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I was recently browsing through the nearly 200 stories we’ve compiled with our Patient Harm Questionnaire, when I was reminded again of a troubling truth. Many of the people who suffer harm while undergoing medical care do not file formal complaints with regulators. The reasons are numerous: They’re often traumatized, disabled, unaware they’ve been a victim of a medical error or don’t understand the bureaucracy.
That’s a problem for those individual patients and for the rest of us. There are many places to complain: a state licensing agency; a professional licensing board that monitors doctors or nurses; the Joint Commission, which accredits hospitals or a Medicare Quality Improvement Organization. But if there are no complaints, there are no independent investigations, and that means no outside accountability for providers who may have made mistakes, and no public inspection reports that documents the case -- assuming an agency makes reports public, which is not always the case. It’s a collective problem because patient safety flaws that remain hidden, if they are not corrected, may be repeated.
We have staggering estimates of the number of people harmed while undergoing medical treatment. A review of medical records by the U.S. Health and Human Services Department’s inspector general found that in a single month one in seven Medicare patients was harmed in the hospital, or roughly 134,000 people. “An estimated 1.5 percent of Medicare beneficiaries experienced an event that contributed to their deaths,” the IG found, “which projects to 15,000 patients in a single month.”
But there’s no central system in place to tally and track these events. There’s no way to know when and where patients are being harmed or to tell if the problem is worse in one place than another.
It’s not like keeping track of patient harm is a new idea. More than a decade ago the Institute of Medicine’s landmark “To Err Is Human” report called for a national system to capture cases of serious harm to patients or death. The report said accurate reporting provides accountability and knowledge that leads to learning. That’s information that could save lives.
“You really can’t improve what you don’t measure,” said Dr. Julia Hallisy, president of the Empowered Patient Coalition. “How do you know where to focus your improvement efforts if you haven’t measured what’s happening in the first place?”
Efforts at the state level appear to be falling short, according to federal inspectors. In many states, hospital are required by law to file a report every time a patient suffers unexpected harm -- often called “sentinel” or “adverse” events. But a July report by the HHS inspector general’s office found that only 12 percent of harmful events identified by the office even met state requirements for reporting them. Compounding the problem: Hospitals themselves only reported 1 percent of the harmful events.
We found something similar when I was a reporter in Las Vegas. We used hospital billing records to identify 3,689 cases of patient harm at the city’s hospitals in a two-year period. Each of those cases would fit the state’s definition of a “sentinel event,” meaning the hospitals were required by law to report them. Yet in the same time period they reported to the state only 402 sentinel events.
The federal Agency for Healthcare Research and Quality is now accepting public comment about a proposed program to encourage consumers to complain about harm suffered while undergoing medical care. The goals include collecting information in a common format, developing prototype methods for gathering information on the phone and Internet and creating a follow-up questionnaire for medical providers. Patients will be asked what happened, who was involved and for permission to follow up with the providers involved in the event.
I recently referred the 1,000 members of the ProPublica Patient Harm Facebook Group to a story about the proposal in The New York Times. Many members of the group have suffered harm firsthand and filed complaints, so the article created lively discussion:
- Robin Karr said that based on her experience, she’s skeptical about reporting harm directly to the government “but not without hope” about the proposed program.
- Debra Van Putten said she knows many people who have filed complaints about harm they suffered, but little came of their efforts. Patients want more than mere acknowledgement, she said. They want accountability for whoever is responsible.
- Martha Deed said there are so many barriers to a patient reporting harm -- emotional trauma and physical disabilities, feeling intimidated by providers, social pressure not to complain -- that a passive questionnaire is unlikely to elicit responses. Instead, the patient harm information should be gathered in a way that’s standardized, she said, like the national survey that’s administered to recently discharged hospital patients that has results publicly reported on Hospital Compare.
That’s food for thought for those developing the program. Official public comment is due Nov. 9 and can be sent to Doris Lefkowitz, the AHRQ reports clearance officer:doris.lefkowitz@AHRQ.hhs.gov.
We’d also love to hear your comments. How do those of you who work in the medical field feel about this type of reporting system? Patients, what do you think about it? And what would you recommend as characteristics that would be essential to such a program?
This article first appeared on ProPublica.org.
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Interesting article.
In the last two years, I have had several operations due to cancer, and yes there have been mistakes, but there has also been outstanding performance from knowledgeable doctors and nurses. There is an old saying that "You can tell who is truly working, by seeing who is making mistakes." I have had these operations at three different hospitals. At one of the hospitals, the personnel seem to be miserable. They are afraid to do anything out of the ordinary because the quality people were watching. This hospital worries me, because their personnel only follow protocols, so that they can cover their backs - save their jobs when things go wrong. This means that when I have gone there in emergencies, they follow the protocols even though they know they are doing the wrong thing. Also, the emergency team does not work well together. Each is afraid to do anything that is not on their list of responsibilities. For example, if the patient tells a nurse aide about another prescription they take, then the nurse aide won't tell the nurse. It isn't on their scope of responsibilities. On the other hand, one of the other hospitals, everyone is happy, and they do what they feel is best for the patient. The personnel work there as a team. Their actions are based on their knowledge and gut instinct, and I feel safe there knowing that the people will do their best job to save me if things go awry. Be careful what you ask for (quality teams doing detailed watching over all the health personnel), you may just lower the standard bar.
I'm not looking to constrict doctors and nurses to just following protocols that are written for the typical situation when you enter the hospital. I'm looking for doctors and nurses who look at the symptoms, and follow the best route to help me get better quickly. The one hospital has robots with average care, and the other hospital that allows their doctors and nurses to do what is best for the patient without fear from administrator personnel, has given me outstanding care.
I do have one suggestion. It takes a year to fully recover from an operation. Send a second survey then. The patient then has time to reflect, and give an appropriate and honest response.
On a Sunday night a few weeks ago, I went to a hospital for a bad tooth. Since it was the holiday weekend I would have had to wait three days to see a dentist. The doctor that saw me was in a small room next to where I was waiting. He walked right out of that room to mine. He said open my mouth and stuck his hand in. He never washed his hands from one room to the next, no gloves either. Then after he saw me, never washed his hands. I saw him walk over to a nurses station and started writing something on a clip board. Should I be concerned? I did call the hospital the next business day and got nothing but grief. Sticking your hand in someones mouth after you just saw another patient and not wash your hands seems like a bad idea. If this happened to any of you out there in Internet land, what would you do ?
how do you know he didn't use the sanitizer?
Roger - Your story is not surprising to me. I was hospitalized 3 times this year with very serious pneumonia (pleural effusion and empyema). On more than one occasion, medical staff (doctors, nurses, and techs) came to treat me for something without washing hands or even using hand sanitizer. With my immune system so severely compromised, I had no problem asking anyone to wash their hands appropriately before drawing blood, checking my surgical site (lung tube for fluid drainage), permanent IV (PICC), or even using a stethescope.
Most of the time, they did don gloves, but would then go to a cabinet that other staff touched with bare hands, unlock it, get what they needed, and then come back to me without changing the gloves. Again, I had to remind them to do so.
So, next time, don't be afraid to bring unhygenic behavior to their attention! I'm not a "germ fanatic" by any means, but in a hospital or medical/dental office environment, hygiene is tantamount!
I sat here shaking my head as I read your story about what that ER doctor did. Hope your tooth is all better now!
eric-2573068 -- Hand sanitizer or not, it's against all medical/dental hygiene protocol today to insert bare fingers into a person's mouth.
I dont argue that. But wearing gloves is more for the doc's protection than yours.
This is probably overkill. Those gloves aren't sterile, even out of the box
No accidents will occur under ObamaCare.
We will only have the best, qualified doctors.
We will only have the best, qualified nurses.
Ha ha ha ha ha ha ha ha ha ha ha ha OMG it is so sad!
@NJ Person....
Thanks for your comment.
What bothers me the most is the hospital seemed to not care. I have read so many articles about people dying because of un-sterile conditions. Again, thanks for the comment.
I agree that gloves are more for the protection of the staff. By the same token, a phlebotomist should know better than to touch unclean surfaces and then come back to the patient wearing the same gloves. One even held the syringe between her teeth while palpating for a good vein.
What is overkill? When you're given a 30% chance of dying, as I was, there's no such thing as overkill. The staff donned gloves. Then, while wearing those gloves, went to the cabinet to get whatever. That in-room cabinet and combination lock is touched by dozens of people each day, even by those who don't wear gloves. If this is not a problem to you, I don't know what is.
My family had to wear a fresh gown, gloves, mask, and booties each time they entered my room, but medical staff gets a free pass? Another "joke" -- the floor was filthy and was "Swiffered," not washed. The same dry Swiffer cloth was used for several rooms and the hall. Please remember that this was a critical care, infectious disease section of the hospital.
No wonder they gave me daily nasal MRSA swabs!
By the way, this all occurred at a well-respected suburban hospital.
Industrial Strength - you are one big a-shole!
Roger - Yes, I've read similar stories. To me, this is very problematic in the 21st century. We've put men on the moon, but we still can't make medical personnel understand basic hygiene. What I was more afraid of than pneumonia was contracting MRSA or AIDS. If the gloved staff touched surfaces that had someone's infected body fluids on them, I was a dead-ringer to get something more serious than what I already had.
Define unclean. Also, show me any reports of infection from a venous blood draw
Youre obviously emotional about this. But the fact remains that gloves aren't sterile out of the box, so asking for sterile work conditions is illogical
No
There is no such thing as "infectious disease" section of a hospital
To all you people who think wearing gloves is more for the MD's protection than yours------I am happy you are NOT MD's.
What if that doc just drained a sore full of pus----You seem to feel it is ok for those nasty hands to be in your mouth un gloved and unwashed? You obviously make bad decisions if you feel this is ok.
Hand sanitizer does NOT do a complete job. Sing Happy Birthday through twice while continuously washing / scrubbing your hands WITH soap (any soap) under warm (not hot) running water-----That is appropriate hand cleansing technique.
Eric you have no idea about infection, how disease is spread, and how to prevent disease. I want to know where you live and work so I can avoid you. You are a danger to yourself and others and as such should be institutionalized until such time you learn how to maintain safety for yourself and others.
VABlueRidge What you and so many people do not know is that cancer and other diseases are treatable and curable by methods that are less invasive and more cost effective than the American medical model. Cancer alone brings in $350,000.00 average per patient from the time they are diagnosed to the time they die. This is a tremendous amount of money that would be lost if alternative therapies were accepted as equivalent in their treatment and outcome.
Dr. Gerson, Dr. Brzezinski and Dr. Koch, all medical doctors, have developed cures that have been successful with treating cancer patients. The AMA and the FDA have caused many problems for these doctors and have not acknowledged the benefits of their treatments and therapies. The end result is that many cancer patients are not being treated correctly.
So when we talk about mistakes, we only begin to scratch the surface.
Having worked in hospitals for many years as well as having a husband with chronic illness, I've seen my share of events that would make the average person wonder how anyone survives a trip to the hospital or doctor's office.
Never, ever feel uncomfortable requesting that a care giver wash their hands or sanitize an area.
Bad assumption on your part
Who said unwashed?
Sure it does, and multiple studies have shown this to be so. Traditional hand washing is only preferred for visibly soiled hands or after contact with an agent that spreads via spores, like c diff
lexi,
This will be my one and only response to you until you are able to conduct yourself in a mature manner. Im not sure if your real life is so boring that you feel the need to take a shot of internet courage and come on here and spew vile insults, but I suggest you find a different method of escape from your mundane existance
Yay for ObamaCare, provided by the same people that brought you the US Postal Service.
Quality care is their first concern, or is it union benefits........
No Habla Espanol, No Habla ObamaCare-o, the housekeeping staff at the Ramada will not be conducting surgeries, please provide your own translator as ObamaCare wont cover that cost.
Hand washing is the ONLY effective sanitary procedure. Bravo to those who realize gloves protect only the wearer. Amazing that hospital procedures still utilize them and patients believe their effectiveness. In British Columbia, it is under pain of immediate dismissal for ANYONE, including docs, nurses, aids, visitors, who do not wash their hands prior to entering a patients room. Sinks are outside each and every room. Gloves protect the wearer, NOT the patient. Stethoscopes should be wiped with alcohol swabs, ties should be tucked in. Infection control is horrid in this town. Also, communication among docs and departments is critical. But nurses are the front line and must communicate and not fear docs complaints. Patients can not fear retribution for complaining. And stick to your guns. If you believe something is not right, if you know you are not supposed to get that drug, if you know they have not washed their hands, tucked their tie in, speak up and if you can't speak up, hire a private duty nurse who will watch everything and speak up for you. Do not count on the hospitals, docs or nurses working for you on your behalf. They are working for the hospital and the hospital is working for its shareholders. In this day and age of new and wonderful technology, every hospital stay is a major risk to your life and your livelihood. Exercise extreme caution and trust yourself, your gut and your closest family and friends and do not be intimidated by hospital personnel. They are only human and it is your body, your life at stake. Not theirs. To them, you are just a number.
I had a hysterectomy 15 years ago and found out two years when I complained about pain on my right side that the doctor had removed my ovaries at the same time. I was never told that and it is not in the medical file. At the time, I had been told that the knife slipped. However, I was just told that they had to make additional incisions and had to use more stitches than they had planned. The head doctor (the one in charge of the residents) had asked to see me, and I did make an appointment with him for the following Monday. My mother died over the weekend, and I never made it in. To make a long story short, I've been on disability and have been getting treatment for bipolar disorder ever since. I told each psychiatrist that I didn't know what had happened, that I still had my ovaries, that I had a hysterectomy and my mother died and I've hadn't been the same since. What happened is that I needed estrogen and because I naturally would have been getting it anyway, I could have taken it instead of psych medications, which in turn caused weight gain and diabetes. The pain on my side was irritated scar tissue. I feel it when I move certain way. I no longer live in the state in which this occurred.
Scared, what hospital are you referring too that has sinks outside of every room? I live in BC and was recently in the hospital in Richmond for a week and not a single sink outside of any room...maybe Vancouver but not everywhere. Had a horrible reaction to some meds I was given and after getting sick, the nurses said "you look fine" I, however, could feel that my face was completely swollen and when I looked in the mirror I was absolutely right! The problem is an issue everywhere in North America, not just the States. Tried complaining about a misdiagnosis of my young daughters pneumonia (which WAS correctly diagnosed later at another hospital) and they called us not once, not even twice, but 4 times to give my husband the third degree. It's all about the bottom line no matter where we live. Complete overhaul of the systems all over North America is a good idea.
What scares me even worse in hospitals is the fact that visitors almost NEVER wash or sanitize their hands. They finger everything from the parking garage to the elevator to the bathroom to picking things up off the floor and then walk up and give their relative a big hug and kiss, handle bandages, etc. It's also impossible to clean a room 100% and family who handle under chairs, play with the A/C, etc. are handling surfaces that may or may not be cleaned well.
The gloves in the box in a patients room are NOT sterile!! Family members, staff, cleaning crew, etc stuff their hands into that box and pull out gloves. I've seen family reach over and pull out a glove and half the box falls on the floor so they pick them up and stuff them back in the box. So yes the gloves in the room actually can protect the doc more than the patient.
I train all of my students/interns/residents to use sanitizer when they walk in and when they walk out. It's as much for them as it is for the patient.
If you are conscious and knowingly allow a physician to stick his hand in your mouth without sterilizing his hands or putting on gloves then you share 50% of the blame. You have the right to ask politely and most physicians I know will happily use the hand sanitizer again or put on gloves.
THANK you for mentioning this. I can't tell you how many times I've witnessed family members / friends visiting patients in isolation that have received their instructions from RN's. LARGE red signs on the door frames, isolation carts next to the door that get ignored and the visitors will continuously waltz in and out of the iso room without a concern. Another frequent mishap is the visitor will be gloved and will then walk out of the room with the gloves on and begin touching common areas.
Visitors, for your own safety as well as the safety of all patients and staff, please carefully follow all instructions and be on the watch for instructional signage. Better yet, make it a personal rule to wash hands before entering and before exiting a hospital room. This would include when visiting in any type of hospital setting such as a nursing home or hospice.
Roger-785733
The doctor that saw me was in a small room next to where I was waiting. He walked right out of that room to mine. He said open my mouth and stuck his hand in. He never washed his hands from one room to the next, no gloves either.
Roger,
Without the doctor putting on gloves before putting his hands into your mouth, you should have asked him to put on gloves. His actions may have happened so quickly that maybe you did not have time to notice exactly what he was doing. However, do not be afraid to be an advocate for your self. Unfortunately, as in many other areas in life, unless you or a family member speak up for yourself, you will get taken advantage of.
Due to medical mistakes, this article was able to confirm non-reported resulting deaths and injuries.
The GOP has the immoral audacity to whine about compensatory medical lawsuits.
...I think NOT.
@25Walker
That's exactly right, it happened so fast I had no time to stop him.
Thanks for the comment.
I can't put my finger on it exactly, but the nbc newswriters are just getting worse and worse. The writing style in this article just says, "barely made it out of high school". And then there's this sentence:
You don't mention yourself like that in a story. You can mention the investigation, but it must be stated in the passive voice: "A similar result was found in a study of billing records from Las Vegas area hospitals in 2003..." or something like that. How did this make it past the editor (sorry - how did this make it passed the editor)?
I have to laugh at people who do not really have an interest in a story but want to spell check, grammar check and any other checks they can think of to find some way to make themselves feel good.
I do not think many people really care about what the angry guys say.
You are wrong Roger. We do have interest in articles which is why we want to be able to read them.
I have stopped reading articles, LTEs, comments, whatever, which are so badly written I have to struggle and pick my way through them in search of meaning.
The dummying of the U.S. is deplorable.
I know this is off-topic, but ... Writing is communication. Grammar or spelling mistakes lead to poor communication and even miscommunication.
IMO, MSNBC, which is now NBC, is the most poorly edited Internet media site. But, I also find errors in the NY Times on a daily basis. We used to expect better from our journalists and editors.
Angry Guy (#2) is right when he said that reporters/journalists should not write in the nominative case (I, we). That was a big no-no when I was in school as was using "you." There are more no-nos, but I'd be further off-topic in listing them! Also, journalists should never state or imply/insinuate their opinions when reporting. This seems to be the journalism style of today, and it is wrong. It sways the reader. The Opinion section is the category ... well, opinions.
@ jkatze
I have to wonder, if you can not read an article written by someone with 4th grade skills, how do you expect to read an article written by a professional writer ?
The Angry Guy, your idea of proper writing in journalism is about 20-25 years out of date.
On reason is because they may be dumbing down for readers. The president and first lady were actually chided for giving a speech at the 9th grade level. Most speeches that address the whole USA are written at a 5th grade level.
My mother and husband both suffered blatant malpractice that had significant short-term health consequences and inflicted permanent risks of fatal or disabling illness. My mother, who was always fearful about health, has reacted by scurrying off every year to an out-of-state boutique hospital for exhaustive checkups. My husband has, far more wisely in my opinion, reacted by deciding to stop jumping through allopathic hoops, skip the recommended lifelong follow-up care for the malpractice, and be ready to die whenever it may become necessary. Neither sued or filed formal complaints, though both are well-educated and usually quite capable of speaking up for themselves. I think both were just too broken down by months of stress, fear, and iatrogenic disability to want to have anything more to do with the institutions involved. My husband explicitly said that he did not want to spend what might be the last years of his life tied up in a stressful court case. And thus the incompetent and/or deceitful MDs involved continue to enjoy their sterling local reputations and fat salaries.
I had a similar experience. I researched to find an attorney who had successfully sued the the big-bucks medical system involved. He was succinct : 'the problem is you're still alive'. It's far easier to win a wrongful death suit than a medical mal.
my son died of cancer last year, the first surgery he had the doctor did not remove all of the cancerous lymph nods because he did not look at the last cat scan. He said well we can go in again or just see how it goes. the lawyer said there is nothing you can do because you can not prove the outcome would have been different if he had removed all of the cancer lymph nods the first time. The doctor he is fine, my son is dead. Obama care is going to make this kind of thing worse.
@ Desertgranny
I am sorry for your loss. I would be highly upset too if I were you. What I would like you to explain is how is Obama care going to make it worse ?
Again, I am sorry for your loss, but it almost sounds like your blaming Obama for you Doctors mistake. People seem to want to blame Obama for almost anything, pretty common for your kind ---"tea baggers"
Kudos to the first commenter for making a remark on the merits of the piece and not trying to play Monday Morning Editor for NBC News. I agree with VABlueRidge that it does take a long amount of time to recover from surgery and getting another survey done would be helpful for measuring longer term outcomes. And, as a nurse, I can confirm that it is often more difficult to do my job when someone is looking over my shoulder, waiting for me to make a mistake. I think that would hold true for most people. That said, there is pressure in every job, and we know the life-or-death issues that we will be dealing with when we enter the healthcare profession. Teamwork is the best answer and it is wonderful when practitioners are free to work to their full potential. Keep in mind, those same professionals have to have a desire to constantly make the system better and keep improving the quality of their care. Care for the patient will deteriorate the more restrictive the professional environment, but patient care will flourish when those who truly love what they do are given latitude and responsibility to be involved in changes. Allow them to make an impact on the system, rather than having the administration hand down edicts to them. This is the core of good Change Management and it isn't isolated just to the healthcare profession. Find mistakes, involve your people in developing a system to minimize them and hire competent professionals who have a heart in their work.
1) Texas has limited medical claims. Leeches, opps sorry lawyers have told me directly to my face "we will not help you unless you pay us in advance, as there in not enough money in it for us".
2) Report it to a medical board controlled by doctors and/or accountants, like that'll work.
3) If they're lucky you'll be dead before it get to court anyway
4) Basically, you put you life in the hands of someone driven & controlled by money, whether this be a doctor or a hospital, if they screw up, they will put a system in motion that will reduce you to the poor house and if they didn't kill you in the procedure, will wear you down to death anyway.
5) Understand this: No-one will look after you & yours,except you; putting you life in the hands of others may be a necessity, but if it goes pear shaped your on your own.
Excellent observations.
These articles on medical errors are all very biased, and I encourage anyone who reads them to not just be passive readers, but to dig a little deeper and question claims rather than passively accept them.
From the report the article cites, many of these "adverse events" are not errors at all, and many are not preventable. From the text:
adverse events do not always involve errors, negligence, or poor quality of care and are not always preventable
Furthermore, some of the adverse events here are known complications of medications which, if not used, cause more harm to the patient
An oft cited adverse event is bleeding. However, when a patient comes in with an acute heart attack, one of the most important first steps is to inactivate the clotting system of the body to re-establish coronary blood flow. Bleeding is not only common afterwards, its to be expected. However, not giving such meds would in many cases result in the death of the patient
Just food for thought next time someone tries to tell you about all the "adverse events" and mistakes of our system
True that most adverse events are not errors - but many are. And for many that are the patient has no obvious way of knowing it. You speak of complications of "medications which, if not used, cause more harm to the patient." But this presumes that there has been a clinical trial demonstrating that - in a particular type of patient! - the benefits of the medication outweigh the harm it does. In some cases, that is true; in other cases, it is not. For example, I'm sure that you have read the major new study in the Archives of Internal Medicine that reports that the use of novel anticoagulants in people with acute coronary syndrome has no net benefit because the increase in hemorrhages is so great as to balance out the small, nonsignificant reduction in overall deaths compared to placebo. Does that mean no doctor will ever again use the costly new anticoagulants in preference to warfarin in such cases? Ha. A major study from California reported that long-term use of warfarin in low-risk people with atrial fibrillation caused more disability from hemorrhagic stroke than it prevented. Do we think no cardiologist will ever again coerce a 40-year-old AF patient with a CHADS2 score of 0 onto warfarin with lurid rhetoric about the horrors of ischemic stroke? Ha. A patient who is so coerced through incomplete information, who then has a cerebral bleed and ends up a cabbage, has been the victim of medical error that is or ought to be actionable, but if his family doesn't understand this, there will be no lawsuit.
According to the source, 44% are not. Quite a percentage
There are...CURE and PLATO and TRITON-TIMI 38...do you want me to continue?
Please post it
There are volumes of data that support the use of coumadin in afib. Youre flat out wrong here
a patient with that chads score does not need coumadin...a full strength aspirin should be sufficient. Why do you assume a cardiologist would push for coumadin instead of aspirin?
Jane, I find your skill in reading journals to be excellent, but the application of the data into the clinical realm to be lacking. This is clearly from an unfamiliarity with clinical practice.
Ha? actually, the joke is on you. Warfarin is NEVER used for treatment of acute coronary syndrome, so there is no choice between "novel anticoagulants" and warfarin for these patients
Im guessing what you are actually referring to here is the use of dabigitran compared with warfarin for non valvular afib. In this case, I agree partially. Its a new drug, and I have seen articles detailing increased risk of bleeding with this medicine
Its something patients should be advised about, but prescribing this medicine for afib is NOT an error, even if the patient later develops a bleed.
Dr. Eric, if you are a doctor, I'm concerned about the suggestions in your messages above that you ignore literature that doesn't support current practice.
1. There are hundreds of drugs used for thousands of indications in a dozen types of patients, and you seem to think citing three trials that reported positive results is evidence that risky drug treatment will do more good than harm across the board. Nope, no way. A trial only answers, and then only tentatively, the specific question being asked; proving that a few popular practices work doesn't prove that every popular practice is good practice.
2. Obviously, you have not read about the study in question, or you would not think it was "actually" about AFib. I'm sure you are too busy seeing patients to be entirely up-to-date with literature, but you might sign up for some free site like medpagetoday.com that will send you summaries of major news. The citation in question is Komocsi et al, "Use of new-generation oral anticoagulant agents in patients receiving antiplatelet therapy after an acute coronary syndrome." Arch Int Med 2012; doi: 10.1001/archinternmed.2012.4026. There is also an associated editorial.
3. Glad to hear that you don't believe in putting people who have had heart attacks on warfarin. I'd certainly never allow that to be done to myself or my loved ones. I don't have easy access to the journal itself at the moment, but an article about the study states that the authors compared the effects of the novel drugs to that of warfarin/aspirin treatment. This implies that some doctors think putting heart attack patients on warfarin may be justified, and probably that there are published data regarding the practice. (I do know that enough have believed in putting heart *failure* patients on warfarin to justify a large recent trial with a mostly negative outcome.) But if this is not common practice - great! - there are other common practices that are inadequately proven, or disproven, or only proven beneficial in 50-65-year-old males, yet that are being shoved down patients' throats every day of the week.
4. Again, doctors sometimes refuse to accept that not all patient groups are equal. Since you started talking about AF, warfarin has a substantial net benefit in elderly people AF patients and those with many comorbidities, but this is not so in low-risk groups. In fact, the mantra that AF quintuples stroke risk seems not to be true in the lowest-risk patients, who in one study do not have stroke risks significantly higher than those of the general population. Again, a large published study from, IIRC, an Aetna insurance database found net harm from the use of warfarin in that subgroup. It most certainly is true that some cardiologists encourage such patients to take warfarin, and if they are thereby led to take on a large burden and a risk that they would not have accepted if given honest absolute numbers, that is indeed a medical error.
5. I'm glad you are aware of the possibility that high-dose aspirin is more useful in AF than low-dose aspirin; that speaks well of you. (I hope you are also aware that the same is not true in other population groups.) I have witnessed an electrophysiologist outright lie and state that aspirin has zero benefit in AF. But since high-dose aspirin has meaningful risks including cerebral and other internal hemorrhage, it is still doubtful that a person with an absolute stroke risk of less than 1% per year will derive a substantial net benefit. Some people with AF do not "need" any drug, and that is a message they are almost never going to get from a cardiologist.
Mrs Jane,
As usual, you misunderstood. Please quote where I said that.
I won't bother to quote your points, but just respond by number
1. These 3 trials show a benefit to anticoagulants in ACS. Your post does nothing to refute that
2. You don't understand medicine, that much is clear. Your post mentioned warfarin in treatment of ACS. That is not used. Your study talks about direct thrombin inhibitors such as rivaroxaban on top of dual antiplatlet therapy (ie, asa and plavix). There is nothing about substituting warfarin for thrombin inhibitors, or vice versa, as you claimed. I cannot make it simpler for you
3. Dual antiplatelet therapy is NOT warfarin and aspirin. Its plavix OR effient OR brillinta AND aspirin. Again, you cannot understand the journals you are reading if you don't understand clinical practice
4. Define low risk. For chads scores of 0-1 the benefit is minimal, and may be outweighed by bleeding. But higher risk than this (2-6) the benefit is there. I challenge you to prove otherwise
5. There was a study to suggest aspirin offers little benefit in stroke prevention for afib. I can find the citation for you. In addition, an absolute stroke risk of 1% per year is 10% over a decade, and longer for younger patients.
Theres a simple calculator you can use that I have an app for on my phone that I often show patients. Its called chads-bled and will calculate the risk of stroke vs the risk of bleeding based on risk factors
here's a link:
https://play.google.com/store/apps/details?id=appinventor.ai_soowhan.CHADSBLEDcalc&hl=en
I usually enter in the data, show them the results, and let them make the decision.
eric....
Sorry but there are MANY errors that take place in hospitals, in the outpt setting, and at pharmacies. If you were actually a practicing MD who actually worked in various healthcare settings, then you wouldn't dispute the article.
Lauriesarno,
It doesn't appear to me that Eric is disputing the article. Yes, there are many errors that take place within the hospital. As a practicing nurse as well as the "eyes and ears" of my family, I have seen errors and "near misses" first hand. I also vividly remember an error I made 20 years ago. I "owned" it, fixed it and lost a great deal of sleep that night. The next day, I asked for a different assignment. The patient called the Nurse Manager and demanded I be her nurse. I walked into her room and said, "Are you nuts? I wouldn't want ME to be MY nurse, let alone YOUR nurse." She told me that for three weeks, with everything that had happened to her, I was the first person to genuinely apologize for anything that had happened to her.
I never forgot it.
I would also like to point out that sometimes, no matter WHAT healthcare providers do, we are accused of errors. I have had more than one patient attempt to report me because I didn't bring them water in a timely fashion. And on more than one occasion, I have had the water I DO bring thrown at me. And I've worn more than water. I have come home with things on my scrubs that caused me to throw them away rather than even try to wash them
I have been punched, kicked, spit at, propositioned, felt up, cussed out and had a patient come at me swinging at IV pole. The woman swinging the IV pole had been shot up by her boyfriend earlier that day and she was coming out of her "nod" and wanted more heroin - or any narcotic. "No" was not the answer she wanted to hear.
Errors DO occur. If the Golden Arches give me a hamburger instead of a cheeseburger, it's an error and an annoyance - but not fatal. The vast majority of us try to be diligent and thoughtful, and present options as simply as possible.
I know that most people posting here are hurt and angry at providers who refused to be forthcoming - it makes me angry too. All I can do is continue to provide good care and communicate with my patients.
laurie,
what anna said. The fact is TRUE errors occur at a rate much less than 1% of the time.
Anna brings up a great example with the cheesburger/hamburger analogy--this would be classified as an error in the hospital. This along with giving meds 10 minutes late, catheter related UTI, arrhythmia following surgery, etc--all of which are not completely preventable
Heh, Eric, it is apparently the authors of this journal article (which, as I said, I don't have current access to) who in their discussion compared the potential benefits of the novel anticoagulants to those of warfarin in people who had had heart attacks. Take it up with them if you don't like that. I most certainly know that rat poison is not an antiplatelet drug and that dual antiplatelet therapy does not include rat poison - I didn't say otherwise! The way you misread (deliberately?) the messages of anyone with the temerity to disagree with you makes me think that you read medical literature that disputes the value of your practice in the same way.
As for your continuing focus on AF - yikes. Because it is very common and generally not fatal, it is a continuing cash cow for many cardiologists. Some push rat poison on every single patient. Above you agree that there is little or no net benefit for patients with a CHADS2 score of 0 or 1. That is exactly what the published evidence says - good for you. But you then create a straw man by pretending that I believed it did not have net benefit for patients with scores of 2-6, when I indicated the opposite.
Sadly, you then muddy the waters of your apparent good sense by writing: "an absolute stroke risk of 1% per year is 10% over a decade, and longer for younger patients," implying that you think the drug-pushing is actually called for in young patients. At least three errors or problems with this statement: (1) a 1% annual risk is NOT equal to a 10% risk per decade; (2) what's longer for younger patients - a decade? their lives? are you really suggesting that people should pound rat poison at 40 to save them from a stroke at 70? (3) the average stroke rate in the age-matched general population, in the large study that reported no increased stroke risk in the lowest-risk AF patients, was about 1%. If a 1% annual stroke risk is so terrifying and intolerable as to justify anticoagulants, then everyone over 50 will be on rat poison for life, whether they have AF or not. (Suggestion to younger and healthier AF patients: Estimate based on the details of your circumstances what YOUR OWN annual stroke risk is, and if it is no higher than that of a person without AF slightly older than you who would not be pushed to take lifelong antistroke prophylaxis, then feel free to question any allopath who is pushing it on you.)
And then you waffle on the aspirin, Dr. Eric. First you suggest that low-risk AF patients should take high-dose aspirin. When I agree that that could be a legitimate choice and point out that some allopaths claim otherwise, suddenly you flip-flop and start saying that aspirin has "little benefit". High-dose aspirin in some clinical trials has bleeding risks almost comparable to those of warfarin, though in actual patient populations warfarin is certainly higher-risk (to say nothing of the health damage that might be done by its effects on people's diet and exercise habits). Do you, in fact, encourage your patients with AF and CHADS2 scores of 0-1 to take a potentially dangerous drug that you genuinely believe to be of little use, solely so you can see yourself as Doing Something? (Suggestion to younger and healthier AF patients: Beware of cardiologists who know that if they aren't Doing Something, you'll realize that your condition could be adequately managed by your general practitioner.)
No, they did not. There is no indication for warfarin in ACS. We used to give it for large anterior infarcts, but that was at least 15 years ago, and as a prophylactic for LV thrombus, not for the acute infarct.
Here is the methods section from the abstract. Note the complete absence of any mention of coumadin
Electronic databases were searched to identify prospective randomized placebo-controlled clinical trials that evaluated the effects of anti-Xa or direct thrombin inhibitors in patients receiving antiplatelet therapy after an ACS
Again, the idea of using warfarin in treatment of ACS is absurd. It only affects vit k dependent clotting factors, and ACS is a platelet mediated phenomenon. However, thrombin is the common endpoint for both the intrinsic and extrinsic pathway, so it is useful for both afib and ACS
This is not new news by the way. These drugs came out a little while ago and have not seen widespread use for obvious reasons--we already have these patients on at least 2 anti coagulant meds; adding a 3rd is asking for trouble
Please quote what I misread. The fact is you made an error. You should own up to it...its really not that bad. I think ive clearly shown that you were incorrect, which is the reason I disagreed, not for any other reason.
The only reason I brought it up was to give YOU an out. You clearly made an error insinuating that coumadin can be used for ACS interchangably with a direct thrombin inhibitor. I was giving you the benefit of the doubt that you meant afib, as this is the only situation that interchanging these drugs is clinically approved (see ROCKET-AF).
Next time, if there is one, I won't be so generous as to think you made a simple error instead of a bigger one
Not really. I don't get any money for prescribing it, and few cardiologists, if any, run coumadin clinics. In fact, you directly contradict yourself--why would be so inclined to use a more expensive drug, as you suggested earlier, thereby losing the coumadin clinic INR checks, which is the only possible way we could earn money on anticoagulation?
Please quote where you indicated the opposite. If i missed it, then you have my apologies. But I looked again and didn't see it
Partially correct. I tell patients the same thing. But its definitely more than 1%--the risk is cumulative
I say it, the ACC says it, the AHA says it. In fact, if I didn't give a young patient coumadin that needed it, I could be rightfully sued.
Also, they can have strokes much earlier than 70--ive seen it in the 4th and 5th decade quite often, stemming from afib
If you actually practiced medicine instead of just typing on your keyboard, youd know that too
So a chads score of 1 has an ANNUAL risk of CVA without anticoagulation of 2.8%. Their risk of major bleed on therapy is is 1% (source CHADS and Has Bled)
Unless you suck at math, the obvious answer is anticoagulation. Now I usually individualize at this point (for example, the elderly at risk for falls), but easily above this level its a no brainer most of the time
So again, your lack of clinical experience is showing. Medicine is not an exact science. We like to think aspirin is better than nothing, but some studies have shown this to in fact not be true. Here's the citation for you--i got lazy and just googled it.
http://arwatch.co.uk/2011/11/aspirin-unsafe-and-ineffective-for-stroke-prevention-in-af/
since you continually and conveniently insist you no longer have access to this article, i have copied and pasted the entire relevant discussion portion here.
In the past decade, a similar risk-benefit profile was observed with the use of warfarin in combination with aspirin.5 In that meta-analysis, therapeutic-range anticoagulation with warfarin (international normalized ratio, 2-3) was associated with a significant reduction in ischemic events (odds ratio, 0.73; 95% CI, 0.63-0.84; P < .001) but triggered an increased risk for major bleeding. Because of the higher risk for bleeding and thrombotic events compared with dual antiplatelet therapy, long-term use of oral anticoagulation after an ACS has been restricted to the prevention of thromboembolic complications in special subsets of patients after an ACS (eg, those with atrial fibrillation or after pulmonary embolism). In patients experiencing atrial fibrillation or undergoing orthopedic surgery, new-generation oral anticoagulant agents successfully reduced bleeding complications, and the use of some agents (eg, apixaban and high-dose dabigatran) was associated with a decreased risk for thromboembolic events compared with warfarin or low-molecular-weight heparins.6 - 9 However, our results suggest that the excess risk for bleeding associated with the use of novel anti-Xa agents and DTIs is prohibitively high among patients receiving dual antiplatelet therapy after an ACS. Beyond its prognostic significance, the occurrence of bleeding is also an important element of compliance. Greater frequency of major bleeding events may have been the primary impetus for the high discontinuation rates of anti-Xa agents and DTIs across the trials analyzed herein.
Now lets revisit your original statement (i have bolded the most pertinent clause):
As should now be obvious to you, the article clearly states that warfarin is NOT indicated in ACS, and this drug would NOT be used "in preference" of it.
Im sure you will not respond out of embarasment of being proven wrong, but I think I know you well enough to be pretty sure you'll read this, and then pretend you didn't.
Have a great weekend!
I'd venture the guess that most don't pursue reporting the incident because they are aware the only way to actually have anything done about it is to sink a ton of cash into hiring a lawyer. Also, they believe their insurance coverage will either be cancelled or increase in cost.
In military medicine, mistakes are often not reported because military doctors are protected against malpractice and families worry about repercussions from command if they make waves.
Hmm, working in military medicine I found the opposite to be true. Because they do not have to worry about being sued they are more willing to admit mistakes. As far as repercussions go- does your husband work at the medical facility? If not, his command would know nothing about any incidents, problems or complaints unless you choose to inform or involve them.
You really don't think commander talk? Very naive. I have seen it happen.
Real Army Wife-your husband must have a real jerk for a commander. My husband is a Marine, and I've seen COs here go to bat for their Marines and spouses to get proper care.
Also, I once complained about my care with no reprecussions on my husband at all. It was a very horrible and rude Navy doctor who told me I was a hypochondriac when it turned out I required surgery. For him, I filled out a survey and attached a letter of complaint to the commander of the hospital, as well as attached the same letter to my request to change doctors. I don't know exactly what came of it, but it definitely didn't negatively affect my husband. But the doctor I was assigned to next treated me with kid gloves, so I think some type of consequence happened.
Naive? Just how many people have died in your arms? How many body parts have you collected hoping one will match the guy who might survive? How many dead babies have you had to bag and tag? You little freaking pansy, how dare you. Toughest job in the military, kiss my azz.
You really think you are so important that grown men call each other after work to gossip about your latest medical appointment? You think being an Army wife gives you any clue to how commands relate to one another and what is considered important?
I hope you realize that you can opt for civilian medical care. I have a feeling your military providers would not mind losing you.
"Why patients don't report medical errors"? My guess is a lot of them don't live to report them, and be sure no Doctor or Nurse will step forward. HIPAA volition, covers a lot of bases.
Very true Boromir. My father passed away last year from cancer that had eaten through his skull into his brain. Interesting part is that they had a CT Scan of his sinuses from 3 years prior that showed "what appears to be scar tissue". They didn't bother to biopsy said appearance even though his nose had been completely reconstructed due to cancer. Needless to say, none of us had the desire to deal with a lawsuit or even a complaint. Why bother?
In Delaware, a notorious child-molesting pediatrician was reported by two nurses even before any parents did. They were ignored. Nothing bad happened to them...they were just ignored.
Medical errors are not reported for the same reason parents do not report teachers. Can you imagine reporting a physician or a hospital and then still having a working rapport? I recently went through a medical error at a small local hospital with my father. Although I met with the hospital administrators to discuss the situation, I know that my father's future care might be compromised if I took it any further. So a lot depends on what is done with the information. Please don't tell me that my call or report would be anonymous since everyone in that small community hospital would know the what patient it was based on the case details.
Well, when my wife had a technician cause a blood clot the entire length of her arm and it cost us $1,000 in treatment to clear it, never will work correctly again, we put in a claim to the hospital. They told us, after 90 days, that we should expect such things when you have medical care. The doctor was upset with us and gave my wife the 'finger' on her leaving her last visit. Now we need to find a new doctor.
how did he cause that?
I am so sorry Rustystumps. You can report the incident to your state's Medical Board and put the incident on Angies List or other rating service. So long as you specify that it was YOUR personal experience there should be no problems. If you are worried call legal aid or the nearest law school----NOT to sue (although you may have a case) but to ensure that what you report is written so it is not considered slander.
Bad Docs get away with it due to patients too fearful to report them. Why is it that if your mechanic errs when fixing your car he has to redo the repair for only the cost of the parts while doctors can remove the wrong body parts with little or no fear of repercussions. They even rebill for an entire surgery if they get it wrong the first time!
RustyStumps -- I'd run as fast as my middle-aged legs can run from that bird-flipping doc! Wow.
Rusty- It would be highly unlikely that a technician was actually the reason for causing a clot. If you would include the medical history and lab results with your statement then maybe a more realistic cause could be determined.
@Judi1949.
If your doctor does a "medical error" and you are worried about a working rapport after, you clearly need a psychotherapist. FIND A NEW DOCTOR.
The big problem with medical errors is that the medical establishment won't yank the license of bad doctors or bad nurses. Punishment is in secret, and often not even a slap on the wrist.
Firstly, this is untrue. Licenses get "yanked" every year.
Secondly, being very open about it in today's litigious environment would only encourage more lawsuits, which are already at absurd levels
It's true that malpractice lawsuits are a problem, but less transparency is not the answer. Any solution that involves more secrecy had better be related to security in some way; otherwise it's the wrong solution. If you want to protect doctors from punishment from their mistakes, fine; medicine is hard. But trying to hide the problem is the very worst answer you can come up with.
Malpractice awards are less than 1% of the $2.5 trillion annual health care costs in the U.S.
It keeps doctors and hospitals honest and practicing good medicine. "Tort reform" is a smoke screen and a deception, it would do nothing but allow doctors to get away with murder.
You can't ask people to be more open and at the same time encourage a system that punishes them for doing so. I agree transparency is a good thing, but what youre asking for is unreasonable and unrealistic
Yes, but the awards are only the tip of the iceberg. What about the costs of suits that result in judgements for the defandant? What about the cost of practicing defensive medicine?
Contrary to popular belief, a test, like a CT scan for example, makes no money for the dr that ordered it. The radiologist gets paid, but not the ordering physician. The only exception is doc owned imaging facilities, which are rare and for which self referral is forbidden through stark laws.
So why have orders for imaging tests skyrocketed in the past few years? A big reason is defensive medicine. If on the stand, a doc says he didn't order a test because he thought it would be too expensive for society, he may as well start writing out the check right then
my mother inlaw was given 10 tmes the doseage of hepron she was to get for 5 hrs the blood literaly ran out of her skin when they rolled her over her back was black from blood medicare and every one else said that was not the reason for death IT WILL ALWAYS BE TO ME =
you need to get the written copy of med records, no electronic records. asap. Medicare is not to whom you complain, but the state Licensing board. get the lot numbers and names and make copies. You will not get all copies of the records to include the occurence report done by the staff who gave her the overdose. the manufacturer of the heparin brand used. Someone needs to go after these pharmaceutical criminal corporations in addition to the users/administerers of the junk they sell. take down big pharma and the providers. see study proposed by Astrazenca Pegasus study to use/give med to prior MI patients with an end result of death, MI or stroke that will end the study phase. currently an international study going on with recruitment to unwitting people and their families. First do no harm to our bank accounts is the rule. Medicare DOES not accept electronic records and Neither Should YOU!
Know that radiation is a cause of double strand DNA breaks and radiation is damaging with even 1 exposure. see auntminnie.com 7 May 2012 article about med that halves DNA damage , see pics of double strand DNA breaks. Avoid all radiation scans, NONE are routine and they are done with long exposures and you don't often know when it's being used. in all specialties, dental xrays are not routine. see RIM- radiation induced meningiomas- which are caused by sinus , dental and head xrays/CT scans. most don't cause sx or need removal. so don't fall for that one.
Sunny, the paper copies that are provided to you and Medicare are paper prints from the electronic record. I have seen how electronic charting has been able to prove who did what, because an electronic signature is captured and you can see precisely who signed what. Medicare and their reviewers actually like that.
My husband went for heart surcery and died on a brain injurie.Attorney say yes something went wrong but is to hart to proof.Not a lot money can be made so attorney will not take the case or all the others and ask
When we are asked to complain we have a perception of some sort of negative consequence following. As mentioned in other posts, our medical providers have relationships with us, and unless the problem is so large as to end the relationship, we may not want to get our doctor in trouble. I suggest that we report in general how medical care was provided, and the results, and from these more complete reports we could find where the errors are. As medical consumers we may not even realize what was an error or mistake, and what was a side effect. If a complete picture of the care was available, trends could be found, and perhaps overall care could be improved.
I went to see Dr. Paul J. Zosel, of Bellingham and Mt. Vernon, WA., supposedly a Periodontist (although the associations have no record of his membership, nor that he claims to be a specialist), and the motherf**ker caused me to experience Stage II blood loss, which in turn caused me to have A HEART ATTACK.
I saw him on July 10, had the heart attack after 54 hours of continuous heavy bleeding on the 12th, and it kept bleeding until July 15th, and my cardiologist was FINALLY able to stent that artery on the 16th. But this QUACK DENTIST caused me to bleed profusely for FIVE FULL DAYS because he f**ked up.
You can bet your ass I checked him out with all the dental associations and have filed a DETAILED complaint with the Department of Health in Washington State.
Eventually, I'll own his lakefront house, his boat, and his goddamn Cessna T210M, tail no. N117HL, soon as we find out quantitatively how much permanent damage this f**k caused to my heart muscle.
this is not a medical definition that I am familiar with
blood loss does not cause a "heart attack". Sometimes it can cause demand ischemia, but this is not the same as a traditional "heart attack"
So how would bleeding cause a blockage in your coronary artery?
The true motivation finally shows itself. This type of unabashed greed is killing american medicine
Good thing you are so concerned with justice rather than material things. Delude yourself if you must, but you will never own any of those things. You will receive a settlement from his malpractice insurer. We learn all about asset protection in our training...
No offense, but you look and sound like the prototypical gold digger. I'm sure that your smoking, drinking, and other self abusive behavior probably had nothing to do with your medical condition.
search double strand DNA breaks and see all the damage even 1 xray or CT scan causes! radiation causes depletion of oxygen molecules, hence anti oxidant and use of common cheap med NAC or N Acetyl Cysteine or BioShield to protect against radiation damage. know that 95% of meningiomas are Radiation Induced Meningiomas, too, dental xrays contribute to back of head meningiomas. See auntminnie.com 7 May 2012 article on DNA double strand breaks - med halves damage of DNA breaks, radiation damages blood vessels, lungs/hearts/kidneys , athrosclerosis cause, fibrosis, avoid it and mri metal injections of gadolinium metal. fda.gov has black box warning on this. Not worth it. heparin is a messy drug to be given. all the junk used in hospitals is under some type of last phase of a clinical trial sponsored by pharmaceutical companies who could care less about you. Radiation is HEAT and heat damages tissues with one exposure. Penetrating heat/gamma waves. They know this and won't stop using heat to damage people or admit it, raddocs fear loss of income but it won't hurt them one bit. medical radiation is not natural sunlight radiation. it's different, ionizing radiation. look it up. NO radiation xrays, dental, chest or CT scans and contrasts are routine. NONE are routine. Avoid them at all costs. latent sx do occur. They know this. They have an IMAGE problem.
and the Medicare Quality Assurance reviews are a joke. Useless Medicare , got that? YOU PROTECT LOUSY, INCOMPETENT MD's and NP who collect your money and do nothing but HARM Patients. YOU PROTECT the criminals.
And, speaking as a dentist, I have neither seen or heard of any dentist causing bleeding to an extent that would be life-threatening from typical periodontal procedures. Even though many of our patients are on anticoagulants. Bleeding episodes like this are rare even in oral surgery offices, where bleeding is to be expected.
I call BS.
State Licensing Agencies, Professional Licensing Boards, and Joint Commissions are all gubmint agencies and therefore political and therefore politicized. We are way down the road from the days when "professionasl" were the only ones who knew what goes on in their profession and were therefore allowed to be self-governing their members. They used to license, discipline and regulate their members and we had a society that was building and creating and moving forward on every level. That generation was replaced by people who inhereted the professions built by others and they didn't have the same regard for being a professional. Less care and shenanghans started showing up more often. Accountants ruined their profession with the likes of the Arthur Anderson sheisters who gave us the Enron series of corrupt practices. The gubmint took away their self regulation priviledges as a result. Docs have long had a state licensing board. All these professions have failed at getting rid of the crooks and incompetents in their ranks. But the gubmint agencies have never thought it wise to create a database of complaints, validate them and publish the valid results. They may as well collude with the professions to conceal the bad members and become complicit at creating new victims by allowing bad practitioners to stay in business. The logic is akin to a Judge allowing a repeat drunk driver to stay on the road because he says he has a job and needs to feed his family. And he keeps putting people in hospitals and graves as a drunk driver. Apparently the gubmint authorities think the next victims of these people are worth less than the victimizer professional. There is no reason to complain to a gubmint agency about a professional since they've already shown their lack of resolve. They aren't interested. They say they are (because the job requires saying so) but their own procedures make it impossible for regulatory effectiveness. This explains why we have so many filthy restaurants operating and yet we have Health Departments in every county in the US. Bad Docs and hospitals are here to stay !
as long as licencing boards cover up for them, and only announce mistakes and bad doctors a year after they've known about their criminal acts, such as notifying the public 1 year after a DDS was caught giving /using multi dose vials and re used needles for over 8 that's EIGHT YEARS and did nothing about him. got him on Rx abuse, which he eventually surrendered his license and the patient's burden was to get tested for Hep C/HIV at THEIR expense. for drug abuse, an impaired practioner only has to complete a rehab program and can keep practicing. a psychologist known to write diagnosis without seeing patients is allowed to keep practicing for SSDI exams. a doc who is not allowed to treat thyroid patients, does and sends them to Wy to obtain Rx meds for normal thyroid conditions and has atleast 10 years hx of sexual abuse/women pts/ requires chaperone's that pts can sign to refuse. What a racket.
I wouln't even know if they made a mistake on me. I know it happens but how would I know?
get copies or view your medical records in the medical records department. be suspicious if the electronic record is availed only. YOU WANT TO SEE the written hard copy that insurance companies and Medicare sees. Ask for copies of all documents you sign and all MD notes, nurses notes, med records, occurence reports which they say are not for copy, but nurses make copies anyway. take pictures, know med doses, recalls, buy a nurses drug handbook, look for blackbox warnings on meds esp fda.gov ie. gadolinium notice it does not tell you it's metal. it is. metal injected for the magnets in MRI scans. CT scans use TC 99 and other nuclides, search them. radiation induced meningiomas, see RIM causes. see auntminnie.com 7 May 2012 article about med that halves damage of DNA breaks. know what double strand DNA breaks are, read medscape.com, protect your kidneys, heart. lungs, if in doubt, check out. don't accept anything IV without the nurse explaining anything to you. that goes for radiology techs. No power injectors in radiology exams. NONE.
Patients must be assured of immunity from being sued for defamation by the subject of the complaint. I had a client who filed a complaint and the subject of the complaint sued her for defamation.
why? Does a dr not have to tell a hospital or medical board every time he is sued? There should be consequences for filing frivilous lawsuits
if it's her opinion, did she win. patient's opinions online are protected, free speech. if a patient is THAT MAD at the MD, there is a reason. BaD doctors are protected by just as bad other bad and good doctors and TRUST should not be reinstated to protect these monsters. The Nuremberg Code and FULL Informed consent is not full informed consent. Read Deadly Monopolies by Harriet Washington 2011. up to date. she's right on. read history of human experiments. You'll see.
My daughter went for lapband surgery at Palms of Pasedena Hospital in St Pete Fla...I don't know what they did but they took it out the next day and her surgical pictures look like she was burned inside with a hot iron. Everyone says they don't know why????? She was in the hospital 40 days 30 of them in ICU..she had a wound 7 inches deep and 13 inches wide. The surgeon says she doesn't know why....well my daughter did live and we spend time at doctors still because of this. I am sure she will never discuss this with her new patients. So much for respected surgeons (barriatric) and hospitals.
As a practicing physician, I disagree with the basic premise of this article that there is an epidemics of medical error, and medical malpractice running amok
Bad outcome does not equal medical error.
Public does not grasp this concept, and if anything goes wrong, they blame the doctors, hospitals and nurses. Most people do not understand that even if everyone follows the standard of care, there will be adverse AKA bad outcomes.
The quoted 'study' by Institute of Medicine has long been criticized for their flawed methodology. It is more of a political piece than true scholarship. It was done by Berwick, Obama ex-appointee to one of government agency running medicine.
erbe (#20) -- You make a valid point when you say ... "Bad outcome does not equal medical error." But, before any procedure/surgery, all patients are required to sign a disclaimer acknowledging that they've been informed of "whatever" and essentially absolving the medical provider (doctor, hospital) of fault. So, the odds strongly favor medical personnel from the starting gate.
Mistakes do happen even when protocol is followed. Unforeseen problems may occur. What you're not addressing is "negligence." The public does grasp concepts if they are well-read and educated, so refrain from belittling those who do not hold medical degrees but have done their homework even better than doctors do.
This year, I had serious pneumonia and CABGx3. After final discharge, when I went for office follow-ups, both my cardiac surgeon and cardiologist questioned why I was taking Vitamin D supplements. I had to remind both of them to check my recent blood work reports that I gave them for their files. My D levels were almost non-existent, and in-hospital they ordered that supplement for me. They already had copies at their offices, because they were the ones who originally ordered the blood testings while I was in-hospital. However, neither placed Vitamin D on my discharge directions for me to follow at home.
Both of these doctors are cutting edge at The Valley Hospital in Ridgewood, NJ and both have respected affiliations with Columbia Presbyterian in NYC. They are not hack doctors, but they're too busy to read their own fine print.
It can be tough sometimes to tell what is a medical error and what is the perception of a medical error, or side effect. for instance, people swear up and down to me that the flu shot gave them the flu. The flu shot cannot transmit the flu virus as it does not have any whole virus in it.
And, a bad outcome doesn't mean that a health care practicioner is the one who caused it. Sometimes.....maybe.....the smoker and drinker cause their own problems.
My problem with the hospital and surgeon is this, I went into the Hospital for back surgery, to fuse two vertabra where a disc had degenerated. I ended up with Septicimia, Septic Blood Poisoning, I nearly died, was in an induced coma for a month and lost 60% of the use of my left leg. Then I endured 4 months of learning how to walk again and must excercise daily to retain my ability to walk. I walk totaly reliant on a cane and my right leg knee is now worn out requiring surgery.
When I inquired of two legal firms if the hospital and surgeon had some financial responsibility, I was advised that when you enter a hospital you should expect that you can end up getting a very serious infection. When I go on some other sites on the internet, they state that prevention of infection in hospitals is preventable with appropriate procedures.
When you evaluate the cost of my care, two months of added hospitalization, two weeks of rehabilitation and three months of therapy, it would appear that some money should be invested in PREVENTION.
Not to mention the fact that this cost me my business and my livlihood.
there are more bacterial cells in and on you than human cells. To prevent only a small fraction of a percent of those from causing an infection is an impossible task
The fact that the vast majority of surgeries have no infectious complication is a tribute to modern medicine
Indeed, it is a tribute to modern medicine that infection can be prevented far better than in past civilizations' surgical traditions. Unfortunately, not all doctors utilize these wonderful techniques to the greatest possible extent. My husband used to work in a hospital where it was common knowledge that certain surgeons had enormously higher infection and complication rates than others. Did anyone give those guys' patients advance warning? Of course not.
The real question is whether anyone told Concerned USA in advance that most back surgery has either not been proven to help, or has been proven not to help, large portions of the patients on whom it is used. There's a good chance that your likelihood of benefit is no greater than your likelihood of lasting injury. I have great sympathy for him/her, since I have a family friend who was nearly killed, and left permanently disabled, by an incompetent back surgeon.
First of all: when has the US or States done their J-O-Bs?
Texas has the TxDept of Health Ombudsman: to whom you report and they never respond because
l) you have foreigners who cannot even speak English
2) which is the issue in the lst place--medical personnel taking the seats in our USA's taxpaid Universities
3) we are importing errors..training and language is a paradox
Our gov is retired-on-theJ-O-B...in 20 yrs they are out being parasites on the worker who has to work from age l8 to 65 or + for them..PROOF in the life-expectancy of US Citizens who do work
4) 47% do nothing--but certainly utilize the system at other peoples expense.
5) LAWYERS seem to help those like the man who ate too much popcorn...instead of the person mangled because the surgeon wanted to practice on him...but amputating ..
6) Our Veterans cannot sue the VA...but illegals and terrorist can.
All of the above comes down to when you are a victim--a real vicitm vs. someone claiming "bullying" the latest White Collar go get em and "Discrimination" he or she grabbed my butt and that compared to a l5 year old being raped by a dozen over aged males...
Who was really scarred for life?
When Dustin Hoffman can get a DUMBER than LIFE LJURY JUDGMENT of $9Million for being in a dress in a magazine after playing Tootsie...we have our heads in the toilet...yet a child is raped and the Supreme Court says PORN is a lst AMEND expression.
Dial#2 for Spanish...
PS Attorneys don't help someone--they help themselves...so it must be deep pockets..usually the ONE who caused the damage never puts out a dime--and for attorneys--to make a name--it must be simple, and easy...so much for having an attorney for every l00th person in the USA while physicians have thousands of patients...and no appointments in between--
MEDICAL FRAUD..nothing being done...why not? Payola to the political lifers and their offspring just like Hollywood nepotism reigns
My husband survived Colon cancer for the last 4 years now. Surgery, Chemo and Radiation therapy. The hospital he attended, because of insurance requirements almost killed him twice.
The Chemo dept. let an IV of Chemo dislodge because no one was monitoring it and slip from the vein into the muscle tissue. It has caused permanent damage to his right arm. He no longer has feeling or full mobility in that arm.
The second time was caused by another Chemo mishap. They gave him a drug that caused so much severe diarrhea that his skin literally turned gray! They advised him to wait and see if it got better! If I had, I'd be a widow now. Even I know what severe dehydration looks like. And I am not trained to.
They then kept us waiting for over two hours, I brought him in because I knew he was dying, in reception because they "forgot" we were there! I told them to get him some help or call security because I was going to start slugging some people very shortly.
They moved him to a room...but didn't bother to call a DR. to see him! We waited one more hour at his insistance and then I went ballistic. Not on the floor nurses because by law there was nothing they could do without a DR.'s order. The head nurse broke into a meeting and told the DR. what was going on. Nobody in the damn Chemo office had told, left a message or in any way alerted anyone to his condition.
He immediatly started an IV that saved my husbands life. Such a simple thing! They then gave me a persciption of extremely costly shots, which I administered at home because the insurance wouldn't pay for his hospital stay any longer. He refused to complain and because he was the patient, they sluffed off my complaints.
Because I my self have suffered at the hands of incompetant and just plain ignorant medical help in the past, when I was seven I was diagnosed with stomach ulcers, no diagnostic tests, just some quacks pronouncement after palpatting my stomach area, I had chronic appendicitis and almost died when it burst.
Later in life, with a CPU I diagnosed that I had a rogue Gallblladder going on and although I had tests and at least twenty years of excritiating pain, no DR. diagnosed me correctly till I almost died once again. None of them wanted to listen to the patient because they are so well educated and god knows the rest of us are just plain ignorant!
My advise...Know your own body and do not ignore your pain. You don't have to go overboard or read into things that are not possible for your health. Just get to know your symptoms and educate yourself on cause and treatment. Demand that your providers recheck the results and never...ever...settle for only one opinion. Check out your providers stats. How many died at their hands because of a bad diagnosis or just sloppy treatment.
If you are hospitilized demand they wash and sanitize before touching you in any way. Do not be afraid to speak up for yourself or your loved ones. Dr.s ARE NOT GODS. They make mistakes because of the same reason's we all do. They are over worked, they are too busy or they are idiots.
Question any thing you don't understand or feel iffy about. Ask why and demand knowledge of the treatment and why they chose it for you. Then get your ass or ask someone you trust to get on line and the pros and con's for you. It's your life, not theirs. Always demand sanitation before they touch you or anything that invades your body.
It would be a true hell to come through a double bypass and die of an infection because some nurse or DR. had dirty digits!