Patient Safety Blog

Christina Laun at RN Central has made a helpful list: 25 Tips to Help Protect Yourself from Medical Errors.

Reading the entire list is a good idea. But many of the items on the list can be boiled down to two principles: 1) be an active participant, and 2) don't be afraid to seem entitled or pushy in demanding knowledge of what is going on. Don't be afraid you're annoying your doctor by asking questions, for instance. Speak to every member of your surgery team and make sure they know what they're doing--do not simply trust, and remember that there is no reason to feel ashamed or embarrassed about asking questions.

Furthermore, bring family or friends to support you, if you can. If you're ill, you may not be able to do the things on the list yourself. Having someone to ask the questions you don't think of and notice the things that you don't notice is an invaluable asset.

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Posted In: Medical Error

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Vesna Jaksic has an interesting article on Law.com on potential problems with binding arbitration agreements between doctors and patients, wherein patients sign away their right to a jury trial.

From the article:

Binding arbitration agreements between doctors and patients -- in which patients waive their right to a jury trial -- are becoming more common, a trend that could put patients at a disadvantage if medical malpractice disputes surface, attorneys warn.

A growing number of physicians, nursing homes and health care institutions are asking consumers to sign these agreements before offering services, said Stuart Ratzan of Miami's Ratzan & Rubio.

Some states have passed or are trying to pass legislation that would limit how these agreements are used. For instance, an act waiting for congressional approval in Washington D.C. would require (among other things) that the costs associated with arbitration be disclosed in the arbitration agreement. This is important because the patient must pay for arbitrators to do their job, whereas they do not have to pay for judges and juries.

It would be particularly disturbing if these agreements became common enough that people cannot get medical care without signing one.

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Tara Parker-Pope has an interesting interview with Dr. Gary Brandeland about how doctors deal with medical mistakes. Dr. Brandeland's obstetrical patient died due to someone else's error, but Dr. Brandeland still suffered from guilt over it. In addition to the interview with Ms. Parker-Pope, he has an essay describing the incident.

One of Dr. Brandeland's insightful comments is that mistakes tend to be more systemic than individual: nursing shortages and hospitals cutting back on staff to cut costs are factors that lead to overworked or confused nurses, which in turn lead to medical errors.

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A depressed medical resident is six times more likely to make a medication error than one who is not depressed, according to a new study published in the British Medical Journal.

The study's findings are not absolutely conclusive, as the authors note. But the common problem of medication errors is often correctly attributed to the brutal schedule imposed on most medical residents. The authors advocate further study of doctors' working conditions with an eye to improving them.

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Doctors are unwilling to report colleagues for making medical mistakes, as we have discussed before. A new study from the University of Iowa shows that a significant number do not report their own, either, even though they believe they should.

Lauris Kaldijan, lead researcher for the study, had this to say about it:

Kaldjian said in an interview that he was encouraged that most of the doctors believed reporting errors was an important way to improve health care quality. But he said he was troubled by the fact that fewer than half of them would have reported the hypothetical error if it didn't cause problems. He said doctors and other medical workers should take their cue from the airline industry, which encourages pilots to report every error so it can be analyzed for possible systemic flaws.

As the linked article notes, there are several positive aspects to this study. For instance, awareness of the problems caused by medical error has increased, and belief that errors should be reported is strong.

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Out of nineteen industrialized nations, the U.S. has the most deaths that could have been prevented by access to timely, effective medical care.

Ellen Nolte and Martin McKee of the London School of Hygiene and Tropical Medicine performed the study, looking at deaths before the age of seventy-five caused by numerous diseases and complications. They found that France performed the best by this measure--though France, and other countries that ranked higher than the U.S., spends less money on health care than the U.S. does.

Not only was the U.S. the worst in these rankings, but we Americans are also ranked four places lower than we were in the last study (which covered 1997 and 1998). We are getting worse and spending more money.

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Posted In: General , Medical Error , Medications , Standard of Care--Hospitals , Surgery

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Guilt, fear, and further isolation plague families of victims of medical error, says the New England Journal of Medicine.

Why guilt? Because families feel like they should have kept a closer watch on their loved one, and regret the trust they placed in the health care institution or its workers. This guilt persists even if the family took reasonable precautions--for instance, the authors of the article discuss a case where a patient was given morphine and died of kidney failure despite the fact that his family repeatedly told doctors and nurses that he had sickle cell anemia. The family often feels inadequate for being unable to watch the patient twenty-four hours a day.

They also feel fear: fear of retribution, fear that health care workers will neglect or compromise their loved one's care if they make some sort of formal complaint. This is particularly true of people in disadvantaged and disempowered sections of society.

Their emotional turmoil is often compounded by the reactions of the health care workers, who will often isolate the patient's family after realizing their error. This leads to further pain and may even lead to further medical mistakes:

Guilt persists in the daughter of a woman who died after a series of errors culminating in a missed case of pneumonia. Although the daughter is a nurse, she could not gain entry into her mother's circle of clinicians, who closed ranks after the errors occurred. "The nurses were ruder to me than you can ever imagine, and the doctors wouldn't tell me anything," she said. "They looked at me like I was a dumb little girl. I became so addled that I couldn't act decisively and get her out of there to another hospital. I'll never get over my guilt."

This isolation comes at a time when, as the authors point out, patients most need someone to communicate with them on a personal and human level. They suggest that honest, direct communication--without condescension, buck-passing or hedging around to avoid lawsuits--is the best way to keep the patient safe as well as feeling satisfied with the care he or she has received.

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Posted In: Communication , Medical Error

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A new study shows that although an overwhelming majority of doctors believe they should report colleagues who make serious medical errors or otherwise violate professional standards, most do not actually do so.

This hesitance to report colleagues is understandable. But it makes detecting, tracking and studying medical error very difficult.

The senior author of the study, Dr. David Blumenthal, says that he is optimistic because most doctors support existing standards and the lack of report is not due to disagreement over ethical obligations. He also notes that doctors who practice in groups of three or more are more likely to report than other doctors.

Another interesting result of the study is that one-third of doctors admit that they would order an unnecessary MRI. Given the costs and the possible side-effects of unnecessary testing, this fact may have consequences.

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Rhode Island Hospital has, for the third time this year, done a brain surgery on the wrong side of the patient's head.

The hospital has been fined $50,000 and has received a reprimand from the state Department of Health. In this most recent instance, the patient was 82 years old. Fortunately, the patient was unhurt by the mistake. However, in one of the previous instances of this mistake at this hospital, the patient died as a result.

Rhode Island Hospital has said that it will be conducting a review of its procedures and implementing reforms. One such reform would be to allow nurses greater power in ensuring that procedures are followed correctly. Another would be to mandate better verification of surgery plans, which would require better communication between surgeons and other doctors. These reforms highlight a major factor in averting medical errors: teamwork. The multiple healthcare professionals involved in taking care of a patient need to be empowered to speak up if they see something going wrong. They also need to know what the others are doing, and to make sure that they are not acting contrary to the recommendations and instructions of other healthcare providers. Performing a surgery on the wrong side of the head is only one possible thing that could go wrong in the absence of communication. Another example would be giving a patient medications that, combined with medicine the patient is already taking, could cause problems. Such errors can be minimized through proper communication between healthcare professionals.

For more information: When Surgeons Cut the Wrong Body Part

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Posted In: Medical Error , Standard of Care--Hospitals , Surgery

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Imagine having to go to the hospital tomorrow for a procedure that the doctors tell you is simple and practically risk-free. You’re not worried. Your loved ones are not worried.

The trouble is, the procedure ends up killing you. Through some mistake or miscommunication or broken link in the healthcare system, you die while receiving what ought to be a low-risk medical treatment.

This scenario is not nearly as uncommon as it should be. However, there is a rising tide of activism and reform coming from those who suffer such incidents. Consumers Advancing Patient Safety (CAPS) is one of the many groups involved in such work. Among their other activities, they invite those who have suffered through breakdowns in the healthcare system to share their stories with CAPS so they can reach a wider audience and help each other to understand that what happened to them was not a fluke but an indication of systemic flaws.

The most recent such story CAPS has published is an interview with Helen Haskell, who in 2000 lost her 15-year-old son Lewis Blackman to a medical error caused by an inappropriate medication given during a relatively routine surgery.

The chief point to take away from Helen Haskell’s story is that there are multiple levels of doctors in a hospital. Lewis was mostly treated by residents, who are fully trained doctors in the sense that they have graduated from medical school, but are still considered in training for whatever specialty they have chosen. Care by residents is standard and safe—but when Helen wanted to speak to a more senior doctor, she was unable to do so. Hospital bureaucracy can get in the way of patients getting the information they need. In addition, patients can often get confused about who is treating them and at what level of training that person is: is he or she a nurse, or a medical student, or a resident, or an intern, or a fellow? It is not always easy to tell.

Another key point is the concept of “rapid response teams” that can be called in if a patient or family member believes that something seriously wrong is happening. Helen Haskell believes such a team would certainly have saved her son’s life. In any case, it would give patients recourse if their concerns are ignored.

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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.

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