Patient Safety Blog

The overwhelming majority of hospitals will not admit mistakes to patients if there is little chance of patients finding out, and may not even discuss the mistakes after the patients do find out. Of course, hospitals do this to fend off the threat of lawsuits.

Yet Dr. Steven Kramm, former chief of staff at the VA hospital in Lexington, Kentucky, argues that the opposite approach might be best from everybody's perspective. A PowerPoint file of Dr. Kramm's report entitled "Victim Compensation Without Litigation--the Lexington Experience" can be found on the SorryWorks website. To find it, scroll down and click on the link that says "Download."

Some of the key points of Dr. Kramm's assessment:

-As mentioned above, most hospitals say nothing to patients if something has gone wrong. If the patient does know and wants compensation, the hospital takes the same action regardless of whether it is at fault or not. That action often involves cutting off all contact with the patient; even where this is not the case, the patient is usually kept at a distance and given little information. (Slides 3-4)

-From 1987 onwards, the Lexington VA took the opposite approach and offered full disclosure even when the patient did not know anything had gone wrong.

-The process involved practitioners and administrators identifying cases where compensation might be justified, discussing the possibility of disclosure in those cases together, and finally making the disclosure to the patient with a presentation of compensation options. The hospital would also suggest that the patient might retain an attorney, as this would prevent the patient from having "buyer's remorse" or feeling cheated. (Slides 9-11)

-The result was that, from 1987 to 2003, the single largest payment made by the Lexington VA was $341, 000 for a wrongful death case and the average settlement was $16,000. They negotiated over 170 settlements and took only three cases to trial, out of which they lost two and won one. (Slide 15)

-By contrast, the mean malpractice judgment for VAs across the nation in 2000 was $413,000, the mean pre-trial settlement was $98,000 and the mean at-trial settlement $248,165.

-The overall mean payment for Lexington (regardless of whether the case was settled or went to trial) was $36,000 as of 2000.

Clearly, Lexington comes out as the financial winner, in addition to having a policy that gives more consideration to accountability and sympathy.

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Disclosure

Bookmark:

The President's Cancer Panel--consisting of Lance Armstrong, Dr. Margaret Kripke and Dr. LaSalle D. Leffall--says, in its new report, that the U.S. government should be doing more to promote environments and lifestyles that prevent cancer and other diseases.

Part of the report's argument is that most federal funding for cancer research goes towards genetic and microbiological solutions, and that macro-solutions involving environmental and social factors are neglected. This is part of a general problem in the philosophy of health care in the U.S., the report says: we are overly focused on treatment rather than prevention.

Of course treatments are important, but the report is right in its criticism of the neglect of the concept of a healthy lifestyle in U.S. health care. Making such lifestyles possible would require social changes as well as personal changes--which may be one reason why the government and our society finds it more convenient to focus on treatment, as treatment will not require systemic overhaul of society. It is more tempting to try and simply patch people up with treatments rather than take the time and effort to ensure that fewer people get sick in the first place.

Here are some examples of environmental and social factors that the report considers responsible for poor American health: lack of fresh food access, lack of access to healthy food in general (for those in poorer socioeconomic conditions), large subsidies to producers of corn and so which are processed into foods that contribute to various diseases, lack of opportunity to exercise and lack of health insurance.

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Cancer , General

Bookmark:

Patients often want to know what they can do for themselves to prevent medical errors. Often they feel helpless, ignorant and confused when they are seeking health care.

Thanks in part to the Internet, there are now sources that remedy this situation by providing information and helpful suggestions. Many of these various suggestions boil down to certain basic principles.

One crucial thing is to make sure each of your healthcare providers knows what you've told the other ones and what they are doing to you. Your primary care physician should know what you've told your specialists and what those specialists are prescribing for you. Each specialist should know what every other specialist is prescribing for you, and the reasons for this, and what your state of health is in general. This way, the doctor prescribing something for your leg won't accidentally give you something that could harm your heart or that you might be allergic to.

Another important general principle to keep in mind is not to be afraid to ask questions. Ask about what exactly your medications will do, if there are any alternative treatments, if there are any side effects, or about anything else that strikes you as important to know. Ask if anything confuses you about how long you should be taking a certain medication, or how often, or what activities might or might not be acceptable while you are taking it.

Do not worry about annoying your doctor or sounding stupid. Your doctor is there to look after your health and to help you understand what you should be doing, not simply to give you orders. Asking questions becomes doubly important when you are staying in a hospital. Do not hesitate to question nurses and other caregivers about what exactly is happening with regards to your care.

Another good thing to do is take advantage of all the information that is available to you in books, in magazines and on the Internet. Through these sources you can find expert answers to many questions--though these do not substitute for the attention of a medical professional.

Other places to find information on this: The Family Doctor, Medical Errors: Tips to Help Prevent Them.

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Medical Error

Bookmark:

Infections contracted in hospitals can be a serious threat to patients' health. The CDC estimates that roughly two million patients per year develop infections in hospitals, out of which approximately 90,000 per year die. The Consumers' Union discusses how many states have adopted laws requiring hospitals to disclose rates of patient infection, and how more states are considering such measures.

Disclosing infection rates will hopefully lead to better patient safety and stronger compliance with prevention protocols. It is a good idea for people to remain aware of the infection rates at local hospitals.

Thankfully, some hospitals are beginning to fight the problem more aggressively. Although many people who work in large U.S. hospitals view infections as either a non-issue or as inevitable, hospitals are beginning to take more severe measures to curb them.

As described in the July 27th, 2007 issue of the New York TImes, three state legislatures have passed bills requiring hospitals to routinely test high-risk patients. The article also notes that that CDC projections estimate that one out of 22 patients would become infected while hospitalized, and that some European countries have had success in aggressively fighting infections.

This is a late response to a problem that has existed for a long time, as an earlier Times article documented on the Veterans Affairs website indicates.

Infection is often caused by carelessness about hygiene, and can lead to tragedy—for instance, the article refers to a woman who lost her mother because of an infection that was probably contracted because a caregiver had unwashed hands. Patients ought to be aware of this issue. If possible, it is a good idea to seek out hospitals where some anti-infection measures are taken.

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Standard of Care--Hospitals

Bookmark:

A diagnosis of cancer puts a patient in an extremely frightening and vulnerable position. Unfortunately, there is often little aid for people in this situation. Instead, they are presented with bureaucratic hurdles and confusion about whose advice to follow.

For an example, one could look at the July 29th, 2007 New York Times Magazine section which had an article describing the story of one such cancer patient named Karen Pasqualetto.

There are several insights that can be gleaned from such experiences. First, there is the need for patients to seek second and third opinions—a need that usually goes unfulfilled because most people do not have the insurance or financial resources to cover this.

Second, patients need to educate themselves on standards of care, because otherwise they probably will not be getting it—particularly if they are not white or are low-income. See the National Healthcare Disparities Report from 2005 for disparities related to race and socioeconomic status. The ScienceDaily also has an article about racial bias resulting in poorer treatment for African-American patients.

Third, there are enormous advantages to having a team of doctors who speak to each other rather than a bunch of disconnected specialists who offer competing and contradictory advice. Patients should encourage communication between doctors as much as possible.

Fourth, visiting centers for the study of particular kinds of cancer can be extremely helpful, especially when dealing with the more obscure varieties of the disease. These centers have the aid and cooperation of several doctors, so the opinions given there are more likely to reflect a consensus of experts.

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Cancer , General

Bookmark:

The ScienceDaily pointed out recently that illiterate patients are at a serious disadvantage when it comes to getting proper healthcare, even to the point of having a higher mortality rate than literate patients. Another good discussion of the topic can be found in a July 24th, 2007 essay in the New York Times Health Section on illiteracy and the healthcare system by a Dr. Erin Marcus. As the ScienceDaily article and Dr. Marcus make clear, lliterate and semiliterate patients face many grave problems when confronted with the healthcare bureaucracy.

Dr. Marcus points out that health educators recommend that patients be given materials at an eighth-grade reading level or lower—but most consent forms and HIPAA forms and other such documents are at a much higher reading level. This has obvious, and negative, consequences for patients and can be a reason for patient “noncompliance” with doctors’ recommendations.

Patients with low literacy levels should, if possible, seek out doctors they trust to explain these materials to them and should not hesitate to ask for clarification.

The people with the real power to change this, however, are not the patients. Rather, it is the healthcare administrators who can arrange for patients to be given accessible information in accordance with the advice of health educators.

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Accessibility of Healthcare

Bookmark: