know only our part of the patient’s puzzle. This fragmentation in care has increased for several reasons: First, the pandemic. Last minute quarantines, illness and more has led to unexpected team member substitutions and discontinuity. Second, we have increasingly specialized fields, which means more consultants, more people involved in decision making. Third is the much needed effort to reform medical training to promote wellness, safety and duty hour regulations. As a result, continuity and handoffs have suffered. In my last post, I talked about how family is an essential component to continuity (especially when they are at the bedside). But even that is not always possible.

So what can we do about it? Well, one important strategy is to trust each other less.

That means to be aware of anchoring bias. To question everything. To not accept the status quo for patients, and to ask WHY?

Why do they have this diagnosis? Why did that test not get done? Why are we going to delay workup? Why do we think it is diagnosis A and not diagnosis B?

Why do they have this diagnosis? Why did that test not get done? Why are we going to delay workup? Why do we think it is diagnosis A and not diagnosis B? At work, we usually trust our partners implicitly. To a fault even. We put our patients’ lives in each other’s hands routinely. However, because of that trust, we tend to accept what someone tells us automatically. But, to err is human. Sometimes, a mistake is made, goes unrecognized, and is passed on through handoff after handoff.

Quality improvement work teaches us that to get to the root of a problem, you must ask “why” 5 times. Well, I think it is safe to say that in medicine, we need to do exactly that, for our patients: get to the true cause whenever possible. Funnily enough, 5 year-olds do this by default. Yet we don’t. Why is that?

Sometimes it is out of respect. We don’t want to question someone’s skills or abilities.

Often we are simply tired. Exhausted. Spent. Even the incoming doctor may be tired. So we accept what is given to us, and carry on with the plan that has already been set in motion.

And to be honest, it is hard to say “perhaps my colleague made a mistake” even if that can absolutely be the case.

Not because they are bad or have mal-intent, but because we should always question the status quo.

In life we give people the benefit of the doubt – for example trusting that someone did not intend to be rude. Maybe they just had a bad day? However in medicine, perhaps it should be the opposite. Perhaps we shouldn’t give anyone the benefit of the doubt. Not because they are bad or have mal-intent, but because we should always question the status quo. We should always bring fresh eyes to an issue, whether that is in the form of a diagnostic time out, or simply asking “why?”

Everyone has different experiences and backgrounds. These color how each of us interpret data, make diagnoses and treatment plans. I strive to approach each situation as I would if it was my mother in the bed. Or my father, husband, child. I am 100% sure in each of those situations I would not blindly accept what someone else decided. I would ask “why.” We must do the same for our patients.