by Wendy Vapors, 12/03/99
DC: A shocking report released by the Center for the Study Human
Error announced that Human Error is the major cause of mistakes of all kinds in
the United States.
The study suggests the creation of a system of review, designed by and operated
by humans, that will eliminate or at least compensate for these costly errors,
particularly in medicine. The idea already has wide support, but some nearly infallible
humans are annoyed by all the fuss.
Wendy Vapors had a rare opportunity to interview a disgruntled surgeon.
(sfx: operating room scene)
Wendy: Dr. David Clutz is a famous surgeon who rarely has time to be seen and
never grants interviews. But he called me this week so he could have a chance
to counter the impression left by the human error report.
Because of his grueling schedule, Dr.Clutz invited me to conduct the interview
in the operating room while he performed a routine kidney rotation.
Dr.Clutz: If you want your kidneys to last, it's a good idea to rotate them every
45 years. The get over used on one side, and flipping them evens out the wear
Wendy: Were you surprised at the findings of the study, that so many mistakes
happen when humans are involved?
Dr.Clutz: Incensed is more like it.
Dr. Clutz: This undermines the confidence people need to have in each other. As
a surgeon, especially, I expect patients to submit to my will, totally and without
question. How is that going to happen now?
Wendy: Are you saying mistakes don't happen?
Dr.Clutz: Of course mistakes happen. We're only human, some of us.
Dr.Clutz: Clamp, I mean.
Dr. Clutz: But the people we're treating ... the patients ... they're REALLY human.
Extremely human. And sick, many of them. You deal with very sick people every
day and over the course of a year you're going to lose a few. Thousand. You say
human error is rampant and it creates a convenient excuse for lower standards.
I think our expectations should stay high.
(sfx: map unfolding)
Wendy: Don't you know where the kidneys are?
Dr.Clutz: Of course I know. But my dad always said "measure twice, cut once."
Wendy: He was a surgeon too?
Dr. Clutz: No, he worked at a deli counter.,
(sfx: ruler roll out)
Dr.Clutz: Wow, look at the size of that clavicle.
Wendy: I thought the clavicle was up at the head end.
Dr Clutz: The point I want to make about human error is ... this report paints
a very bleak picture that is not entirely true, that's all.
Wendy: What would be more accurate, then?
Dr.Clutz: Something that says your Doctor is a dedicated public servant. Highly
trained. Something that doesn't feed the stereotype of the doctor as a haughty,
impersonal, self absorbed, high income, low-on-people-skills nerdboy would be
a nice change, for a change.
Wendy: Well, I think you have a good point.
Dr.Clutz: Duct tape.
Nurse: Duct tape.
(sfx: peel roll, stick down)
There. That'll do.
Wendy: Did you just patch someone up with duct tape?
Dr.Clutz: There again, a typical mistake. This is not a "patch", it's
a sterile fabric splint.
(sfx: map unfolding)
Wendy: Are you searching for the kidneys again?
Dr.Clutz: Please, Ms. Vapors. Thank you for your time. I won't keep you any longer.
Wendy: (annc) And so ... at least one human takes offense at the suggestion that
"Human Error" is so prevalent in everything we do. And if he has his
way, Dr. David Clutz will continue his tradition of perfect performance on into
the foreseeable future. I'm Wendy Vapors.
Dr. Clutz: Hmmmm.
Wendy: Are they here?
Dr. Clutz: What makes you think that?
Wendy: They're kidney shaped.
Dr. Clutz: Hmmm. Maybe.
Dale Connelly Reporting Home