Earlier this year, my husband had major surgery. He was in the hospital for five days, which meant he was under the care of dozens of doctors, physicians assistants, nurses, medical technicians and other hospital personnel. I stayed with him nearly 24/7 so I was able to deal with the ever-changing cast of caregivers in charge of my husband's recovery.
Most of them were informed or took a more-than-cursory look at his chart. But several did not. I quickly learned the benefit of going through a litany of sorts each time a new staff member came into the room; I rattled off allergies, recent medication dosages, and any doctor requests.
My husband was loopy from painkillers and the after-effects of anesthesia, so it wasn't often that he could chime in. With a notebook constantly in hand, I realized it was a full-time job being his advocate. Several times I had to stop caregivers from strapping on IVs with medical tape that gave my husband a severe allergic reaction, even though on his chart, his wall and his wrist, there were red alerts noting his allergy. And this was all after a surgery that lasted many extras hours due to all sorts of complications.
Because of all that, maybe I'm not totally surprised that a new study by patient safety researchers shows that medical mistakes may be the third leading cause of death in the United States.
The analysis, published in the BMJ, found that medical error claims more than 251,000 lives each year, behind only heart disease (611,000 deaths) and cancer (585,000 deaths).
The researchers wrote, "Human error is inevitable. Although we cannot eliminate human error, we can better measure the problem to design safer systems mitigating its frequency, visibility, and consequences."
"It boils down to people dying from the care that they receive rather than the disease for which they are seeking care," lead researcher Martin Makary, a professor of surgery at the Johns Hopkins University School of Medicine, told the Washington Post.
Researchers said the most commonly cited estimate of annual deaths from medical error in the U.S. — a 1999 Institute of Medicine (IOM) report — is limited and outdated. The IOM report described an incidence of somewhere between 44,000-98,000 deaths annually due to medical mistakes.
Makary and his co-author Michael Daniel, also from Johns Hopkins, used data from several large studies, including those by the Agency for Healthcare Research and Quality and the U.S. Department of Health and Human Services Office of the Inspector General. They found more than 400,000 deaths a year due to mistakes, which is more than four times the IOM estimate.
As the Washington Post points out, that's an average of nearly 700 deaths each day.
Makary told the Post that they did the research in hopes of shedding light on a problem that few hospitals and health care providers will talk about. Few provide public information about medical errors and even the Centers for Disease Control and Prevention doesn't require errors to be reported in the data the agency collects through billing codes. That makes it difficult to get a snapshot of what's going on nationally, even if not locally reported.
That should change, Makary suggests. He says the CDC should require doctors to report whether an error led to a preventable death.
"We all know how common it is," he said. "We also know how infrequently it’s openly discussed."
Hiring an advocate
The statistics are sobering and enough to make you want to avoid a hospital stay. In some cases, there are simple steps you can take. "NOT THIS LEG!" in permanent marker can ward off surgery on the wrong knee, for example. But in more extreme cases, what if you don't have a friend or family member to help make sure nothing goes wrong?
Many hospitals have patient advocates on staff. They can help you navigate the care you or a loved one is receiving and help get assistance or find answers. Some employers and health care providers may also have patient advocates available.
Like a hotel concierge for your personal healthcare, there's also a growth in private patient advocates who work as private consultants to manage health care needs. They might schedule and attend doctor appointments, dispute medical bills, research medical treatments and handle insurance claims.
The field is relatively new, Trisha Torrey, founder of the Alliance of Professional Health Advocates, tells the Chicago Tribune, with maybe only 250 in the U.S. Depending on the service provided, private patient advocates may charge between $75 and hundreds of dollars an hour.
What you can do
Whether you or a family member are going in for an appointment or heading to the hospital for surgery, be prepared. We collected the best tips from the Agency for Healthcare Research and Quality and the Institute for Safe Medication Practices to help you advocate for care:
Ask lots of questions. Why are you doing this? What should we expect? When will we know results?
Don't assume anything. Make sure every caregiver knows about drug allergies, reactions or anything that might be critical to care, even if it's on your chart.
Write everything down. Be sure you understand care instructions and write it down so you can refer to it later.
Give information. Tell your caregivers about every prescription or every reaction you've had. It will matter when they are prescribing medication.
Follow up. Don't assume no news is good news with test results. If you haven't heard back, ask for outcomes.
Ask for a second opinion. If you are concerned about a test or medication, check in with your primary doctor or another health care provider. Not all medications and tests may be necessary.
Advocate for pain relief. Sometimes caregivers are busy. Keep track of when doses are due and follow up. Don't let anyone give you medication without checking your patient ID bracelet.
Check cleanliness. Make sure everyone who comes in your room, washes his or her hands or uses antibacterial soap.