Wrong-side amputations. Patient mix-ups. Equipment left inside patients' bodies. ....

[dan_nc]

http://abcnews.go.com/Health/story?id=3789868&page=1

Medical Errors: A Look Back
Errors of the Past -- And What Hospitals Are Doing to Prevent Future Mishaps
By DAN CHILDS

Nov. 20, 2007—

Wrong-side amputations. Patient mix-ups. Equipment left inside patients' bodies.

Fortunately, the chance of a serious mistake occurring during any given medical procedure is small. But these errors do happen -- and due to the sheer number of medical procedures that take place in the country every year, they add up. A report last April by the independent health care-ratings company HealthGrades found through Medicare hospitalization records that nearly 3 percent of patients in the nation's hospitals risk experiencing hospital errors.

The report further suggested that those patients who experience an error in treatment or care at a hospital have a one in four chance of dying from the mistake. In total, HealthGrades said, 247,662 patients studied between 2003 and 2005 died from potentially preventable problems.

.........

[Wise Young]

Originally Posted by dan_nc

http://abcnews.go.com/Health/story?id=3789868&page=1

It is interesting that so many people take it for granted that doctors will work hard to save and cure them but not only don't bother to thank when they succeed but will sue them when they don't succeed. Medicine is not an exact science. Most of the time, you don't know what is going on and have to make decisions based on partial and insufficient information. It is not surprising that unanticipated things happen.

Hindsight is 20/20 and a lot of people may have died for potentially preventable reasons but I don't think these statistical studies give the truth concerning the magnitude of the problem. The statisticians who compiled the data have not examined each case and have little idea how and why individual patients died or had complications. They don't know and unfortunately don't care. They are just seeking publicity with these kinds of studies. In my opinion, it is bad science.

Wise.

[Le Type Français]

I don't think suing doctors for malpractice is wrong at all. It's about responsibility. Unfortunately, the litigation system is so inconsistent. I've read stories of people getting ridiculous amounts of money over a slight mishap and then stories of people getting nothing or very little over serious mishaps.

[dan_nc]

These are fringe cases with sensational examples. The reporters' follow-up in these cases are minimal.

Even so, the the second paragraph of the article found that only a mere 3% of patients risk experiencing a hospital error.

It is reassuring that the hospitals has stepped up and implement change to improve quality. In most instance cases, administrators has taken greater steps to ensure patient safety infrastructure, in and out of the operating room. Of course there are risks involved in surgical procedures; it's all a matter of mitigating that risk. I think the important thing is to compile that data, measures those outcomes, and develop safer protocols.

[Lazlo]

I do believe many patients are way too quick to shout 'malpractice'. But a wrong-side amputation, in the case of an arm, foot, hand, or leg, would be pretty devastating and a malpractice suit would be appropriate IMO.

When I went in for leg surgery, right before I went into the OR, they made me use a marker to mark which leg they were supposed to operate on. My first response was "what, you don't already know?" But I realized it was just a simple but effective way to minimize the risk of a mix-up.

As far as people expecting a doctor's work to be flawless every time, I compare it to my own profession, computer engineering. No matter how hard we try to keep everything running smoothly, we still make mistakes on occasion. Granted, nobody's life is at stake, but a large computing system, like a human body, is very complex and it is sometimes impossible to predict all the after-effects of making a change to the system.

[betheny]

The litigation is what keeps the number down, imo. I'm not litigious, I mean I didn't sue because I broke my neck in a public fountain I should not have been in (a guy on the airplane asked me why not, just 3 days ago. Umm, because it was my own damned fault, hello!). I'd probably get pretty litigious if they cut off the wrong hand, still had to cut off the sick one, and left me handless. I'd be a suing machine if that happened.

[dan_nc]

I agree, betheny. Malpractice lawsuits are not from a medical procedure with a bad outcome. That's why we have informed consent. Any medical procedure has inherent risks.

Malpractice lawsuits are for situations where professional negligence on the part of the doctor or hospital results in injury.

[Wise Young]

Betheny,

I of course agree with you if the scenario is what you describe. A doctor cuts off the wrong foot and then has to cut off the foot that was supposed to be cut off. He saves the life of the patient. The patient loses two feet. I agree that there should be a malpractice suit in such a circumstance. Whether there is a malpractice suit or not, nowadays the doctor is likely to lose his license and career.

I know a doctor who went through this a couple of years ago. I think that he is a very careful surgeon and cared for his patients. It was a diabetic patient who had such severe ischemia of one foot with ulcers and infections that the doctor decided to amputate one foot. Actually, he was considering amputating both feet because both were pretty bad. He decided to do one but he amputated the wrong foot.

He lost the lawsuit and I think he lost his license as well in that state. In any case, I don't think that it was intentional and both feet were pretty bad. In the operating room, if one looked healthy and other looks bad, the wrong foot is very seldom amputated. The situation only occurs when the disease is not apparent in both feet or both feet have similarly bad disease.

The incidence of these types of major errors (amputation of the wrong limb, leaving a surgical instrument in the patient) are very rare, much less than 3%. Actually, 3% is far too high. That is 1 in 30 operations. Much more frequent are unintentional oversights, little errors that lead to major errors. A miscommunication, a wrong dose, a failure to notice a lab test result, and a missed diagnosis. These account for the 3% of "potential errors".

My son was just in the hospital for a week and therefore these issues were much on my mind. Since leaving NYU ten years ago, I have not spent much time in U.S. hospitals and certainly not as the father of a patient. When I compare what they do in hospitals today and what I use to do when I was an intern at Bellevue Hospital, there is a world of difference and they do it much better now.

In the old days, "quality control" really was up to the doctor and the head nurse. Before rounds, I would write the day's worth of lab tests from the slips onto a clipboard, so I can rattle off the numbers at rounds. There were no computers. The intern was the keeper of the data, the list of things to do was the "scut" list, the admission and discharge, and essentially the advocate for the patient and family.

On my every other nights off, I use to stay until 11 pm to write notes, orders, and to make sure that everything was done before I went home for several hours of sleep. I got to the hospital by 6:00 am to draw blood from the patients that the blood-drawing team failed at before the operating room opened at 7:00 am.

I remember being very reluctant to leave the hospital on my nights off because my first patients who died did so on my nights off. It was very traumatic and I didn't want to leave. Decades later, at Bellevue, I took some of the head nurses at Bellevue to lunch. A nurse sat next to me and asked if I remember working with her on the comatose Portuguese ambassador from the United Nation whose liver had failed and we were doing intraperitoneal lavage, a method of washing the peritoneum to clear bilirubin from his blood. Did I remember? The flashback was so strong, I could smell the god-awful odor...

Most communications occur done during the rounds. There may be five or six people, half from the previous shift and half from the impending shift, describing what happened and what needs to be done. The handoffs from shift to shift pose the greatest risk of error from day to day. The essence of care was and is still good communications. The worst times in any hospital are when the doctors change, usually in July. There are millions of little details that don't get transferred, some important and some trivial.

Wise.

[Le Type Français]

Dr. Young,

I do think patients can be more pro-active as well. I think marking the healthy limb and putting DON'T REMOVE is pretty smart.

[Wise Young]

Originally Posted by Le Type Français

Dr. Young,

I do think patients can be more pro-active as well. I think marking the healthy limb and putting DON'T REMOVE is pretty smart.

LTF,

I agree. Patients and families not only must be proactive but they can and should be the keeper of the medical record. Communication and information transfer is crucial. The most experienced patients keep their own charts and they ask for copies of everything.

I always found it strange that patients and families in the United States must jump through hoops to get their own medical records, x-rays, and lab tests. In Hong Kong, I was pleasantly surprised to find that when they do a colonoscopy examination, the patient gets back not only written report of the findings but also a DVD that contains the entire procedure.

This is something that I believe they should do now with all surgery. They should have video records of the operation on DVD, all pathology, discussions with the familiy, etc. So many of so-called "medical errors" arise from loss of information, failure of communication, and misunderstandings. We now have the technology to record everything. Why not?

Wise.