A shocking article appeared in the medical literature a while back (BMJ, May 3, 2016). It was titled: “Medical Error–The Third Leading Cause of Death in the U.S.” The physician who spearheaded the investigation estimated that each year between 200,000 and 400,000 hospital deaths were linked to medical mistakes. He implied that this might be an underestimate since many physicians do not mention on the death certificate that a patient’s demise was attributable to a mistake. Some doctors hated this article so much they called upon the editors of the BMJ to retract it.
Why the Truth Mattered to Albert Einstein:
Shortly before he died, Albert Einstein wrote:
“Whoever is careless with the truth in small matters cannot be trusted with important matters.”
This is especially important in medicine.
Doctors are expected to tell patients the truth about their condition and the treatment that is being recommended. We also trust them to keep our secrets confidential, just like lawyers and clergy.
When mistakes are made, doctors are supposed to fully disclose what happened, explain how and why it occurred, describe how the effects will be minimized and outline how such a mistake will be avoided in the future (Agency for Healthcare Research and Quality, July 2016). A sincere apology is also crucial.
Do Doctors Intentionally Mislead Patients?
A recent study suggests that often the mandated steps are seen as too scary, burdensome or embarrassing (BMJ Quality and Safety, Oct., 2016). Doctors in Georgia, Massachusetts and Washington were invited to respond to two vignettes that presented hypothetical errors. In one of these stories, a cancer diagnosis had been delayed. In the other, two doctors each assumed the other was investigating a patient’s serious health problem.
To the authors’ surprise, most of the doctors who responded to the questionnaire indicated that they would not disclose the details of those mistakes to the patient or family. They wrote:
“Our study shows that, despite all the attention over the past 14 years to the importance of open communication with patients following error, full disclosure remains elusive. Most physicians would provide only partial disclosure after either of the events studied here. When asked what they would tell the patient about the cause of the error, 77% of the physicians for the delayed diagnosis of cancer case, and 58% of the respondents for the care coordination breakdown case, would offer either no information or make vague references to ‘miscommunications’. More than half of the physicians in both cases reported they would not volunteer an apology or would offer only a vague expression of regret. This limited approach to disclosure by physicians in this study falls far short of patient expectations and national standards.”
The Real World from Readers’ Experiences
Reading that medical mistakes are common and may be a leading cause of death in the United States is way too abstract for most people. Learning that doctors do not report errors also seems irrelevant. That’s why stories from real people help clarify the seriousness of the problem. Many of our readers have their own stories. One man wrote:
Shared anonymously:
“It is my experience that doctors NEVER admit to making a mistake for fear of being sued for malpractice. In December 2000, I began to suffer with chills, night sweats, fatigue, weakness, stomach pain and weight loss. I saw an internist who sent me to a gastroenterologist who did a colonoscopy, which was normal. He did not even see any polyps. He then implied that my symptoms were psychosomatic and sent me to a psychotherapist and a cardiologist.
“Thank God the cardiologist ordered tests that showed I had endocarditis. I was started on antibiotics but it was too late to save my heart valve, which had to be replaced. Of course, I never heard again from the internist or the gastroenterologist who had both said my symptoms were all in my head!”
Linda in South Carolina reported her experience:
“As a licensed professional counselor and school counselor, I have spent years helping folks to take charge of their lives, set goals, take steps and live. Although it has been a southern tradition that whatever the doctors say is fact, I have personally seen people lose their lives because they followed the doctors medical orders.
“On May 19, 2014, I went to world famous MUSC in Charleston. After going through the protocol of ER tests and discussions, the ER physician showed me a picture of my heart and said, “Your heart is beautiful. There is no blockage. You should see mine.”
“I was given a ‘cocktail’ for a diagnosis of a gastric problem. I was told to take 3 days off from work and if the symptoms (burning, stomach pain) return, take more antacid. On May 22, 2014, while trying to get some antacid from a nearby pharmacy, I asked them to call for an ambulance. I passed out. Later that evening an ER cardiologist woke me up as they were taking me to CICU. He said, ‘You had a close call. You had a heart attack. You died.’ The next week, the cardiologist who placed a stent in my heart said that ‘People who had what you had are dead. You had no potassium.’
“It seems that whenI took a diuretic that was prescribed by my primary care physician, he failed to tell me to eat bananas or mention anything about loosing vital nutrients. The ER did not catch the signs, either. It was not indigestion.
“You would think that by now a nationally-known teaching hospital would be aware of the fact that women do not have the same signs as men when they have a myocardial infarction. I thank the Lord for my life. I wanted to let the hospital and doctor know what they did so that they would not do it to other women.
“The ER doctor apologized, but I still have the bills and the primary care physician said, ‘They always want to blame somebody.’ Again, I thank God for my life. Keep up your work of letting people know about the dangers of just taking anything they are told and completely placing their lives in a doctors’ hands.”
A Great Grandmother offered this tragic story:
“My friend, grandmother to my granddaughter-in-law, had arthroscopic surgery to remove her gall bladder. She was sent home the following day. When she called her doctor in terrible pain, she was told to take a couple of aspirin. By the time she was hospitalized several days later, it was found an intestine had been perforated. She died and her family won a lawsuit when it was found an intern had performed the operation instead of her doctor – who was on the golf course.
“On December 26, 2013 I had a heart attack and was taken to an emergency room in a major hospital, given morphine in a drip and was unconscious until 16 hours later when the emergency room doctor decided I was not going to die.
“They took me to OR where one stent was put in an artery. I was sent home two days later, nauseated and gasping for breath. When I went to a GP the next day, she said I had a lung infection and gastritis and sent me home with antibiotics. The antibiotics made me sick and the breathing worse.
“Finally my daughter called 911 and the medics immediately knew I had a heart problem. When I was taken to another hospital, the doctor was waiting for me and immediately took me to the OR and put in a second stent and started diuretics. Within a week I was home but needed home health care for several months. My cardiologist says my heart has been permanently damaged because of the delay in care. Before December 26, 2013 I took a little Synthroid pill – now I take 13 pills daily.”
Barbara in Washington relates:
“My mother (84 y/o at the time) walked into the hospital to be rehydrated. She’d been taken off prednisone, prescribed pain meds for the pain she was experiencing due to the miniscule fractures in her vertebrae (she’d been on prednisone for years for arthritis. The pain meds made her sick to her stomach so she was not eating or drinking, hence dehydrated. She never left the hospital – ten days later she was dead. And no explanation from the hospital as to why she died or what went wrong. How can anyone die from a simple procedure such as rehydration?”
S. is a pharmacist in Portland, Oregon:
“As a pharmacist who is catches medical errors on a daily basis, the stats are real. Hiring uneducated technicians is incredibly dangerous. I catch approximately 3 to 4 minor to major errors per day and report them only to be chided by my manager and made to feel terrible about caring if our patients are getting the correct medication or not.
“Errors are not only coming from physicians, NPs [nurse practitioners], PAs [physician assistant/associate] etc. Please be mindful or your medication when you receive them and verify you have the correct medication inside the bottle. I know I am diligent; however if I was not here, would someone else be as careful catching errors made by pharmacy technicians?”
People’s Pharmacy Response to S:
It has been estimated (based on research) that the average pharmacy fills four prescriptions incorrectly each day (Journal of the American Pharmaceutical Association, March-April, 2003). That represents over 50 million errors annually. Other research suggests the number is even higher–one out of every five prescriptions deviate from what the doctor wrote on the prescription. If that number is true it would equal 800 million “deviations/mistakes” annually. Can you even wrap you mind around such a large number?
Cindy in Seattle, Washington comments on integrity:
“I think it’s pretty obvious that doctors DO NOT own up to medical mistakes. Of course it has to do with the bottom line; lawsuits can cost millions!
“I rarely get sick… not even once per year! But two years ago I got a bad cold that went into my chest. I had severe congestion and coughed hard for about three weeks. The main symptoms went away but some minor congestion in my lungs absolutely refused to resolve.
“Finally my doc referred me to a lung specialist, who found a ‘spot’ and decided to do a pulmonary endoscopy — a ‘very minor’ outpatient procedure which she said might cause some ‘minor discomfort’ temporarily but nothing more.
“As I climbed down off the table after the procedure, I was hit with the worst pain I’ve ever experienced. My knees buckled! This pain continued unabated for at least three weeks, accompanied by massive chills and fever, night sweats, nausea. I was sick as a dog! Over this period, the “‘lung specialist’ kept changing the story. She gave me at least four conflicting “possible explanations” for all this, each time stressing that she had no idea why this should have occurred, and that there shouldn’t have been any pain, etc.
“I should’ve been admitted to the hospital, but she never even suggested that. It was utterly freaky! After three hideous weeks on strong antibiotics and pain meds (which I’ve never taken before), the symptoms began to subside and I gradually improved. But never received any real explanation, and no apology. I was absolutely fine when I climbed onto that table, and in a world of hurt when I climbed off. Something bad happened during that endoscopy (which turned out ‘negative’), but they would never admit it. And of course I had to pay for the meds, the follow-ups, the CT scans and so forth…even though it was their fault! Sheesh. Grrr.”
C.P. in Missouri offers an “inside” story:
“My daughter is a RN, and was working in WV. I won’t tell the year or at what hospital. She had been a RN for two years.
“She told me and her Dad that she was in charge of care of a very elderly man who had just had surgery. The man’s doctor came in to the room. He was going to take some blood out of the man’s carotid artery. The Doctor pushed air into the man’s artery, instead of taking blood out. My daughter was shocked. The Doctor said, ‘ooops, well he was dying anyway.’ She told us he gave her a look, ‘don’t ever mention this to anyone.’ We were shocked when she told us about it.
“I visited my Doctor a few weeks ago. I told him that someone in my family had just been diagnosed with Ehlers-Danlos, and I had some of the symptoms, and I wanted to be tested for it. He said, ‘What use is it to be tested. There is no treatment for it, and you’ll just have to live with it.’ Well, I will see a podiatrist next week. I’ll ask him to order the test. If I have it, I want it to be documented, for my future.”
Jim B. is a physician in Tennessee and also offers an “insiders” perspective:
“As a primary care physician, health care researcher, and author of The End of Healing (a novel about a young physician’s journey into the underworld of the healthcare industry), I find the study findings quoted consistent with what other studies have shown and the stories I hear from patients. Primary care doctors are so accustomed to care breakdowns–they are the norm and the daily expected outcome of a broken healthcare infrastructure designed for generating profit rather than health–that it seems impossible to report them all or to take responsibility for them. The providers feel completely out of control.
“This is especially true in primary care where over 50% of providers report serious burn out. Their burn out is caused by their toxic work environment and outmoded systems that make continuity and high quality care nearly impossible. This is the real world The End of Healing reveals, and patients and providers suffer needlessly as a result. We must first understand that world if we hope to change it for the better.”
Physicians MUST Tell the Truth:
Physicians are human and humans make mistakes. Reporting them and apologizing is supposed to be the standard of care. That holds as much for errors in prescribing as it would for misdiagnosis or a surgical slip-up. Patients are often willing to forgive a mistake when they are told the truth.
Virginia in Georgia:
“As a retired RN I know that these stats are correct! It’s getting worse because RNs know computer screens not actual real live patients and technicians do the actual care, with little training. The TV ads for schools to learn how to work in the medical field are just plain scary! I have your book ( Top Screwups Doctors Make and How to Avoid Them) and gave one to my 92 year old friend. Advice: stay alert around care givers!”
Here is what others say about this book:
Phyllis in Virginia:
“Great Reading! This book has been very helpful to me. Wish I had purchased this a long time ago. It should be required reading, especially by doctors.”
Bill says:
“I am in health care and I found the book enlightening! As you stated, our primary care providers do not have all day long to diagnose us and we must get to the point! As well as being assertive.
“Especially now that we get all these junk generic medications from overseas. They could have the diagnosis right and the medication right, but the generic may not be doing what it is suppose to. Let your health care provider know!”
Joyce in Florida:
“Very enlightening, and many of the anecdotes reflect my own experiences with doctors. I have already begun my list of questions for next month’s doctor appointment. Thanks for a book that needed to be written.”
If you are at your wits end about what to get for friends and family, why not consider Top screwups. You just might save a life!
There is a 16% sale till Wednesday, December 15, 2016. Use the coupon code: XMAS16 in the discount box on checkout.
