Fear as "The Great Motivator"
all the emotions ... fear is the one which is likeliest to get things
Smallpox. Anthrax. Chemical terrorism. Airplane attacks. Sniper attacks.
Most of us have experienced these fears at some point over the last 19
months, if not consistently, or at least fleetingly. "What if ... "
has become a common refrain as legislators scramble to fund antiterrorist
actions and smallpox vaccinations.
It is unlikely, however, that we have spent even half as much time worrying
about medical errors -- which kill approximately 98,000 people each year.
This statistic in no way diminishes the gravity of the terrorist attacks. But
we need to be aware of how fear -- which led to improvements in security after
Sept. 11 -- can be used in the medical field as well.
3,000 people died on September 11, 2001. Fear of follow-up attacks led to
improvements in security for every public facet of society -- airports, baseball
stadiums, shopping malls, convention centers.
Five died of anthrax apparently distributed through the U.S. mail. Fear of
additional infections led to improved security in mail delivery, not just at the
post office but also at in-house mailrooms for businesses and schools.
Last October, 10 people were killed and three critically injured by two
snipers eventually captured in Washington, D.C. As fear gripped the Washington
metro area, people kept their children home from school, stopped fueling up
their cars, shopping at home improvement stores and walking through parking lots
alone. People became more aware of license plates, white vans and trucks.
In 2002, 254 died of West Nile virus. Millions of Americans in affected
states, fearing fatal encephalitis, changed their habits to avoid mosquitoes --
wearing long sleeves and pants, and staying indoors at dawn and dusk.
No one thus far has died from smallpox or its vaccination. But fear has led
to a federal vaccination program for smallpox. (And fear of complications from
the vaccine is preventing many healthcare workers from being vaccinated.)
"Fear is the great motivator -- and skill is its offspring. If necessity
is the mother of invention, fear is the mother of competence, the mother of
Regardless of the object of fear -- be it disease, terror or error -- we
cannot deny that fear itself is indeed a great catalyst for action. That fear,
properly channeled to the appropriate action, can be a positive force for good.
But what actions are appropriate to counter the fear of medical errors?
Over-treating (by ordering unnecessary tests and labs) to avoid accusations of
malpractice is not the answer; it leads only to inefficiency in the medical
system. Education, first and foremost, is the appropriate action. In the current
medical climate -- with the high rates of medical errors and the resulting
rising costs of malpractice insurance -- education is fundamental.
- Education about proper diagnoses, tests and procedures.
- Education about correct surgical sites.
- Education about double-checking patient names and prescriptions to ensure
the right person is receiving the right medication in the right dosage.
- Education about look-alike or sound-alike medications.
- Education about checking patient records for allergies.
- Education about infections.
- Education about equipment and its proper use and maintenance.
- Education about blood transfusions and organ transplants.
The much-hyped case of Jesica Santillan, who died after receiving a
heart-lung transplant from a donor with a non-matching blood type, is a primary
example of an error that could have been easily prevented. Asking simple
questions about blood type or allergies can literally mean the difference
between life and death.
Educating healthcare workers to do it the right way, every time, and to ask
the right questions, every time, is essential. Knowledge of proper procedures is
essential. Knowledge of what not to do is just as important.
So how does one obtain such knowledge? Read the latest journals (don't let
them pile up in the magazine stand at home or on your desk at work). Visit
healthcare related Web sites; AORN and APIC consistently provide up-to-date
infection control-related knowledge. Attend seminars. Take continuing education
courses -- in-house, online or in the pages of your favorite infection control
magazine, Infection Control Today.
This month, our Best Practices department addresses an ongoing problem:
surgical site infections. According to the Centers for Disease Control, there
are an estimated 500,000 surgical site infections in the U.S. each year, which
equal one-quarter of annual nosocomial infections. The cost -- to both finances
and health -- is astronomical. Bonnie Barnard explores the problem in-depth and
tells us exactly how to prevent it.
Our continuing education program is designed with you in mind. Upcoming
topics include asepsis, patient safety standards and how to prepare for JCAHO
surveys. If there are topics you'd like us to address in future issues, please
let us know. If you have written an educational piece that is relevant to an
infection control course, let us know that, too.
If you have upcoming in-house educational sessions, please feel free to
distribute copies of the Best Practices to your "students" for them to
submit for continuing education credits. The courses are intended for the good
of your employees in the short term; in the long term, they contribute to
continued health for all of us.
1. McClellan JL. www.pygalgics.com/F/fear.html
2. Morgenstein, Henry. www.nmc.edu/~hmorgenstein/essays/fear.html