This is bad for academic medicine

When the history of the patient safety movement is told, it will be appropriate that the Association of American Medical Colleges* will be left out.  The recalcitrance of this organization in acknowledging patient safety problems was legendary for the first decade of this century. The AAMC’s leadership not only refused to acknowledge the depth of patient harm but also precluded use of the organization’s arms in working on the issue.

For example, when an AAMC committee was to be established in the mid-2000’s on patient quality and safety issues, the leadership insisted that the word “safety” be omitted from the committee’s name and charter.

For example, when people would submit articles on patient safety to the AAMC’s main journal, Academic Medicine, they would be summarily refused, refused even the courtesy of peer review.  The authors were told that patient safety was not an issue of public concern and therefore did not warrant space in the journal.

For example, at sessions with the world’s experts on patient safety and doctor education (like Don Berwick and Lucian Leape), high officials from AAMC would reiterate their belief that hospitals did not have a patient safety problem.

Things finally changed in 2010, when a new CEO arrived.  In an article, he and the organization’s president addressed the issue:

In order to develop a health care culture of safety that leads to clinical improvements, an unprecedented collaboration between medical schools and their partnering health systems is required, according to Drs. Kirch and Boysen. They identify five factors critical to the success of a culture shift: leadership from the top, student involvement, a focus on safety during residency training, health information technology, and teamwork among health professionals. “When combined with a growing investment in comparative effectiveness research, these factors will help physicians improve care at the bedside,” the authors write.

I suppose better late than never, but think about the societal loss caused by the absence of the major academic medical organization from this issue for so long–notwithstanding important findings by the Institutes of Medicine on the topic.

Perhaps the AAMC leadership reflected the views of its membership.  I recall, when I was emphasizing patient harm on this blog and posting clinical outcome data, the Chair of the Partners Healthcare System called the Chair of our system and said, “Can you get Paul to stop publishing those numbers.  This is bad for academic medicine.”

Or perhaps the membership took direction from the AAMC leadership, who, after all, were highly regarded in the profession.  Either way, the lack of action on and attention to patient safety was a significant failure and led to the slow inclusion of patient safety curricula in America’s medical schools. Let’s consider, therefore, that the AAMC contributed for years to the delay in addressing the large number of preventable deaths and harm in America’s hospitals.

* As noted in its materials: The Association of American Medical Colleges is a not-for-profit association representing all 144 accredited U.S. and 17 accredited Canadian medical schools; nearly 400 major teaching hospitals and health systems, including 51 Department of Veterans Affairs medical centers; and nearly 90 academic and scientific societies. Through these institutions and organizations, the AAMC represents 148,000 faculty members, 83,000 medical students, and 115,000 resident physicians.