Wednesday, April 05, 2006

Medical Errors Continue to Increase

Medical errors continue to increase. Here are some reasons why:

  1. Doctors resist technological innovations that will track patient meds, their own protocols, etc. Computer technology that is more accurate than the vagaries of physician experience frighten them. "I'm being replaced by a computer!"
  2. There is no continuity of care. Period. Any patient who goes into the hospital for an unknown cause, idiopathic head pain, for example: will be shoved from specialty to specialty. Heaven forbid you get sick on the weekend. You won't be seeing a doctor that you would see during the week, for sure. No one takes responsibility for your well-being. You belong to the "system". Everyone can point the finger when bad outcomes occur--"hey, it wasn't on my watch."
  3. At research hospitals, the doctors are good at research. VERY FEW are true clinicians. You are an experiment. Count on it. These doctors will follow cook-book doctoring or try the latest protocol from Famed Institution, but they will not rely on their own training, intuition, and experience--they are used to the lab, not real life.
  4. If the cause is not easily found (MRI, CAT Scan, etc.) the patient will be sent home, told to take an aspirin, told it is in their head, etc. The happens to heart pain people all the time--"it's anxiety", "you ate greasy food". Go home. Boom dead.
  5. If you are very old or very young, the ER docs don't know what to do with you. Very few emergency departments staff Pediatricians. If your child is hurt in Houston, go to Texas Childrens. They will know what to do. Btw, the Memorial system is NOTORIOUSLY bad for chldren in the Houston suburban area. How is it in your area? Find out before you need to know.
  6. Doctors routinely over-prescribe medications. No doctor can know how more than two meds interact. Guaranteed you'll be on more that a couple if you're in for more than a day or two. They underestimate the side-effects, long-term effects of drugs and hand out addictive substances that the patient will have to deal with at home after the procedure.
  7. Medical staff are often exhausted. More errors happen at night. More errors happen on the weekend. Residents working "post-call" have often been "on call" more than 24 hours. Have you tried to tie your shoes when you have been deprived of sleep? Right. Now try making a medication decisions or sew up a surgery.
  8. There is an inherent bias to cover for each other. Why? Everyone makes mistakes, even in the most important business in the world. It is horrifying to live with hurting a patient. No one wants someone to get hurt or die on their watch, but it happens to nearly everyone. Rather than step in when someone is clearly screwing up, the tendency is to cover. Hey, I would want to be covered for if that happened to me, the rationale goes.
  9. If the doctor on call is not the specialty you need, you may be stuck with an emergency surgery by someone who rarely does the procedure. No one likes to think about it but there are good and bad doctors. There are good and bad surgeons. Make sure you get the stats on your doctor. When my husband had surgery for his cancer, I asked the local guy how many pocedures he did a year. "One or two." Not just no. Oh, hell no. We found a doctor who did hundreds per year. Much better outcomes, I promise. And the local doc was relieved, truth be told. He just didn't want to inconvenience us by sending us to a hospital far away. We'll take the inconvenience, thank you!
  10. Medical institutions are arrogant, patriarchal institutions filled with arrogant, patriarchal cowboys and girls who ignore and minimize patient experiences. Not all institutions, not all doctors, but many. You can tell a doc that "my child has a very small trachea, please use a smaller tube during the surgery"--if the doc is open to feedback she'll use it. If not, she'll jam the size tube down the throat that she deems right for the baby size (this is an actual example, btw. My son has a quiet voice now because of stretched vocal chords due to an arrogant "world famous" anesthesiologist. Her exact quote, when I made the request, "Do you know WHO I AM?!" Yes, she was the head of Anesthesiology for Baylor College of Medicine, as a matter of fact and Lead Professor. So what?). Doctors go into the business precisely because they like being the expert and experts DON'T take advice from commoners, I can assure you.
Can you see why hospitals are such scary places? These are just a few of the reasons to guard your life when you enter these hallowed halls. Check the med levels. Ask questions. Ask this question over and over, "What is the plan?"

Learn the medical heirarchy:
Nurse Assistant to Nurse to Head Nurse to Nurse Practitioner to Intern (not doctor yet) to Resident (just barely a doctor) to 2nd year Resident to 3rd year Resident to Fellow to Attending Physican to Chief Physician. The Attending Physician makes the final call on care. Everyone else would like to give their opinion but it often matters less than nothing.

Learn the specialties. I won't go into them here but you need to know the difference between a proctologist and perinatologist. Why know this? When you need another opinion call a specialist.
Speaking of opinions, it is not for lack of trust that you ask another opinion. It is for wealth of comfort. If you have three docs say three things, pause. If you have three docs say the same thing, your confidence can increase....some.

Trust your gut. Does everything look okay statistically, but feel wrong? Say so. Moms to children especially have a sixth sense. DO NOT discount it. Yell until you are heard. It won't look like insanity when you prevent a huge problem.

Have someone with the patient at all times. Often friends and family members are more constant companions to the patient than the nurses and doctors. These people can intervene and ask for help and correct errors before they happen.

Be respectful but not reverential. Doctors are people not some form of higher beings. They have had training, yes. But they are HUMAN. Faith belongs to God, not doctors.

I've earned my trepidition of the medical system throgh tough knocks. There are great physicians out there. Unbelievably accurate diagnosticians. Almost miraculous surgeons. Tender-hearted and compassionate nurses. There are lots of great people helping people heal.

And there are arrogant, ignoramouses too. Even the kind, talented people have bad days. No one wants to contemplate it, but it's true.

Final advice: think long and hard before you submit yourself to the Institution. Is there anything you can do to save yourself the trip? Anything at all? I guarantee you there is something you can do. Eat better. Exercise. Love your family. Protect your health. Get adjusted. Give yourself every opportunity to prevent sickness and disease. And when you do end up in the hospital be a diligent advocate for yourself or have one for you.

1 comment:

Danni R. said...

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