Injury or infection caused by medical treatment is one of the leading causes of death in the US. In fact, most of us will experience a diagnostic error at some point in our lives, according to “Improving Diagnosis in Health Care,” a report from the Institute of Medicine.
These errors are equal-opportunity killers, affecting patients regardless of gender, race and socioeconomic status. Examples: Receiving the wrong medication…contracting an infection in the hospital…having surgery performed on the wrong body part……and more.
Three case studies of medical errors and what you can learn from them…
Case #1: In 2012, astronaut Neil Armstrong underwent coronary bypass surgery at Cincinnati’s Mercy Health Fairfield Hospital. The procedure included having a temporary pacemaker implanted to regulate his heartbeat. It was successful, but soon after, Armstrong began bleeding internally and his blood pressure dropped. He needed immediate surgical intervention but instead was taken to the catheterization lab where minimally invasive procedures are performed. By the time he got to the operating room, it was too late. He passed away a week later. Result: The hospital awarded Armstrong’s family $6 million in a wrongful death settlement, according to Harvard T.H. Chan School of Public Health.
What went wrong: Armstrong had chosen a local medical facility rather than a larger, renowned institution for the procedure. For a serious procedure—a stent in your heart, knee replacement, treatment of chronic obstructive pulmonary disease—select a facility where the procedure is done frequently. A 2015 US News & World Report analysis of hospital outcomes for these procedures and two others between 2010 and 2012 showed that more cases equal fewer deaths. And according to a 2019 Journal of Orthopaedic Surgery and Research meta-analysis, patients undergoing hip arthroplasty had superior outcomes when the surgery was done in a high-volume hospital.
That’s not to say you can’t get quality care at a low-volume hospital—but expect improved outcomes with hospitals that often handle your procedure…are equipped to handle problems that might arise…and are staffed by experienced health-care providers who are knowledgeable about your condition.
What to ask before moving ahead…
How many of these procedures do you do a day/week/month? You want large numbers. Ask how the number compares to that of other providers.
What are the potential complications, and how often do they occur? Data on complication rates depends on state and locality. You can contact several institutions to compare the stats. Also check LeapFrog (LeapFrogGroup.com), which collects, analyzes and publishes data on the safety and quality of health care.
Will you be performing my procedure? Make sure your provider is not just supervising—as is often the case in teaching hospitals.
Case #2: A grave mistake was made in 1994 when two patients—Boston Globe health reporter Betsy Lehman and teacher Maureen Bateman—both were being treated for breast cancer at Dana-Farber Cancer Institute. They were given huge overdoses of their experimental chemotherapy medication. Lehman died immediately. Bateman recovered, but her heart was severely damaged and she died in 1997 from several cancers. Result: Both families were awarded undisclosed settlements from the hospital, according to AP News. The doctor responsible for prescribing the overdoses was suspended for three years by the Massachusetts Board of Registration in Medicine, and the hospital initiated a patient-safety campaign that continues to this day.
What went wrong: Health-care workers are overworked and overscheduled these days. You should always know what medication and dose you are receiving…and ask for it to be double-checked by a health-care professional. Inquiring is an added layer of protection. This is especially important for treatment that has potentially dangerous side effects, such as chemotherapy and kidney dialysis.
What to ask before receiving any medication…
Can you double-check that the medication and dose are correct? If this feels intimidating, lighten it up a bit by saying, “Humor me! I just need a little reassurance.” Before you are sedated for a medical procedure, ask what procedure is to be performed and make sure the correct body part is clearly marked.
I regularly receive this medication. Does everything look the same, prescription-wise? The best health-care organizations welcome these questions from patients.
Are you and the institution QOPI certified for cancer treatment? The American Society for Clinical Oncology introduced the voluntary Quality Oncology Practice Initiative (QOPI) in 2006 to enhance patient safety for cancer patients. Participation in the QOPI Certification Program allows medical practices to measure the quality of their oncology care against 100+ measures and compare their performance with other practices nationwide. An interactive map of QOPI-certified practices can be accessed from Practice.asco.org (follow the drop-down menus under the “Quality Improvement” tab).
Case #3: When Christina Flach called her husband’s doctor’s office on March 7, 2018, saying that her husband was experiencing chest pain, fever, weakness and fatigue, a nurse trained to triage patients scheduled a telehealth visit with Flach’s physician for four hours later. During that three-minute appointment, the doctor recommended Flach try multiple over-the-counter and prescription medications and call back if his condition worsened. It did worsen, and early the next morning, Flach—a former Olympic and Wimbledon doubles champ—went to the emergency room, where he was diagnosed with pneumonia, a methicillin-resistant Staphylococcus aureus (MRSA) infection, acute respiratory failure, renal failure, septic shock, hemoptysis (coughing up blood) and more. Despite treatment, he died several days later. Result: The Flach family won a medical malpractice lawsuit against Kaiser Permanente Medical Group.
What went wrong: Telehealth visits can provide health-care access for patients and reduce cost, but they come with greater risk for missed diagnoses. According to CRICO, the risk-management branch of Harvard Medical Institutions, 66% of telehealth-related malpractice claims between 2014 and 2018 were related to missed diagnoses. According to malpractice-insurance carrier The Doctors Company Group, these missed diagnoses tend to be related to cancer, stroke and infection. Misdiagnoses are not unique to telehealth. But while certain fields of medicine, such as psychiatry and dermatology, lend themselves to telehealth, it may be more difficult to identify system-wide infections.
What to ask yourself before choosing telemedicine…
How sick am I? In some situations—especially if you feel like you’re at death’s door—being seen in person may be wise. Physicians have tools for improving virtual assessments, but if you have chest or abdominal pain, shortness of breath or swelling in the legs, an in-office visit is best.
Do I have the right set-up for telehealth? You’ll need a private space and strong Wi-Fi connection. Lighting is key, allowing your provider to accurately gauge your coloring and see any rashes, bumps or other similar concerns. Sit with your back to a wall and not a sunny window. Be on time so you can spend as much of your visit as possible on important health-related matters.
