Thursday, May 24, 2012

Hospital Essentials That Could Save Your Life

Hospital Essentials That Could Save Your Life

In the US, over 12,000 people die every week from health care gone awry; said another way, that’s about 624,000 deaths a year. These aren’t people who die because of the illness or injury that brings them to the doctor. These are people who die because of the care they receive once they get there. In fact, you stand a one-in-four chance that your death will be caused by medical care. Russian roulette offers better odds.”

In 2002 my Uncle Buddy was one of those deaths. At 84 years old Uncle Buddy had survived both the Normandy invasion and the Battle of the Bulge, but he could not survive modern medicine’s cavalier cascade of preventable, but fatal, diagnostic and treatment errors at the Robert Wood Johnson Hospital in New Brunswick, NJ.

While his death was tragic, the hospital and doctors’ responses (and lack thereof) were infuriating and unconscionable. Obviously, with 12,000 people dying in hospitals every week, this is the rule, not the exception.

No errors were ever acknowledged and/or reported by the hospital, doctors, or staff. Nobody learned from the mistakes or changed anything, and business continued without missing a beat…killing how many patients before, that day, and ever since?

Most incredibly, there is no mandatory legal requirement for hospitals or doctors to report adverse events, serious medical mistakes ordeaths. All are reported on a voluntary basis. What isn’t measured cannot be fixed! As such, hospitals and doctors have no way of knowing or evaluating, let alone correcting, errors made and implementing safety systems to prevent them. Nor is there a unified national long-term strategic plan to reduce medical errors.

In what other industry would we tolerate such a bleak rate of mistakes, let alone fatalities, which remotely approaches this?  Imagine what would happen to the airline industry if 3 to 4 jumbo jets were crashing every day! They would shut it down. Or, what happens when two people die, and only a few others become sick, from Salmonella or E. Coli poisoning in a fast food chain. It would make national headline news, the restaurant would close, there would be a massive national recall of meat, and the packing plant would close until the source was identified and the problem fixed. This does not happen in medicine, in spite of the fact that low-balling at 624,000 deaths per year, it is the number one cause of death in the US.

As Rosemary Gibson points out in her book Wall of Silence; The Untold Story of the Medical Mistakes That Kill and Injure Millions of Americans: “Hospitals should be the safes places. The fact is they are not.”

Clearly, the assumptions that we make about our health, doctors, hospitals, drugs, tests and procedures are both grossly inaccurate and dangerous. What you don’t know can kill you when you enter, what appears to be, a disease care lottery.

Here are some hospital essentials that can decrease your risk of injury and/or adverse outcome, and perhaps save your life. (Quoting and paraphrasing pgs. 239-244: Wall of Silence)

  1. Know that mistakes can happen. By knowing that mistakes can occur, you can be on the lookout for them.
  2. Do not go into a hospital like a lamb, passively accepting what you are told at face value. Be aggressive and demanding. Your job is to get the best care possible, have your problems addressed safely, and survive your hospital stay. Question everything: every drug-dose-drip-test-procedure.
  3. Ask your direct caregivers if they washed their hands before touching you. Ask your doctor to tuck in his tie or take it off.
  4. Learn as much as possible about the disease or injury affecting you and your treatment options—down to every detail.
  5. Don’t put blind trust in doctors or hospitals. Seriously research to find the doctor and hospital that are best for you. Ask questions and delve deeper.
  6. Understand what ‘board-certified’ means.
  7. Obtain a copy of your medical records and read them. Ask questions and they will take you more seriously.
  8. Keep your own detailed coherent journal. Record every doctor who sees you and for what purpose. Write down all procedures, medications, vital signs, fluids-IV’s
  9. Trust but verify: Ask to find out who is taking care of you and their role—whether it is a nurse, resident, fellow, or veteran physician.
  10. Know how to contact and access your doctor directly (phone #’s, etc).
  11. As best possible, try to have someone with you in your room 24/7.
  12. If you hear nothing after a test is conducted, don’t assume that everything is ok. Call and ask for results.
  13. Follow your gut instinct. If something doesn’t seem right, it probably isn’t. ASK questions! You may have to take matters into your own hands to save your own life!

Monday, May 7, 2012

How to Talk to Doctors: It Could Save Your Life

My mission in my blog is to expose and explode perpetuated medical mythologies that undermine human health; and to educate people to understand exactly what health is, thus empowering and enabling them to optimize their genetic potential to achieve it.

Reading through my blog one might get the idea that I am anti-medical. That is not true. I am absolutely opposed to the medical disease model as applied to everyday health.

One of the most important advisers you need in your life is a good medical doctor; one that takes time to listen to you and then performs a thorough hands-on physical examination of your chief complaint. Subsequently, he/she explains, to your complete understanding; the diagnosis, the treatment they propose (including the risks versus benefits), your responsibilities now, and ongoing, to safeguard your health.

However, as time is the greatest luxury in today's medical care, you as a patient have some important responsibilities.

Should you need a medical doctor it is imperative that you know how to talk to and question them to elicit the best care from them.

Most importantly, remember that a doctor is not an authority figure. A doctor is a consultant, like a financial consultant; someone whose opinion you can listen to, discuss, dissect, accept, or reject. A doctor's word is not the final word; your word is.

William Osler, the father of modern medicine, once said: “if you listen to the patient, they will tell you what is wrong with them (the diagnosis).” Physical examination findings should then confirm what the history revealed; and any additional or special tests are only needed to confirm a questionable diagnosis and/or aid in further diagnostic and treatment decisions.

Accurate diagnosis is quintessential to proper treatment. Said another way, misdiagnosis creates a dangerous cascade of treatment errors, that all too often are fatal.

Therefore, it is of vital importance that you are a good historian, as aided by your doctor's ability to elicit an accurate history of your chief complaint, including: a detailed description of your symptoms, onset (how and when), progression, aggravating and relieving factors, prior care, tests, pre-existing and/or concurrent complaints, etc.

It is when the doctor gets to the diagnosis and treatment discussions that you really need to be armed and ready with questions, and know how to speak to doctors.

In his book How Doctors Think, Jerome Groopman, MD, states: “no one can expect a physician to be infallible. Every doctor makes mistakes in diagnosis and treatment.” In fact, autopsies reveal that 10 to 15 % of all diagnoses are wrong, and “the majority of errors are due to flaws in physician thinking, not technical mistakes.” Note: misdiagnosis is different from medical mistakes.

Therefore, to reduce the frequency and severity of diagnostic errors there are certain routine questions you as a patient, or your health proxy, should ask.

1.      What else could it be? This question is a key safeguard against several common critical errors in  doctors' thinking.
2.      Is there anything that doesn't fit? “This follow-up should further prompt the physician to pause and let his mind roam more broadly.”
3.      Is it possible I have more than one problem? “this question is another safeguard against one of the most common cognitive traps that all physicians fall into: search satisfaction... This question should trigger your doctor to cast a wider net...”

In addition, simple procedural questions to ask your doctor such as; “Did you wash your hands?” could also save your life.

Today more people die from hospital-acquired infections than die from breast cancer (41,000/year) and automobile accidents (45,000/year) combined. Said another way, (doctors') hand washing might save twice as many lives as would a miracle cure that would completely eliminate breast cancer.”

Prior to any/all treatment, the doctor is required by law to give Informed Consent. This is based on the legal understanding that “every human being has an inalienable right to determine what shall be done with his own body.”

According to the AMA: “Informed Consent is a process of communication between a patient and physician that results in the patient's authorization or agreement to undergo a specific medical intervention.”

Informed consent is an education process during which the doctor must discuss with you, to your full comprehension:
1.      the diagnosis
2.      the nature and purpose of a proposed treatments
3.      the risks versus benefits of the treatments
4.      alternative treatments and their risks vs benefits
5.      the risks vs benefits of doing nothing at all.

If your doctor fails to fulfill this responsibility, you may need a new doctor. At the very least, it is incumbent upon you to discuss all of these things prior to submitting to any treatments.

Knowing how to talk to your doctor can save your life.