Medical Mistakes: The Patient as "Whistleblower" Reporting to the Government
The United
States federal government in an attempt to prevent medical mistakes is
considering a pilot program which will analyze these mistakes by doctors,
pharmacists and hospitals. Medical mistakes not only can unnecessarily harm
patients but end up costing everyone including the government money. The interesting part of the program is that
it will be the patient (or, I suppose,
also the patient's family) who will be the "whistleblowers" and
notify the government of a suspected mistake.
To get an idea about the program read about it in a recent article in
the New York Times from which a few
extracts follow.
For each incident, the government wants to know “what happened; details of the event; when, where, whether there was harm; the type of harm; contributing factors; and whether the patient reported the event and to whom.”The questionnaire asks why the mistake happened and lists possible reasons:¶ “A doctor, nurse or other health care provider did not communicate well with the patient or the patient’s family.”¶ “A health care provider didn’t respect the patient’s race, language or culture.”¶ “A health care provider didn’t seem to care about the patient.”¶ “A health care provider was too busy.”¶ “A health care provider didn’t spend enough time with the patient.”¶ “Health care providers failed to work together.”¶ “Health care providers were not aware of care received someplace else.”A caution as noted in the article from an official of the American Academy of Orthopedic Surgeons:“However, patients may mischaracterize an outcome as an adverse event or complication because they lack specific medical knowledge.“For instance, a patient may say, ‘I had an infection after surgery’ because the wound was red. But most red wounds are not infected. Or a patient says, ‘My hip dislocated’ because it made a popping sound. But that’s a normal sensation after hip replacement surgery.” [Thus] it was important to match the patients’ reports with information in medical records.
What do you
think about you becoming the "whistleblower" to notify the government
when you suspect your doctor made a mistake?
..Maurice.
Graphic: From Google Images and modified by me with ArtRage
Graphic: From Google Images and modified by me with ArtRage
posted by Maurice Bernstein, M.D. @ 10:10:00 PM
4 comments
4 Comments:
Reducing medical errors is so significant to overall health care quality, and the costs go beyond mere financial ones. I fear that in an attempt to create a culture around "whistle blowing" we might be reproducing the very structure that is preventing open and transparent reporting though. Since providers have difficult reporting and disclosing errors, I wonder how motivated and comfortable patients and families are going to be. Have most patients read this article? Are providers talking to their patients telling them that they are in a position to be accountable and blow the whistle? Perhaps, however, this move will indeed generate a little more exposure (and hopefully disruption) to the souring rate of medical errors. Because without a doubt, disclosure should not be a one-dimensional conversation or process.
In an ideal world, there would be no need for government-sponsored "whistle-blowing" because providers would be honest, compassionate and receptive when patients and families report problems with the safety of their care.
In the real world, it's often very difficult for patients to make their concerns heard. They may be afraid the doctor won't take them seriously; they may be afraid the care team will somehow retaliate; they may find the process too intimidating or bureaucratic.
Although I think most clinicians are sincerely trying to do their best and become very distressed when a patient experiences an adverse event, their emotions often are overly involved and they don't always respond appropriately.
I don't see the AHRQ proposal as being the equivalent of whistle-blowing, and I think you're making a value judgment that the facts don't really call for. The goal is to capture what patients and families see, perceive and experience when something doesn't go well with their care. Many of us do notice things; we're not idiots. This is a mechanism for us to help identify problems, close calls, etc. that clinicians may not see.
What is the alternative - to go back to the days when patients were dumb and passive? Give us some credit for being capable of participating in a meaningful way.
Perhaps the act by patients or family to make others aware of possible medical errors is better expressed with an expression other than "whistle-blowing" since the term generally has been used in the sense of reporting criminality. The expression is thus tainted.
I agree that despite all the recent advances in medical science and medical care there still is a certain "inertia" in medicine when one considers the implications and even the extent of errors in medicine. As isolated one on one errors which may not necessarily lead to catastrophic events affecting hundreds in one event and in one place such as aircraft accidents have placed identifying and preventing incidents of medical care well behind the safety monitoring and management found associated with aircraft or rail transportation.
What can be done to improve medical safety? First, make medical safety one of the highest concerns of the medical profession in all of its venues. It should rank as high as finding a "cure for cancer". Medical accidents must be quickly identified, recognized as such and techniques should be developed as in aircraft transportation to reduce their likelihood. But this first requires input that such a medical accident has occurred for analysis and action. The problem is that it may be that incidents which might lead to harm are often written off by the medical professionals as events which are simply parts of the "standards of practice" and can be expected. This is the inertia that must be first overcome. Utilizing patients and their families to provide input to organizations attempting to overcome this inertia for identification and followup with techniques to prevent medical accidents is, I think, an essential beginning. ..Maurice.
As a patient who suffered "collective" prejudice from a doctor that others tried to protect via my social security number, and a person who tried like hell to get the vital statistics on race, gender, religion and death in hospitals to no avail (they provide them but not in ratio to total population), I think the government should require states to keep records and submit monthly reports to that end on all deaths related to race, religion, nationality, etc. per hospital. I do not believe the government cares about "quality of care" and I have been told that in my lawsuit against the government. The government knows that infectious disease is exploited, and it has been entrenched in medical care way before Obamacare. Obamacare only allows it to become more obviously and permittedly entrenched. Don't be hoodwinked by anything the government does because from my own experience they used my healthcare to blacklist and keep me unemployed. My case involves the sharing of my medical information across state lines, a complaint I submitted in 1997. What was the result? I have been surveilled and prevented from employment. I am not contagious either. I had a burst appendix and the radiology to prove it and doctors left me for dead with it. I believe they did this because of gender hatred and hate of Christianity. Back at that time you might remember, if you lived in New York at least, there was a "I hate white people" mentality that Oprah Winfrey did a show about. Doctors were killing like banchees. The 100,000 death in hospital rate is a lie. It is more like 300,00 a year. Multiply that by 10 years and you got $3Million. It is that "hate" that is also responsible for the rise in hysterectomies. The government MUST remedy mass death, but because it is involved and presently supports our country's transition to a more "socialistic" model, I believe it necessitates a reduction in population to give the appearance that the New Model of socialism can work as well as capitalism. I believe people are targeted as patients based on race and religion is what I am saying. After all, when one goes into surgery, he or she is generally asked about their religion and what they believe. And I believe it is more like persecution, and it is THIS that the government ought to be investigating. If it did that then the hospital errors and purported "mistakes" would resolve on their own.
CT
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