Higher error in certain groups? II

Robert Bell rmsbell200 at YAHOO.COM
Tue Oct 7 01:09:44 UTC 2014


Victoria,

I hear your frustration. 

Much in the Western countries is all about greater fairness. The "all people are equal” mantra reigns supreme.

However, with democracy there are competing influences and the interests of the majority of people are somehow overlooked by these competing interests. In the US the Political Parties, PACS, Supreme Court, and lobbying groups,, etc. have great influence and essentially control the pace of change in the country.

Change more often than not comes slowly. Civil and voting rights for women took forever.

The average employed person in healthcare, being conflicted because of that employment, can do little to effect change in Errors in Medicine. Perhaps if there is a National outcry things might change?

The average patient who has experienced an error can also do little to change the system. Perhaps if there is a National outcry things might change?

The IOM has spoken up and many other organizations have spoken up but few things change in a significant way. As we know the numbers dying, and injured, seem to be increasing according to recent estimates.  

I was hoping that there Affordable Care Act would be able to help, but have heard little that this is the case. Would welcome hearing from members if this could be a possibility further down the road?

Would also welcome thoughts from anyone on how to break the log jam so that we truly start attacking the problem in a coordinated, gradual sensible way that does not need a National outcry. Is that possible?

Is the solution, National, Statewide, or both? Is this a time for renewed effort?

What can we learn from other countries? Are they making better progress than we are?

Questions, questions, questions?

Robert Bell, M.D.  



On Sunday, October 5, 2014 10:16 AM, Ross Koppel <rkoppel at sas.upenn.edu> wrote:
 


No one could possibly know for the reasons previously noted.   BUT:     One almost universal indicator, however, is available:  Pharmacists in teaching hospitals routinely stop/refuse about 4% to 5% of all orders (made by young docs).



Ross Koppel, Ph.D. FACMI
Sociology Dept and Sch. of Medicine
Senior Fellow, LDI, Wharton
University of Pennsylvania, Phila, PA 19104-6299
215 576 8221 C: 215 518 0134
On 10/2/2014 7:37 PM, Robert Bell wrote:

What is the error rate from the pharmacy on the finally ordered medications in your teaching hospital. Has that been studied?
>
>
>Robert
>
>Sent from my iPad
>
>On Sep 30, 2014, at 9:10 PM, Ross Koppel <rkoppel at SAS.UPENN.EDU> wrote:
>
>
>Follow up to previous email
>>
>>I forgot to mention why the orders were stopped  (and
            remember this is a teaching hospital): 
>>
>>pharmacists called the young docs
>>senior docs or colleagues questioned them
>>nurses questioned them
>>they thought about it some more
>>they got a lab or other result that suggested another
            approach/idea/drug.   (Note about this one:  We hypothesized
            that older/more experienced docs would not be so quick to
            order if they knew a lab result was coming.  We've never
            fully studied that hy, but every more experienced doc we
            discussed it with loved the hy).  
>>
>>Note:  We did not count orders stopped within one minute or
            so.  That was the fat finger grace period.  
>>
>>
>>Ross Koppel, Ph.D. FACMI
Sociology Dept and Sch. of Medicine
Senior Fellow, LDI, Wharton
University of Pennsylvania, Phila, PA 19104-6299
215 576 8221 C: 215 518 0134
On 9/30/2014 5:20 PM, Robert Bell wrote:
>>
>>Following up on Ross' comments, coud I ask members of the list, what are the top three things each would like to see happen to significantly reduce the deaths and injury that occur with medical errors (including diagnostic). I have the idea that having a priority ranked shopping list of the agreed upon things to start doing would advance the discussion from where it currently rests.
>>>
>>>Most seem to agree that we are not making much
                      progress. How can we change this?
>>>
>>>Robert Bell, M.D.
>>>
>>>
>>>
>>> 
>>>
>>>
>>>
>>>________________________________
>>> From:  Ross Koppel <rkoppel at SAS.UPENN.EDU>; 
>>>To:  <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>; 
>>>Subject:  Re: [IMPROVEDX] Higher error in certain groups? 
>>>Sent:  Tue, Sep 30, 2014 1:03:15 AM 
>>>
>>>
>>>Rob,     You are making two points....and I'm not sure either disagrees with anything I said.
>>>
>>>1. We need the numbers.  All agree.  I would
                            add that:
>>>
>>>    We are probably missing 98% of
                            medication errors.  
>>>    We have excellent data on wrong site
                            surgery and wrong patient surgery
>>>    We have terrible data on wrong patient
                            errors involving meds....for prescribing,
                            dispensing and administration
>>>    We have bad data on Dx errors.... but at
                            least one can get a sort of handle on them
                            if one follows the trajectory of the patient
                            over a long time.  
>>>But, yes, we need the numbers and they are
                            hard to get.
>>>
>>>2. Your observations of errors you notice
                            with any of your contacts with the medical
                            profession:  I argue that the errors you
                            observe -- while apparently quite high --
                            are much lower than what the average patient
                            undergoes.  On the most trivial level, you
                            are literate and you speak English.  On a
                            higher level, they know you're a doc and
                            don't want to screw up.  Most patients, even
                            if we gave them a digital recorder, would be
                            unable to identify the vast majority of
                            errors to which they are subjected.
>>>
>>>Heck, I wrote one of the major papers on
                            workarounds to barcode medication admin.  
                            Last month I was in the hospital ED for a
                            bad dog attack.  They gave me the wrist band
                            of a Mr. Thomas Keller, born 1977  (may have
                            been 1971.... I can't remember).    
>>>
>>>If you are saying you see many errors all
                            the time:  Then yes, absolutely.  If you are
                            saying Docs face more errors than the avg
                            patient, then I disagree.   
>>>
>>>NOTE:  Many, Many errors are caught and
                            stopped before they harm patients.  And much
                            of the harm that does get through is low
                            level. 
>>>
>>>Ross 
>>>
>>>
>>>Ross Koppel, Ph.D. FACMI
Sociology Dept and Sch. of Medicine
Senior Fellow, LDI, Wharton
University of Pennsylvania, Phila, PA 19104-6299
215 576 8221 C: 215 518 0134
On 9/29/2014 8:10 PM, Robert Bell wrote:
>>>
>>>Ross, that has not been my general experience over 40 years. But I have no way of proving it.
>>>>
>>>>
>>>>There is hardly a contact that I have with the medical profession that is not associated with some big or small problem, be it the wrong doctor's name on a urine specimen, lack of communication in a doctor's office (telling the staff you are there in the waiting room) being given someone else's paperwork for labwork, having crossed leads on an EKG read by the physician as normal, surgery that has unexpected negative results, or missed serious diagnoses, etc. And yes, many good things have happened.
>>>>
>>>>
>>>>Prior to a talk I gave to staff at a local hospital, I collected my own errors in every day life that I made. My definition of an error was something that truly annoyed me. Like leaving my car keys in the house when jumping into the car in the garage, or doing four shopping tasks but forgetting the fifth. I seem to remember that on one day I had 8, and the next day 6 such events.
>>>>
>>>>
>>>>Keeping a list of errors, both small and large, that happen with each personal medical contact might be valuable!
>>>>
>>>>
>>>>That is why the 440,000 figure for annual deaths, for me, could well be correct.
>>>>
>>>>
>>>>But in all of this Ross, we need good figures, not guesses.
>>>>
>>>>
>>>>How do we get that information? Can we move very far forward without it?
>>>>
>>>>
>>>>Rob Bell, M.D.
>>>>
>>>>Sent from my iPad
>>>>
>>>>On Sep 29, 2014, at 5:40 AM, Ross Koppel
                              <rkoppel at SAS.UPENN.EDU> wrote:
>>>>
>>>>
>>>>My guess is that health care professionals get better and safer care than most patients, in general.  The perceived "higher rates" of errors are a reflection of health care professionals ability to notice errors that occur to many patients.  
>>>>>
>>>>> 
>>>>>
>>>>>Ross Koppel, Ph.D. FACMI
Sociology Dept and Sch. of Medicine
Senior Fellow, LDI, Wharton
University of Pennsylvania, Phila, PA 19104-6299
215 576 8221 C: 215 518 0134
On 9/28/2014 6:07 PM, Hoffer, Edward P.,M.D. wrote:
>>>>>
>>>>>Anecdotes abound - doctors and nurses caring for health care professionals, particularly those they know and/or who work at their institution, often cut corners or avoid unpleasant procedures. While this is intended as kindness, it often means appropriate care is withheld. Whether anecdotes truly reflect reality, I have no way of knowing. Ed Edward P Hoffer MD, FACP ________________________________________
From: Teresa Graedon [terry.graedon at GMAIL.COM]
Sent: Sunday, September 28, 2014 9:30 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG Subject: Re: [IMPROVEDX] Higher error in certain groups? Robert, That is an interesting idea. How would it work? I suspect that HCPs are simply more likely to detect errors than less (health-care-) educated patients. I'd be interested in data, though, or a plan to gather the evidence. Terry Graedon, PhD
The People's Pharmacy On Sep 26, 2014, at 10:46 PM, Robert Bell <rmsbell at ESEDONA.NET> wrote: 
>>>>>>I have the idea that HCPs, particularly physicians, are more like to be exposed to errors in medicine when they are patients. Is there any truth to this and, also are there other groups of patients that are more likely to be involved in errors when patients? Rob Bell, M.D. Sent from my iPad
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