Dr. Gupta is a giant! It’s not that Sanjay Gupta, MD, is all that tall, but he is an amazing physician and communicator. Let’s start with the fact that he is a distinguished neurosurgeon. He is also an Emmy award winning medical correspondent for CNN. His books have become national bestsellers. He does it all with grace, dignity and compassion.
That’s why Dr. Gupta’s article, “More Treatment, More Mistakes,” in the New York Times (July 31, 2012) is so powerful:
“DOCTORS make mistakes. They may be mistakes of technique, judgment, ignorance or even, sometimes, recklessness. Regardless of the cause, each time a mistake happens, a patient may suffer. We fail to uphold our profession’s basic oath: ‘First, do no harm.'”
What we find so extraordinary about Dr. Gupta’s introduction is that relatively few physicians are willing to come to grips with this basic truth. Accountability has not been a priority in medicine. Even more amazing is that no one seems to care.
We have been attempting to alert physicians, pharmacists, policy makers and patients to the epidemic of health care harm for decades. It astonishes us that the CDC (Centers for Disease Control & Prevention) does not include medical mistakes or health care harm in its list of leading causes of death. If it did, iatrogenic (treatment-attributable) deaths would rival heart disease and cancer.
This is not a message anyone wants to hear. Doctors hate it, even when it comes from a respected colleague like Sanjay Gupta. It would be as if pilots were told by their hero Capt. Chesley Sullenberger (AKA Sully) that they were responsible for 500,000 deaths annually due to airplane accidents. This is not a welcome message. If it were true, no one would ever get on an airplane. And yet health care harm is responsible for more than 500,000 deaths each year. That is why patients need to pay attention to avoiding medical mistakes.
Deaths from Health Care Harm:
- Hospital Acquired Infections > 100,000 (CDC)
- Fatal Hospital Adverse Drug Events (ADEs) 106,000
(Lazarou, JAMA, 1998) - Fatal Adverse Drug Events Nursing Homes 93,000
(Handler, Ann. Longterm Care, 2010) - Fatal ADEs (outpatient) 198,815
(Bootman, Am. J. Health-Syst. Pharm., 1997) - Pressure ulcers (bed sores) 60,000
(Allman, N. Engl. J. Med. 1989) - Misdiagnosis 132,500
(Range: 40,000 to 225,000)
(Newman-Toker, JAMA, 2009; Shojania, JAMA, 2003;
Wachter, Arch. Intern. Med., 2009) - Lethal blood clots 119,000
(Range: 100,000 to 300,000)
(Raskob, Am. J. Prev. Med. 2010; Heit, Blood, 2005) - Unnecessary surgery 12,000
(Starfield, JAMA, 2000) - Surgical complications 32,591
(Zhan, JAMA, 2003) - Excessive radiation 29,500
(Berrington de Gonzalez Arch. Intern.Med., 2009)
Statistics do not tell the story. After a few numbers our eyes glaze over. As Irving Selikoff, MD, once said, “Statistics are people with the tears wiped away.” There are an amazing number of tears in healthcare today.
Real People’s Stories:
Here are just a few stories from real people:
“After frequently repeated incidents of urinary tract infections (UTI) for well over a year, I asked my doctor to refer me to a urologist for tests. He said it was unnecessary and he treated me with medication appropriate for UTI. At that time things became so painful that a friend literally dragged me to her own doctor, then was referred to a urologist and the diagnosis was bladder cancer.
“Chances are that it could have been better treated had it been discovered earlier. I was treated with BCG for over 2 years and finally I am cancer-free. However, the treatment left me with chronic pain in the bladder and the ureter and can not function without regular and constant pain medication.
“The original doctor was stubborn and impatient when I asked for referrals to specialists… I changed doctors immediately, of course, but I find it difficult to be understanding and forgiving of his behavior. ”
C.M.Y.
“Practically never sick a day in his adult life, my father started feeling bad at age 58. He went to the best nearby university medical center. A cyst was found on his pancreas and removed. He returned home, and immediately felt well again.
“But about three days later the hospital called saying that the biopsy on the tissue removed indicated that it may have been pancreatic cancer, which is known to spread rapidly to the stomach and intestine, and that, to safeguard against the further spread of the cancer, they recommended immediate surgery to remove the pancreas, part of the stomach, and part of the large intestine.
“My mother tells the story that when they returned to the hospital to prepare for the second surgery an attending physician strongly urged my father to wait before undergoing what was considered radical surgery, of doubtful benefit, until there were clear signs that cancer of the pancreas was in fact present and that it was spreading. He explained that, without a pancreas, the patient would then have to take pig pancreas extract daily in order to digest food.
“For reasons that never have been clear to me, Dad decided to undergo the surgery. He died about 18 months later at the age of 60. The pig pancreas extract did not work, and we watched a 6” 2′, 210 pound man waste away. He weighed about 70 pounds when he died.
“Our mother told us that, prior to making the final payments for the surgery, when she was going through the medical records sent by the hospital, she found a copy of the biopsy test report on the tissue from the cyst removal, and it was negative for cancer. Of course, the whole family was shocked, dismayed, and felt the incident was nearly unbelievable.
“On the one hand it appears to be something other than a case of hospital error. On the other hand, in a broader context, it probably could be very successfully argued that, in fact, this was exactly a case of hospital error.”
S. K.
“Following a minor surgery, my brother, who had pancreatic cancer, was given an injection of Dilantin. Shortly thereafter he went into a coma from which he never recovered.”
K.W.
“A good few months ago I was diagnosed with a disease that would render me blind. I had an appointment at the hospital today and the doctors determined that I am fine! You can imagine I’ve been in pieces for months over this and for no reason!”
Warren
“Doctors sometimes ignore dangerous drug interactions. I recently ended up in the hospital after taking terbinafine. All 3 doctors called my reaction a rash. It wasn’t; it was Stevens-Johnson Syndrome (SJS). Many doctors are afraid or unaware of Stevens-Johnson and think it’s an umbrella for a catch-all diagnosis. SJS can kill you and many people have died from it. I could have been a statistic if I hadn’t gone to the ER when I did.
“My reaction was this: I had bruise-like marks all over my body from head to toe; the skin died in approximately 3 layers because the skin was burned from the inside out. All my skin came off including my ears, nose, scalp and all the way down to the bottoms of my feet. Then lesions surfaced on my face, fingers, hip, tail bone and arms. When I left the hospital and inquired when the red marks would go away they said a couple of days.
“It’s been 32 days and it looks like I have months ahead to keep recovering. It makes me sick the way they herd you in and out of the hospital and treat you for something that they don’t know about. That is, IF there is a treatment or cure. Only one out of four of the doctors I saw was honest and identified my condition for what it was.”
Ginger
“I went with a very painful knee to an orthopedist who, after a cursory exam, told me I had torn my medial meniscus and needed surgery. I asked for an MRI and was told twice that he knew what I had from the symptoms and an MRI was NOT necessary. He scheduled surgery in two weeks. He put me in a long leg soft cast to immobilize the knee and free me from pain until the surgery.
“A friend saw me later that day, asked why the cast. When I told her about the surgery and that I desperately needed a second opinion, she gave me the name of another orthopedist who saw me in 2 days and did an MRI. The radiologist and the nice lady Dr. conferred, and said I had no evidence of a torn medial meniscus! just missing the fluid behind the knee cap.
“I cancelled the surgery, wore the brace for a month and stopped driving my stick shift car with clutch. After 35 years of manual transmission driving, I had worn my left knee pad. It is 7 years later, my knee is totally recovered. I do use a stick drive occasionally, but put it in neutral at red lights and rest my knee. SECOND OPINIONS ARE A MUST.”
Diane
Avoiding Medical Mistakes:
These stories are just the tip of the iceberg. Thousands of people are misdiagnosed every day in this country. Once a diagnosis goes off the track then the treatment is likely to be incorrect as well. Unnecessary surgery can lead to all sorts of complications. So can the wrong medicine in the wrong dose or the wrong combination.
It is essential for patients to take an active role in their own care. In our book, Top Screwups Doctors Make and How to Avoid Them, you will find key information on avoiding medical mistakes that are commonly made by health care professionals. What can you do to prevent a misdiagnosis? We provide a list of the “Top 10 Questions to Ask to Reduce Diagnosic Disasters.” You will also learn about the:
- Top 10 Screwups Doctors Make When Prescribing
- Drug Interactions That Can Be Deadly
- Top 10 List of Potentially Problematic Pills
- Top 10 Screwups Pharmacists Make
- Generic Drug Screwups
- Safe Patient Checklist
Please take time to read Dr. Gupta’s important opinion piece in the New York Times. His discussion of Stevens-Johnson Syndrome will reinforce what Ginger describes above. And take responsibility for your health! Your doctor is trying but time pressure makes proper diagnosis more difficult. Your health is far too important to leave solely in your doctor’s hands. You must be an active member of the team. We hope our book will help you participate in the process with effective tools to reduce the risk of screwups.
Update:
Dr. Gupta’s article was written in 2012. The problem has not disappeared. You can read what we wrote in 2014 here. In 2016 we learned of a tragic story about a fatal error. A fascinating article in 2016 written by another doctor, Martin Makary, suggests that medical errors are the third leading cause of death in the US (BMJ, May 3, 2016). Vigilance is still essential for avoiding medical mistakes!
Revised 12/8/2016
