Improving Patient Safety: Updates on Oral and Maxillofacial Surgery

In a recent blog post I discussed how a few new videos have appeared in recent months related to oral and maxillofacial surgery Videos Related to Oral and Maxillofacial Surgery. The American Association of Oral and Maxillofacial Surgeons (AAOMS) has also updated several sections of their website in the last year or so. They now have a section titled Orthodontics and Oral Surgery where they have videos related to showcasing various techniques that oral and maxillofacial surgeons and orthodontists perform. In addition they have updated and written a new page titled “Culture of Safety“. The page is a welcome addition and discusses how safety is the number one priority in the oral and maxillofacial surgery office.

Now I wanted to take a moment to respond to this page and some other developments I have seen lately across the blogosphere.

1) The first point to address relates to the issue of safety versus appropriate treatment. Much of the of the motivation for my website was based on the fact that it was never discussed to me back in 2006 that no scientific evidence supported or refuted third molar extraction. In addition, many of the complications that can occur from wisdom teeth extraction were conveniently not mentioned. Furthermore, AAOMS was actively promoting the extraction of healthy wisdom teeth. AAOMS in September, 2007, placed a 4-page advertisement supplement in USA Today urging the extraction of wisdom teeth without mentioning any possible risks and complications that could occur from their removal. In 2010, they held a third molar conference with the intent of the press conference to provide media with a chance to write articles and perhaps discuss on a TV news segment the potential problems with leaving healthy impacted wisdom teeth in hence why they should be removed. (see Third Molar Multidisciplinary Press Conference, Multidisciplinary Conference on Third Molars (Wisdom Teeth) , and  Wisdom Teeth Removal Controversy)  It is only recently in late 2011, that AAOMS reversed course (see Advocacy White Paper on Third Molar Surgery by AAOMS )

Hence, my one of my motivations was to get people to question whether or not removing healthy impacted wisdom teeth is the correct treatment choice or not. AAOMS seemed to be promoting a strategy of having most wisdom teeth extracted and not mentioning any scientific evidence to patients and failing to disclose many of the risks, so I was frustrated. In order to help to get people to think about risks and benefits of third molar surgery I looked a numerous articles and lawsuits to find some data. This is discussed on the complication, death, and lawsuit pages in most detail.

Now in my mind the idea of safety and the idea of appropriateness of treatment are two separate distinct issues.

2) The second point to address is on the culture of safety discussed to occur in AAOMS offices. The webpage states

“While the culture acknowledges that as human beings, we are all capable of making mistakes, it further holds that we are capable of recognizing our errors and identifying ways to prevent them from happening again.”

In my mind it is great to see openness and transparency about this issue. Unfortunately, in my experience as described in 1) AAOMS seems to have a history of not being transparent and open about many issues. When I was conducting research on wisdom teeth on the internet prior to my surgery in 2006, many of the relevant facts I would have like to know were not at all open and easily available. I have created an extensive complications page in order to determine if I had overlooked anything that could have caused me to have a 24/7 headache since 2 days after having 4 wisdom teeth extracted. The question that always ran through my mind when I was conducting this research was isn’t it important for treating clinicians to know what problems in the past have occurred so they can be better rectified in the future. Unfortunately, I was not seeing any large effort of this underway at the time of the updating the bulk of the complications page a few years ago.

AAOMS discusses creating transparency and establishing accountability. Unfortunately they seem to be ignoring the main reason as to why a culture of safety has been slow to come about in medical practice which is due to the legal system. I have discussed alternatives to the medical legal system before. Kevin from the popular KevinMD.com blog has recently written a post on improving patient safety.

“…[while] openly talking about errors needs to come from inside the medical world, she neglects another important factor: the medical malpractice system.  It’s confrontational, a quality that impedes openness. It’s also why some hospital lawyers encourage opaqueness after adverse events, not only within the medical community, but to patients as well…until our malpractice system encourages that same transparency and ceases to be adversarial, any gains in patient safety will continue to be limited.”

I have also talked about this issue before when I talk about the U.S. Legal and Medical Malpractice where I say

“Understand that the current medical malpractice climate in the U.S. provides very little incentive for health care professionals, physicians, and hospitals to disclose errors, learn from them and improve quality, and apologize to patients that have been injured. Patients and doctors need to be in an environment where they can work together that is mutally beneficial”

In the past AAOMS has focused on trying to get legislation passed that limits non-economic damage caps nationally to $250,000 see
The War on Healthcare: Patients Who Hate Doctors. I wondered to myself why the focal point is not on trying to get legislation passed that will change the medical malpractice system to some other form.

On the culture of safety page AAOMS has the following quote

“The culture of safety concept was first conceived by the aviation industry. In the 1970s, the industry suffered a number of accidents attributable to human error. In response, the industry changed its standards and operations drastically. By implementing cross training, checklists, and better communication channels for now-empowered crewmembers, the safety record of the aviation industry today is an enviable one.”

As I have mentioned before in this post alternatives to the medical legal system the airline industry is very different than the health care industry as the doctor usually does not have his or her health and well being on the line. When a pilot operates a plane if it crashes they might get hurt or killed, so they have a strong incentive to correct any mistakes. In the case of a surgery, if the surgeon makes a mistake only the patient may get hurt or killed, so I suggested a way to have doctors have more skin in the game so to speak.

Nonetheless, it is nice to see some efforts being undertaken to attempt to improve quality and patient care.

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