Top Doctor’s Office Dangers

Featured Article, Power to the Patient
on June 4, 2013
Scary medical mistakes.

As much as we’d like to think that our next hospital stay or doctor’s visit will go off without a hitch, there’s no guarantee. The scary truth is that medical errors can occur. Just take a look at the numbers: In a 1999 landmark report, the Institute of Medicine (IOM) noted that errors account for about 98,000 deaths each year in the U.S., at a cost of $29 billion. In 2011, a study published in the journal Health Affairs found that medical errors are involved in one-third of hospital admissions—10 times more often than previously believed. What’s more, detection methods commonly used to track patient safety miss 90 percent of medical mistakes.

“Errors are usually the result of safety systems that are not well established and well thought out, and communication that is either missed or misinterpreted,” says registered nurse Patricia McGaffigan, interim president, National Patient Safety Foundation.

It’s not possible for mistakes to be completely eliminated, but patients and families can take a more active role in protecting themselves and their loved ones. “It is critical that people be cautious when they enter into encounters with the healthcare system,” says McGaffigan. Here’s a rundown of the most common medical errors identified by hospitals, healthcare providers, researchers and patient safety advocates—and how not to fall victim to them.

The error: Wrong-site surgery. This occurs when a surgeon operates on the wrong side of the body or limb, operates on the wrong person, or does the wrong surgical procedure. Procedures in place to prevent wrong-site surgery include a pre-op time-out, during which the surgical team reviews the surgery; marking the area that will be operated on—after checking with the patient; and even writing “NO” on the area or limb that will not be operated on.
What you can do: Before your operation, find out how the surgical site will be marked. For example, if you are scheduled for a knee replacement ask the surgeon, “What systems will be in place to make sure the correct knee is operated on?” advises McGaffigan. On the day of your surgery, double-check the marking process. And pay attention when the doctor or nurse actually marks the site. “If you have questions or concerns, speak up,” says McGaffigan.

The error: Medication mix-ups. An estimated 1.5 million medication errors occur annually in the U.S. according to the IOM. Adverse drug events (ADEs) range from prescribing the wrong drug to giving the incorrect dosage. Preventive technologies include bar code scanning, designed to read and compare information on a patient’s wristband and the prescribed medication. Computerized systems can eliminate problems caused by hard-to-read handwriting and allow healthcare providers to cross check a patient’s medical history for possible red flags such as drug allergies and to make sure a patient is being given the correct drug.
What you can do: Be patient. Before a healthcare provider gives you medication, he or she will ask you your name and date of birth. “That checkpoint is built in as a safety measure, not an aggravation measure,” says McGaffigan. Always ask about the medication you are being prescribed, why you need it and what the dosage is. (If you can’t, have a friend or relative do this.) “Every time you see something different, be it a new color or different sized pill, ask what is being given to you,” says McGaffigan. Ditto, every time you see an IV transfusion being prepared. Asking questions doesn’t mean you’re a busybody.  “It promotes communication about medication, and serves as a good teaching moment for patient and staff,” says McGaffigan. “Staff can learn more about the patient and what her concerns are and what her level of potential health literacy what might be. The patient can reinforce her interest in making sure she gets the best care possible.”

The error: Hospital-acquired infections. According to the National Patient Safety Foundation, one in 20 hospitalized patients develops an infection. The most common ones are catheter-related blood infections; pneumonia, which commonly affects patients who need a machine to help them breathe; and surgical site infections. These can affect the skin, tissues beneath the skin, organs and implants, such as knees or hips. Hospitals have systems in place to reduce the risk of infections. For instance, sterile procedures must be followed when implanting and removing a catheter, says McGaffigan. Surgical dressings must be changed and sites cleansed following specific protocols.
What you can do: There’s no way a patient can know each and every protocol. Instead, focus on the simple things. If a healthcare provider is about to insert or remove an IV, for instance, and she isn’t wearing gloves, ask her to don a pair, advises McGaffigan. Check that providers always change a surgical dressing the same way, and that they wear gloves. If something seems amiss, speak up.  If there is an antibacterial station at the door to your room, make sure healthcare providers (and guests) use it before touching you, stresses McGaffigan. If there’s no station, don’t be shy: Ask the provider or visitor if she has washed her hands.

The error: Falls. An estimated 500,000 falls happen in hospitals each year, reports the National Patient Safety Foundation. A 2012 report in the Annual Reviews of Medicine found that patients who fall stay 12 days longer in the hospital and pay $4,233 more for their care than people who don’t fall. Cognitive problems, muscle weakness, age (falls are more common in people over 60), gait problems caused by a stroke, and medication are some of the reasons people fall. Healthcare providers should assess patients when they enter a hospital or other facility to determine their fall risk and at-risk patients wear a wristband or specially colored socks identifying them as such, says McGaffigan. Chairs can be wired with an alarm that sounds if a patient shifts his weight.
What you can do: Make sure a provider assesses you before you get up following a stint in the ER or OR. Be honest about any risk factors you may have. And if your loved one has, say, cognitive issues, let the provider know.

The error: Hospital readmissions. This is defined as being readmitted to the hospital within 30 days after being discharged, notes the National Patient Safety Foundation. Readmissions can occur as a result of being discharged too soon, because of poor care or because people are discharged to the wrong settings.
What you can do: Ask what the typical length of stay is for someone with your condition. But keep in mind that how long you remain hospitalized may vary depending upon your condition, notes McGaffigan. Believe it or not, discharge planning should begin shortly after you’re admitted, following a “comprehensive assessment of your physical, emotional and spiritual conditions, your personal needs and your ability to make decisions about your care,” says McGaffigan.  For example, if you are having a knee replacement but live alone in a third-floor apartment with no elevator or support system, your post-hospital needs may differ from those of someone who lives with family in a one-story home. Beginning discharge planning upon admission ensures that all of your needs are considered and arrangements are in place when you are ready to leave the hospital, says McGaffigan. For instance, find out whether you will need rehabilitation and how long it might last, what medications you will be taking and for how long, and when you will next see a physician or a nurse. Discharge planning “should not be happening in a flurry to get an empty bed,” she says.

Error: The wrong diagnosis. Equipment failures or communication problems can contribute to a missed diagnosis. Plus, doctors can be conditioned to look for particular patterns of symptoms (a way of thinking called “pattern recognition”) and fail to consider possible causes outside the ordinary.
What you can do: “A patient may have vague symptoms that aren’t necessarily specific to a disease,” says McGaffigan. To increase your chances of being diagnosed correctly, “have a clear and informed story,” she advises. Write down your symptoms and questions ahead of time, referring to them when you see the doctor. And keep a list of all the medications you take, and the dosages, so you can tell the doctor. “If you have a frequent complaint and you haven’t been helped, don’t give up,” says McGaffigan. Always get a second opinion. And don’t be afraid to ask: “Could it be … ? ” That could prompt the doctor to take a fresh look at your symptoms and consider a condition that had never entered his mind.