morwen
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When Doctors Make Mistakes
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Apr 4 13:47 UTC 2002 |
This comes from the April 2001 issue of Good Housekeeping. I tried to
find a copy of the article online but I only found this:
http://204.29.171.80/framer/navigation.asp?charset=utf-
8&cc=US&frameid=1565&lc=en-
us&providerid=113&realname=Good+Housekeeping&uid=3641534&url=http%3A%
2F%2Fwww.goodhousekeeping.com%2F
Which is probably too long to really work as a link. What I'm going
to do instead is put in the original article directly from the
magazine (not online) and then, in subsequent posts, put in some of
the stories that they quote. For those of you with the aforementioned
issue, the article is on page 136.
By the way, this is likely to be a long one, so bear with me, okay?
WHEN DOCTORS MAKE MISTAKES
"Misread pap smears. Lost lymph nodes. The wrong diagnoses.
Each year some 98,000 people die as a result of medical errors."
"When Laurie Kastrup of Upper Saddle River, New Jersey, found a lunp
in her breast in September 1994, she immediately consulted a top
breast cancer surgeon at Columbia Presbyterian Medical Center in New
York City. Kastrup, then 38, was told that the lump would be excised
and biopsied. If it was malignant, the surgeon would also remove her
lymph nodes so that a pathologist could determine if the cancer had
spread--a vital step in staging the cancer and plotting a course of
treatment.
"As it turned out, Kastrup did have breast cancer. All went according
to plan--or so it seemed. Once she was home from the hospital, Kastrup
called the surgeon's office several times, anxious to find out about
her test results--and to learn of her breast cancer had spread. Each
time, she was told that the pathology report wasn't ready. Then,
about three weeks after the procedure, the surgeon called Kastrup into
her office and confessed that the lymph nodes had never even made it
to the lab. In fact, they were lost. 'The surgeon was upset, so I
told her not to worry, just to take some more,' Kastrup recalls. To
her horror, the surgeon explained that *all* the critical lymph nodes
had been removed.
"Because the surgeon had removed all the cancer from Kastrup's breast,
she didn't have a mastectomy. Instead she underwent radiation and a
six-month course of chemotherapy. For two and a half years, she was
fine. Then, in early 1997, cancer was detected in her brain and
lungs, and Kastrup underwent three grueling surgeries, intense brain
radiation, and an additional 30 weeks of chemo.
"Today, as a result of two brain operations, Kastrup is partially
blind in both of her eyes. She can't walk without help, has seizures,
and wears a wig to replicate the long, lush, curly hair she once had.
and she is extremely weak. 'I can't work or cook,' Kastrup says, her
voice barely audible. 'I can't get through the day without
sleeping.'
"Kastrup is suing Columbia Presbyterian Medical Center, charging the
hospital with, among other things, failure to deliver her nodes to the
lab and failure to outline her medical options after her nodes were
lost. She is convinced that early, aggressive treatment would have
given her a better prognosis. (Columbia Presbyterian Medical Center
maintains that Kastrup was, in fact, treated aggressively.) When the
Hospital lost her lymph nodes, Kastrup says, she lost her chance to
fight the cancer as hard as she could.
"Another shocking lapse occurred just last December [2000: Julie] at
the noted Hasbro Children's Hospital in Providence. A young girl
scheduled for eye surgery instead had her tonsils and adenoids removed
and tubes put in her ears. The reason? A disastrous and completely
avoidable mix-up. Two young girls, close in age with similar first
names, were waiting for their operations; when a staff member called
for the girl who needed the tonsillectomy, the wrong child stood up.
Apparently no one--not even in the operating room--checked the name on
the patient's wristband. Indeed, the mix-up was discovered only when
a staffer came for the girl who was suppose to have eye surgery--and
couldn't find her.
"AN EPIDEMIC OF ERRORS
"Lost test results. Surgery on the wrong person-or body part.
Misread lab results. Misdiagnoses. Medication mix-ups. Every day
mistakes like these occur in hospitals, outpatient clinics, and
doctors' offices across the country.
"In November 1999, the Institute of Medicine (IOM), a division of the
National Academy of Sciences, issued a report estimating that as many
as 98,000 Americans die each year as the result of mistakes by health-
care providers. Hundreds of thousands more suffer serious injuries.
The total cost of these preventable errors: between $17 billion and
$29 billion.
"Two new studies indicate that the problem may be even more serious.
At one urban teaching hospital, researchers with unprecidented access
listened in on what doctors, nurses, and residents actually said to
one another about medical "accidents." The findings, reported by Lori
B. Andrews, J.D., a professor at the Chicago-Kent College of Law; a
medical mistake rate nearly five times as high as the IOM estimate.
"And since June 1997, when the Department of Veterans Affairs began
requiring that medical errors at VA hospitals be monitored, the number
of reported deaths and injuries has soared: nearly 3,000 mistakes in
nearly 19 months, resulting in more than 700 deaths.
"Yet many errors never come to light. Even if a patient or a
patient's family files a civil suit for medical malpractice or
wrongful death, it doesn't necessarily mean the error will be
disclosed. Many suits are settled out of court--which keeps the story
far from the public eye.
"SEARCHING FOR REASONS
"Why do medical mistakes happen? Economic factors probably play a
role. Currently [as of April 2001:Julie], one hospital in three is
losing money--a 16 percent jump in five years--according to the
American Hospital Association. And lack of money can lead to
potentially dangerous staff shortages or overworked personnel. Newly
minted residents may end up performing complex procedures without
adequate supervision. Or basic tasks--such as the trasnfer of lymph
nodes to a lab may not get done at all.
"But the heart of the problem, according to one expert, is a poorly
designed system. 'What we haven't done with health care is build in
the safeguards that exist in other complex industries, such as
aviation or nuclear power,' says Kenneth W. Kizer, M.D., president of
the National Quality Forum, a nonprofit agency charged with developing
a strategy for improving health care.
"Safeguards, Dr. Kizer maintains, should range from the simple to the
high-tech--from a call-back procedure in which, say, a nurse verbally
repeats a doctor's order to a computerized order-entry system for
medication, which eliminates illegible doctor handwriting, a major
source or drug errors.
"CHANGE IS COMING
"Help is on the way thanks to government and corporate programs. The
federal Agency for Healthcare Research and Quality in Rockville,
Maryland, recently received $50 million from Congress to investigate
and impliment safer health care. A group of Fortune 500 companies has
banded together to encourage employers to patronize insurers whose
hospitals and doctors meet specific safety criteria. And, at the
grassroots level, people whose lives have forever changed because of
medical errors have become advocates for patient safety. After
Patricia McEachern of Tampa was left partially paralyzed by a botched
angiogrom [details posted later in this item:Julie], she and her
husband, Ray, established the Association for Responsible Medicine (
http://www.a-r-m-.org ), which fights to protect the patient's right
to safe, informed medical care.
"Change is coming. 'We're really beginning to rethink our whole
approach to errors,' Dr Kizer says. 'But there is a long way to go.'
Sadly, change, when it happens, won't help Laurie kastrup and others
like her. 'I'm not bitter,' Kastrup says now, 'I feel I should enjoy
everyday because I have no idea how many days there will be. But what
happened to me is atrocious. I don't want to see it happen to anybody
else.'"
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These strategies can help reduce the likelihood that you'll be the
victim of a medical error.
In general
Call for test results within a week, advises Joanne Turnbull, Ph.D.,
executive director of the National Patient Safety Foundation. Lost
diagnostic tests are common, so don't assume that because your doctor
hasn't phoned, everything is okay. Many tests, including Pap smears
and blood work, can be repeated.
Get a second or third opinion if you need surgery or treatment for a
new and potentially serious illness.
Check the background of any new doctor you see. Find out where he or
she trained and for how long and if he or she has a malpractice
record. In some states, malpractice settlement information is posted
on the Internet. In other states, it may be available in the county
courthouse. The Agency for Healthcare Research and Quality (AHRQ) is
working to improve methods for identifying doctors and nurses who may
need close supervision.
If you need to be hospitalized
Choose a high-volume hospital. A study in the Journal of the American
Medical Association confirms that there's a much greater chance of
error if a new or high-tech surgical procedure is done at a hospital
that doesn't perform it frequently.
Make sure your hospital is accredited by the Joint Commission on
Accreditation of Healthcare Organizations, which sets standards for
hospitals and patient care. Check out your hospital at
http://www.jcaho.org , or call the JCAHO at (630) 792-5800.
If you are in the hospital
Keep track of your medications. Computerized medication-entry systems
have been developed, but fewer than 2 percent of hospitals require
physicians to use them. Check with the nurse each time a medicine is
brought to you or designate a friend or family member to do it for
you. Question any change in medication or dosage; if you don't receive
a satisfactory answer, don't take the medicine until you can check
with your doctor. If you have a drug allergy, hang a large sign over
your bed that reads, DO NOT GIVE ME _____. Just because it's written
on your chart doesn't mean you won't get it.
Make sure your provider wears gloves before handling your catheter or
IV and cleans his or her hands before coming in contact with you, says
Julie Gerberding, M.D., director of the Division of Healthcare Quality
Promotion at the U.S. Centers for Disease Control and Prevention.
Ask your provider if you really need a catheter. Bladder catheters are
the main cause of hospital infections. Although initially sterile,
they pass through nonsterile parts of the body during insertion. And
the longer they stay in, the greater a patient's risk.
If you need surgery
Ask who will oversee any resident who will be performing an
operation. "A reputable physician or surgeon should be present and
immediately available," says the AHRQ's director, John Eisenberg, M.D.
Make sure your surgeon knows which operation you're scheduled for. The
American Academy of Orthopedic Surgeons asks members to "autograph"
the limb or area they're going to operate on before the patient
undergoes anesthesia. Obviously, this method won't work for every
surgery, so always review your procedure with the doctor or surgical
nurse.
[this last is from that link I posted earlier: Julie]
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Any comments? I will be occasionally posting details on 5 other
stories mentioned in the magazine. Any other stories that you have
heard of, or discovered online or where ever, should be posted here as
well.
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