Sunday, September 24, 2006

Managing medical mistakes: Let the patient beware!

" This is an article I wrote for the Times of India ( 21 Sept 2006). "
Medical errors remain one of healthcare’s pressing little problems. It is estimated that every year approximately 98,000 people die as a result of medical errors in the US. Though no statistics are available for India, the situation is no better, judging from the regularity with which news stories about angry mobs vandalising hospitals and beating up doctors appear in the media.
Clearly, the human and financial cost of medical errors is high. Not only do they take a toll on the patient, they also have hidden effects on the healthcare system. To prevent errors from recurring and to avoid volatile situations, many doctors and hospitals practise defensive medicine. As a result, patients are routinely overtested and overtreated, thus adding to the cost of healthcare.
While the scope for errors is high in operation theatres, intensive care units and emergency rooms, where patients are admitted with complex problems, there are certain other circumstances where errors are common. Such as in hospitals with poor resources—these tend to be illequipped and have overworked doctors; at night when the staff is tired; and when there is inadequate supervision, because there are only junior doctors on duty. In fact, the Institute of Medicine report, To Err Is Human: Building a Safer Health System, which was released in December 1999 in the US, showed that most errors result from faulty systems, not from incompetent providers. To prevent mistakes, hospitals and doctors need to be aware of these settings and be even more careful.
Doctors need to work on developing systems to prevent mishaps. A good example is the use of preprinted forms for post-operative orders, which simply need to be ticked and signed, so important orders are not forgotten. The use of technology can also help in reducing medical errors. For example, the use of electronic medical records will prevent errors due to illegible handwriting. And personal digital assistants can serve as peripheral brains, since they can be equipped with extensive drug and clinical databases.
If a patient dies, a calm-headed analysis is far more productive than giving vent to emotions, but this can only occur if there are systems in place to analyse these errors transparently and openly.
When an error occurs, most of us would like to be informed about it—we expect the doctor to provide an explanation or an apology, and to rectify the error. However, most doctors still react by covering up errors because they are afraid of being beaten up or being sued; and this often makes a bad situation worse. In fact, even in the US, which has such a poisonous litigious climate, there is now a nationwide movement to teach doctors how to apologise for medical errors. Their web site, Sorry Works, at, has many examples of how this approach helps both doctors and patients.
Having said that, a lot lies in the hands of the consumers of healthcare—the patients. You need to become an active partner in your medical care. While any one doctor or nurse can make a mistake, a well-informed patient can prevent such errors by acting as his own last line of defence. This is why it is so important to seek more information. You can learn how to do so at Your doctor may forget and make mistakes, but a well-informed patient will not allow him to do so!

1 comment:

  1. Will electronic recordkeeping really prevent handwriting errors?
    Among the hospitals that call me in to prevent medication errors (by giving handwriting classes to the doctors), a fairly high percentage claim to have "computerized everything" 1 or 2 or 5 or more years ago … yet they still have handwriting problems, because of a crucial 1% to 5% of handwritten documentation that just won't go away.

    Doctors in "totally computerized" hospitals still scribble Post-Its to slap onto the walls of the nurse's station, still scrawl notes on the cuffs of their scrubs during impromptu elevator/corridor conferences with colleagues … and, most of all, doctors with computer systems often have the ward clerks operate the computers, use the Net, or
    whatever: working, of course, from the doctors' illegible handwriting.
    Bad doctor handwriting, incorrectly deciphered by ward clerks using the computer for any purpose, thereby enters the computerized medical record.

    And what happens when disasters knock out a hospital's network? More than one hospital, during Hurricane Katrina, lost its generator, its electric power — and therefore its computer system — for the duration.
    Even the computer-savviest staffers in the disaster zone had to use pens. Let's hope they wrote legibly.

    Kate Gladstone - Handwriting Repair -


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