Dr. Sanjay Gupta on combating medical errors
Just how serious is the problem of medical errors, and what can be done to eliminate them? Thoughts now, from Dr. Sanjay Gupta:
I want to begin by stating the obvious: Doctors make mistakes. We're not perfect, we're human. Even the best doctors experience critical lapses. And when that happens, patients suffer.
Roughly 100,000 deaths a year are due to medical errors.
In my 20 years of practicing medicine, I've witnessed things that will stay with me forever. I will never forget when one of our most talented neurosurgeons operated on the wrong side of someone's brain.
It was an emergency - a young man had fallen and was bleeding internally - and everything moved into overdrive. Someone hung the CAT scans backwards. The surgeon took a quick glance, and began the operation. Holes were drilled, bone was removed. It was only when the outer layer of the brain was opened did the surgeon realize that something terribly wrong had happened.
The patient survived. The doctor later confessed to me that he spent hours throwing up after the case.
For me, the critical question is: How do we, as a profession, avoid repeating in the future what we've done wrong in the past? Learning from mistakes means admitting to them first, and that's never easy for doctors to do.
So there is a secretive and hallowed tradition in surgery: A weekly meeting at teaching hospitals across the country. It is a gathering where we openly discuss our errors.
I remember a doctor who presented a mistake so reckless and uncaring that I wanted to stand up and throttle him. I didn't have to. One of my colleagues doled out a much more appropriate punishment: He pulled a newspaper out of his pocket, and began reading the obituary of the recently-deceased patient. She was somebody's mother, she was somebody's daughter.
That doctor lost his medical privileges.
For two decades, I have been keeping notes on these meetings because I've wanted to learn from the mistakes others made. About ten years ago, my notes became the basis for a novel that I've just finished called "Monday Mornings." In the book, I put my characters where no doctor wants to be - confronting errors. For obvious reasons, it's fiction. But the issues that I take on are very real.
My hope in writing this book is to put medical mistakes under the microscope. I'd like to help people understand the challenges and the concerns that confront real patients and real medical professionals.
Our common goal. patients and doctors alike, should be to eliminate error. To do so, the medical profession must be vigilant . . . and the public must be educated. It takes all of us to build a better system.
For more info:
- "Monday Mornings" by Sanjay Gupta M.D. (Grand Central)
http://www.youtube.com/watch?v=-AjnGowZH0A&fb_source=message
http://www.youtube.com/watch?v=LMsGK_0XhXY&feature=relmfu
1. Pre-surgery screening - all meds and supplements need to be listed. General rule of thumb should be no supplements 7 days ahead of surgery. Certain medicines need to be stop a couple days ahead of time - the patient should be given a written list (i.e. some high blood pressure meds need to be stopped 2 days ahead of time).
2. Surgery day - let patient move themselves to operating table and then put asleep. It helps prevent injury. This is especially true for patients with lymph node issues - previous cancer.
3. After surgery, but still in hospital - check blood pressure. If blood pressure is low, don't automatically give BP meds, until blood pressure goes above normal. Also, if heavy blood loss has occurred, ask doctor before administering BP meds. The heart is under stress from the recent blood loss.
4. After surgery, if blood thinner medication is needed, hospital staff needs to understand the differences. Not knowing how to administer the meds can cause blood clots or bleeding. For example, Lovenox rule of thumb is 12 hrs plus or minus an hour. So, the time of the last dose is critical. Time of dose should be written on something very public like a white board in room.
5. Make sure your patient trys to clear their lungs every hour during the day - prevents pneumonia.
6. Home rules written to patient and caregiver.
a. Low blood pressure issues need to be covered. For example, if blood pressure still low, please explain that certain BP meds should not be taken until B.P. is high again. Also, don't eat turkey or swiss cheese, since with low BP, cardio vascular spasms can occur. These spasms are hard on the heart.
b. Blood clot prevention at home. Stay away from supplements or over the counter meds that are vegetable derived. Try to get up at least every hour during the day. Drink enough water to keep the blood well hydrated. New pain in the back that can't go away, needs to be checked by doctor for possible blood clot.
c. General rule of thumb, stay away from supplements and all stimulants for up to 3 weeks after surgery.
d. Many pain medications are addictive, so try to get off them as soon as possible.
e. Remember that most pain meds use tylenol for pain relief, so if you add extra tylenol don't overdose.
http://content.healthaffairs.org/content/30/4.toc
I would not have objected if Gupta had offered to start a non-profit foundation with the proceeds of his book to take care of people who have suffered at the hands of physicians. But, to say "Mea Culpa", beat his breast, plug his book, and then call this an "Opinion"??? Come on!
There is a Big Problem here and it's NOT that doctors don't make enough money as it is. Shame, shame, shame on Sunday Morning.