Dealing – together – with medical error

The Running A Hospital blog has another discussion of dealing with medical error. This time, the hospital has opened up an error of its own (a wrong side surgery) for examination by the Open School of the Institute for Healthcare Improvement.

Sample comments:

  • From IHI’s Jim Conway: “Our systems are too complex to expect merely extraordinary people to perform perfectly 100% of the time. We as leaders must put in place systems that support great practice by people who suffer from being human and will make mistakes.”
  • From a patient who had two surgical errors in ten months: “After years of suffering through our incredibly brutal tort(ure) system I finally had the chance to talk to the surgeon. The most meaningful words he spoke were the descriptions of how badly he suffered also from the event we shared in that OR. Finally I was not alone!”

As we’ve often said, participatory medicine brings a new kind of partnership between patient and caregiver. Neither denial nor a Wall of Silence (famous book) has any place in a healthy relationship. It breaks my heart to think of the good lives that are ruined by our cultural inability to deal with honest errors in complex situations.

Yes, as Linda Kenney of MITSS mentions in a comment, some employees (in any industry) are reckless and must be weeded out. That too can be a denial issue. But first, we need open discussion.

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5 Responses to “Dealing – together – with medical error”

  1. Sheila says:

    Dave, What rights does a patient have when a hospital commits an error? My father has to spend three extra days in the hospital due to a hospital error (they forgot to give him his heart medication, and the whole reason he was hospitalized was because he was having problems due to a low level of the medication in his blood). I have seen you speak before at Health 2.0 and know that you could at least point me to the right resource.

    All I want is for my father not to be billed for the additional days in the hospital due to their error, and for hospital officials to apologize and communicate a quality control plan to prevent the error from happening again to my father or another patient.

    • Sheila,

      I’m sorry to hear about your father’s situation.

      I personally don’t know the ropes for your situation. I’ll ask on Twitter and Facebook for people who are in that world.

      • Dennis (Investigator/Negotiator) says:

        Dave and Sheila,

        I know this is an awful answer, but…it depends. What’s the insurance? What state is he in? Is anyone in there with your Dad, advocating for him? If he’s on Medicare, I’m pretty sure they’ll make the hospital fix the mess and pay for their own screw up. Most insurance companies, if someone apprised them of the situation, will demand the same. Beyond the payers, however, you can always negotiate if you aren’t satisfied with the deal.

  2. Sheila says:

    Thanks Dennis and Dave for your replies. My father decided he wanted to start by talking to his doctor. If the outcome is not satisfactory, then at least we now know he can let his health insurance duke it out with the hospital. He may or may not want a family member to advocate for him, and I will of course respect his desires. His primary focus needs to be on getting better, so I am treading lightly.

    In the meantime, I am doing research so I can present some options to him should the outcome of today’s conversation be unsatisfactory.

  3. Hi Dave,

    You might be interested in this New England Journal of Medicine article on LARGE-SCALE medical errors (such as widespread lab mistakes that result in misdiagnoses, both positive and negative, for large numbers of patients) – http://www.nejm.org/doi/pdf/10.1056/NEJMhle1003134 – (September 2, 2010)

    Researchers from the University of Washington in Seattle suggested that disclosure of medical errors should be decided on a case-by-case basis rather than a one-size-fits-all solution.

    Dr. Denise Dudzinski and her UW team maintain that there are some instances where disclosure itself may cause harm if anxiety related to worries about what may be only a minimal medical risk outweighs the ethical benefit of disclosure.

    Dr. Dudzinski and her colleagues said the ethical justification for disclosing harmful errors to patients is strong, but there’s no consensus about the need to disclose “near-miss” incidents, especially if:

    - patients are not physically injured
    - they may not benefit from the disclosure
    - they may be psychologically harmed by the disclosure

    Yet, by withholding information about the error, how can institutions be sure whether any patient was physically harmed?

    Probably the most interesting to me, as a person who has spent decades in the public relations field, is the almost-casual comment tacked on the end of the NEJM article, when they
    cautioned medical institutions to “assume that media coverage of large-scale adverse medical events is inevitable. Responses to the media should demonstrate the institution’s commitment to honesty and transparency to build public trust.”

    In other words, get ready to CYA.

    regards,
    Carolyn Thomas

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