I have written about this in three previous blogs, each describing or explaining one or another aspect of outrageously incompetent medical care.
"Why Are Medical Mistakes Our Third Leading Cause of Death?"
"High Tech Medicine Can Be Bad for Your Health"
"We Have Too Many Specialists and Too Few General Practitioners"
In this blog, we benefit from the unique perspectives of Donna Helen Crisp -- a patient-victim who also happens to be a nurse, lawyer, and author of the important book "Anatomy of Medical Errors: The Patient in Room 2."
Donna Helen writes: "The Center for Disease Control (CDC) compiles data on the leading causes of death. Heart disease and cancer are the top two. This list is important because it influences public health priorities, including research and funding allocation.
Unfortunately, medical errors are not on this list even though they would rank at least third. Precise numbers aren't available, and estimates are controversial, but medical errors probably cause the deaths of between 250,000-440,000 patients a year- astounding and terrifying numbers.
Many more patients, like me, survive their medical errors, to suffer untold complications, sometimes for the rest of their lives.
Why are medical errors nowhere on the CDC's list? Because human or system factors are not considered when doctors, coroners, and funeral directors fill out death certificates. They use only categories of disease, morbid condition, and injury for coding.
I know about this because I experienced horrific medical errors and adverse events after entering a hospital for a simple surgery. Instead of going home the next morning, I ended up in a coma in an ICU for weeks -- after my surgeons had unknowingly torn my intestine in two places.
I was slowly dying and no one knew it. Residents were busy writing orders for me to eat breakfast and be discharged. With no one supervising the new doctors or coordinating my care, it took about forty hours before anyone realized how sick I was.
Things got worse in my emergency repair surgery. A student placed a tube incorrectly, causing me to aspirate barium dye into my lungs. In addition to the infection I had from my leaking bowel, I developed new raging infections, including sepsis.
I endured three more surgeries as doctors tried to save my life. After a month, I finally went home, unable to move, with a huge hole in my abdomen, connected to a wound vac draining machine. I had no idea how to put my life back together.
While most people know someone who has suffered with or died from heart disease or cancer, few people realize the risks patients face from injury or death due to medical errors in hospitals. Physicians and hospitals seldom disclose the truth. Patients get worse or die without knowing what went wrong.
It is possible to lower or avoid some risk factors for cancer or heart disease. Alas, there is little a patient can do to prevent medical errors. Patients cannot diagnose themselves, prescribe correct medications, observe their surgery, or coordinate their own care.
It took years for me to learn what went wrong in my specific case. Here are some of what I learned about why things go wrong:
• Corporate profit is often protected at the expense of patient safety.
Health insurance companies are complicit with hospitals, both of which need patients to produce income.
•Training new doctors is often valued more than patient safety. Patients are seldom told the extent to which they will be practiced on by new doctors or fellows. A famous teaching hospital may be the most dangerous place to be a patient.
•When things go wrong in hospitals, silence is the common response. Doctors and surgeons often deny or cover up errors, or pretend they never occurred.
•Patients and families often wrongly believe a tragic outcome is due to bad luck, or fate.
Here are some of my proposed solutions:
•Healthcare systems and insurance companies need to value patient safety more than profit.
•Hospitals and other healthcare facilities need to operate with transparency so errors can be identified, understood, and eliminated.
•Consumers (and providers) of health care need to learn the truth so they can advocate for safety and prevent medical errors and adverse events.
•Hospitals need to provide leadership and training to encourage and support doctors and other staff to be accountable for their actions.
•The public must become aware of the risks they face in medical settings from preventable errors.
•Consumers of health care need to become their own change agents.
Here is what patients can do:
• Ask question about every procedure every step of the way and expect clear answers about risks and benefits.
• Maintain current advance directives -- living will and health care power of attorney. Keep originals and provide copies when entering a health system.
• Ask who will participate in your procedure or surgery. Will students, residents, fellows, or observers be present? If so, what will they be doing to your body?
• The "informed consent" you are required to sign is usually minimal and generic. Much of what you are consenting to is not written on the form or discussed with you. You have the right to add or delete certain items before you sign the consent form, even if a doctor or nurse says otherwise.
• Keep a list of your medications and know the purpose, risks, side effects, and interactions. On average, there is one medication error per patient per day in hospitals.
• Have someone act as your advocate and stay with you at all times, or at least during the day and evening. Staffing shortages are common. Once, I sat in a chair for more than two hours waiting for someone to help me back to bed. It was after midnight and my family had gone home.
• Know the chain of command. If there is a problem, speak with your nurse, the nursing supervisor, the unit manager, the doctor, doctor on call, or the doctor's supervisor. Never assume a new nurse or resident is an authority on your problem.
•If no one can help you, dial zero and ask the hospital operator to connect you with the administrator on call. If this fails, consider dialing "911." I know a nurse who worked at a major medical center. One night, when she could not get anyone to help her patient, she called "911" and it worked."
Thanks, Donna Helen. Hospitals are now competing for patients in all the wrong ways -- trying to be the fanciest hotel, not the safest and best deliverer of care. Instead of spending fortunes on new lobbies and ritzier rooms, hospitals should be doing much more to perfect quality assurance programs that can prevent errors.
Doctors no longer have time to know their patients and instead are often treating lab tests, not people. We need fewer high tech specialists and many more primary care doctors to organize care and ensure it makes sense and is done well.
Health providers must admit mistakes and learn from them. This actually reduces the risk of malpractice suits and results in fewer future mistakes.
Patients and families can't be passive. You really have to become fully informed and fight for safe care. Unfortunately, your basic assumption must be that things will go wrong unless you take some responsibility for monitoring them.
People should become much less afraid of disease and much more afraid of treatments.
To learn more about medical mistakes, everyone should see one of the best movies ever made, the hilarious black comedy, 'The Hospital.'
Allen Frances is a professor emeritus at Duke University and was the chairman of the DSM-IV task force.
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