Reducing mistakes in medicine

Friday, December 17, 1999

Reducing mistakes in medicine

Medical personnel are going to goof; it's up to patients and families to act as watchdogs

Several years ago, when my mom had to have a rare tumor removed from her heart, my sisters and Ideveloped a game plan.

“No IV's in this arm,” we wrote in black Magic-Marker ink directly onto her right arm, a precaution because hand surgery a few years earlier had severely frazzled the arm's nerves.

We taped similar “no-IV” signs on the wall above her bed and made sure that someone was in the hospital room with her most of the time.

And guess what a nurse nearly did one evening while no one was watching? Tried to stick an IV needle directly into that right arm.

Luckily, one of us was there to intervene, and even though it's possible nothing terrible would have happened, we weren't taking any chances.

The simple act of having a family member, friend or advocate in the hospital room with a patient is just one tactic patient-care experts recommend to reduce the chance that something will go wrong during seemingly routine medical care.

Earlier this month, the Institute of Medicine in Washington, D.C., estimated that 44,000 to 98,000 U.S. patients die in hospitals each year because of medical mistakes. The figure is a wide estimate because no single agency tracks medical mistakes the way accidents are logged, for example, in manufacturing, air travel or on the nation's roads.

In many cases, patients are given the wrong medicine or the wrong dose. Sometimes, doctors operate on the wrong body part. Patients can be harmed, misdirected, disabled or killed by misdiagnosis, miscommunication, bad information or sheer neglect.

“Today, hospitals have cut back on staff, such as licensed practical nurses and nurses' aids.The pharmacy may be working with one pharmacy (technician) instead of three, ” says Mike Donio, spokesman for the People's Medical Society, a patient consumer group based in Allentown, Pa.

But there are definite strategies patients can use to reduce the risks of medical treatment.

“It sounds so mundane, but communication is one of the most important things,” Mr. Donio says. “You've got to make sure that you and your physician and/or practitioner are all on the same page when you're going to have any kind of treatment, be it medical or surgical.”

That means taking an active role in your care, says Sister Kathy Green, vice president of mission services for Mercy Health Partners in Cincinnati.

“Health-care consumers really have to see themselves as responsible for their own health,” she says. “I always encourage people to educate themselves about their condition as much as they can. Ask a lot of questions. When we buy a new car, we probably ask more questions than we do when we go to the doctor.”

Here are some basic things to do to make sure you get proper health care with as few risks as possible.

• Pick a good doctor and really get to know him/her. Even if you have to pick from an insurance company list, ask around before choosing a doctor. Interview several doctors in person before finding one you like — personally, philosophically, practically. Check the doctor's credentials with a local medical society (e.g., the Academy of Medicine of Cincinnati) or in a medical directory (e.g., American Medical Association directory or the Directory of Medical Specialists, both at the public library). Public Citizen Health Research Group publishes a list of questionable doctors (202) 588-1000; the Center for the Study of Services publishes lists of the nation's top doctors (www.guidetotopdoctors.org).

• Know what medicines you're taking, when, how much and why. Mistakes with medicines are a leading cause of patient death (about 7,000 a year) and sickness. When a doctor prescribes a new drug, ask him/her to write its name legibly on a separate piece of paper for you. Ask why it's being prescribed, when it should be taken, what the side effects are. Get complete information from your pharmacist, too, and ask for drug information sheets provided by the drug's maker. Keep a list of all medicines you're taking — prescription, over-the-counter, vitamins, minerals, herbal supplements. Make sure all doctors who see you know everything you're taking and why. If drugs are prescribed or given in the hospital, ask the same questions and double-check the names/labels before they're administered. If necessary, refuse to take the drug until your questions are answered.

• Be curious ... and curiouser. “If you don't understand something someone has told you, you need to ask questions and seek clarification,” says Karen Bankston, vice president of patient care services at University Hospital. Keep asking until you get answers (or switch doctors). What are my options? Why this treatment? What can I expect in terms of recovery? What are the risks? If you don't accept or agree with a doctor's recommendation for religious, cultural or lifestyle reasons, say so. “Don't leave the physician's office and say to yourself, "Well, I'm not going to do that.' Ask if there are alternatives or other options.”

• Get a second opinion. For any type of surgery, always get a second opinion (or more). Do the same if you're not comfortable with your doctor's diagnosis or recommended treatment.

• Take someone with you. Especially if you're hospitalized, make sure someone is with you most of the time — a friend, a family member, a third-party who can serve as your advocate, listener and protector. “Whether it's family members or friends or relatives, someone's got to be there,” Mr. Donio says. “At some point, they also become part of the team.” Before you're hospitalized or as soon as you check in, introduce yourself and those who are accompanying you to the nurses, staff and hospital's patient representative/social worker. Let the staff know who will be involved in making decisions with or for you.

• Don't take chances with surgery. Make sure everyone on your medical team — doctors, nurses, anesthesiologist, even the orderly who comes to take you to the operating room — knows what surgery you're having and where (e.g, which knee, which arm, which side of your face). Indicate the location of surgery on your body with a pen or marker. “It may sound goofy,” Mr. Donio says, “but if someone only writes "knee surgery' on your chart, at least they'll know which one when they pull back the gown and find your arrow saying "this knee.' ” If the hospital videotapes surgery for training purposes, ask for a copy — not to intimidate the doctor but to have a record of what was done.

• Read your insurance plan ahead of time. Know what's covered and what's not. “Unfortunately, insurance companies don't always make it easy,” Ms. Bankston says. Sit down and read your insurance booklet from cover to cover, including benefits for routine care, emergency care, drugs, mental health, tests, ambulance service and checkups.

• Get a copy of your medical records. You're entitled to a copy. Doctors and hospitals don't always like to hand them over, and you may have to pay to have them photocopied. As an alternative, ask your doctor to let you see and read your own chart.

• Don't hide your past. Even if doing so feels embarrassing or intrusive, let all members of your medical team know about your family's history, personal history and any experiences that can affect your health. Hiding important pieces of information — a family's history of depression, drug use, physical/sexual abuse, heart disease or diabetes, for example — can negatively affect your health.



Front Page
Local
Sports
	Bengals
	Reds
	Bearcats
	Xavier
Business
Health
Technology
Weather
Traffic
Back Issues
Photographs
AP Wire
	World
	Nation
	Sports
	Business
	Arts
	Health

Jobs
Autos
General
Obits
Homes

Movies
Dining
Calendars
Weekend

Columns
Borgman

HelpDesk
Feedback
Circulation
Subscribe
Phone #'s
Search