Keep Away if Possible: 1 in 4 Chance You'll Be Harmed at a Hospital
Story at-a-glance
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One in four patients in a hospital is harmed in some way
from a medical mistake
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An estimated 30 percent of all medical procedures, tests and
medications may be unnecessary – at a cost of at least $750
billion a year
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For the past two years, the American Board of Internal
Medicine Foundation, one of the largest physician
organizations in the US, has released reports on the most
overused tests and treatments that provide limited or no
benefit to the patient, or worse, causes more harm than
good. The list currently includes a total of 135 different
tests, procedures and treatments
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Once you’re hospitalized, you’re immediately at risk for
medical errors, so one of the best safeguards is to have
someone there with you. This is particularly important for
pediatric patients, and the elderly. Helpful tips and
questions to ask to help prevent avoidable medical errors
are discussed
By Dr. Mercola
Medical errors are one of the leading causes of death in the
United States, and what’s even more shocking is that the harm
often is preventable.
Hospitals often make egregious errors ranging from minor
mistakes to treating the wrong patient, leaving behind surgical
tools in a person after surgery, or operating on the wrong body
part.
According to the 2011 Health Grades report,1
the incidence rate of medical harm occurring in the United
States is estimated to be over 40,000 harmful and/or
lethal errors DAILY!
Dr. Martin Makary is the author of The New York Times
bestselling book Unaccountable: What Hospitals Won’t Tell
You and How Transparency Can Revolutionize Healthcare,
which is a story about the dangerous practices and mistakes of
modern medicine. He’s a practicing surgeon at Johns Hopkins
Hospital and an associate professor of public health policy at
the Johns Hopkins School of Public Health.
As a busy surgeon, he’s worked in many of the best hospitals
in the country, and can testify to the amazing power of modern
medicine to cure. But he’s also been a witness to the medical
culture that routinely leaves surgical sponges inside patients,
amputates the wrong limbs, and overdoses children because of
sloppy handwriting.
Healthy eating, exercise, and stress management can help keep
you OUT of the hospital, but if you do have to go there, knowing
your rights and responsibilities can help ensure your hospital
stay is a safe and healing one.
Variations in Quality Medical and Safety of
Health Care Driven by 'Perverse Incentives'
One in four patients in a hospital is harmed in some way from
a medical mistake, according to the New England Journal of
Medicine. Many doctors have been concerned about the
quality and mistakes in healthcare, but the culture has been
such that it dissuaded open discussion and transparency.
“We’re really at a very exciting time in medicine,”
Dr. Makary says. “For the first time, we’re
speaking up openly and honestly about this problem. We’ve
got research now that supports it.
...[W]hen I was at a major medical conference once, I
heard a surgeon at the podium ask the audience of thousands
of doctors, 'Do you know of somebody out there in practice
who should not be practicing because they are too
dangerous?' And every single hand went up. Everybody seems
to know about this problem. Everybody even knows of somebody
who’s too dangerous to be in practice. Yet for a long time,
we haven’t been honest about the problem.”
Dr. Makary goes on to tell a story from his days as a medical
student. A young man came to the emergency room with a fractured
humerus, and the doctor told him he needed an MRI, an X-ray, and
a CAT scan. The young man replied he didn’t have health
insurance, at which point the doctor suddenly changed his tune,
telling him to just stay off his arm, wear a sling, and all
would be fine.
“I thought about it,” Dr. Makary says, “The
doctor was right; all those tests don’t really change what
we do, because the treatment for that type of fracture was
just a sling and to rest it. So, we see these wide
variations on what we do. And when you ask the doctors,
'Look, what’s going on? Why do we have so much variation in
quality and safety in America?' they point out things like
'Look at our perverse incentives that promote bad care among
as subgroup of doctors out there.'”
Is Your Surgery to Satisfy Your Doctor’s Quota?
Doctors are under tremendous pressure these days. Not only
are they asked to see more patients per hour, many surgeons even
have surgery quotas to meet.
“They’re told they need to do so many operations in a
month,” Dr. Makary says. “Sometimes doctors tell me
they get text messages and emails, saying, 'You need to do
so many operations by the end of the month.' They’re
expected to do more, often with less resources.”
Quotas aren’t the only symptom of a major disconnect between
healing a patient’s problem and running a for-profit disease
management scheme. As discussed by Dr. Makary, sometimes a
computer software program will order tests and studies
automatically, and the doctor just has to sign off on them.
“Doctors don’t like blind triggers that result in
overtreatment. They want to practice medicine the way it was
intended to be practiced – individualized in care,” he
says.
While computers can help with some standardization in
medicine increasing dependence on computerized diagnosis and
even treatment is an issue that needs to be seriously considered
and discussed. We’ve had a continually evolving improvement in
artificial intelligence, so much so that in the next 20 to 30
years computers will be able to interview a patient and then
spit out an entire battery of recommendations. However, the
recommendations will only be as good as the information it’s
based on. What good will it do if all RoboDoc can do is spit out
tests and treatment protocols based on biased, inaccurate or
fraudulent data at a more efficient rate than human M.D.'s?
Unnecessary Treatment is a Massive Problem
According to a report by the Institute of Medicine, an
estimated 30 percent of all medical procedures, tests and
medications may in fact be unnecessary2
– at a cost of at least $750 billion a year3
(plus the cost of emotional suffering and related complications
and even death – which are impossible to put numbers on). While
overuse and misuse have become a deeply ingrained part of the
culture of medicine, there are hopeful signs that things are
starting to change. Dr. Makary points out a number of standard
blanket recommendations that have been changed in recent years,
such as daily aspirin regimen, PSA testing, and annual
mammograms.
“[N]ow people are saying, 'Wait a minute, maybe we’ve
gone too far.' ...We told everybody for decades [that]
everybody should be on an aspirin once a day. And a lot of
people were saying, 'Wait a minute, do I really need to be
taking a pill every day, even thought I’m totally healthy?'
There were studies, and they looked at certain outcomes but
a recent large study has shown that the internal bleeding
consequence balances out the benefits to your heart. So
we’re now pulling back that recommendation. If you have a
healthy heart, if you don’t have a history of heart
problems, we’re now pulling that recommendation back.
Same thing with PSA testing. You’re seeing the
medical community say, 'Wait a minute, we don’t need to do a
PSA test for prostate cancer on every older man in the
world.' We’re also seeing the recommendations on breast
cancer screening with
mammography in that middle-aged group being
pulled back.
We’re seeing a lot of research coming out now that’s
saying some of these giant recommendations to do more stuff
probably were not based on sound science. When we look at
the full gamut of consequences of overtesting, we may be
creating too many false-positives and hurting more people
then we’re helping.”
More Doctors Beginning to Realize What They Were Taught is Wrong
Many doctors are now beginning to accept that some things
they were taught in medical school is simply wrong.
“I was taught, for example, that everybody has one
million nephrons (the unit in a kidney). We now know that’s
not true. We now know that it ranges from 200,000 to two
million, and everyone’s different. If you have a lot, you
may have more of a reserve. If you have few, you may be more
frail in your ability to withstand an insult to your kidney.
We were taught fat was bad for you. We were taught,
'Don’t eat fat. Fat is bad. Go low-fat everything.' That was
probably wrong advice that the medical community gave to the
general public. We now know that what’s far more important
than avoiding fat is limiting sugar, a highly addictive
substance, which a driver of obesity and heart disease and
has many detrimental effects, mainly the hormonal effect of
changing your fat storage balance. Little did we doctors
know that by demonizing fat we were encouraging
high-carbohydrate foods because they are notoriously
'low-fat.' Obesity surged parallel to the 'avoid fat' era of
medicine. We are now dealing with a generation addicted to
sugar and we’re seeing the largest growth in obesity in the
history of the country.
In terms of the percent of our population on
disability and the average time on disability, we are now
the most disabled country in the world. And one leading
driver is obesity-related chronic diseases—a problem
burdening our healthcare system. These are lifestyle
diseases (medical problems that can be avoided with better
behavior). We’re now recognizing that some of the emphasis
in the direction that we had in medical school was just not
based on the solid evidence that we’re now seeing.”
Helping Patients and Doctors Choose Wisely
For the past two years, the American Board of Internal
Medicine Foundation, one of the largest physician organizations
in the US, has released reports on the most overused tests and
treatments that provide limited or no benefit to the patient, or
worse, causes more harm than good. Last year’s report warned
doctors against using 45 tests, procedures and treatments. This
year, another 90 tests and treatments were added to the list. To
learn more, I encourage you to browse through the Choosing
Wisely web site,4
as they provide informative reports on a wide variety of medical
specialties, tests, and procedures that may not be in your best
interest. As reported by NPR:5
“The idea is to curb unnecessary, wasteful and often
harmful care, its sponsors say — not to ration care. As one
foundation official pointed out last year, rationing is
denial of care that patients need, while the Choosing Wisely
campaign aims to reduce care that has no value.”
Unfortunately, it seems matters will only get worse with the
passage of the Affordable Care Act because it’s just a
continuation of the same broken process. I agree that people
should be covered under health insurance, but they should be
covered with appropriate care; not care that perpetuates the
same problems addressed in Dr. Makary’s book.
“What we’ve got to do is educate the everyday patient
to empower themselves, to understand what they’re having
done, and to learn to ask the right questions,” he
says. “We’ve put together a list of sort of important
questions a patient should ask, and we’ve put it on the book
website,
UnaccountableBook.com.
Things like: 'Do I really need to have this done?
What if I don’t take this medication? And then, whatever
that consequence could be, what are the odds that that could
happen? And if it does happen, can we treat it once that
happens?'
I remember consenting people for surgery as a
resident. I was way over my head. They would ask me, 'What
happens if I don’t have an operation or take a medicine?'
And I just give them a standard answer sometimes. 'You could
die. Something could go wrong.' And yet, I was rushing.
You’re working sometimes for 40 straight hours; you’re
working 120 hours a week. As a resident, you’ve got a
mission. You get certain things done to get through this
little list of things you need to do during the day...
Research now shows that most patients are under-informed
about the risks of medical tests, procedures and
medications, and the benefits are overstated.”
On Referrals, and...
According to Dr. Makary, under-referral is another major
issue that leads to improper medical treatment. Some doctors
will simply declare that “nothing can be done,” without
realizing a specialist may have an entirely different set of
tools at their disposal. There are even “micro-specialists” out
there specializing in a tiny area within a particular field of
medicine. The trick is to find them.
“There are probably not enough referrals to
specialists as there should be. I think sometimes you need
to take things in your own hand and just ask for one. Or
say, you know, 'Would it help if I spoke with someone who
specializes in this?' Or go to their websites and find the
experts. There are some very good websites out there now for
patients, [like] ConsumerReportHealth.org. Medicare is now
putting a lot of hospital performance up on the web in their
website Hospital Compare. It’s
HospitalCompare.hhs.gov. So, there are some good
resources out there now.”
Dr. Makary suggests asking an emergency room nurse for their
recommendations for specialists and doctors well-versed in a
particular ailment. Another helpful strategy can be to ask
around for alternative practitioners or treatment options. Your
local health food store can be a good place to start.
“If you don’t know of a nurse, secretary, doctor, or
technician that works for a hospital that can give you this
scoop on who’s really good, ask some of these important
questions.”
Dr. Makary suggests “For surgery, ask the following
questions:
- Do I really need this done?
- When am I going to be back to feeling good?
- What if I don’t have this procedure done?
- Can I wait a year and see if this gets better?
- What if I wait and then something develops in the
interim? How do we handle it that at that point and what are
the odds of success then versus now?
There’s a movement – a revolution – that we described
in the book Unaccountable, which is starting to provide
useful information on websites, so that patients can
navigate the healthcare system.”
Safeguarding Your Care While Hospitalized
Once you’re hospitalized, you’re immediately at risk for
medical errors, so one of the best safeguards is to have someone
there with you.
Dr. Andrew Saul has written an entire book on the issue of
safeguarding your health while hospitalized. Frequently, you’re
going to be relatively debilitated, especially post-op when
you’re under the influence of anesthesia, and you won’t have the
opportunity to see the types of processes that are going on.
Dr. Makary agrees it’s important to have someone there to act
as your personal advocate, or to take the time to stay with your
loved one who is hospitalized. This is particularly important
for pediatric patients, and the elderly.
“Sometimes, we rely on a competent talking patient to
help verify what we’re doing before we go in the operating
room. But if we got somebody who’s not mentally coherent
because they’re elderly or a kid and there’s no family
member around, these are danger zones. These are high-risk
areas for medical mistakes,” Dr. Makary warns.
“It’s important to ask what procedure’s being done or
why is the procedure being done. 'Can I talk to the doctor?'
You have a right to know about what’s being done to you or
your loved one in the hospital. When you’ve got a kid in the
hospital, I think it’s particularly important to ask the
questions.”
For every medication given in the hospital, ask, “What is
this medication? What is it for? What’s the dose?” Take notes.
Ask questions. Building a relationship with the nurses can go a
long way. Also, when they realize they’re going to be
questioned, they’re more likely to go through that extra step of
due diligence to make sure they’re getting it right—that’s human
nature.
Pushing for Greater Transparency in Healthcare
The issue of transparency is a big focus of Dr. Makary’s
book, Unaccountable. In it, he discusses a number of
ways transparency can be improved, not only from an
organization-hospital perspective, but also from an individual
position perspective.
We now have a lot of data metrics to measure healthcare
quality, such as different hospital’s infection rates,
re-admission rates, patient satisfaction scores, and surgical
complication rates. According to Dr. Makary, the ways to measure
hospital performance are now maturing to the point where they
need to be available to the public, and he’s seeing a
“transparency revolution” starting to take place.
“I believe it’s going to reshape our entire
healthcare landscape,” he says. “Instead of
choosing a hospital based on a billboard advertisement or
valet parking at a hospital, you should be able to look up a
hospital’s performance – their quality, their volumes, and
their satisfaction [rate]. You know, 60 percent of New
Yorkers will look up a restaurant’s ratings before choosing
a restaurant. Yet people are walking into the hospitals
blind to the hospital’s performance. We’re seeing an
exciting revolution now in healthcare. It’s a transparency
revolution, and it’s really why I wrote this book,
Unaccountable.”
Help for Victims of Preventable Medical Errors
Part of the nature of being human is that we make mistakes.
No one is perfect. Mistakes will be made. And with more
transparency, these mistakes will be known. So, what can you do
should you find yourself a victim of a preventable medical
mistake? Dr. Makary suggests connecting with patient communities
like:
- Citizens for Patient Safety6
- ProPublica Patient Harm7
Besides that, he suggests:
“Ask to talk to the doctor about that mistake. If
you’re not satisfied, write a letter or call the patient
relations department. Every hospital is mandated to have
this service. They are set up to answer your concerns. If
you’re not satisfied with that, write a letter to the
hospital’s lawyer, the general council. And you will see
attention to the issue, because you’ve gone through the
right channels.
We don’t want to encourage millions of lawsuits out
there. But you know, when people voice what happened, what
went wrong, and the nature of the preventable mistake,
hospitals can learn from their mistakes. Sometimes they’re
taking a lot of attention now to prevent mistakes from
happening again. You should let that mistake be known.”
Additional Resources
Dr. Makary co-developed a checklist for surgeons to use
before surgery or any other hospital procedure. His research
partner, Peter Pronovost, created a checklist in the ICU for
patients that are in the intensive care unit. The World Health
Organization (WHO) ended up taking an interest in their
checklists and used some of their principles to develop the
official World Health Organization checklist.
The WHO surgical safety checklist and implementation manual,8
which is part of the campaign “Safe Surgery Saves Lives” that
Drs. Makary and Pronovost were a part of, can be downloaded
here. If a loved one is in the hospital, print it out and
bring it with you, as this can help you protect your family
member or friend from preventable errors in care. You can also
learn more in Dr. Makary’s book, available on
UnaccountableBook.com and other book stores.
Avoiding Unnecessary Medical Care Can Save Your Life
One of the reasons I am so passionate about sharing the
information on this site about healthy eating, exercise, and
stress management with you is because it can help keep you OUT
of the hospital. But if you do have to go there, you need to
know how to play the game.
My primary recommendation is to avoid hospitals unless it's
an absolute emergency and you need life-saving medical
attention. In such cases, it's advisable to bring a personal
advocate -- a relative or friend who can speak up for you and
ensure you're given proper care if you can't do so yourself. If
you're having an elective medical procedure done, remember that
this gives you greater leeway and personal choice—use it!
Many believe training hospitals will provide them with the
latest and greatest care, but they can actually be far more
dangerous. As a general rule, avoid elective surgeries and
procedures during the month of July because this is when brand
new residents begin their training. According to a 2010 report
in the Journal of General Internal Medicine,9
lethal medication errors consistently spike by about 10 percent
each July, particularly in teaching hospitals, due to the
inexperience of new residents. Also be cautious of weekends.
Knowing how to prevent disease so you can avoid hospitals in
the first place is clearly your best bet. One of the best
strategies on that end is to optimize your diet. You can get up
to speed on that by reviewing my comprehensive
Nutrition Plan. Additionally, knowing what to do to make
your hospital stay as safe as possible is equally important if
you have the misfortune of being hospitalized. Understand that
you, the patient, are the most powerful entity within the entire
hospital system. However, the system works on the assumption
that the patient will not claim that power. Knowing your rights
and responsibilities can help ensure your hospital stay is a
safe and healing one.
© Copyright 1997-2013 Dr. Joseph Mercola. All Rights Reserved.
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