How to Protect Yourself Against Medical Mistakes

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Medical error, medical mistakes. Poorer outcomes. Spooky stuff when we are laying ourselves out there, vulnerable to a provider and that which we may not understand. I bring some solutions today, and strategy.

Today is important to me because I enjoy strategy and the lovely little intersections of care and conversation. The places folks may miss, or get tripped up.

Some of the tips I am about to share you may know and some you may not. Read for your own care, and that of the people you love, have them in mind also as we go along today.

The first bit of strategy is your stance.

We can and must be active participants in our healthcare. ‘Active participants’, meaning no more reporting for care and having a provider do to, or for you. When we participate it can impact and improve our outcomes. We need to be active, responding, and participating in what goes on. Part of that is keeping our eyes open and doing a few simple things.

The stuff we are talking about today, the information, stance, and readiness is important. It’s everyday-important. It’s “Know this for when unexpected medical events occur”-important. It’s “Teach someone you love or incorporate it into their care”-important. Let’s go.

Let’s begin with this startling information. It is our WHY for today.

Medical error is the nation’s third leading cause of death, behind only cancer and heart disease, according to researchers at Johns Hopkins. They estimate that it causes more than 250,000 deaths each year. 

Part of that word ‘startling’ is ‘start.’ You and I can begin to do a few things to help avoid some of the most common medical errors.

Have a Care Partner With You

When you go to the doctor, are preparing for or are in the hospital, whenever you are in a medial encounter it is a good idea to take someone along. They are an extra set of eyes and ears, they hear different things and they may hear things differently. They might act as scribe, they can ensure that you get your questions answered (you did prepare questions and talking points, right?) and that instructions and treatment are understood. A Care Partner might prompt the questions and help you to understand and carry out the next steps. A spirit of teamwork and accountability becomes automatic.

Medication – Take As (and all) Directed

If you get the wrong drug or amount, it can cause serious problems. Some are powerful, and it can be tricky to give them in a dose that’s both safe and effective. Human error, and poor communication can all lead to mistakes. Pay attention, ask questions, and keep an updated list of your medicines so your doctor knows about any other drugs you take.

Those portals where we list our medications and allergies are important. Going over it with your medical team when you first arrive in your medical appointment is too.

If the medication is new, read the information sheet. Be vigilant of any changes in your body, and contact your doctor if you feel something is “off,” or you may even call the pharmacy if you have a question.

Tip: Do you have a relationship with your pharmacy and perhaps the pharmacist(s)? This can be a real boon. Besides assess to drug information, who else is open beyond traditional businesses and medical office hours? Pursue this relationship.

Misuse of Antibiotics

These drugs attack bacteria, so they won’t help the common cold, the flu, or other things caused by a virus. And if you take them too often when you don’t need to, they might stop working for you. The lesson here is simple, really: Take as prescribed.

Have you or someone you know ever had a lingering viral infection, something that just lingered on and on? Was it because they stopped the medication? (“I felt better in three days so I quit taking those big pills.”). What you did was effectively beat the virus back, but like a persistent weed in a garden an illness not completely treated can reemerge, and with a vengeance, because now it may have figured out a workaround. Viruses are sneaky like that (Look at Covid).

Hospital Stay: Too Long or Too Short

It’s no fun being in a hospital, but you shouldn’t be rushed out before you’re ready. Studies show that people who go home too quickly, especially after surgery, are more likely to become seriously ill again because of related problems. 

But you don’t want to stay too long, either. That’s linked to higher rates of infection and other problems. People contract what are called “Hospital Acquired Infections” or HAI.  They can be present or incubating and follow you home.  The most famous and scary examples are MRSA, C.diff, UTI’s,  and pneumonias.

Patient Advocates like myself monitor stays and discharges closely. We’ve appealed, delayed, or thrown whatever stop sticks we can in front of a discharge that is too soon. Or on a Friday at 3 PM, and a solo ager has no way to get home, and no one to receive and help when they do get there.

I will comment that many times the “not ready for discharge” has to do with an unprepared patient’s home situation, like no help lined up, no home care engagement underway or the worker determined and assigned. Perhaps they need (to be there for delivery of) equipment like a bedside commode or wheelchair. The patient may live alone and have no food in the house or way to get prescriptions picked up. If you know a hospitalization is in your future, then start planning for discharge right then.  I like to singsong “For every discharge there is an admission. Start planning then.”

Wrong Site Surgery

The most dramatic example of this is when a surgeon takes off the wrong limb, but it also can happen if they operate on the wrong organ or even the wrong person. The layout of the surgery rooms and wings, distractions, and running behind schedule can all lead to this. Imagine this: the surgeon is scheduled in one of many operating rooms and at staggered times; they too are navigating. That is why they use protocols, like checklists, and checking wristbands, even scanning those to match the packet of instruments prepared and sanitized for a procedure.

One thing you can do is make sure the right area on your body is marked before surgery. When I had surgery a couple of years ago there was to be a surgeon and what is called an Interventional Radiologist. I had a special appointment and trip to see this ‘IR,’ and it turned out to be most interesting. They explained the procedure, their part in guiding it, everything. Then they broke out the Sharpie and made marks on my body (“X” marks the spot!). I felt a bit like a pig with her bacon mapped out, but I left there a smarter pig. I had to smile when they offered me the Sharpie saying they cannot use it again. Made sense.

What’s Left Behind

Yes, we’ve read about this in some tabloids: it's rare, but it's possible for the surgical team to accidentally leave something like a sponge or instrument inside your body. This can lead to serious internal problems, including an abscess, a blockage, small tears, infection, or inflammation. Signs of these issues include severe pain, swelling, fever, nausea, and changes in your bowel movements.  Tell your doctor right away if you have any of these symptoms after surgery. Know how to get in touch (and your Care Partner, too).

Delay in Treatment

This is when you don’t get the medical care you need when you’re supposed to. It can happen during diagnosis -- like if you're not scheduled for a test in a timely way, the results are late, or there’s a misdiagnosis -- or during treatment. Human error, bad communication, and poor planning, among other things, can cause delays. If you don’t hear back from your doctor, don’t assume things are OK. You and your Care Partner should know how to get in touch with the provider.

It’s a good idea during testing to leave knowing what is next. When will you gain results? Will you see it in a portal, will you get an email  or a call from the office (confirm any phone numbers or email addresses)? Talk timeline and Next Steps.

Ask questions. If symptoms are progressing, your provider needs to know.

Bed Rest

Within the first 10 days of any bed rest, in the hospital, rehab, or at home, we start to lose muscle mass and bone density. If you’re in bed longer than that, it also can affect your heart, lungs, and brain, and cause bed sores. 

That’s why many doctors want you up and about as soon as possible. A present-day example is with a hip replacement. Patients are up and walking, same day.  Many folks are having effective same day surgery with outpatient settings. The average hospital stay that was seven days in 1980 is now two days. More can be done on an outpatient or same-day basis than ever before, and that protects us.

Don’t Assume Every Provider Works From the Same Information

Just because you told one doctor what drugs you take doesn’t mean all your doctors know. Tell all your care providers -- several times if necessary -- if you take medications or have bad drug reactions, or other health problems. It’s also good to create a list of current medications and make sure a Care Partner knows this as well. Information can get mixed up, lost, or just plain forgotten in the communication between different health care professionals.

Use that Discharge Summary! It was not so long ago that patients weren’t given anything written (and studies show that many of us forget what we were told by a provider, often  before we reach the car!). Nowadays I see a written Discharge Summary as a standard practice, and often the important portions are highlighted and circled. 

Train your Care Partner, too. They can review the summary. Make sure they know what to do (since you may be “gooed out on medication”), and who to call if there is a question (nurse’s line, pharmacist, something). 

Once after some dental surgery I had an adverse reaction to the medication post op. I was hallucinating. I have this Andrew Wyeth print named Christina’s World. You may know it. Let’s just say that sagebrush was somehow rolling toward me, and back into that picture. My father, who was my Care Partner that day,  had transported me to the procedure and helped me with the prescription pick up afterwards. He called the provider’s office and we gained instructions as to what to do and how to take the new Rx that was to be phoned in to my pharmacy.  My father then had to drive to the pharmacy to pick up (and sign for) another very strong and controlled substance. We didn’t plan for that. What if I’d been alone?

Do Your Homework, and Ask Questions

Ask your doctor about your condition and treatments. It’s important to understand how drugs or procedures will affect you. Do not hesitate to ask why they’re recommending something.

Don’t be one of those patients who “consult Dr. Google.” If you are researching online, stick to the big, credible names, like NIH (National Institute of Health), the sites of top universities (Ex: Johns Hopkins, Mayo Clinic), government sites like CMS (Centers for Medicare and Medicaid Services) or NIA (National Institute on Aging). 

You might ask your provider the best ways to learn more (psst!- a perfect example of participating in your own healthcare!).

Speak Up

If you have questions or concerns, don’t be afraid to ask. You have the right to question anyone involved in your care. Anticipate that you may later have questions, and ask how is best to contact the office or get solid answers.

Have your Care Partner ready to ask your questions if you cannot or will not. (which means you’ve had some of the “conversations -with an “s”!”. You’re makin’ Momma proud here).

After all (or even before all) YOU are the customer here, right?

Pick a ‘Point Person’(Who’s driving the bus?)

You can choose a health care professional, such as your primary care doctor, to coordinate your care. If you have multiple providers, a couple of specialists and therapies it can help cut down on confusion and mistakes, especially if you have multiple health problems, doctors  or are just coming out of the hospital.

A word about “Primary care” - you would not believe how many times I’ve had to reach back to get a PCP to drive the bus! Sometimes in our participation we must engage and work hard to involve a PCP. 

Also, we can “landscape” their office: who do you call if there is a question? What are procedures when someone has a question and maybe the availability to gain responses (are they closed on Fridays, or Wednesday afternoons)? Should your questions be  lodged in portal or is that slow, or only for non-emergency inquiries? Does the office have a Referral Coordinator.? How does it all work? Get the same knowledge of a specialist’s office: Then make sure your Care Partner is aware as well.

Same-paging: This may be a good place to mention a tool that I offer, The Face Sheet Tool. The Face Sheet Tool is a free download, find it on my website nancyruffner.com. It helps you to identify, list, and share all your pertinent information when pursuing healthcare or a treatment stay. For you, for your Care partner, for your loved ones – Bring everybody onto the same page with this at-a-glance Tool. Help yourself or another with your free download.

Choose the Right Hospital

If you’ll be at a hospital for a procedure or testing that’s planned, take the time to read up on the facility. If you have a choice, choose one that has lots of experience with your condition. Or if your specialist works among more than one hospital you may be able to discuss having your procedure done in the one with the highest safety grade.

Safety Grade? How do I find that out? Become familiar with the Leapfrog Hospital Safety Grade. Reports are published twice annually for hospitals across the US, and you can find out a letter grade rating and then dig deeper to see other factors like problems with surgeries, safety problems,  infection control,  and staffing issues. There are easy videos that will show you how to get the most out of the site.

So, do agree that this kind of information is important, for your own care of that of someone you love?

Remember that it all begins with a stance, an intention, to be an active participant in your own healthcare. 

Get a Care Partner (We get farther and better, together).

Stack the deck in your favor for a favorable outcome.

We are the customer. 

And you know I cannot resist an opportunity to lay my favorite mantra on ya: “We can all have a say about how things will go and where we’ll end up.”

To Your Good Health!