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How To Stop Hospitals From Killing Us: One Doctor Speaks Out

If medical errors were a disease, they would be the sixth leading cause of death in the United States, in between accidents and Alzheimer’s.  In the world of medicine, doctors take an oath to do no harm, yet on the job they soon absorb another unspoken rule; to overlook the mistake of their colleagues. The current status of medical mistakes are alarming, doctors operate on wrong body parts as many as 40 times a week, some 30-40% of all tests and medicines are unnecessary, and a quarter of patients will be affected by a medical error, according to medical specialists surveying their own field. Not only do mistakes take a devastating toll on humanity, it also costs the healthcare industry billions every year. According to Dr. Makary, a surgeon at John Hopkin’s Hospital, it doesn’t have to be this way, and he offers the following steps towards more transparency and personal responsibility in the field of medicine in his article, How to Stop Hospitals From Killing Us.

Online Dashboards

Makary suggests all hospitals should have an online dashboard application easily accessible on the hospitals website, displaying their rates for infection, surgical complications, patient satisfaction scores, and “never event” errors, a term for mistakes that should never occur, like leaving a surgical sponge in someone’s body.This kind of public reporting would make hospitals improve quickly, because why would someone have heart surgery in a hospital with an 18% death rate for this particular surgery versus a 2% death rate at another hospital?

Cameras

Cameras are already being used in healthcare, but usually no video is made. Reviewing tapes of surgeries and other procedures could be used for peer-based quality improvement, as Dr. Doug Rex from Indiana University has already proven in the following example.

Dr Rex, a gastroenterologist, decided to use video recording to check the quality of colonoscopies performed by doctors in his practice. Without their knowledge,  Dr. Rex began recording and reviewing videotapes of their procedures, measuring the time and assigning a quality score. After assessing 100 procedures, he announced to his partners that he would be timing and scoring the videos of their future procedures (even though he had already been doing this). Overnight, things changed radically. The length of the procedure increased by half,  the quality scores by 30%. In short, the doctors performed better when they knew someone was checking their work.

Ban Gag Orders

Patients checking in to see doctors are often being asked to sign a gag order, which is a promise to never say anything unfavorable about their physician online or elsewhere. Also, if you are the victim of a medical mistake, hospital lawyers will ban speaking publicly about your case as part of any settlement. We need more open dialogue about medical mistakes, not less. Dr Makary even suggests these types of gag orders should be banned by law, as they are “utterly contrary to a patient’s right to know and to the concept of learning from our errors.”Transparency is key to preventing medical mistakes in the future. Doctors perform better when their work is being checked, and hospitals will eliminate doctors who keep their safety scores down. The public has a right to know how safe their hospital is, and doctors who repeatedly make mistakes shouldn’t have their errors kept in the dark. As Dr. Makary says, “To do no harm going forward, we must be able to learn from the harm we have already done.”

This blog has been summarized from Dr. Marty Makary’s article How to Keep Hospitals from Killing Us for the Wall Street Journal Online Edition, September  20, 2012. Full article here: http://on.wsj.com/OKbg0T