Sunday, May 12, 2013

Government Wants Patients to Report Medical Mistakes - Is This a Mistake?

I’m all for enhancing patient safety.  Count me in on reducing medical errors.  I acknowledge that medical mistakes harm patients and many can be prevented.  The medical profession should promulgate and support any initiative that accomplishes these objectives.
The public has become suspicious of the medical community who seem to circle the wagons when external scrutiny of its actions is threatened.  Yes, sunlight is the best disinfectant, but many of these shining lights are murky shadows that do not illuminate as intended.
Murky Sunlight
Copyright Christopher Down
The government and insurance companies are now providing financial penalties if certain medical quality benchmarks are not met.  While this sounds attractive and overdue when it is expressed in a headline or a slogan, the true motivations and capability of these efforts have been questioned.  Is it really about safety? 
I have tried to expose throughout this blog the fallacy that the medical malpractice system serves as a deterrent and improves medical quality.  I reject this lame claim and maintain that this unfair medical malpractice system diminishes medical performance and harms patients.  For those, who dare to enter this chamber of horrors, I invite you to bravely peruse the posts that are securely stored in the Legal Quality category of this blog.   I have commented on various plaintiff attorneys’ blogs and I’m always struck how so many of them feel that the current system is well designed,  fair and provides necessary justice to their injured clients.  I regard much of this as self-serving ideology that crumbles through gaping credibility cracks.   Would we regard a physician as credible who vigorously opined that our health care system needs no reform?
Our government has a new initiative to protect patients.  In this pilot program, patients would notify the government of suspected medical errors by doctors, pharmacists and hospitals.  An investigation would ensue.
Good idea?  Sure, the concept is reasonable but how would it be implemented?  Realize that most of the reported ‘errors’ would not be mistakes at all, just as most lawsuits against doctors are ultimately dismissed as no true negligence was present or could be proved.  Many of these ‘errors’ would be recognized complications of medical treatment which are blameless events.  Other complaints might relate to perceived inadequate physician communication or indifferent bedside manners.  Other true errors might be too minor to warrant reporting such as a patient’s IV (intravenous) line had to be inserted repeatedly or a patient was given the wrong meal which resulted in no untoward effect. 
Medical records would have to be reviewed in every case and medical personnel interviewed to try to ascertain the facts.  Where would we summon the manpower and the resources to investigate the gazillions of complaints that would be forthcoming once sick folks and their families are encouraged to serve as medical quality officers with a duty to report to serve the greater good? 
Even in a medical malpractice case, it is vexing to discover the truth after months of intense medical record scrutiny, discovery and depositions.   How would this new system aim to get to the truth after a cursory review of the circumstances?
One way to encourage physician support of such as effort would be if the facts and opinions that are uncovered would be kept confidential and privileged from use by the plaintiffs’ bar.  With this provision, then we would know that safety is the priority objective.
Finally, I think that medical error reporting should be reported to hospitals where the alleged errors occurred, and not to the federal government.  The hospital is much better suited to provide review and oversight of its own patients and personnel.  They know the players and are better positioned to evaluate the situation thoroughly and efficiently. I recognize that there is a conflict of interest here and that there would need to be independent voices participating to assure that there is no cover up or slanting of the facts to protect those who have erred or the institution.
Does this post agitate you?  Have I strayed beyond the Bloggers Code of Ethics?  Have I made a mistake here or even been negligent?    Your role is clear.  I am a practicing doctor.  You think I have erred.  Now, do the right thing.  Report me.  


The Medical Contrarian said...

I believe you have focused in on the important nuance here. It is key to bring patients into the feedback process. They are in unique positions to identify when care delivery goes awry or when things happen which are undesirable and may go unnoticed. Physicians should welcome systems which help them identify what are areas needing improvement in time frames which are clinically relevant.

However, the primary team involved in these sorts of efforts should not include the state. We have already concentrated state power to an unhealthy degree and placing them front and center in error reporting will have a chilling effect.

Michael Kirsch, M.D. said...

Agree, particularly with your final sentence.

Anonymous said...

I recently attended a hospital surgery meeting at which we discussed the importance of complying with safety benchmarks. One problem benchmark: Not all patients were getting their I.V. antibiotics infused within an hour of the surgeon's incision. Some hospitals reported 100% compliance (I'd check accuracy of those reports before running with that statistic); our hospital fell short. An anesthesiologist brought up a small problem: Some patients receive Vancomycin, which must be infused slowly due to its toxicity. Hence, the infusion can before that magical one hour. An administrator suggested patients receive an alternative antibiotic...or start a second infusion of Vancomycin that falls within the hour. (Yes, let's treat the benchmark, not the patient.) A surgeon pointed out that Vancomycin is often administered because the patient has an allergy to other antibiotics. I was disappointed that one of the administrators didn't suggest that we start the incision in the pre-op room, place a temporary bandage, and then continue surgery in the O.R. Perhaps THEN we could achieve 100% compliance.

When I cook using Joy of Cooking recipes, the results are predictable. Recipes don't work so well with humans.

raymend said...

" Many of these ‘errors’ would be recognized complications of medical treatment which are blameless events. Other complaints might relate to perceived inadequate physician communication or indifferent bedside manners. Other true errors might be too minor to warrant reporting such as a patient’s IV (intravenous) line had to be inserted repeatedly or a patient was given the wrong meal which resulted in no untoward effect. "

The above quote reveals a troubling trivialization of a very serious subject. Here's what I know from my side of the stethoscope: I have experienced extreme indifference, extreme ignorance, extreme cruelty, extreme arrogance, extreme apathy, extreme negligence, and, quite occasionally, extreme excellence from doctors in my life. And I have seen many doctors. And it's not just me - friends and family, coworkers and acquaintances, have had similar experiences. One year I lost two coworkers because ER doctors kept turning them away, telling them they had, respectively, migraines and indigestion. One had a cerebral hemorrhage at work and was never able to work again, the other had a heart attack and died. Both had gone to the ER repeatedly in the months preceding their deaths.

I myself had the quality of my life changed because of an undiagnosed illness.

Medical errors ARE real. And serious. And common. And it seems like some in the medical community are finally noticing. That's great! But, in the meanwhile, change needs to happen. Now. If doctors won't join in and admit there is a huge problem, then you betcha the government should. I'm surprised the insurance companies haven't already.

Thank you. Enjoy your blog.

Michael Kirsch, M.D. said...

@Raymend, I regret that you have had such disappointing experience with the medical profession. What method of dealing with medical errors do you advocate? Do you support the current medical malpractice system, for example? Should we have a 'no fault' system? Are you mindful of the difference between an error and a blameless unfortunate event? Are you aware that the latter is often confused with the former?

Unknown said...

You have an interesting point, but I still am not sure I'm sold on your assertion that medical malpractice lawsuits harm patients. I think they can be an important (and effective!) tool for putting pressure on doctors and hospitals to improve their safety systems and the like. It's economics; if the cost of getting caught making mistakes outweighs the effort saved from being lazy (or whatever caused the error), the hospitals will work to reduce whatever is causing the errors in the first place. And at this point, with hundreds of thousands of patients being injured or killed by medical error every year, why wouldn't you want to do everything possible to reduce that?

Michael Kirsch, M.D. said...

Rhonda, your comment deserves a thoughtful response. I would encourage you to read through a view of my postings in the Legal Quality category where I explain my view that challenged the premise of your comment. Thanks for your view.

Anonymous said...

Hey - what is the name of the government's new program or what part of the government is running this program?

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