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How Not to Kill Your Patients





How not to Kill your Patients

Charles Atkins, MD

(Published in an abbreviated version in The Hartford Courant May 28, 2005 under the title, "A Word to Patients: Make sure Someone's got your Back")

"The secret of the care of the patient is in caring for the patient"

--Francis Peabody (1881-1927)

Without becoming the king of patient-confidentiality violations; I need to talk about some bad things that have happened to friends and family as they’ve interacted with the healthcare industry. It’s gotten to the point that when I reveal I’m a doctor, I get an earful—complete with gory descriptions—of just how dangerous a patient’s life can be.

The gripes run the gamut, from chronically late appointments to several near-death inpatient mishaps. I think the "Get well soon" card could easily be replaced by the "Hope they don’t kill you" card. What is going on?

We’ve pondered the much-reported statistics from the Institute of Medicine on how many tens-of-thousands of preventable-hospital deaths occur annually as a result of medical mistakes. But the numbers don’t cut to the reality. As a social worker friend of mine, who’s been through an odyssey of hospitalizations and surgeries—most of them to make up for a botched procedure—told me, "you can’t go into the hospital unless you have someone watching out for you. Otherwise, they’ll kill you."

He’s right. Nowadays, if you go into a hospital you really should appoint someone—preferably someone who loves you, has an encyclopedic knowledge of medicine, and won’t profit from you death—to ride shotgun over your admission.

The opportunities for screw ups are endless, and can come from any direction. I remember receiving a tearful phone call from my octogenarian friend Lisa—with whom I write a weekly column—when an aide had entered her hospital room and told her that she needed to go downstairs to have a line inserted. Now Lisa, who had just been through a potentially life-threatening hospitalization for a GI bleed brought on by a bad combination of a blood thinner and painkillers for her arthritis, had been under the impression that she was to be released that day. Worse still, the last time she’d had one of these lines put in it had resulted in a phlebitis that had rendered her upper arm useless—years later this painful and disfiguring problem has not resolved. She was frightened and scared, and I told her that one of two things was going on. Either her doctor hadn’t told her something important, and she was in fact not being discharged and that’s why they needed the line put in, or…someone had screwed up. I told her not to go for the procedure, but to hunt down her attending physician, and get answers. She did that and got back to me later in the day. Her doctor had never ordered the line; communications had gotten messed up, and she was indeed supposed to be discharged.

As I listen to these stories, and read various studies of medical mishaps, and strategies to decrease them, I wonder if the healthcare industry isn’t wandering off into well-intended, but wrong directions. Yes, I think the Joint Commission’s (JCAHO) National Patient Safety Goals are good things, but are unique patient identifiers, unapproved abbreviation lists, better limb-labeling procedures etc. really the answer, or are these tiny bandages slapped onto a vast wound?

Embedded in these stories I find four recurrent themes. The patient is not being listened to; test results have obliterated the art of the physical examination and careful history taking; communication between providers is poor or non existent; and the entire medical industry has moved in a direction that dehumanizes us to where we become the "diabetic in 13C, or the substance-abusing schizophrenic in cubicle two."

A respectful, careful and caring approach for working with people in pain has lost importance. It seems these values only find their way into hospital mission statements and various word-smithed written specifically for Joint Commission reviews. Where I’ve not seen care and compassion, is at the bedside. So how do we get these things back—if in fact we ever had them? I guess the challenge, and also the first step, is that a healthcare organization, whether it’s a hospital, nursing care facility, or school that trains professionals, needs to elevate a humanistic approach to a place of real value; it can’t be window dressing. Teaching a medical student or intern to read an X-ray is no more important than supervising and mentoring them to develop an empathic bedside manner. During my own training, I spent hours being instructed in the former, and very little time on the latter. In hospitals, where yearly goals and objectives are reviewed and revised, reality based strategies need to be identified whereby the values of compassion, kindness and attention to the patient’s needs (physical, emotional and spiritual) are brought to the forefront of the performance improvement agenda; these must be transformed from pretty ideas and words, to actions and standards of care.

Yes, the details in changing a culture are staggering. But if you think about it, there’s a basic truth that could provide a rudder to move the healthcare industry in the right direction; it’s simple. At some point either we, or someone we love, will need these services. If we could keep that in mind, I suspect we’d see healthcare become safer and genuinely caring.




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