Medical errors are a leading cause of death and disability. Some patient safety experts estimate that between 250,000 and 400,000 people die annually because of medical mistakes (BMJ, May, 2016; Journal of Patient Safety, Sept. 2013). Dr. Martin Makary and his colleague, authors of the BMJ study, suggest that medical mistakes are the third leading cause of death in the U.S. If you ask a slightly different question, you get an even more alarming assessment. How many treatment-attributable (iatrogenic) deaths are there each year? According to our own calculations, that number could be over 700,000. That makes health care harms the leading cause of death in America. There are ways to reduce harmful medical errors. Will they be adopted?
Reduce Harmful Medical Errors by 40%
One way to reduce such errors is by improving communication between health professionals, patients and their families. That is the conclusion of a study involving over 3,000 pediatric patients admitted to seven North American hospitals (BMJ, Dec. 5, 2018).
The team adopted an extraordinary communication system they called “family centered rounds.” It differs dramatically from the usual hospital experience.
The Old Way of Communicating:
If you have ever been hospitalized, you know that a team of health professionals often shows up at your bedside early in the morning. It may be comprised of an attending physician, a resident or two, medical students and possibly a nurse. They analyze your situation, make some recommendations if necessary and hustle out as fast as possible to manage their huge workload.
During this brief interaction, it is not unusual for family members to be absent from the room. This is especially true if it is very early in the morning. Doctors often use medical jargon and speed through the process. If there is time to ask questions, you may not understand everything they say or grasp the implications. Rarely do health professionals take the time to get your feedback to see if you really understood their messages.
A New Way of Communicating!
In this study, the health professionals worked together as a team. Here is how they described the process:
“Families, nurses, and physicians coproduced an intervention to standardize healthcare provider-family communication on ward rounds (‘family centered rounds’), which included structured, high reliability communication on bedside rounds emphasizing health literacy, family engagement, and bidirectional communication…”
Put another way, the new system required physicians and nurses to involve families and patients in rounds. Medical jargon was minimized, and families were encouraged to ask questions and share their concerns.
What we love about the new system:
- “Family speaks first, shares questions and concerns first on rounds”
- Doctors and nurses “use plain language, eg. fever, not febrile”
- “Illness severity (family reports if child was better, worse, or same); nurse input solicited”
- “Situation awareness and contingency planning (what family and staff should look out for and what might happen)”
And here’s the really important piece:
At the end of the interaction the families were supposed to verify that they had heard and understood what was said. The researchers called this “synthesis by receiver” (“family reads back key points of plan for the day prompted by presenter, supported by nurse as needed”). We call this “teach back.”
“Teach Back” to Reduce Harmful Medical Errors!
When pilots communicate with air traffic controllers, they always verify what they think they heard. That way they make sure there have been no miscommunications. When this is employed in health care we call it “teach back.”
We encourage patients to tell their stories to health care professionals whether during an office visit or in the hospital. Physicians and nurses need to know exactly how you are feeling. Then comes the important part. They need to teach back to you what they heard so you can verify that they got it right.
The same thing is true for patients and families. When the doctors and nurses get done telling their piece, families need to teach back what they think they heard. When everyone agrees, then the communication has been successful.
The Results of Family Centered Rounds:
The BMJ study revealed that family centered rounds helped reduce harmful medical errors. By adopting this system the hospitals were able to diminish serious medical errors by 38 percent.
Here, in their own words, are the conclusions of the researchers:
“The improvements in harmful errors occurred without a statistically significant increase in duration of rounds or decrease in the amount of teaching on rounds. Additionally, our intervention was associated with improvements in key communication behaviors, family and nurse engagement on rounds, and several measures of family experience. Our findings suggest that implementing a standardized, structured programme to improve communication with patients, families, and the interprofessional team on rounds could improve patient safety and other outcomes.”
People’s Pharmacy Perspective:
We are thrilled with this study. It is innovative and cost effective. Most important, it could improve patients’ health.
Changing medical culture is challenging, though. Getting doctors and hospitals to make these kinds of changes requires innovative leadership. Nurses have to be treated as equals on the team. Ditto for families and patients. There must be mutual respect all the way around. No more medical jargon!
We won’t hold our breath that this approach will be adopted anytime soon. That is why we wrote our book Top Screwups. We wanted to help patients avoid deadly errors. We think it may be easier for patients to learn how to protect themselves from medical mistakes than it is to get health professionals to change the way they have been doing things for decades. In the book we have detailed strategies for helping you to reduce harmful medical errors. Here are some highlights:
Safe Patient Checklist When Visiting a Doctor:
• Take a prioritized list of your top health concerns/symptoms.
• Ask the doctor for a recap to make sure you have been heard.
• Take notes or record the conversation: you won’t remember everything you have heard.
• Take a friend or family member to be your advocate and record-keeper.
• Get a list of all your medications and supplements so that interactions can be prevented.
• Find out about the most common and serious side effects your medications may cause.
• Ask the doctor how confident he or she is about your diagnosis. Find out what else could cause your symptoms.
• When in doubt, seek a second opinion.
• Always ask your providers to wash their hands before they examine you.
• Get your medical records and test results. Do not settle for a brief summary.
• Keep track of your progress: maintain a diary of relevant measurements such as weight, blood pressure or blood sugar readings.
• Be especially vigilant when moving from one health care setting to another. Mistakes and oversights are especially common during transitions.
• Ask how to get in touch with your providers. Get phone numbers or email addresses and learn when to report problems.
What else is in Top Screwups?
• “Top 10 Tips to Stopping Screwups in Hospitals (page 22)”
• “Top 10 Diagnostic Screwups (page 44)”
• “Top 10 Reasons Why Doctors Screw up Diagnoses (page 46)”
• “Top 10 Questions to Ask to Reduce Diagnostic Disasters (page 69)”
• “Top 10 Screwups Doctors Make When Prescribing (page 78)”
• “Top 10 Questions to Ask Your Doctor When You Get a Prescription (page 95)”
• “Top 11 Tips for Preventing Dangerous Drug Interactions (page 108)”
• “Top 10 Screwups Pharmacists Make (page 111)”
• “Top 10 Tips for Taking Generic Drugs (page 139)”
• “Top 10 Tips to Surviving Old Age (page 167)”
• “Questions to Ask Your Doctor Before Agreeing to Surgery (page 177)”
• “Top 10 Tips to Promote Good Communication (page 188)”
