Since graduating medical school in 2008 I’ve often pondered how so many good people doing their best in the sphere of healthcare can still not prevent so many bad outcomes. After my first daughter was born in 2016 I blogged about our terrifying experience in a hospital after she was admitted for neonatal jaundice. Despite the fact that my wife and I are physicians – we faced disorganized care, a lack of Attending physician support overnight for residents, and hospital staff that was unresponsive to our concerns as parents and as medical professions. As her bilirubin kept getting worse throughout the night, the final straw came when I asked to see an Attending physician was told there was none physically present and the plan was to “continue present management.” I put my daughter in her car seat and escaped down the elevator, when finally the ICU team (with an attending physician) got involved and stopped us. They seemed genuinely horrified at the care up to that point, and provided modern appropriate phototherapy, iv fluids and protocol driven lab checks. Thankfully my daughter suffered no permanent harm, and I wrote a letter to the hospital administration because I was genuinely concerned about families that may not have good healthcare literacy or an advocate present.
MANY SIMILAR STORIES OF PATIENT HARM
The blog post garnered comments and personal emails to me from many people with similar and even more alarming experiences in hospitals; some of whom were doctors, nurses and other medical professionals sharing their dismay and disappointment at what has become prevalent in our healthcare system. Our stories highlight one small aspect of a reality – that despite spending the most out of any country per capita on healthcare, we can’t guarantee good outcomes.
I thought I would share some comments people posted:
“Every physician and nurse would agree that the quality of care provided in our hospitals has plummeted over the past decade (actually, the last several decades). Nurses are chained to their computers, and attending physicians are non-existent, having all been run away by the headaches and hassles.” -SouthernDoc1
“The problem appears to be that people have figured out that patients are unable to determine what constitutes good medical or nursing care, but they know that patient’s can tell whether a room is clean, comfortable and has good food, and if they are triaged promptly. We get what we measure. Right now, we are not measuring medical care, (and we don’t know how to measure that anyway). So since we need to measure something, we are measuring hotel care. That means that even more money will be spent on beautiful premises and landscaping and even less on what actually matters.” – A. B-Terrier
“I once checked myself out AMA from my OWN hospital. I was admitted overnight when I failed to regain mobility after an ortho procedure that was intended to be same day outpatient care. When my IV infiltrated and then occluded (including the accompanying PCA) my call light was ignored for 47 minutes. I pulled the cord loose to initiate an emergency call…and nothing happened for an additional 12 minutes. I was able to reach my purse, take P.O. pain meds, clamp the IV, and call OUTSIDE the hospital to be patched back to the nurses’ station for that floor. I shudder to think what would have happened to a non-medically trained patient in this position…especially one elderly, confused, and in serious pain.” -Pattie Brown
DISSENTING OPINIONS
To my surprise – there were also those who didn’t agree with me – and in fact gave considerable push back about my statement that medical errors harm a large number of Americans. Some anonymous commentators seemed earnestly annoyed that I was propagating what they perceived to be a myth, and somehow throwing an egg on the face of our profession. The point of my blog post and this continued discussion wasn’t to point the finger at any one person that night – it wasn’t the resident (physician), the nurse, the absent attending (allowed to take home call) – rather it was a whole combination of factors that lead to delays in care and in clinical deterioration.
Here are some of the dissenting opinions. I have copied these not to refute them, but because I have spent considerable time contemplating what I can learn from them and what criticism they have of my position.
“In any case, any death from preventable medical error is one too many, but we can’t begin to solve the problem if we don’t understand its scope. Alarmist claims that hospitals are killing patients left and right serve no benefit, and can actually cause harm if patients delay seeking care they need out of fear. This issue is too important to be hijacked by bad data and inflammatory headlines. We owe our patients better.” -Bananarama
“I’m an internist myself, and I agree. If Dr. Verma truly believes, with the thousands of patients that he’s likely seen in his career, that medical errors are the third leading cause of death in this country, I really don’t know what to say.” -Goonerdoc
MY RESPONSE
My response to these anonymous folks was:
“I’m not a policy expert and am interested to hear what you think: Are medical errors in the top 10 causes of death in your experience, top 50, or not a factor at all? I would say the leading cause of death in this country is greed… But there will never be a scientific study to ever prove this. (Though is one even needed? We have more resources than most countries on Earth, and we can’t solve basic problems like homelessness and hunger). This blog was just one personal story of a bad experience. The majority of my interactions with US-healthcare as a physician and as a patient have been positive… otherwise I may not be here writing this.
In the end, does it matter what the exact number is? If somehow we were able to do a real time tally of all hospital deaths, and simultaneously attribute a new and updated ICD-10 code to medical errors – and the number came to 50 000 deaths / year … would that be any less alarming? It wouldn’t be in my opinion.
I say that because the article was just about my own personal story, and giving some pretty straightforward tips on how patients can mitigate their own risks of falling victim to medical errors.
Also, I’m not pointing the finger specifically at physicians. There are today many other members of the healthcare team, so it would be difficult to blame the ones with the highest level of training (and with the greatest burden of medical board oversight, board certification/MOC/etc). Part of the problem may be that other ‘providers’ have different training requirements and different levels of experience, and yet in many places are used interchangeably with physicians. Also, business entities seem to worry more about the bottom line than patient care and sacrifice optimal nurse:patient and physician:patient ratios.
But yes, I do believe hospitals are fraught with danger. Of course they are. As a silly example- somehow we are still talking about hand washing in 2018 to prevent hospital acquired infections (danger caused by every single person walking into a patient room). The outcome may be the same, but this has a very different visceral response from the public than ‘nurse so-and-so gave the wrong injection’ or ‘doctor so-and-so ordered the wrong dosage.’ So applying my simple call to action to that would be : ‘ask questions.’ A lot of hospitals hand out ID badge attachments – “ask me if i’ve washed my hands.” Insulting? Maybe. Required? Apparently so – because somehow we still can’t get people to do it (not just doctors; people – techs, phlebotomists, nurses, PA, NP, etc)
Again, I don’t think overall “we as physicians are killing people” … but we are members of a system that still hasn’t figured out how to prevent the death of less people than we are capable. I think physicians, nurses,other healthcare professionals that accept to partake in this difficult work are doing their best individually – that’s how I look at myself in the mirror. We just need to figure out collectively how to do better.”
In Summary: My opinion about some of the factors of bad outcomes:
Inadequate Staffing
Suboptimal Training of Staff
Lack of Team Communication
No Publicly Viewable Error Reporting Mechanism
The Profit Motive Superseding Patients in Our Healthcare System