Out and About (Sort of): Medical Errors are Distressing by Howard Freedlander

I was alarmed when I read this week that medical errors in hospitals and health-care facilities may be the third leading cause of death in the United States behind heart disease and cancer.

A study produced by Martin Makary, a professor of surgery at the Johns Hopkins University School of Medicine, based on analysis of four large studies conducted between 2000 and 2008, calculated that 251,000 deaths occur annually due to surgical mistakes, prescription of wrong drugs, misdiagnoses and poor communication during “hand-offs” in shift changes. Fortunately, many errors do not necessarily lead to death, just discomfort and displeasure.

After listening for 45 minutes to a National Public Radio (NPR) program on this disturbing subject, I became even more concerned. Death in many instances does not happen from the disease for which a patent is being treated.

Dr. Makary, a Washington Post health reporter and the chief of mortality statistics at the Center for Disease and Control spoke honestly about an epidemic, mainly undisclosed, sweeping our country. This is what I learned:

Not surprisingly, doctors are reluctant and fearful of revealing the real cause of death. The panelists agreed that the medical industry needs to change its culture, enabling an honest assessment on a death certificate—without the fear of lawsuits. This may be easier said than done.

Federal grant-making agencies must change its perspective and invest in studies that reveal, empirically, the reasons for medical errors, their commonality (or not) in specific surgeries and treatments and the ways that hospitals and health-care facilities can change their processes and culture to reduce death by error.

Medical professionals need to listen more carefully to their patients.

Standards of care must be universal to ensure healthy outcomes.

I will address the failure to listen.

A friend with whom I worked was being readied for heart surgery at a well-regarded Washington, DC hospital. The medical train was moving quickly to operate on my friend. Somehow, this friend had the good sense and gumption to call a halt to the process. He informed his well-intended surgeon that no one took the time to talk with him, explain the upcoming surgery and seek his input. What amazed and impressed me was the next part of this story: the doctor actually apologized to my friend, conceding that the medical team was concentrating on the process of treatment and not my friend as a human being deserving of some two-way communication.

As discussed during the NPR program, the patient often is not heard during what Dr. Makary characterized as a “messy, complex and fragmented” treatment environment.

One more story, this one concerning me. At this time last year, as I was confronting treatment options for prostate cancer, I sought a second opinion from a Johns Hopkins Hospital surgeon. I had the feeling that this second opinion would be the primary one. When I mentioned to the doctor that I had read favorable reviews about him and his patient-oriented approach on his urology department’s website, he simply replied that he wanted to be more than a mere technician, implying he wanted to take a holistic approach to the treatment of a cancer-ridden patient. No wonder an equally caring doctor in Easton referred me to this Hopkins physician.

Allow me also to state that my experience in the medical and hospital world has generally been favorable. While I marvel at the skills and dedication of medical professionals, I also bemoan, in some cases, a lack of people skills, characterized commonly as “bedside manner.”

The question then begs an answer about how to correct and eliminate human error. Vilification of hospitals and health-care facilities does not move the ball downfield in scoring victories over poor communication, misdiagnoses, sponges and instruments left in patients’ bodies and arrogance.

Part and parcel of curing the epidemic is operating on the culture. Is it possible to migrate the candor and lessons learned consequent to an airline or transit accident to the medical industry? Can doctors feel comfortable being honest while facing lawsuits? Can best practices result?

Deaths numbering 251,000 from medical errors is inexcusable. Thanks to Dr. Martin Makary, the nationwide problem is now out in the public arena.

The epidemic is not terminal. It just calls for honest attention. And a cultural change that’s more difficult to treat.

Columnist Howard Freedlander retired in 2011 as Deputy State Treasurer of the State of Maryland.  Previously, he was the executive officer of the Maryland National Guard. He  also served as community editor for Chesapeake Publishing, lastly at the Queen Anne’s Record-Observer.  In retirement, Howard serves on the boards of several non-profits on the Eastern Shore, Annapolis and Philadelphia.