A recent study by Martin Makary and Michael Daniel (2016) at Johns Hopkins University concludes that medical error may be the third leading cause of death in the United States, following only heart disease and cancer. This is an alarming piece of information, especially since the statistics included only deaths in hospitals, and cases in which medical error was evident and likely contributed to death. Missing from the numbers are non-fatal negative consequences of error, errors that occurred in nursing homes, home health care, and in outpatient care, whether fatal or not, and of course all of those errors that went undetected or unreported in available records. In other words, the negative impact of medical error is likely to be much greater than was indicated by this study.
News sources have covered this finding and some discussion has surfaced here and there about how we might gather more accurate information about causes of death, as well as how we might improve our ability to recognize and respond to medical error. Yet consumers are meanwhile left to figure out how they can protect themselves from what appears to be a widespread problem with potentially deadly consequences. We are deluged with information about how to prevent heart disease and cancer, but we are expected to trust our doctors, consent to treatment with only sketchy information about what that treatment might entail, and believe that our healthcare providers know better than we do what is best for us.
Even the most competent professionals with the very best of intentions are going to make mistakes from time to time, and large systems such as hospitals, clinics, and nursing homes are pretty much guaranteed to have problems resulting from poor communication, malfunctioning technology, inadequate procedures, and employees who aren’t so good at following even the sound procedures that are in place. So healthcare consumers are putting themselves at risk each time they blindly follow doctors’ orders, go along with treatments they don’t understand without asking questions, or override their own judgment because a medical professional has a different one.
Navigating the healthcare system with even a modest degree of safety requires staying alert, asking lots of questions, doing some of our own research, and making our own decisions to the extent that we are able to do so. It may also require seeking second opinions, arranging for friends or family members to be present during important conversations or procedures, and perhaps appointing a Power of Attorney for Healthcare who is authorized to make decisions on our behalf if we should become incapacitated. It is critical that patients work at becoming educated consumers, and that we assume primary responsibility for our own health and well being. It is not our doctors’ responsibility to keep us healthy. That responsibility belongs to us.
How to Address Medical Error
You may find it helpful to think of your healthcare providers as consultants—experts in certain areas from whom you seek advice and services from time to time. Like your accountant, dentist, banker, attorney, veterinarian, or therapist, they work for you, and are accountable to you. You are entitled to information about their diagnosis and treatment recommendations, and you are entitled to have your questions answered in language you can understand. You have the right to refuse treatment or treatment by a particular provider, to seek a second opinion, and ultimately to decide what care you will accept. Don’t let a provider strong-arm you into something you are uncomfortable with or don’t think is right. Instead, gather information about your options and take the time you need to make a decision about how you want to proceed. Unless it is an emergency, on-the-spot decision making is often not required.
So what do you do if you observe a possible error in the making? As a patient you may notice potential slip-ups. Perhaps a nurse is trying to give you a medication you don’t think is yours or that another nurse already gave you. Maybe a medication just looks different, and you aren’t sure if it is just a generic or if it is actually the wrong medication. Perhaps a treatment is having an effect that is very different from the effect it is supposed to have, or you notice your doctor has the wrong x-ray stuck up on the wall. Whatever it is that has you concerned, it is always ok to ask about it or to bring up your concern. Your observations and your timely questions may prevent an error from occurring, or it may give your provider an opportunity to rethink what they are doing or to explain an apparent discrepancy that is indeed no cause for concern. If you don’t speak up, you may never know.
What if you think an error has already occurred? This is an even trickier situation, because your caregivers may be unwilling to admit the possibility of error. Fear of potential lawsuits discourages healthcare providers from admitting to or documenting errors and you may see cover-up attempts rather than genuine attempts at explanation or investigation. If you are having problems that may be the result of medical error, questions remain a good place to start, however you may not get the answers you are seeking. Other avenues to explore would be obtaining a second opinion, and/or getting copies of your medical records to either examine yourself or ask another provider to review for you. If you remain dissatisfied with the answers you are getting, and your concerns remain unresolved, you may also want to consider consulting someone from a different practice or facility, to decrease the likelihood that they will be dismissive of your concern. Your life may depend on it!
Important Note: This blog is intended for informational and discussion purposes only, and does not substitute for professional care. Your circumstances may differ from those discussed, and your needs may be different. If you are experiencing distress you feel unable to resolve on your own, please seek assistance from a qualified professional of your choice.