Posts Tagged 'medical errors'

Doctors Protect Colleagues at Patient Expense

One of the questions I am asked frequently is about the best way to find the right doctor for a second opinion. That question — and its answer — have become among the most important answers I’ve ever provided, ever since the proof of my answer was provided in the results of a study last week by the Institute of Medicine as a Profession (IMAP.)

How many times have you heard that advice — get a second opinion! It’s important to do so if you will ever need any type of difficult or invasive treatment for your medical problem. Long term drugs, drugs with difficult side effects, any type of surgical procedure or any procedure which will have a long term effect on you — yes — you need a second opinion.

Why? Two reasons. First, to make sure your diagnosis is correct. Second, to make sure you know about all the treatment options, have someone to discuss them with, and can then choose the one you have the most confidence in according to your own goals for the treatment.

The advice I give? Never ever ever see a second opinion doctor who has any relationship to the first opinion doctor. Don’t see a second doctor from the same practice, from the same building, from the same hospital, from the same country club, from the same neighborhood, from the same bowling league — you get the idea. The idea is that they can’t be friends or close colleagues.

Why? Because two friends won’t contradict each other. Your number two will rarely give you different answers from your number one doctor if they know each other and respect each other. Knowing that, then you also understand that your number two won’t be as objective as necessary and if you need anything at all when you are being diagnosed and decisions are being made for treatment, then you know you need objectivity!

The study done by IMAP proves this point. Without going into all the details, the bottom line is that too many doctors talk out of both sides of their mouths. While, on the one hand, 98 percent of them say that medical errors should most definitely be reported, 46 percent said they had witnessed an error and had not reported it.

Why didn’t they report those errors?  Because they were committed by a friend, or close colleague, or a business partner or even just the guy down the hall.

Hmmm… a major ethical disconnect if you ask me.

You’ve seen me type it before: trust, but verify. A second opinion is absolutely necessary. We want to believe that our doctors are not the ones who do these unethical, and possibly dangerous things. But it turns out that about half talk out of both sides of their mouths. That means if you have seen two doctors, then one of them fit that unethical profile. If you’ve seen 10 doctors, then five of them do.

A second opinion from someone with no relationship to your first opinion doctor may be lifesaving in its objectivity.

Read more, and get more details on my About.com blog.

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When Dirty Doctors Can’t Be Identified

As promised in yesterday’s post, I’m reporting today on a frustration among those of us who work in patient safety.

That frustration is once again sparked in this report from the Hartford Courant. Fifteen year old Mark Tsvok, injured in an auto accident in 2004, died from his injuries as a result of the misdeeds of Dr. Daniel H. Hechtman who made one misstep after the next in his treatment (or lack thereof) of the teenager.

After a series of investigations and hearings, Dr. Hechtman lost his license to practice anywhere in the state of Connecticut.

So what did he do?

Find the rest of this post at its new location:

http://www.trishatorrey.com/2007/10/17/when-dirty-doctors-cant-be-identified/

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How Apologies Lead to Fixing

I’ve talked before about blamers and fixers. Here’s a way of looking at that concept that may make you a wiser patient.

One of the big questions about medical mistakes is whether practitioners should own up to them. Until recently, doctors were highly discouraged from admitting any kinds of problems had taken place, whether it was prescribing the wrong medications or amputating the wrong limb. The thought was that by admitting guilt, they would be setting themselves up for losing lawsuits.

Once again — the concept of blame creates problems. The fix is what might seem surprising.

Studies have shown that in fact, when doctors are willing to accept responsibility enough to apologize, and review and learn from their mistakes, malpractice lawsuits are far less likely to be filed. In fact, a study undertaken at the University of Michigan Hospital where they have a policy of disclosure for both errors and near-misses, reflected a two-thirds reduction in medical malpractice claims, according to All Things Considered on NPR.

Clearly — taking responsibility can even save money!

What no one I know about has yet examined is this: why does that happen? Why can something as simple as a doctor’s apology keep a patient from filing a lawsuit?

Here’s my guess at the reason:

When young children misbehave, they are blamed for the problem they caused, then taught by their parents to apologize. The apologizing itself is deemed a way to begin the “getting beyond” whatever their indiscretion was, both for the misbehaver and for whomever the victim was. Also, as children, when someone hurts us or does something we know was wrong against us, we are taught to learn to accept an apology as the first step toward forgiveness. That’s how we learn the beginnings of closure, and we learn to depend on closure as the way to get over whatever happened.

Later, when something bad happens to us that we have no control over, we human beings want to blame. It gives us something to focus on. We blame the terrorists for 9/11. We blame the government for Katrina problems. We blame faulty design for the Challenger blowing up. Sometimes we even blame God, or whomever we revere, when something horrible happens that we can’t point any other finger at.

Often, that finger-pointing blame is appropriate. Who or whatever we blame deserves it, and what we want is for the object of our blame to then feel appropriately guilty — and therefore to apologize. The acceptance of that guilt is what lets us begin the closure process. Any healing that may take place will be based on that closure.

The Institute of Medicine tells us up to 98,000 Americans are killed by medical errors or misdiagnosis each year — which means 98,000 doctors deserve the blame. When those 98,000 doctors were told they were not allowed to apologize, then families of the victims had no way to begin their closure process by accepting an apology and starting to forgive. They needed to find closure in some other way. So they filed lawsuits.

That the number of malpractice lawsuits were reduced to one-third of previous levels because doctors are allowed to apologize, should therefore come as no surprise. In fact, in the NPR story used to illustrate the point, not only did the victim of the medical error feel relieved that she had been apologized to, but she further stated that she felt as if they had listened to her, and had learned from the mistake made on her, so that another woman wouldn’t suffer later from the same mistake.  She no longer felt like a victim.  In fact she felt like she had inspired something very positive.

The NPR story said that up to 70 percent of hospitals are now leaning in the direction of disclosure and apologies. That’s excellent. I hope to hear soon that 100% of hospitals are buying in.

And what can patients do in the meantime?

In my opinion, we can measure how patient-centered a hospital is by examining its policy about error disclosure. If they support disclosure, and allow their doctors to apologize and learn from errors, then they are far more likely to be interested in outcomes for patients than those hospitals that don’t support this sort of transparency.

So, taking this idea another step: as patients, if we think we may need to be hospitalized in the near future, we can actually use this information to our advantage. Call the hospital and ask what their policy is. Ask a doctor who has an affiliation at that hospital what their policy is.

Are they forthcoming and pro-learning? Or are they offended that you asked the question so they dance around the answer?

See what they respond, and how they respond. Tune in to their attitude. It can tell you a lot. And that might make a huge difference in your hospital experience.

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Learn more about doctor’s apologies here.

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Newsweek’s My Turn: What About the Patient?

Last week, Newsweek’s My Turn featured an essay by Dr. Richard Karl. Newsweek called it “Good Doctors Spot Mistakes, Save Lives”… a lousy headline for a well-meaning essay, even if the essay needs a postscript.

(I’ve provided that postscript below.)

Dr. Karl, a surgeon, describes the frustration of trying to track down a sponge which he fears he has left inside his patient. He uses this example to cite one of the many ways physicians, and the medical system in general, harm patients — 15 million of them per year, by count of the Institute of Heathcare Improvement.

He then provides the reasons he thinks this phenomenon has gotten so out of control, from too much innovation to development of too many new drugs and treatment techniques to patients demanding to be a part of their own care decisions.

He’s right. The world has changed.

But the real measure of this man is in his bottom line, where he states, “Most everybody I know in medicine is bright, hardworking and altruistic. Many, though, have been beaten down by hundreds of urgent pages, middle-of-the-night phone calls, decreasing reimbursement, more paperwork and less grateful patients. These doctors have become less careful, and their patients suffer as a result.

It is time for my colleagues and me to reclaim our profession. It is time for doctors and nurses to work together, time for electronic records to actually work in providing the right information to the right person, time for pharmacists and nurses and social workers and doctors to see patients together.”

I hear you Dr. Karl, and I can see that you are trying to shift your thought process from being a blamer to being a fixer. I appreciate that.

But here’s the postscript: in your description of who needs to work together on the “healing together” team, you’ve missed the one person who is, arguably, the most important participant of all: The patient!

Patients: you’ll understand the need to take responsibility by understanding the constraints your providers operate under (as described by Dr. Karl) — it only makes sense for you to be an active participant in your care decisions.

Doctors: if you embrace the empowered, informed patient as a part of the healing team, you’ll find that everyone will benefit. And that, after all, is why you became a doctor.

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