Column: A Way to Prevent Lethal Medical Errors
Ask yourself this: Why are so many doctors violating the Hippocratic Oath, “First do no harm.” It’s what newly minted physicians promise when they graduate from medical school. But it’s a promise that too often goes unkept, with lethal consequences.
As many as 440,000 patients die each year from preventable mistakes. Shockingly, medical harm is the third leading cause of death in the United States, just behind heart disease and cancer.
One reason for this epidemic of patient harm is that hospitals and other health care institutions tolerate staff who routinely ignore proven safety procedures. Fifty percent of health-care workers don’t clean their hands, even though hand-cleaning is the most effective infection prevention mechanism. Too many surgeons fail to implement checklists and timeouts that would assure they are operating on the right limb or organ. Nurses are so harried that they don’t have time to make sure they are giving the right medication to the right person, in the right dose at the right time. And too many lower-level hospital staff don’t challenge higher-level professionals who are about to make a mistake because they fear being reprimanded or even fired.
We know that more than 75 percent of medical errors and injuries result from poor communication and lousy teamwork. Yet, the health care industry (unlike the airline industry) does not routinely train staff at all levels in the basic skills of teamwork and communication. Another reason so many people suffer from medical harm is that too many physicians are putting patients at risk by prescribing invasive treatments patients don’t even need.
For example, decades worth of studies document the dangers of mammograms to women between 40 and 49 with no risk of breast cancer, yet they are still part of routine screening programs. Orthopedists are still recommending surgery for back pain even though studies have long documented that this often does more harm than good.
Or consider the cancers that result from unnecessary CT scans, which are doled out to patients who have no idea that a CT is not in fact one X-ray but a bundle of hundreds. Finally, think of how many people are placed in jeopardy — and dollars misspent — when for-profit health care chains, like Hospital Corporation of America or Health Management Associates, push physicians to admit more patients who would be better treated on an outpatient basis.
Reducing the high number of deaths and injuries caused by medical error is not hard. The federal government has already developed a voluntary program (called TeamSTEPPS) to improve the quality and safety of patient care. Many hospitals have started to use it, with excellent results.
But more need to do so, and every medical facility should upgrade its own internal patient-safety standards.
Until that happens, Hippocrates’ injunction to doctors — “First do no harm” — will remain neatly framed, but too often ignored, on many a medical office wall.
Suzanne Gordon’s latest book is Beyond the Checklist: What Else Health Care Can Learn from Aviation Teamwork and Safety.