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Medical errors – apologies required

Our Chief Privacy Officer sent me an interesting article today about how hospitals are promoting “disclosure and apology” (by physicians to patients or their families) when a medical error is committed.  The report suggests that less money will be spent in malpractice suits if physicians fess up to their mistakes instead of trying to hide them.

Another study suggests that 99% of physicians believe that it is morally right to confess errors to patients and family members, but that only about 33% report doing so.  The article says that the number one reason why they don’t report errors is fear of being sued.

While these statistics don’t reflect well on physicians, I think there’s some murkiness here that’s worth reviewing.  First of all, what constitutes an error?  When a young resident physician performs a procedure in an inferior manner due to lack of experience, is that an error?  When a code team is not called soon enough because a patient doesn’t appear gravely ill initially, is that an error?  If an unconscious patient arrives in the ER and is treated with a medicine that causes a life-threatening allergic reaction, is that an error?  I think that many times physicians perceive some “errors” as unfortunate and regrettable aspects of the natural practice of medicine and don’t report them formally.

Another reason why physicians may not report errors is because it’s unclear that the error has a specific adverse effect – perhaps a patient’s Tylenol was given at the wrong time of day.  That’s an error – but is it worthy of formally reporting it to the patient?  What about when the lab loses the tube of blood drawn from a patient?  Should the patient be told about it or should the labs be added to the next day’s scheduled draw?

The majority of “errors” that I’ve witnessed are in the realm of sub-optimal care due to inexperience, inattentiveness, or misinterpretation of test results.  However, errors of the sort that result in death and serious harm appear to be alarmingly frequent (some studies argue that there are 40-90 thousand of these errors per year).

I think that physicians should always tell patients the truth about their care, the risks associated with certain procedures, and the full range of choices that are available to them.  I do believe that patients value (and deserve) to know the truth – even when it makes the physician or hospital seem less than perfect.  In the cases of errors that result in serious consequences – honesty is the best (and only) policy.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

My medical heroes

On New Year’s Eve when many people are drinking champagne and worrying about who they should kiss at midnight, Dr. Brian Fennerty, Section Chief of Gastroenterology at Oregon Health & Science University is fighting to keep patients alive in the Intensive Care Unit. Severe internal bleeding has put these patients’ lives in jeopardy, and Dr. Fennerty stays with them all night, ordering blood transfusions and tamponading their bleeding.

Dr. Jack Cook, US Navy veteran and former submarine commander, is under a mountain of medical charts. At 67, he is spearheading the transition from paper records to an electronic medical records system for his group practice of primary care physicians in Virginia. He wants his patients to have the opportunity to experience chart portability – something he believes might save their lives in cases where they are brought to the ER in an unconscious state. Although this project will take his group 2 years to complete, and cost untold hours in lost wages (with no clear reimbursal benefit for his practice) he is making the investment for his patients’ sakes.

In the middle of a teleconference, Dr. Iffath Hoskins, Chair of Ob/Gyn at Lutheran Medical Center in Brooklyn, excuses herself to perform an emergency C-section on a young woman with a complicated pregnancy. Against all odds she saves both mother and baby, and reschedules the teleconference for late that evening so she can complete her interview on time for a feature article at Revolution Health.

Just returning from Africa, Dr. Leo Lagasse, Vice Chairman of Ob/Gyn at Cedars-Sinai Medical Center, is preparing for his next mission’s trip with medical residents and faculty. His non-profit organization, Medicine for Humanity, has been behind countless trips to Afghanistan, Kenya, and Eritrya – serving impoverished women with medical problems. Dr. Lagasse takes time out to explain to me the link between smoking and cervical cancer for an article I’m preparing.

Dr. Charlie Smith is spending the afternoon with his son Jordan in Arkansas. Jordan was accidentally shot in the chest by a child with a BB gun, tearing a hole in his heart that caused him to go into cardiac arrest. He was rushed to the hospital where surgeons resorted to cardiac massage to keep him alive – he survived the ordeal, but his brain never fully recovered from the temporary lack of oxygen. He was rendered permanently bed-bound, and raised at home by his loving parents. Dr. Smith created a company called eDocAmerica to allow him to work from home and spend more time with Jordan. eDocAmerica is devoted to answering consumer medical questions via email.

At Harlem Hospital, Dr. Olajide Williams works tirelessly to raise awareness of stroke symptoms in a high risk inner city population. He organizes outreach through musical youth initiatives, lectures nationally to narrow the racial gap in quality care, and declines all prestigious medical recruitment offers. He is steadfast in his devotion to his community – no matter what the cost. Dr. Williams spends part of his weekends preparing blog entries for Revolution Health.

These are only a handful of the wonderful physicians associated with Revolution Health. I hope you’ll enjoy getting to know them through their blogs, articles, and future contributions. They are here for you… to support your need for credible information, to answer your questions, and to help guide you towards optimum health.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Thin People More Likely To Die

Just when you thought being super thin was best for your health… the Mayo Clinic published a short news brief in their December newsletter, “Mayo Clinic Connection” that casts some doubt on the benefits of being thin:

“Whereas obesity is a strong risk factor for heart disease, the standard test for measuring obesity – Body Mass Index (BMI) – may be of little use in predicting the risk of death. Results from studies involving 250,000 heart patients showed that those with the lowest BMIs had the highest risk of death. People who were overweight – but not obese – had a lower risk.”

Having a low amount of body fat has its advantages (like for rock climbing or marathon running) but being ~10 pounds overweight may actually be advantageous for your heart health. This is not an invitation to gain weight – just a little encouragement that “pleasantly plump” is not always such a bad thing. At least, that’s what I tell myself!

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Is bleeding after intercourse a sign of cervical cancer?

I’d never really thought about this issue until I read a study from the American Family Physician where some hardy souls sifted through the world literature for the answer to this very question. Their conclusion was that one out of every 220 women experiencing post coital bleeding has invasive cervical cancer.

The general prevalence of cervical cancer (in the US) is about 10 in 100,000.

So, if you’re experiencing bleeding after sexual intercourse, you should follow up with your Ob/Gyn to determine the cause. Also, regular pap smears are important in sexually active women as most cases of cervical cancer have no symptoms at all.

(How common is post-coital bleeding? About 1% of women report this problem.)

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Herbs & Vitamin Supplements: A Word Of Caution

Complementary and alternative medicine (CAM) is important and popular, but ignorance about its potential harms can be dangerous to consumers. Physician passivity about the subject may also be doing consumers a disservice. Two interesting articles underscore this:

From the NIH:

In spite of the high use of complementary and alternative medicine (CAM) among people age 50 or older, 69 percent of those who use CAM do not talk to their doctors about it…

A telephone survey, administered to a nationally representative group of 1,559 people age 50 or older, revealed some reasons why doctor-patient dialogue is lacking. Respondents most often did not discuss their CAM use with doctors because the physicians never asked (42 percent); they did not know that they should (30 percent); or there was not enough time during the office visit (19 percent).

From MSNBC:

If you’re banking on a daily vitamin to make up for any deficiencies in your diet, you may be getting a whole lot more — or less — than you bargained for.

Of 21 brands of multivitamins on the market in the United States and Canada selected by ConsumerLab.com and tested by independent laboratories, just 10 met the stated claims on their labels or satisfied other quality standards.

Most worrisome, according to ConsumerLab.com president Dr. Tod Cooperman, is that one product, The Vitamin Shoppe Multivitamins Especially for Women, was contaminated with lead.

The same product also contained just 54 percent of the 200 milligrams of calcium stated on the label.

The analysis also showed that Hero Nutritionals Yummi Bears, a multivitamin for children, had 216 percent of the labeled amount of vitamin A in the retinol form, delivering 5,400 International Units (IU) in a daily serving. That’s substantially more than the upper tolerable level set by the Institute of Medicine of 2,000 IU for kids ages 1 to 3 and 3,000 IU for those 4 to 8.

Because too much vitamin A can cause bone weakening and liver abnormalities, the Yummi Bears “could be potentially doing more harm than good,” Cooperman said. “Vitamin A is one of those vitamins where you really don’t want to get too much.”

It’s important for physicians to educate themselves about CAM therapies and make it a part of their practice to ask their patients about the supplements they take. The Natural Standard databases are a great resource for physicians and consumers, and will be available soon at Revolution Health. Natural Standard, initially created by a team of Harvard physicians, systematically reviews the evidence behind the efficacy claims of various herbal remedies and supplements.

What resources do you use to evaluate the safety and efficacy of the herbs and supplements you’re taking?

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

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