First the Process, Then the Art of Medicine? The Gruyère Theory

Abstract

I would like to start with a small anecdote to underline the value of the process. During a visit to the American Academy of Orthopedic Surgeons meeting in Washington, myself and my wife brought our 10-year-old son to the hospital due to a terrible pain he was suffering in his left heel. The pain had commenced on the plane journey from France to the USA. And, such was his discomfort that he was unable to sleep the night after our arrival despite medication. In the first 6 hours in the hospital, he was attended by four doctors. He had had an MRI, but it had not provided a definitive diagnosis of a tumour, infection or stress fracture, so a biopsy was planned. We were admitted in preparation for the procedure. As part of the admission process, we were asked all of the same questions again, for a fifth time: name, medical history—every piece of information that had already been recorded on file—date of birth, height, weight… Suddenly, a deep discussion between several doctors ensued. The prescribed doses of medication were totally wrong. The dose of the medication did not correlate with the weight of our son. According to the medical staff, this was a near-miss event, but a severe mistake had thankfully been avoided.