Why Deadly Decisions by Doctors Persist
When humans are involved, errors happen — but patients have a role to play too
The practice of medicine is an art — though we tend to think of it as a science. While all health care providers and systems strive for perfection in care, errors still occur.
Recently, researchers from Johns Hopkins University published a study in the journal BMJ that examined the rates of medical error-related deaths in the U.S. The team reviewed data on nearly 35 million hospital admissions and calculated that almost 200,000 deaths per year are due to medical error.
Never accept a treatment plan unless you fully understand why that treatment is being provided.
This would rank medical errors as the third leading cause of death in the U.S., according to the Centers for Disease Control and Prevention.
Even more recently, the Department of Health and Human Services found that an estimated 29 percent of Medicare beneficiaries experienced adverse events during their rehab hospital stays, resulting in temporary harm, prolonged stays or transfers to other hospitals, permanent harm, life-sustaining intervention — or death.
Physician reviewers determined that 46 percent of these adverse and temporary harm events were clearly or likely preventable.
While there is some debate in the medical community as to the accuracy of the Johns Hopkins numbers and exactly how they were calculated (there were mathematical models and extrapolation of data involved) — both studies send a sobering message: There are far too many errors occurring in medicine today.
How do errors occur? They happen, in part, because you’re not paying enough attention to your own health care. (More on that in a minute).
- Adverse drug events
- Catheter-associated urinary tract infection
- Central line-associated blood stream infection
- Injury from falls
- Obstetrical adverse events
First, though, while years of school and on-the-job training (in the form of internship, residency, and fellowships) help ensure that physicians learn how to care for patients, and while much of what doctors do is based on solid clinical trials and data, clinical judgment still plays a significant role in patient care.
In addition, medicine has become more technologically advanced over the last 30 years. We’re more reliant upon computers, electronic medical records, and the “systems” in place to host all of these programs. Most errors are due to “system” failures such as communication between staff during shift changes, medication errors (wrong drug or wrong dose), and errors during transfer of patients between care units (missed doses, incomplete therapy).
Certainly, some errors are due to poor judgment or bad decision-making on the part of health care providers. However, these are in the minority. So what can every patient do to stay safe in the health care setting?
1.) Understand that it’s your health care.
Know what medical problems you have, what complications are possible, and how best to treat these problems. Understand you are a vital part of the treatment plan — doctor and patient must work together to improve outcomes. For example, if you have high blood pressure, keep a log of your blood pressures at home. Then show the log to your doctor so that he or she can get a better idea of how you are doing on a particular treatment when you are not in the clinic or hospital.
2.) Ask your physician questions.
Never accept a treatment plan or allow a health care provider to order a test unless you fully understand why the treatment is being provided and what it should accomplish. Ask about alternatives and if there are other possibilities. If necessary, ask for a second opinion. If a physician orders a test for you, ask why the test is being done and how the test will change your treatment plan.
3.) Question everything.
When you are hospitalized, nurses and other providers are often stretched thin. Hospital staff are asked to care for more patients with higher levels of acuity. When you are given a medication, make sure to ask what it is, what it is for, and what side effects to watch for. If you do not get an acceptable answer — do not take the drug.
You are the final "fail safe" in the chain of events that can help prevent a medication error. If you or your loved one is too ill to advocate for themselves in the hospital, make sure to have someone there to ask questions for them.
Medical errors are an unfortunate reality in today's society. As we continue to improve and innovate health care systems, we will continue to advocate patient safety. The treatment of disease is not just the job of the physicians and nurses who care for you. Rather, it is a coordinated effort between doctors, patients, nurses, and other health care providers.
Kevin R. Campbell, M.D., is an assistant professor in the Department of Medicine, Division of Cardiology, at the University of North Carolina.