The tragic news yesterday confirmed what we have all been anticipating, ie, that Malaysia Airlines Flight 370 went down in the southern Indian Ocean with 239 people on board. This heartbreaking news for the families and for the world at large brings a small degree of closure to this incredible story. The next several weeks will be devoted to trying to decipher what went wrong.
What is so interesting about this catastrophe is that it has galvanized public attention all around the globe. This story has been front and center of news reports on television, newspapers, magazines and the web since the airplane’s disappearance on March 8, 2014. Experts and analysts have spent weeks seeking answers and 26 countries have participated in the search. Tens of millions of dollars have been spent trying to understand the nature of this tragedy.
There is something about a missing airplane or aviation accident that captures the public’s attention unlike almost any other disaster. People in the patient safety arena often compare the number of people who are harmed or killed by medical errors to the number of people who die in an airplane crash. Experts tell us that at least 300 people die every six hours because of medical mistakes and health care harm. That is the equivalent of four wide-bodied jets crashing every day.
From the time that Malaysia Airlines Flight 370 went down till today, it is estimated that the equivalent of 64 jets would have metaphorically crashed with a loss of life totaling over 19,000 people, all because of health care harm.
This epidemic of death and destruction goes unnoticed. Hospital administrators, nursing home leaders and health care professionals largely remain silent. Thousands of individuals have died over the last two weeks because of medical mistakes, but no one seems to care except close family and friends. There were no headlines. No analysts or experts appeared on the evening news to discuss the reasons behind this tragedy. No one offered solutions on how to solve the problem or even bring it to the attention of policy makers.
One of the reasons that plane crashes make headlines is because they are extremely rare events. The airline industry has gone to great lengths to prevent mistakes and accidents. There are checklists, redundancy procedures and everyone involved in the industry is empowered to detect and report problems. That includes the mechanics, baggage handlers, flight attendants, pilots, air-traffic controllers and anyone else involved in helping get airplanes from point A to point B. Anyone who sees something out of the ordinary is encouraged to share that information up the chain of command and expect to have it acted upon promptly.
Health care is still a highly hierarchical organization. There are providers who do not want to hear concerns from nurses, pharmacists or the people who clean hospital rooms. Peter Pronovost, MD, is an anesthesiologist and patient safety advocate. Several years ago he shared a story with our radio listeners about a surgery he was involved with. From the vital signs of a patient undergoing an operation he realized that something bad was happening. It looked to Dr. Pronovost as if the patient was experiencing a life-threatening allergic reaction, probably as a reaction to exposure to latex surgical gloves. Dr. Pronovost asked the surgeon to change his gloves. The surgeon refused, insisting that it could not be an allergic reaction to latex. He wanted to continue the operation. Pronovost suggested that if the surgeon was wrong, the patient would likely die, but that argument wasn’t working. Finally, Dr. Pronovost asked the scrub nurse to contact the dean of the medical school to intervene. In response, the surgeon pulled off his latex gloves, cursing the anesthesiologist, but ultimately saving the patient’s life.
Far too often health professionals are reluctant to challenge a colleague’s judgment. In a New York Times interview (March 8, 2010), Dr. Pronovost describes his hospital’s old culture (Johns Hopkins has made huge changes since that time):
“As at many hospitals, we had dysfunctional teamwork because of an exceedingly hierarchal culture. When confrontations occurred, the problem was rarely framed in terms of what was best for the patient. It was: ‘I’m right. I’m more senior than you. Don’t tell me what to do.'”
This sort of scenario plays out in other hospitals across the country every day. That is one reason why so many people die as a result of medical mistakes. Health care harm is arguably the leading cause of death in America, ahead of heart disease and cancer. People die from hospital acquired infections, adverse drug reactions and interactions, misdiagnoses and the resulting incorrect treatments, excessive radiation, postoperative complications, lethal blood clots and unnecessary surgery. Because these deaths are mostly unnoticed, they make no headlines. Here are just a few stories from our radio show this past Saturday:
“We had a family member in the hospital and the specialist on staff and the hospital staff disagreed about treatment.
Several major mistakes were made and the family member nearly died. Difference between God and a doctor is God doesn’t think he’s a doctor.” Cheryl
“When Dad had paralysis and tingling in one arm and hand, his doctor said it was nothing to worry about. Four days later Dad had a massive hemorrhagic stroke. When we got to the hospital, we learned that a big stroke is common after people have had warning signs like Dad had with the tingling and paralysis.
“MedEvac flew him from a small hospital to a big one with great urgency, but after he arrived they let him sit all night with nothing done (so the brain damage from the blood increased.) The next morning I said yes to surgery they said was to “only to save his life.” They also told me there was a chance he could return to normal. Little did I know how slim a chance that was.
“His survival led to great suffering and numerous indignities and mistakes by the hospital. Later, at one of the (horrid) nursing homes they sent Dad for ‘rehab’ management, Dad was put next to a man with respiratory MRSA, and he caught it.
“Dad died 9 months after his stroke as a result of aspiration pneumonia. The hospital had insisted on putting in a feeding tube. Thank you for bringing this to the public’s attention.” L.T.
“Several months ago I was hospitalized for several days and noticed a number of lapses among the nursing staff, some of which seemed to me that might have had serious consequences. When I later reported these to my doctor (whose practice is affiliated with the hospital but who was not involved in my hospital care) he said that there was absolutely nothing he could do about that, that nursing was the hospital’s responsibility, not his. That really surprised me. When I was growing up doctors were the absolute masters of everybody and everything involved in hospital care. I had thought that doctors would be interested in the care their patients received. When did that change?” Anonymous
“It’s absolutely true. My friend (a specialist, who I also see as a patient), about 6 months ago went with his wife to the ER. He had pain in his abdomen, in the area of his appendix. He told the attending physician that appendicitis ran in his family, and that he was pretty sure that was his problem, and that he himself was an MD. The attending physician insisted it was his gallbladder.
“My friend asked that the physician perform some test (don’t remember name), to confirm the gallbladder diagnosis. The next thing my friend knew, he was waking up from surgery, and his gallbladder had been removed. Later tests confirmed his gallbladder was completely normal.
“My friend was sent home. Some time in the next week, his appendix burst. Now he had to go back to the ER to have a second operation (the right one, but far more serious now). He almost died, and in addition to having his appendix removed, had to have portions of his intestine removed, due to the now more serious situation.
“Luckily for my friend, he is now alive and well. If this can happen to an MD, what hope do you and I have? Yikes!” Eliot
The reason we wrote the book, Top Screwups Doctors Make and How to Avoid Them, was precisely because of these medical mistakes. To our surprise and disappointment, the book has pretty much disappeared without a trace. Doctors have mostly ignored it along with hospital administrators, policy makers and people who presumably care about patient safety.
Here are just a few tips from that book that you might find helpful in your interactions with the healthcare system:
Top 10 Tips to Stopping Screwups in Hospitals (page 22)
- Expect mistakes.
- Be assertive.
- Say no!
- Track transitions.
- Call “Condition H” (Help).
- Deal with discharge.
- Cultivate communication.
- Double-check everything.
- Take a friend or family member.
Top 10 Diagnostic Screwups (page 44)
- Pulmonary embolism (blood clot in lungs)
- Drug reaction or overdose
- Lung cancer
- Colorectal cancer
- Acute coronary syndrome (including heart attack)
- Breast cancer
- Congestive heart failure
- Fractures, various types
Top 10 Reasons Why Doctors Screw Up Diagnoses (page 46)
- Information overload
- Going it alone
- Tunnel vision
- Time pressure
- Missing test results
- Ignoring drug side effects
- Follow-up failure
- Hurried hand-offs
- Communication breakdown
Top 10 Questions to Reduce Diagnostic Disasters (page 69)
- What are my primary concerns and symptoms?
- How confident are you about this diagnosis?
- What further tests might be helpful to improve your confi dence?
- Will the test(s) you are proposing change the treatment plan in any way?
- Are there any findings or symptoms that don’t fit your diagnosis or that contradict it?
- What else could it be?
- Can you facilitate a second opinion by providing me my medical records?
- When should I expect to see my test results? Will you call with them, or will they come by mail or electronically?
- What resources can you recommend for me to learn more about my diagnosis?
- May I contact you by e-mail if my symptoms change or if I have an important question? If so, what is your e-mail address?
Questions to Ask Your Doctor Before Agreeing to Surgery (page 177)
- What exactly will be done?
- Why has it been recommended?
- What are the alternatives?
- What kind of anesthesia will be used?
- What are the pros and cons of the procedure?
- What are the pros and cons of the anesthesia?
- What would happen if I opt out of the procedure?
- What is the name of the doctor or surgeon who will be doing the procedure?
- Who will be administering the anesthesia?
- Will there be any other medical staff or learners present?
- What will they be doing?
- What are the pros and cons of any medication I will be given?
- Are there any symptoms that are so serious they require immediate action?
If you would like more details about these questions and how to protect yourself and those you love from medical mistakes, here is a link to Top Screwups.
Let’s learn something from the airline industry and put into place our own checklists and protective strategies so that we can reduce the epidemic of health care harm that is overwhelming this country. Share your own story below.