Medical care is one of the most conversed topics, not only in the past, but more so in this century and the future ahead, as we have an increasing number of people who need access to medical care. At some point in their lives, individuals, young or old, have received at least some medical care. However, what happens when the care goes awry? What is your attitude if it happens to you or your family members? While some people are accepting and open-minded, others are very critical and have deprecating attitude towards care providers. For the proponent of those who can never accept mistakes as part of health professionals‘ lives, it is wise to acknowledge that these workers are human beings and hence the irrationality of expectation of constant perfection. “To Err is Human“, a book published by The Institute of Medicine (IoM) in 2000, posits that it is not that we have incompetent health care professionals; it is that the good people are working in bad systems which need to be ameliorated to improve safety.
Without delving in great details in this article about statistics and by keeping in mind the notion of human imperfection, it is safe to assume that errors will always happen. Instead of condoning this fact, we need to strive to find the panacea to minimize the occurrence. In fact, medical error is worldwide phenomenon. Numbers may vary by continents and specific countries. However, statistically in developed nations where medical equipments and access to care is almost universal, the numbers are not surprisingly equivalent. Health care reports in the last decade asserted that Australia, New Zealand, and some European countries confirmed 1 death in 5 hospitalizations as a result of medical errors. The US is at 1 in 4, while Canada 1 in 10. This is very startling indeed and what’s shocking is that some of these are preventable types and the numbers do not even represent non-hospitalization ones.
How do we define medical error? According to Institute of Medicine (IOM), medical error is a failure of planned action as intended or the use of the wrong plan to achieve an aim. It is imperative to keep in mind to distinguish medical errors from adverse events. While the former deals with injury or in extreme cases, deaths due to mistakes made by individuals; the latter involves unfortunate, undesirable or unintentional results of medical treatments, though not necessarily unexpected. Hypersensitivity reaction or side effect of medications which happens to patients is NOT considered medical error, assuming that the prescribed medication is the correct one according to the diagnosis. This is due to the fact that some individuals have different physiologies and might react differently to medications. Gum discomfort following orthodontic surgery is another example of an adverse event as well as a patient experiencing some pain after artificial joint replacement surgery. Although there is no single method of classifying types of errors, a US government task force known as Quality Interagency Coordination Task Force (QuIC) categorized them according to type of care provided (medication, surgery, diagnostic imaging, etc.), severity of the injury (minor discomfort, serious injury, death, etc.), legal definitions (negligence, malpractice, etc.), setting (hospital, emergency room, intensive care unit, nursing home, etc.), and individuals involved (physician, nurse, pharmacist, patient, etc.)
What is the culprit of these errors? Most of these factors are preventable and need to be circumvented and circumscribed to maximize patient safety. Some transpire specifically in a health field corresponding to each worker‘s responsibility, while others are prevalent in all. For instance, physicians may make diagnostic errors and pharmacists may contribute to dispensing errors. However, poor communication is a universal contributor and might happen to both physicians and pharmacists. Physicians with illegible handwriting undermine communication by inadvertently creating confusion for pharmacists to interpret prescriptions, which might lead to dosing and medication errors (e.g. medications with similar names). In fact, communication errors happen quite frequently, not only among care providers but also between them and patients. When patients are not able to understand pertinent information or when professionals do not spend enough time clarifying or ensuring certain topics of discussion, misinterpretation may arise. Patients may take the wrong medications at the wrong time or mixing it with others, resulting in deadly interactions. Next, what about time management and physical burnout? Despite having 24 hours per day, our human physiology limits as to how much to spend for resting and for being active. As we get inadequate rest, our productivity suffers. When we start feeling overwhelmed while providing care, neglecting to take care of our own physical and mental needs; burnout takes place leading to poor performance and errors. Students, interns or residents with their inexperience may require better learning objectives and teaching methods. Inanimate objects such as manufacture and equipment errors may also contribute to fatal errors. Imagine a tablet-producing equipment in manufacturer that is not properly maintained. One of the outcomes could be that of too high dose of each tablet produced. If quality control is excellent, this might be adverted. However, if this step is a downfall and the product reaches the market, what happens will not be pretty. An insulin pump which has a manufacture defect on the tubing, resulting in no insulin delivery into the patient‘s body, will yield a fatal hyperglycemia for insulin-dependent diabetic patients.
There are many aspects that are being suggested to reduce the rate of medical errors. First, we need to improve the working conditions of health professionals in the hospital and community settings. We need to make sure that the amount of staff is adequate to minimize work overload. Proper shifts, scheduled breaks, and exercise programs must be encouraged to promote healthy living. A famous Latin quotation “Mens Sana In Corpore Sano” states that there’s healthy mind in healthy body. When your body is not sufficiently taken care of, your mind will suffer. Some patients even question their overweight doctors about the advice they gave to patients to espouse healthy lifestyle, while they ignore their own suggestions. Second, adopting new technology is certainly welcomed in many aspects of health care if this means maximizing productivity, efficiency, and reducing errors. The use of computer software to record diagnostic findings and to prescribe medications by physicians will save time and at the same time, will circumvent reading errors by pharmacists and nurses. Verbal manner provides an excellent way to minimize error when communicating verbally (e.g. by phone). Instead of rushing during phone order, doctors must ensure that pharmacists or nurses grasp what’s being requested. Those who receive the order may need to re-read the order back for further clarification. Third, hand-held manuals or references are definitely tools that need to be employed to avoid information overload. After all, human brain has limits as to how much information can be stored. Imagine having to memorize and still remember all the details. Therefore, health care workers must be humble enough to acknowledge that it is impossible to know everything about the intricacies of human body. Consulting references when appropriate is thus recommended. Fourth, manufacturers of medical equipment like ventilators may also contribute by designing such machines that are standardized to ensure ease and familiarity of use by workers. Different varieties will often create confusion especially among the inexperienced. Finally, with the amount of errors that occur, we need a proper way of documenting them. Each hospital and community health setting must have its own way of documenting of what has happened and what kind of interventions will or have been implemented. Of course, this task is insurmountable without the cooperation of the health workers themselves. Some worry that they may lose their jobs if such reports are being made. However, without them, we are blind as to how we can improve. In addition, it is unethical because health workers are obligated to do things to ensure patient safety. Follow-up methods and tactics must be discussed to prevent repeat mistakes.
Certainly, relying solely on health care providers’ efforts to minimize errors will come to a dead end without involving the cared ones, especially now that we realize the limitations of what humans are capable of. Then, the next question that arises is what can we, as patients, contribute? The answer is solely by being proactive and not passive. The 21st century is the age of information and by being totally passive will not bode well towards the contribution for our own health. We need to ask questions during our appointments. When in doubt, we need to ask for clarifications for things that we are not entirely sure about. Inquire about the procedures: what and why it is necessary to have it done, how it will be done, what kind of things that we need to pay attention to during and after the procedure. Ask about why certain medications are being prescribed, what the purpose is, what kind of drug interactions you should watch for, what adverse effects you should pay attention to, how the medications are to be administered, what other treatment options are available, and what the pros and cons are. If they are not willing or claim that they do not have sufficient time, the chance is that they are too occupied for other patients as well. It is probably a good reason to search for others who have the time to listen to you.
