January 29, 2010

The mystery of modern medicine

My friend Jim had a pacemaker/defibrillator installed this morning.  Halfway through the surgery, the surgeon couldn't get the bleeding to stop.  Jim survived because the surgeon's skill overcame the incompetence of the nurse who, a few hours earlier, gave Jim a blood thinner.

On the whole, blood thinners are counter-recommended immediately prior to surgery. Both Jim and Mary questioned whether he should receive it. The nurse on duty insisted. The nurse made a mistake.

I have few illusions about health care. Observing the treatment Fred, my late husband, received at a world   class medical facility, I conclude that on the whole doctors, nurses, cooks, maintenance people, and the other people involved in health care want to provide adequate care.*  The everlasting problem is human error.

The solution?  Layer after layer of safeguards that prevent error in the first place and recognize when error has occurred in time to prevent catastrophe.

My favorite personal horror story comes from the University of Arkansas Medical System (UAMS), one of the nation's top treatment centers for multiple myeloma. Fred was to have a stem cell transplant. He'd been given melphalan to destroy his blood system (and incidentally, his immune system).  At about seven one evening a few days later, a nurse hooked up a new infusion on the IV pole. Fifteen minutes later she returned and unhooked it.

"Why are you stopping the infusion?" I asked.

"Because the medication wasn't meant for him," she answered. "It's all right. None got to him.  It was all still in the line."

When the head nurse came to discuss the situation, she said the infusion was chemotherapy intended for another patient. I said the other nurse was not to touch Fred again. I was assured a note was already in his chart; that a review of procedures was taking place as we spoke; and that a second review by a hospital crisis team would be done in the morning.  The intent was to establish what safeguards were violated and how to prevent future violations..

The mystery of modern medicine is why hospitals don't coach patients and families in becoming a first line of defense in protecting themselves.

How many people erred in Jim's case? Well, one person didn't put appropriate information on his chart or another person didn't read it.

But wait! Jim and Mary had the information and called the nurse's attention to it. At that stage the error wasn't due to an absence of information on the nurse's part but an absence of power on the patient's part.

How did that happen? Maybe the nurse was the kind who assumes patients are idiots and don't know what they're talking about. Clearly, he or she didn't double-check when the question was raised. The next safeguard preventing error would, I think, be the anesthesiologist; he or she would care what was in the patient's system already, right?  And the operating room team would verify his readiness for surgery, right?  And the surgeon would verify just for his own curiosity that this not uncommon error hadn't occurred.

I swear to God I don't mean to be offensive but the only word that appropriate described Jim's treatment at Greenville Memorial Hospital in Greenville, South Carolina, this morning is cl*sterf*ck. We're relieved that he survived. 

The moral of the story?  In the event of major illness, the patient and the family are exhausted and overwhelmed; but you are the first line of defense.Trust no-one. Get second opinions. Get third opinions.  If you have contacts in the medical community, put them on speed dial and don't hesitate to ask, "Does this sound right to you?"  Stand your ground. Being nice is a good thing, but trust me on this one: being alive beats being nice every single day of the world.

*In some areas VA hospitals are the glaring exception.  The news reports of a few years ago have faded from memory, but a quick online search showed incompetence, filth, and indifference are still major problems at some locations. Put "VA hospitals maggots" in your search engine, or "VA hospitals rats" and see what you find. Then get in touch with Congress and the president.

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