September, 2016
By Charles A. Pilcher MD FACEP
Last year Dr. Frederick Southwick et al. published the results of their ongoing survey of patients’ perspectives on medical error in BMJ Quality & Safety. According to the authors, the study “highlights the potential efficacy of patient-initiated surveys for providing meaningful feedback and for guiding improvements in patient care.”
What their survey of 696 patients revealed is that most errors involve diagnostic and therapeutic error, exactly the things that keep malpractice attorneys in business. And many of those errors are never captured in the medical record or reported as an “incident.” Of the 696 responses, 450 provided written narratives of the incident, and of those half were from family members, the majority of whom reported that their family member had died.
The leading categories of diagnostic and therapeutic error reported were:
- delay in diagnosis and treatment
- misdiagnosis
- failure to rescue a worsening patient
Other categories were:
- surgical or procedural complications
- wrong site surgery (4.3%)
- retained foreign objects (3.6%)
- hospital associated infections (including sepsis, post-op infections, c. diff and UTI’s)
- medication errors (12.8% reported receiving a medicine to which they were allergic)
Concerns raised by patients were:
- Lack of provider accountability (90% of responses), including insistence the care was appropriate, denial of responsibility, secrecy, lack of family contact and abandonment, especially after they complained.
- Communication failures including abandonment, disrespect, intimidation and failure to listen.
The study provides emotional quotes from many of the respondents about what happened and how they felt (e. g. “My child kept getting worse. I kept telling them. No one listened to me and she died.”). These comments will sound familiar to plaintiff attorneys who are consulted by patients and families inquiring about filing a lawsuit.
The impacts of the adverse events included:
- psychological stress (33%)
- death (33%)
- financial loss (33%)
- additional surgery or therapy (33%)
- chronic pain
- loss of function
- emotional trauma for family members (67%)
- stress related to caregiving roles causing financial loss or loss of lifestyle (50%)
Again, the quotes (e.g., “Tragic. It tore my family completely apart.”) tell an emotional story.
The majority of the participants in the study offered suggestions to prevent such errors in the future, including:
- develop protocols
- coordinate better among the various providers
- listen
- include patients and families in care decisions
- disclose errors and apologize
Again, the comments are telling, e.g., “The surgeon literally waved his hand in front of us to ‘shush’ us and said there was nothing we could offer that could possibly be of use to him.”
This study or survey certainly doesn’t come as any surprise to plaintiff attorneys, nor to the defense attorneys who are tasked with responding to the medical errors – perceived or real – of physicians and other caregivers. Patient’s stories are real. Their feelings and emotions when an error occurs are even more real. But the study does provide one of the few insights in the medical literature that could lead to improvements in the quality and safety of patient care – and better outcomes.
If only we will listen.