close up of three doctors faces wearing surgical scrubs and masks

Medical errors are a leading cause of death and disability. Some patient safety experts estimate that between 250,000 and 400,000 people die annually because of medical mistakes (BMJ, May, 2016; Journal of Patient Safety, Sept. 2013). Dr. Martin Makary and his colleague, authors of the BMJ study, suggest that medical mistakes are the third leading cause of death in the U.S. If you ask a slightly different question, you get an even more alarming assessment. How many treatment-attributable (iatrogenic) deaths are there each year? According to our own calculations, that number could be over 700,000. That makes health care harms the leading cause of death in America. There are ways to reduce harmful medical errors. Will they be adopted?

Reduce Harmful Medical Errors by 40%

One way to reduce such errors is by improving communication between health professionals, patients and their families. That is the conclusion of a study involving over 3,000 pediatric patients admitted to seven North American hospitals (BMJ, Dec. 5, 2018).

The team adopted an extraordinary communication system they called “family centered rounds.” It differs dramatically from the usual hospital experience.

The Old Way of Communicating:

If you have ever been hospitalized, you know that a team of health professionals often shows up at your bedside early in the morning. It may be comprised of an attending physician, a resident or two, medical students and possibly a nurse. They analyze your situation, make some recommendations if necessary and hustle out as fast as possible to manage their huge workload.

During this brief interaction, it is not unusual for family members to be absent from the room. This is especially true if it is very early in the morning. Doctors often use medical jargon and speed through the process. If there is time to ask questions, you may not understand everything they say or grasp the implications. Rarely do health professionals take the time to get your feedback to see if you really understood their messages.

A New Way of Communicating!

In this study, the health professionals worked together as a team. Here is how they described the process:

“Families, nurses, and physicians coproduced an intervention to standardize healthcare provider-family communication on ward rounds (‘family centered rounds’), which included structured, high reliability communication on bedside rounds emphasizing health literacy, family engagement, and bidirectional communication…”

Put another way, the new system required physicians and nurses to involve families and patients in rounds. Medical jargon was minimized, and families were encouraged to ask questions and share their concerns.

What we love about the new system:

  • “Family speaks first, shares questions and concerns first on rounds”
  • Doctors and nurses “use plain language, eg. fever, not febrile”
  • “Illness severity (family reports if child was better, worse, or same); nurse input solicited”
  • “Situation awareness and contingency planning (what family and staff should look out for and what might happen)”

And here’s the really important piece:

At the end of the interaction the families were supposed to verify that they had heard and understood what was said. The researchers called this “synthesis by receiver” (“family reads back key points of plan for the day prompted by presenter, supported by nurse as needed”). We call this “teach back.”

“Teach Back” to Reduce Harmful Medical Errors!

When pilots communicate with air traffic controllers, they always verify what they think they heard. That way they make sure there have been no miscommunications. When this is employed in health care we call it “teach back.”

We encourage patients to tell their stories to health care professionals whether during an office visit or in the hospital. Physicians and nurses need to know exactly how you are feeling. Then comes the important part. They need to teach back to you what they heard so you can verify that they got it right.

The same thing is true for patients and families. When the doctors and nurses get done telling their piece, families need to teach back what they think they heard. When everyone agrees, then the communication has been successful.

The Results of Family Centered Rounds:

The BMJ study revealed that family centered rounds helped reduce harmful medical errors. By adopting this system the hospitals were able to diminish serious medical errors by 38 percent.

Here, in their own words, are the conclusions of the researchers:

“The improvements in harmful errors occurred without a statistically significant increase in duration of rounds or decrease in the amount of teaching on rounds. Additionally, our intervention was associated with improvements in key communication behaviors, family and nurse engagement on rounds, and several measures of family experience. Our findings suggest that implementing a standardized, structured programme to improve communication with patients, families, and the interprofessional team on rounds could improve patient safety and other outcomes.”

People’s Pharmacy Perspective:

We are thrilled with this study. It is innovative and cost effective. Most important, it could improve patients’ health.

Changing medical culture is challenging, though. Getting doctors and hospitals to make these kinds of changes requires innovative leadership. Nurses have to be treated as equals on the team. Ditto for families and patients. There must be mutual respect all the way around. No more medical jargon!

We won’t hold our breath that this approach will be adopted anytime soon. That is why we wrote our book Top Screwups. We wanted to help patients avoid deadly errors. We think it may be easier for patients to learn how to protect themselves from medical mistakes than it is to get health professionals to change the way they have been doing things for decades. In the book we have detailed strategies for helping you to reduce harmful medical errors. Here are some highlights:

Safe Patient Checklist When Visiting a Doctor:

• Take a prioritized list of your top health concerns/symptoms.
• Ask the doctor for a recap to make sure you have been heard.
• Take notes or record the conversation: you won’t remember everything you have heard.
• Take a friend or family member to be your advocate and record-keeper.
• Get a list of all your medications and supplements so that interactions can be prevented.
• Find out about the most common and serious side effects your medications may cause.
• Ask the doctor how confident he or she is about your diagnosis. Find out what else could cause your symptoms.
• When in doubt, seek a second opinion.
• Always ask your providers to wash their hands before they examine you.
• Get your medical records and test results. Do not settle for a brief summary.
• Keep track of your progress: maintain a diary of relevant measurements such as weight, blood pressure or blood sugar readings.
• Be especially vigilant when moving from one health care setting to another. Mistakes and oversights are especially common during transitions.
• Ask how to get in touch with your providers. Get phone numbers or email addresses and learn when to report problems.

What else is in Top Screwups?

• “Top 10 Tips to Stopping Screwups in Hospitals (page 22)”
• “Top 10 Diagnostic Screwups (page 44)”
• “Top 10 Reasons Why Doctors Screw up Diagnoses (page 46)”
• “Top 10 Questions to Ask to Reduce Diagnostic Disasters (page 69)”
• “Top 10 Screwups Doctors Make When Prescribing (page 78)”
• “Top 10 Questions to Ask Your Doctor When You Get a Prescription (page 95)”
• “Top 11 Tips for Preventing Dangerous Drug Interactions (page 108)”
• “Top 10 Screwups Pharmacists Make (page 111)”
• “Top 10 Tips for Taking Generic Drugs (page 139)”
• “Top 10 Tips to Surviving Old Age (page 167)”
• “Questions to Ask Your Doctor Before Agreeing to Surgery (page 177)”
• “Top 10 Tips to Promote Good Communication (page 188)”

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  1. Virginia
    GA
    Reply

    Hospitals are the most dangerous places in the world, consider yourself lucky to get out alive.I am an RN and I can tell you that only increases your anxiety as a patient. The advent of Hospitalists also creates a risky situation–they follow generalized care plans and do little actual diagnosing & will guess frequently–GUESS!! They are not going to see you again. Patients and their caregivers are not adequately prepared for discharge either; handing you a stack of papers on the way out the door is totally inadequate. Many items and supplies can help many patients but only if the family knows about them. Hospitals should concentrate on patient care rather than acquiring more properties and expansion.

    • Pat
      Aurora, IL.
      Reply

      Bless you, Virginia. Many people/patients will so appreciate your front-line experiences being shared.

  2. Sharon
    Texas
    Reply

    I agree that the poor care patients receive in hospitals these days is INEXCUSABLE AND UNACCEPTABLE! There were so many mistakes on my husband’s last hospital stay it is a wonder he got alive. I am “medically sophisticated” as the term goes, having worked in pharmacies, hospitals and clinics for over 30 years. I dare say that if I had not been with him at all times and even slept in the room with him at night, he would not be here today. I had to go TELL the nurse’s desk that my husband had an ALARM GOING OFF THAT SAID AFIB!!!!!! Next danger was giving him WRONG MEDICATIONS!!! None of us have any idea how many patients DIE in hospitals due to incompetent staff. A frightening and very dangerous situation!

  3. Roy
    Chicago
    Reply

    Years ago, when I first began caring for my aging parents, I encountered some errors in their hospital care. I was aghast, believing errors were unusual. I told a friend, a retired medical researcher, that I was thinking of starting a website to allow people to publicly post their experiences of medical errors. He said the website would be flooded with responses. I didn’t fully appreciated his words until I read later that medical errors are reasonably estimated to be the third leading cause of death in the U.S.

    I never did create the website, but such websites would be invaluable tools, both for patients and for quality-improvement managers.

    Regarding the suggestion to record consultations: I have had health-care sessions with ten or more doctors, and all but two agreed to my recording their sessions. (One of the two made outlandish statements during the session, so I can understand his peremptory refusal. The other doctor met with us only for about five minutes, to point out features on an X-ray.)

    I listen to such recordings as soon as I get home, and I unfailingly benefit: I hear something I missed, am reminded of something I’d forgotten, or come up with questions about what I heard.

    I would think twice about consulting with a doctor who disallows recording.

  4. Linda
    Helena, MT
    Reply

    The rampant medical malpractice in hospitals and among medical providers hasn’t killed me yet but it wasn’t because they didn’t try, repeatedly. That’s why I will stay away from the U.S. *health* system and its careless providers, at all costs. For every competent individual I encounter there are two dozen or more who are incompetent and uncaring. I’ve had more than enough of it.

  5. karin
    New Jersey
    Reply

    A medical term that is likely to be misunderstood by patients and families is:
    PROGRESSING/PROGRESSIVE. To the lay ear, when a condition is described as “progressing,” it sounds like good news. The patient is making progress, getting better. But to doctors, it means the opposite: the problem is getting progressively worse.

    12-18-2018

  6. Marianne
    United States
    Reply

    Is it possible to call family members when they can’t be available and put the medical rounds on speaker phone so that all can participate?

  7. Vicky
    Reply

    Family centered rounds should include the option of a video call or phone call with the patient’s family or closest confidant. Many people have no family living in their vicinity, have fractured families, or no family at all.

  8. Terry
    NC
    Reply

    In a perfect world, doctors would welcome patient input, and patients would then feel less intimidated about questioning their doctors.

  9. Jan
    Missouri
    Reply

    The opportunities for miscommunication and errors are seemingly endless. One of the processes of hospitalizations most fraught with errors and ambiguity is the discharge process. Medical and nursing staff often fail to ensure that patients and families receive understandable, logical and helpful information. When a patient is seen by more than one physician during hospitalization, the discharge instructions sometimes conflict. As a nurse, I have had to assist several family members and acquaintances to navigate post-hospitalization care.

    One of the most egregious safety risks I have ever encountered involved a 90+ year-old patient, discharged home after a heart attack and heart failure. His was given a prescription for Lasix (a diuretic) with instructions to take one daily. However, his discharge instructions were to take one every other day. The man’s wife assumed the instructions on the prescription were correct. When I called the prescriber (a nurse practitioner), she said she intended that the patient take the Lasix every other day, as she had written on the discharge instructions. She added that she intentionally wrote the prescription for daily because she believed, based on the severity of his illness, that he would eventually need it daily.

    My opinion is that health care professionals are often too busy completing the “checklists” of care that are required by regulations and policies, without actually comprehending the rationales behind those requirements. As the research revealed, time constraints are one of the major barriers.

  10. Cari
    NC
    Reply

    I would like to recommend a book by Donna Helen Crisp, RN, MSN, JD. It is entitled, Anatomy of Medical Errors The Patient in Room 2. This is a nurse’s story of surviving multiple medical errors at a large university teaching hospital. I could write a book of my own of all the things I’ve seen. Just yesterday, at a cardiology appointment, the medical assistant did not take my blood pressure correctly. She said it was 120/70 which would have delighted me but, I knew it was wrong. So, I asked my doctor to take it. When she took it, it was high and I needed another BP medication. What if I had just let that go? Many people would have. Patients need to either be in the know or they need to take an advocate with them. There is a lot of sloppy work out there these days. In addition, I gave the medical assistant a list of my current meds and she did not make one change in the computer. She also did not put in the name of my new PCP and if I had not had the receptionist show me everything, when I was checking out, my records would have been sent to my old PCP. So, there were three errors just in one visit by an incompetent medical assistant. We shouldn’t have to be exposed to this type of thing. If a person is not dedicated to their job in the medical field, they would do us all a favor by seeking a new career.

  11. Heide
    Delray Beach, FL
    Reply

    “Top Screwups” a book much needed to have nearby to read and reread often, BUT the much too light and small print is hard on older eyes. Therefore it is a book that I can only read for a very short time. Please readdress your these problems on this very fine and informative book.

  12. Theodoros
    Planet Earth
    Reply

    This information needs to be on the front pages of every newspaper in this country, in GIANT PRINT, on prime-time TV & Radio broadcasts 24/7,at least until something of significance is DONE! (I am not referring to TALK)!

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