medical errors

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Why I Left Medicine: A Burnt-Out Doctor’s Decision To Quit

By Diane Shannon
Guest Contributor

When I introduce myself as a physician who left clinical practice, non-physicians ask me why I left. They’re generally intrigued that someone who sacrificed many years and many dollars for medical training would then change her mind. But physicians, almost universally, never ask me why I left. Instead, they ask me how. They call and email me with logistical questions, wanting to learn the secret of how I managed the transition out of clinical medicine (read “escape”).

Earlier this month I attended a conference on physician well-being at the Massachusetts Medical Society where I heard an alarming statistic: the suicide rate among women physicians is more than two times that of women in the general population.

Diane Shannon, plagued by constant worry about patients, and fear of medical errors, gave up her career as a physician. (Courtesy)

Dr. Diane Shannon — plagued by constant worry about her patients and fear of medical errors — walked away from a career as a physician. (Courtesy)

It may be dramatic and self-serving to frame my career change as a way to avoid suicide, but I can attest that medicine was not conducive to my health. As an internist, working in adult outpatient clinics around Boston, I had trouble leaving my work at work. I’d go for a run and spend the entire 30 minutes wondering if I’d ordered the right diagnostic test. I suffered from chronic early morning wakening, even on my weekends off. I startled easily. I found it impossible to relax. I worried constantly that I’d make a mistake, like ordering the wrong dosage of a medication, or that a system flaw, like an abnormal lab report getting overlooked, would harm a patient. I no longer remembered the joy I’d felt when I first began medical school, and I couldn’t imagine surviving life as a doctor.

I no longer believe it was weakness or selfishness that led me to abandon clinical practice. I believe it was self-preservation. I knew I didn’t have the stamina and single-mindedness to try to provide high-quality, compassionate care within the existing environment. Perhaps, due to temperament or timing, I was less immune than others to the stresses of practicing medicine in a health care system that often seemed blind to humanness, both mine and my patients’.

That’s not to say that I don’t miss practicing medicine. I do. I miss engaging in meaningful interactions and being of service, reassuring an elderly woman that we could make her emphysema easier to endure, bearing witness to a cancer patient’s grace in the face of death, supporting a college student facing an unexpected pregnancy. I miss spending my days in deeply meaningful work. Continue reading

Please Discuss: Should Doctors Who Make Mistakes Be Punished?

A patient who had an operation made things very clear…” credit=”Ian Turton/Flickr CC

The latest “Invitation to a Dialogue” feature in The New York Times opinion pages stems from a question posed by the former chief of Beth Israel Deaconess Medical Center, Paul Levy. It begins:

The tendency to assign blame when mistakes occur is inimical to an environment in which we hope learning and improvement will take place. But there is some need to hold people accountable for egregious errors. Where’s the balance?

Read the full invitation here; brief responses are due by Thursday to letters@nytimes.com, and the dialogue will be published in the paper’s Sunday Review. If you send your response to the Times but it is not chosen, please consider sending it to us by clicking on “Get in touch” below, and we can post our own compilation.

My two cents: Doctors have incredibly hard jobs and when one messes up — makes an honest mistake of the type I described in this recent post on misdiagnosing ectopic pregnancy — I don’t think they should usually be punished. It’s a powerful argument that punishment will merely lead to cover-ups rather than improvement. However, from the patient’s perspective, I think I have the right to know about these errors, by name, and what disturbs me is that there is so little accessible information on the most important aspects of medical quality — including which doctors mess up more than others.

Readers? Background reading:
True Transparency: Doctors Who Admit Errors, And How To Help Them
Oops! Mass. General Surgeon Openly Admits Performing Wrong Surgery

Study: A Few Bad Apples Dominate Patient Complaints About Doctors

(Wikimedia Commons)

(Wikimedia Commons)

It’s tricky. Patients want to be able to shop for high-quality doctors — or at least avoid the bad ones — but the quality information they can access remains spotty at best, even in these days of Yelp and Angie’s List.

Here in Massachusetts, we also have the Massachusetts Health Quality Partners, which gather data on patient experience — as featured recently in the Consumer Reports ratings of physician practices in the state. But a recent Health Business Blog tour of the existing quality-shopping resources found it still coming up so short that the headline is “The still-early state of online doctor reviews.”

Of course, if we could all know more about the official complaints against doctors and hospitals — and not just the tiny trickle that end up being made public — that would certainly help. So here’s an interesting idea just out from the journal BMJ Quality and Safety: What if the first three complaints about a doctor could be kept confidential, but once the fourth rolled in, the patient concerns had to be made public?

Doctors named in a third complaint had a 38% chance of being named in another one within one year.

Here’s the rationale: a new study of Australian doctors found a striking phenomenon of “frequent fliers”: “Half of all formal patient complaints made in Australia to health ombudsmen concern just 3% of the country’s doctors, with 1% accounting for a quarter of all complaints,” it found.

Wouldn’t you love to know exactly which doctors comprise that 1 percent, especially when you’re in the market for a new one?
From the press release:

Doctors complained about more than three times are highly likely to be the subject of a further complaint – and often within a couple of years – the findings show.

The problem is unlikely to be confined to Australia, warn commentators, who point out that while regulators often know about these problem doctors, patients usually don’t.

The researchers base their findings on a national sample of almost 19,000 formal patient complaints filed against 11,148 doctors with health service ombudsmen (commissions) across Australia between 2000 and 2011.

Over 60% (61%) of the complaints concerned clinical aspects of care, while almost one in four (23%) concerned communication issues, including the doctor’s attitude and the quality or quantity of information provided.

Most (79%) of the doctors involved in complaints were men, and over half of all those complained about (54%) were aged between 36 and 55.

When the distribution of complaints was analysed across all doctors in practice, this showed that 3% of practitioners accounted for 49% of all complaints made; and 1% accounted for a quarter. Continue reading

Hospital Chief On Apology To James Woods For Brother’s ER Death

http://www.youtube.com/watch?v=g57uTHWYC_Q

The news is nearly two years old, that Kent Hospital in Warwick, R.I. settled a suit by actor James Woods over his 49-year-old brother’s Emergency Room death.

But it is still quite something to hear the hospital chief involved, Sandra Coletta, say out loud before an audience of hundreds that she apologized for what happened and that “Quite honestly, I did nothing other than what my mother taught me.”

The issue of medical apologies is particularly relevant right now in Massachusetts, where the next wave of health reform is expected to include legal changes to help spur more of them.

Coletta spoke in Boston last night at the 10th annual dinner of MITSS, Medically Induced Trama Support Services, a widely respected group that aims to support patients, families, and staffs after things go medically wrong.

‘I can’t tell you how to say you’re sorry. I can just tell you to do what feels right in your heart.’

Things went very wrong with James Woods’ brother, Michael, at Kent Hospital. According to news reports, Michael died of a heart attack while waiting in the emergency room, having come in for vomiting and a sore throat. The Associated Press reported in 2009:

The hospital’s chief executive, Sandra Coletta, acknowledged at a news conference with Woods outside court that mistakes were made. She said the hospital is creating an institute in Michael Woods’ honor and investing $1.25 million over the next five years to study redesigning health care and reducing errors.

Actor James Woods during the trial over his brother's death

Coletta provided an update on the hospital’s changes last night, but she also offered a window into the emotional side of the incident. She was new to her Kent Hospital CEO job when she heard of the Woods suit, she said. When she listened in on the trial, she “found out that we hadn’t done everything correctly. We had had a system failure. We had not followed a physician’s order.” But how could the hospital settle the case, without even defending itself?

“I remember saying to someone, ‘The only way I could ever settle this case is if Jimmy would stand with me and agree to change this hospital for the better. If we could combine our efforts and take the pain that he and his family had endured, and join it with us to improve the care of patients going forward. Then we could settle.’

So we asked if he would meet with us. And I met with him. And that’s really where all the headlines come: ‘She said she was sorry!’ Quite honestly I did nothing other than what my mother taught me. I think all too often in health care we evaluate, and we are counseled, and we read books upon books. But sometimes you just have to go back to your core value.

I faced a man who had lost his brother, a brother he had raised in the absence of a father. A brother who cared for an elderly mother while he was out doing his career. Someone who was very dear and close to his heart. When I met that man, I did not meet ‘James Woods.’ I met a family member who had lost a brother, because an order that was written by our emergency physician was not carried out by the staff.

‘Either you are a better actress than I am an actor, or I’m going to be coming after you.’

We did settle the case and we established the Michael J. Woods Institute, and the purpose of the institute is to redesign health care from a human factors perspective… Continue reading

What We Can All Learn From Michael Jackson’s Doctor

By Ken Farbstein
Guest blogger

Michael Jackson had what most of us think we want: Utterly personal attention from a dedicated doctor, on call all the time for him alone.

That doctor, Conrad Murray, is now on trial for manslaughter (see reports here and here) though no one thinks Michael’s death from an overdose of the anesthetic Propofol was deliberate. By all accounts, the treatment that Michael received was anything but normal or typical, but is there anything that typical patients can learn from what went wrong?

Hindsight is 20/20. Clearly, doctors shouldn’t administer Propofol on their own. This case is unique. But as a patient advocate, I try to learn from every medical error, and to extract useful guidance that patients can act on in the moment. The lessons of Michael’s death have little to do with Propofol. Much remains unclear about exactly what happened, but I see three key lessons:

•Don’t assume information about your medications has been communicated from one doctor to another.
•Keep an updated medication list.
•Get a family member or professional patient advocate to help oversee your care.

The story of Michael Jackson’s death is explored in my book, Getting Your Best Health Care:  Real-World Stories of Patient Empowerment, among case studies of other celebrities.  In particular, I examine more fully the role of his medical team. The conflicting accounts this week by the prosecutor, defense lawyer, and early witnesses make it hard to know the whole truth at this time, but useful lessons are already emerging.

‘For the doctor to proceed then without a professional assistant, a cogent patient, or a computer was like a groggy pilot flying at night with no co-pilot or flight instrument panel: flying blind.’

 

Poor communication among medical personnel

Michael’s primary care provider reportedly communicated some critical information poorly. When emergency medical technicians arrived to try to revive Michael, his primary care doctor did not inform them that he had given Propofol to Michael, according to the prosecutor.  That may have affected the way the EMTs tried to revive him.

Flumazenil was used to reverse the effects of benzodiazepines like the Lorazepam that Michael had been taking.  Miscommunication may have led the EMTs to administer the Flumazenil in a misdirected effort to counteract the effects of the Lorazepam.

The patient’s role Continue reading

True Transparency: Doctors Who Admit Errors, And How To Help Them

A patient who had a different operation made things very clear...


It’s easy to be snarky. I confess that when I posted this story last November about a Mass. General surgeon who admitted performing the wrong operation on a patient and analyzed why, my headline began “Oops!” But the truth is, of course, its incredibly courageous of doctors to admit their mistakes publicly, to break the medical omerta.

The topic is timely today because of a new Harvard study finding that most doctors will face a malpractice lawsuit at some point — and interesting work under way in Massachusetts to encourage medical apologies. The Patrick administration, too, supports making admissions and apologies easier. And the American Medical Association’s amednews.com has just posted an inspiring piece on three doctors who came clean before their colleagues, including Mass. General’s Dr. David C. Ring and Dr. Jo Shapiro of Brigham & Women’s.

The piece begins with a heartbreaking story of a Seattle nurse whose dosage miscalculation led to a baby’s death — and to her own suicide. (A recent study found that doctors have about double the usual suicide rate to begin with, and major medical mistakes triple their suicide risk, amednews reports.) And the piece ends with some of the efforts, in Boston and elsewhere, to help medical staffers who have made errors:

Supporting physicians when things go wrong

Few physicians talk publicly about their medical errors, but a growing number are benefiting from programs dedicated to helping doctors deal with the emotional turmoil that often comes in the wake of adverse events.

Jo Shapiro, MD, helped start the Center for Professionalism & Peer Support at Boston’s Brigham and Women’s Hospital in October 2008. There are 55 physicians and other health professionals at the hospital trained to offer emotional support to peers involved in cases of patient harm.

“When there’s any kind of adverse event that we hear about, one of us will make an outreach call to the physician involved,” Dr. Shapiro says. “We ask them simple questions like, ‘How are you doing? How are you feeling? Is there anything I can do to help you?’ ”

Continue reading

Lawmakers Approve Bill To Reduce Medical Errors

It’s hard to vote against patient safety, so it’s not a huge surprise that a bill to reduce medical errors and boost patient safety passed unanimously out of a public health committee today. Still, it’s worth noting here, via press release:

The Joint Committee on Public Health voted unanimously in favor of House Bill 1519, “An act reducing medical errors and improving patient safety” today. Sponsored by Representative Jeffrey Sánchez, co-chair of the Committee, the bill addresses systemic issues that affect patient safety by encouraging honest, open communication and evaluation of care among health care providers.

“As the dialogue about payment reform in Massachusetts moves toward basing payment on value and not volume, these issues of patient safety and quality become even more important,” Sánchez said. “We need to find the right balance so that the coordination, efficiency, and quality of health care can all be improved in this process.”

House 1519 requires the development of preventive measures to reduce avoidable errors, healthcare associated infections and other unanticipated health outcomes; requires the development of screening procedures for multidrug-resistant organisms, including MRSA; provides whistleblower protection to any person who assists in a complaint with the Board of Registration in Nursing; expands medical peer review laws to any committee formed to perform duties of a medical peer review committee, regardless of whether the committee has an affiliation with a specific hospital, nursing home, or HMO; and requires the study of the impacts of medication errors as well as medical overutilization of services, including the practice of defensive medicine in the Commonwealth. Continue reading

Rep. Jeffrey Sanchez: Make Massachusetts Patients Safer

Rep. Jeffrey Sanchez


This Tuesday, the Massachusetts legislature’s Joint Committee on Public Health is slated to hold a hearing on 33 — count ‘em, 33 — proposed bills on patient safety and quality of care. (The agenda is here.) Here, Rep. Jeffrey Sánchez, the joint committee’s House chair, writes a guest post about his own legislative offering, to be heard at the hearing along with the others.

(CommonHealth welcomes guest posts on health care topics of broad public interest. To inquire about submitting one, please click on the “Get in Touch” button below.)

In Massachusetts, we’re surrounded by some of the best health care institutions and practitioners in the world and don’t typically think patient safety is an area that needs to be addressed. But unfortunately, accidents happen.

Back in 1999, the Institute of Medicine released an eye-opening study, “To Err is Human,” which found that nearly 100,000 people die every year in the United States due to medical errors. As the report’s title suggests, these errors aren’t malicious or intentional; they are often a result of systems or a culture that make it too easy for mistakes to occur. We need to encourage systems that make it difficult, if not impossible, to make an error.

Another area that must be addressed in order to improve patient safety is the rate of health-care-associated infections. Each year in the Commonwealth, there are about 34,000 such infections. In addition to delaying recoveries and affecting quality of life, these infections have a significant financial impact, costing the Commonwealth between $200 and $400 million annually.

There are shining examples right here in Massachusetts of the type of systemic changes that are necessary to address these patient safety issues. Dr. Atul Gawande, a surgeon at Brigham and Women’s Hospital, was part of a team that developed a simple two-minute checklist for use in surgery that has seen a drop in deaths and complications of an astounding 36%. New England Baptist Hospital instituted a program to screen and treat patients for MRSA (methicillin-resistant staph) and ended up reducing all surgical site infections by almost 60%. The Massachusetts Hospital Association and the Massachusetts Coalition for the Prevention of Medical Errors are also working together to reduce the number of central line-associated blood stream infections.

These types of initiatives should be implemented across the Commonwealth. To do so, I have filed House Bill 1519, An Act reducing medical errors and improving patient safety. This bill, which is among those to be heard on Tuesday, includes: Continue reading

Study: Stick With One ER For Fewer Errors, Better Care

Jumping around to different ERs can lead to fragmented care and more errors, researchers find

Nearly one in three Massachusetts adults making multiple trips to the ER jumped around to different hospitals a new study found, thereby risking more medical errors, unnecessary tests, higher costs and generally fragmented care, according to a story from Kaiser Health News.

On a recent Friday night at the Boston Children’s Hospital ER, Dr. Fabienne Bourgeois was having difficulty treating a 17-year-old boy with a heart problem. The teen had transferred in from another hospital, where he had already had an initial work-up – including a chest X-ray and an EKG to check the heart’s electrical activity. But by the time he reached pediatrician Bourgeois, she had no access to those records so she gave him another EKG and chest X-ray. He was on multiple medications, and gave her a list of them. But his list differed from the one his mother gave doctors, neither of which matched the list his previous hospital had sent along.

Because it was nearly 10 p.m., the doctors couldn’t get in touch with the teen’s pharmacy or previous clinicians. It wasn’t until the next morning that the doctors confirmed which medication he was on and were able to insure that he had the correct drugs for his condition. Bourgeois says the best her team could do was care for him that night with medications “we hoped would be safe” and treat his symptoms.

That is not an isolated incident. Nearly one in three Massachusetts adults with multiple ER trips visited separate hospitals — some upwards of five — creating a host of dangerous and costly problems because full health information is not always shared between hospitals, according to a study published today by the Archives of Internal Medicine.