Two are better than one

There's an old saying that "Two are better than one."  Did you know that the saying actually comes from the Bible (see Ecclesiastes 4:9-12)?  I actually didn't - here's the passage:


Two are better than one,
because they have a good return for their labor:
If either of them falls down,
one can help the other up.

Anyway, last time (see "It pays to be nice...") I talked a little about a legal doctrine known as the Captain of the ship doctrine.  Basically, this doctrine held that during a surgical procedure, the surgeon of record was liable for all actions conducted in the course of the operation.  In other words, the surgeon was legally accountable for the actions of the nursing staff and anesthesiologist.  The doctrine first became a legal statute in the case of McConnel v. Williams in 1949, when the Supreme Court of Pennsylvania ruled that, "It can readily be understood that in the course of an operation in the operating room of a hospital, and until the surgeon leaves that room at the conclusion of the operation...he is in the same complete charge of those who are present and assisting him as in the captain of a ship over all on board."  The doctrine was frequently used in the 1950's, but has finally started to fall out of favor (see "Captain of the ship doctrine continues to take on water").  The phrase, unfortunately, is still used today.


Okay.  Why shouldn't the surgeon be liable for the actions of others in the operating room?  I made a point last time that medicine has become a team science.  Our patients have become so complex that the responsibility for any one patient's care shouldn't fall upon one individual's shoulders.  We have made substantial progress in improving safety by taking the individual out of the equation and focusing on system-level issues.  Similarly, we have made substantial improvements in outcomes when we focus on training teams to provide care at the bedside, not just one physician or one nurse.  We work better as a team, and our patients are better for it.


As it turns out, there is solid evidence to back up that "two heads are better than one."  We do work better as a team, and our patients are better for it.  And now there's proof.  Check out a recent study called "Comparative accuracy of diagnosis by collective intelligence of multiple physicians vs individual physicians."  It's a great study that shows that teams of physicians make more accurate diagnoses compared to individual physicians.  Over 2,000 physicians worked on more than 1,500 individual medical cases.  Physicians worked alone or in groups of 2-9 individuals.  The diagnostic accuracy for individual physicians was 62.5% - in other words, physicians made the right diagnosis in slightly over half of the cases.  The diagnostic accuracy significantly improved as the number of physicians working together increased.  The best performance occurred with groups of 9 physicians working together, at which point diagnostic accuracy had improved to 86%. 


It's probably not realistic to expect nine physicians to work on every single medical case.  Such a scenario would be highly inefficient and could lead to problems with communication, collaboration, and coordination of care at the bedside.  Regardless, as it turns out, two heads are definitely better than one. We should definitely keep that in mind when we think about anachronistic doctrines, such as "the captain of the ship."  The captain should never be alone, and thankfully, in most cases at the bedside today, she or he is not.