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Contemplating Safety While Lying Down

I write about what it takes for us — whether we are sick or well — to find and make good use of health care today.

At the end of September I was hospitalized for surgery to remove a tumor in my stomach. Below is one in a series of five observations about my experiences since then.

“You have to get out of this hospital – it’s a dangerous place,” each of my physician friends exclaimed when they came to visit me during my recent stay after surgery for stomach cancer.

Jeez!  I know! Prior to my operation, I was more preoccupied by the possibility of medical errors than of the operation itself or the pain it might cause.  What if they take out my kidney instead of my stomach?  Or leave a sponge in there?  Or over-hydrate me so I drown? What if one of my many overnight vitals-taking-shot-givers infects me with MRSA?

The human imagination has wondrous capacities, especially when fueled by true stories of harm people have experienced due to medical errors.  I read closely the IOM report To Err is Human: Building a Safer Health System ;  I am horrified by the medical errors experienced by Sue Sheridan and impressed by her leadership of Consumers Advancing Patient Safety and  Diane Pinakiewicz’s at the National Patient Safety Foundation to raise awareness about the dangers patients face due to carelessness and lack of system-level controls.

But for all my well-informed apprehension and the warnings of danger by my doctor friends, during my recent hospital stay, I was in no condition to be vigilant about my care.  I was far too ill.  Not too ill to forget the danger, especially when repeatedly reminded of it, but too befuddled by the after-effects of anesthesia and the pain medication to actually track the actions of the many health professionals who poked at me day and night.  My husband, a constant presence during the day, was vigilant, but often I was on my own: in the operating room, during the hours spent getting various scans and overnight.

And so I spent those seven days on tenterhooks, worried about the dangers that lurked in and on the hands of each doctor, friendly nurse and aide.

What is the real aim of efforts to inform the public about medical errors and the appalling state of patient safety in U.S. hospitals?

Is it to get us to choose the hospital we use based on hospital performance reports?  That is an optimistic goal to date.  The primary impact of those ratings appears to be to prompt hospitals to improve specific clinical services that are rated, not to shape patient choices among different institutions.

Are these public education efforts an attempt to spark a citizen uprising against medical errors?  Hmm.  If the pre-election public climate is any indication, competition for our outrage is pretty stiff, and most of us are more focused on putting our hospital experience – even if it is negative – behind us.

Is the aim to ensure that we are vigilant while we are in the hospital?  Yes, our loved ones should watch out for us while we are hospitalized, although many of us don’t have the person-power in our lives to mount a 24-hour defense.  However, as a patient who was sometimes watched over by my hyper-alert husband but often was not, the messages about the possibility of harm caused by my care frightened me.  They permeated my dreams and contributed to an anxious wariness about each staff person who entered my room.

Would I rather not know about the risks of medical errors?  Not for a moment.  If there is a danger, I want to protect myself as well as I can.  I strongly support the work of dedicated volunteers across the country to educate us about them.

But I am also acutely aware of this shift in responsibility, this additional task that patients and families must take on to ensure that we benefit from our care.  And I am concerned that this is yet another example of how, in the name of “choice,” “patient-centeredness” and “autonomy,” we are carefully informed about the risks of our health care while most of us actually possess little of the experience, judgment or ability to act effectively to reduce them.

Jessie Gruman, PhD, is the founder and president of the Washington, DC -based Center for Advancing Health. She is the author of Aftershock: What to Do When You or Someone you Love is Diagnosed with a Devastating Diagnosis.

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propensity
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propensity

I noted the radical shift in responsibility Jessie describes after EMRs and CPOEs were deployed in the medical center where I practice. The nurses and doctors busied themselves with the user unfriendly HIT devices while neglecting the patients. The nurses never get to know the patients because the information is “out of sight, and out of mind”, in the complex grids of the EMRs, after the nurses perfunctorily clicked in the data, while fulfilling the task of satisfying the device and the scrutinizers of admin; but not fulfilling the task of knowing the patient. The adverse impact that these expensive,… Read more »

David H.
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Hi Jessie: I agree that hospitals are dangerous places. And now we read about the spread in hospitals of a “super bug” that originated out of India (a country where antibiotics are handed out like candy). My concern, though, is more for you. I hope the surgery was successful and that the tumor was benign.

Theorajones
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Theorajones

“I am also acutely aware of this shift in responsibility, this additional task that patients and families must take on to ensure that we benefit from our care. And I am concerned that this is yet another example of how, in the name of “choice,” “patient-centeredness” and “autonomy,” we are carefully informed about the risks of our health care while most of us actually possess little of the experience, judgment or ability to act effectively to reduce them.” Amen. Any system of health care quality improvement and safety that expects sick people to act as “enforcers” is, by definition, not… Read more »