Tuesday, September 25, 2012

Medical Errors and the Risk of Dying from Health Care

In an excellent article in the Wall Street Journal by Dr. Marty Makary, entitled “How to Stop Hospitals from Killing Us” he describes the epidemic of errors that occur in hospitals that can even cause death.  As he puts it, “Medical mistakes kill enough people each week to fill four jumbo jets. But these mistakes go largely unnoticed by the world at large, and the medical community rarely learns from them.”    But he is being far too kind and diplomatic.  For in his title he only addresses the problem of hospitals killing us while most people who have health care needs will never see the inside of a hospital.  Instead the title should be “How to Stop Doctors, Hospitals and all of the Health Care System and all Health Care Professionals from Killing Us”.  Admittedly for any article, that kind of complete truth can be overwhelming and does not lead to solutions in the way that he suggests and of the type that we need.

The fact is that all of medicine is plagued by errors of overuse, underuse and misuse.  You can get into trouble as a patient if doctors and other health professionals do too much, do too little or do the wrong things.   And all of these errors can lead to more problems and even eventually to death. 

And medicine and health care do not lack oversight.  Government agencies and the infrastructure that forces you to sign forms as you enter a physician’s office and the many agencies of both government and private review organizations that inspect and review hospitals and other health care facilities and organizations offer oversight so overwhelming that even physician practices often have to hire people just to keep track of the requirements.  And all of that oversight often does not address what happens to you, the individual person who is suddenly faced with becoming a patient.  For all these review agencies and the processes they put in place are more about the reporting of hospital and office data and not about what really happens in those hospitals and offices. 

An article in the blog Fierce Healthcare notes that under the ACA requirements, certain errors by hospitals must be reported and points out that for the state of Utah, in more than one year’s time since the law took effect, 17 avoidable errors have been reported.  Dr. Edmund Kwok who blogs at “Front Door to Healthcare” wisely states, “There is absolutely no way that there were only 17 avoidable medical errors in the whole state of Utah over the course of a year” and any physician, me included, will strongly agree with his statement.

Dr. Craig Hersh who works with me at Accolade and previously worked as a hospital Medical Director explains this phenomena of underreporting of errors in this way: “But statistics can be misleading.  At my hospital we didn’t initially pay much attention to the data capture of quality metrics, as there wasn’t any incentive to do so.  Then one day the results of all local hospitals appeared in the paper in a small article.  We were at the bottom of the pack.  We then committed resources to documentation.  Within one year we went from worst to first in quality (that year hospital quality results were the lead story, so our timing was good).  Frankly, we didn’t change much in the way we did things- we just became better than all the others at documenting.  We also knew that  observed/expected mortality rates (which is often one of the calculated benchmark for quality in the hospital) are highly linked to coding.  As we strengthened our coding, and patients looked sicker by their codes, all of a sudden our observed/expected mortality dropped.  Our actual mortality didn’t change, or if it did it wasn’t a result of any real changes to the care we provided.”

And so the issue of avoiding errors, for many hospitals and medical offices, ends up being more of an issue of capturing the right data and reporting with the correct forms rather than really avoiding errors!  However Dr. Makary has some excellent suggestions in his article that can truly get at helping individuals avoid errors and potentially avoid death in the hands of our medical system.  Transparency is part of the solution however the way that we capture information for true transparency remains very difficult and problematic as the data from Utah suggest.  Two of his other suggestions involve the use of cameras and open notes.  He suggests using cameras to capture procedures specifically so that the videotaped procedure can be graded for quality and suggests an open notes system in which the patient can see the notes that the doctor writes or dictates and offer corrections or additional information based on those notes. 

Allow me to add another suggestion that everyone have a “bodyguard”, a protector against medical errors.  At Accolade that person is an Accolade Health Assistant whose job is to help the person who needs the health care system, whether he or she needs a doctor, hospital, nurse, therapist or any other part of the system, avoid those errors which can lead to injury, costs, and potentially even death as Dr. Makary highlights.   Being a patient armed with the proper information at the time you need it whether you are in a hospital or an office setting, and the proper support of a knowledgeable professional  Health Assistant can be the key to avoiding the health risks and potentially even the unnecessary deaths associated with the errors that now plague health care and thus on a societal basis, contribute to the cure of this epidemic.