Ottawa Hospital reinforces commitment to patient safety

Daniel Tencer
The Ottawa Citizen

OTTAWA – The Ottawa Hospital Research Institute – the research arm of The Ottawa Hospital and a major partner of the Faculties of Medicine and Health Sciences at the University of Ottawa – has lured Dr. Kaveh Shojania (pictured at right), an expert on the topic of medical error, to the nation's capital.

After medical school in Canada, Dr. Shojania completed his training in internal medicine at Harvard University and a subsequent fellowship at the University of California in San Francisco, where he later took up a faculty position. In 2003, he co-authored Internal Bleeding, a startling book that documents and analyses the medical errors that are sometimes made in North American practice.

Internal Bleeding recently peaked at number 11 on the Amazon.com bestseller list and has consistently maintained a position in the top 10 selling books on health in the US since its release in February 2004.

Despite receiving offers from some of the most prominent institutions in the United States and Canada, Dr. Shojania chose Ottawa. His decision was influenced by the opportunity to work with world-renowned scientists and researchers currently conducting leading research at the OHRI and the University of Ottawa.

He was equally enthusiastic about caring for patients at The Ottawa Hospital, where he will join a healthcare team that is committed to taking a leadership role in patient safety. "The people doing research and identifying patient safety issues are some of the same people delivering bed-side care and developing ways to address those issues," said Dr. Shojania.

Having lived in Canada most of his life and having practiced medicine in the United States for almost ten years, Dr. Shojania said he was also glad to return the Canadian healthcare system. "I don't think people realize how good we have it here," said Dr. Shojania. "I would pick the Canadian system any day – even with the waiting times."

Dr. Shojania will be a scientist in the Clinical Epidemiology Program at the OHRI, an Assistant Professor of Medicine at the University of Ottawa and deliver patient care as an Internal Medicine specialist at The Ottawa Hospital. He will work with OHRI Program Director Dr. Jeremy Grimshaw and colleague, Dr. Alan Forster, to establish a strong patient safety research program that will offer healthcare practitioners an easy and quick resource to the latest and most important evidence on a number of safety issues.

In his own research, Dr. Shojania will focus on diagnostic errors. Though the subject of much informal discussion among physicians and frequently the subject of malpractice suits, diagnostic errors have received little formal study in terms of their frequency and causes.

Building on a paper he published last summer in the Journal of the American Medical Association, Dr. Shojania plans to characterize the type and frequency of major diagnostic errors, and also hopes to collaborate with scientists at OHRI to identify psychological factors and cognitive pitfalls commonly associated with major misdiagnoses.

"You start recognizing certain patterns of thought as consistently implicated in major diagnostic errors," said Dr. Shojania. A common example he provided is the tendency to remain committed to an initial, seemingly obvious diagnosis and failing to take into account other symptoms that could appear slight but taken as a whole, point to an entirely different direction.

"It's like on detective shows – the police say it's suicide or "a robbery gone awry," ignoring one major clue after another, until finally Columbo or whoever proves it was a murder and solves the case. Holding onto an initial misdiagnosis despite one contradictory piece of evidence after another is a hallmark of many missed cancers, heart attacks, and other diagnostic errors leading to malpractice cases. What I'd like to do is identify some of these cognitive traps and develop tools for making doctors more aware of them and the impact they have on their thinking."

"Dr. Shojania is a very welcome addition to our team and comes with very impressive credentials in the field of patient safety research," said Dr. Ron Worton, CEO and Scientific Director of the OHRI. "We expect his research to complement that of Dr. Forster in paving the way to improved patient safety."

"We have taken the series of reports suggesting problems in patient safety throughout North America very seriously and continue to take significant steps to address those concerns," noted Dr. Jack Kitts, the CEO of The Ottawa Hospital. "Dr. Shojania's appointment certainly underscores that commitment. With his arrival, The Ottawa Hospital has taken another step to becoming one of the nation's leading authorities on patient safety."

Dr. Peter Walker, Dean of the Faculty of Medicine at the University of Ottawa, was equally enthused by Dr. Shojania's arrival and his potential. "We are delighted to have Dr. Shojania join our faculty and affirm our belief that through research, the overall quality of patient care will be enhanced, not only in Ottawa, but throughout the world."

copyright The Ottawa Citizen

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