Medical errors now third leading cause of death in United States

May 3, 2016

These common medical errors are major killers

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A new study by patient safety researchers shows common medical errors may be the third leading cause of death in the U.S., after heart disease and cancer. (Deirdra O’Regan/The Washington Post)

Nightmare stories of nurses giving potent drugs meant for one patient to another and surgeons removing the wrong body parts have dominated recent headlines about medical care. Lest you assume those cases are the exceptions, a new study by patient-safety researchers provides some context.

Their analysis, published in the BMJ on Tuesday, shows that “medical errors” in hospitals and other health-care facilities are incredibly common and may now be the third-leading cause of death in the United States — claiming 251,000 lives every year, more than respiratory disease, accidents, stroke and Alzheimer’s.

Martin Makary, a professor of surgery at the Johns Hopkins University School of Medicine who led the research, said in an interview that the category includes everything from bad doctors to more systemic issues such as communication breakdowns when patients are handed off from one department to another.

“It boils down to people dying from the care that they receive rather than the disease for which they are seeking care,” Makary said.

The issue of patient safety has been a hot topic in recent years, but it wasn’t always that way. In 1999, an Institute of Medicine report calling preventable medical errors an “epidemic” shocked the medical establishment and led to significant debate about what could be done.

The IOM, based on one study, estimated deaths because of medical errors as high as 98,000 a year.  Makary’s research involves a more comprehensive analysis of four large studies, including ones by the Health and Human Services Department’s Office of the Inspector General and the Agency for Healthcare Research and Quality that took place between 2000 to 2008. His calculation of 251,000 deaths equates to nearly 700 deaths a day — about 9.5 percent of all deaths annually in the United States.

Makary said he and co-author Michael Daniel, also from Johns Hopkins, conducted the analysis to shed more light on a problem that many hospitals and health-care facilities try to avoid talking about.

Although all providers extol patient safety and highlight the various safety committees and protocols they have in place, few provide the public with specifics on actual cases of harm due to mistakes. Moreover, the Centers for Disease Control and Prevention doesn’t require reporting of errors in the data it collects about deaths through billing codes, making it hard to see what’s going on at the national level.

The CDC should update its vital statistics reporting requirements so that physicians must report whether there was any error that led to a preventable death, Makary said.

“We all know how common it is,” he said. “We also know how infrequently it’s openly discussed.”

Kenneth Sands, who directs health-care quality at Beth Israel Deaconess Medical Center, an affiliate of Harvard Medical School, said that the surprising thing about medical errors is the limited change that has taken place since the IOM report came out. Only hospital-acquired infections have shown improvement. “The overall numbers haven’t changed, and that’s discouraging and alarming,” he said.

Sands, who was not involved in the study published in the BMJ, formerly known as the British Medical Journal, said that one of the main barriers is the tremendous diversity and complexity in the way health care is delivered.

“There has just been a higher degree of tolerance for variability in practice than you would see in other industries,” he explained. When passengers get on a plane, there’s a standard way attendants move around, talk to them and prepare them for flight, Sands said, yet such standardization isn’t seen at hospitals. That makes it tricky to figure out where errors are occurring and how to fix them. The government should work with institutions to try to find ways improve on this situation, he said.

Makary also used an airplane analogy in describing how he thinks hospitals should approach errors, referencing what the Federal Aviation Administration does in its accident investigations.

“Measuring the problem is the absolute first step,” he said. “Hospitals are currently investigating deaths where medical error could have been a cause, but they are underresourced. What we need to do is study patterns nationally.”

He said that in the aviation community every pilot in the world learns from investigations and that the results are disseminated widely.

CONTENT FROM THE CLEVELAND CLINIC
Why empathy matters in healthcare
More hospitals are putting patient comfort and wellbeing at the forefront of their operations—from staff hires to building design to team structure.

“When a plane crashes, we don’t say this is confidential proprietary information the airline company owns. We consider this part of public safety. Hospitals should be held to the same standards,” Makary said.

Frederick van Pelt,  a doctor who works for the Chartis Group, a health-care consultancy, said another element of harm that is often overlooked is the number of severe patient injuries resulting from medical error.

“Some estimates would put this number at 40 times the death rate,” van Pelt said. “Again, this gets buried in the daily exposure that care providers have around patients who are suffering or in pain that is to be expected following procedures.”

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Is Anger One of the Stages of Grief?

Is Anger One of the Stages of Grief?

Ashley's Voice

You may find yourself feeling angry:Legend has it that one evening an elderly Cherokee told his grandson about a battle that goes on inside every one of us. The battle, he said, is between two wolves. One is Evil. It is anger, envy, jealousy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority and ego. The other is Good. It is joy, peace, love, hope, serenity, humility, kindness, benevolence, empathy, generosity, truth, compassion and faith. His grandson thought about this for a moment, then asked his grandfather, “Which wolf wins?” His grandfather simply replied, “The one you feed.”
Although anger is commonly identified as one of the so-called Stages of Grief, we now recognize that grief does not occur in easily defined stages, and anger is not always a part of everyone’s experience. Better to think of anger as a state (the circumstances or condition in which you may find yourself at any given time) rather than a stage (one of several sequential phases you may be in, as you work your way toward an end).
What is more, many mourners report not feeling angry at all. Nevertheless, there are times in your grief journey when you’re frustrated and hurting, and it’s only natural to lash out and look for someone to blame. Being angry is a way of channeling energy, of making some sense of the pain. When you are protesting an unjust loss, you may have every right to be angry. Even if you know your anger isn’t logical or justified, you can’t always help how you feel. Emotions aren’t always rational and logical. Feelings are neither right or wrong, good or bad. They just are. And for some of us, being angry may be preferable to feeling the underlying hurt and pain of loss.

  • at yourself for what you did or failed to do, whether it is real or imagined.
  • at your loved one for dying and abandoning you.
  • at a surviving family member for not being the one who died.
  • at medical or nursing staff who expressed little or no sympathy during your loved one’s illness or death.
  • at the doctors or the health care system for failing to save your loved one.
  • at the situation which suddenly rendered you helpless and powerless, when all this time you thought you were in control of your life.
  • at fate or at God for letting your loved one get sick and die.
  • at life because it isn’t fair.
  • at the rest of the world because life goes on as if nothing’s happened, while all your dreams are shattered and your life’s been turned upside down.
  • at others who have not lost what you have lost, who aren’t suffering; who are more fortunate than you and don’t even see it or appreciate it; who cannot understand what you are going through; who will go back to their lives as usual.
  • at others for being happy (part of a couple, part of an intact family) when you are not.

Anger is a powerful emotion that can be frightening. But feeling angry doesn’t necessarily imply that you will lose control or take your anger out unfairly on others. Before you can get through it, let go of the intense emotions attached to it and move on, your anger must be admitted, felt and expressed, if only to yourself. When you simply acknowledge feelings of anger to yourself or a trusted other without actually doing anything about them, no harm is done, to you or anyone else. On the other hand, if anger is suppressed and held on to, eventually you may erupt like a volcano, internalize it and take it out on yourself (in the form of depression or anxiety), or misdirect it toward innocent others such as family, friends and colleagues.

Suggestions for Coping with Anger

  • Recognize what you were taught about anger as a child and how that may affect the way you experience and deal with anger now.
  • Seek to understand what’s driving your anger, resentment or disappointment. Examine whatever expectations you had of others that were not met. What did you expect that did not happen? Were your expectations reasonable? Were others capable of doing what you expected?
  • Discover ways to discharge the energy of anger in appropriate, non-destructive ways that will bring no harm to yourself, to others or to property. Find a safe place, space, activity and time where you can let your anger out through:
    • physical exercise: sports, brisk walking, pounding pillows, chopping wood, digging holes, scrubbing floors.
    • hobbies and crafts: painting, pottery, stitchery, wood working.
    • music: blowing a horn; pounding drums or a piano.
    • writing: keeping a journal; writing a letter and tearing it up.
    • talking: finding someone you can talk to, without feeling judged or being told you’re bad because you’re angry.
    • reaching out: asking others for the support you need, rather than expecting them to know.
  • If you’ve decided your anger with another is justified, you can choose to deal with it by
    • confronting the person constructively with what happened and how you feel about it.
    • realigning your expectations, accepting the person’s limitations and seeking the support you need elsewhere.
    • leaving the relationship.
  • If you think you’re in danger of hurting yourself or someone else, if you’re feeling as if your anger is out of control, seek professional help at once.
  • Remember the wise words of Mark Twain: Anger is an acid that can do more harm to the vessel in which it is stored than to anything on which it is poured.

Your feedback is welcome! Please feel free to leave a comment or a question, or share a tip, a related article or a resource of your own in the Comments section below.

Being A Caregiver – Esophageal Cancer

Being A Caregiver – S. Oxford Brentwood TN

It was the most honorable and fulfilling thing I’ve ever done. It also was the absolute hardest thing I’ve ever done.

My best friend and bandmate, Brian was diagnosed with esophageal cancer in June ’11. He’d had difficulty swallowing for 18 months or so and it was progressively getting worse. The tumor was near the top of his esophagus and at the time of discovery blocked about 75% of the passageway. It was deemed too large to surgically remove initially and radiation and chemotherapy were ordered to shrink it then we’d talk about surgery. First thing done was to put in the chemo port on his chest on the left side and a feeding tube through his abdomen since swallowing was so difficult. These two procedures were done at the same time. One night in the hospital and that was it.

Brain

Brian had no family here and was adamant they not be notified. He felt they had their own lives to live and didn’t have time/couldn’t afford to take the time off to come help and I said “I can handle it”..

Radiation was daily Monday thru Friday (except holidays) for 5 weeks. Each radiation treatment lasted about 45 minutes.  Chemo was every three weeks and it took upwards of 6 hours per treatment. Chemo was set up first on a Thursday and Radiation started the following Monday. The first course of these two treatments was to last 6 weeks – radiation for 5 weeks and three chemo drips. Then he’d get a month off to recoup.. I went with Brian to the first session of each then the following treatments and the rest of this course, he drove himself there and back. On chemo days I’d go over and stay with his dog but otherwise I’d call or pop over in the afternoon each day to check on him. The chemo started kicking his ass the Saturday after his 2nd drip. Nausea, the squirts, fatigue, no appetite.. It would last til Tuesday or Wednesday then he’d feel pretty ok for two weeks.. The radiation didn’t seem to affect him adversely until that first “off” period. Hair said bye bye, fatigue became a monster and his throat was on fire..

After that 3rd round of chemo and 5 weeks of radiation he was on treatment vacation. A week into that it became apparent I was needed full time so I packed up some clothes and toothbrush and moved in.. He was miserable. Needed help getting out of bed, getting to the bathroom.. He came to detest “eating” Ensure thru a tube into his stomach.. By this time a few close friends realized something was up but they were sworn to secrecy.. One of those in particular stepped up often to spell me for an afternoon and give Brian someone else to talk to, too..

It was wearing me down.. I can see that now, but I couldn’t then.. I was too focused on Brian. Sorting medical bills and insurance claims and managing medication (there was a LOT) and trying to get him to smile and feel better. I had tunnel vision.

That month was good for Brian. He felt pretty tolerable the last three weeks or so and his spirits was up..

After that “off” period of 4 weeks xrays were taken, measurements done. The tumor was shrinking as it was hoped but still too large for surgery. So, round two was ordered. Same radiation schedule and same Chemo schedule but with different chemicals.. The 1st chemo drip laid him out. Energy immediately sapped and he wasn’t able to drive himself now.. This round of treatment was identical to the first except I was driving and he had few if any “good” days.

Now it is November and round two is done. There was a little more shrinkage of the tumor but still not enough. To remove it and be sure they didn’t miss anything his voice box, part of his trachea and the flapper thing that closes off the trachea to keep liquids and food from entering the lungs would have to be removed. The risk of aspirating something into the lungs was high to say the least. Pneumonia would set in and in his condition he couldn’t fight it, it was thought.. Two surgeons from Vanderbilt Hospital as well as one from the Mayo clinic were consulted. All advised against surgery. As a matter of fact, two said they simply wouldn’t do it. So, back to oncology we go and we’re told they threw the best stuff they had at it in round two and asked if Brian would like to participate in a trial. It looked promising and, given, it was do the trial or do nothing but wait, Brian elected the trial. It was after the first of the year before that started – talk about paperwork JEEZ… More xrays and measurements done to establish the baseline for his part of the trial. The tests revealed the cancer had spread to his liver, lungs and bones.

This trial round would have no radiation component. It was chemo only and was scheduled for every two weeks. He started the second week of Jan and he rallied! It was amazing! He felt good.. Well, not good like you and I know but good for someone fighting cancer.. It was short lived though and when that feeling began to fade it faded fast! Plummeted is a better word. He was in a wheelchair by the 1st of Feb. On his 4th treatment of the trial chemo – mid March – he was too weak. The trial was ended. That was a Thursday. Appointment set with main oncologist for the following Thursday..

Brian’s brothers had been emailing and calling and at first he’d write back saying all was well and he phone was buggy that was why he wasn’t answering.. The Monday of the week we were to see the Oncologist one of his brothers wrote to me.. I could keep the secret a secret no longer. I spilled all the beans. Brian was dying right before my eyes. He was sleeping 18 hrs a day now. His brother arrived at 9 pm that Wednesday and Brian was already in bed. I hadn’t told him I’d told his brother who was sleeping in the next room.. That Thursday morning I woke Brian as usual and as I was helping him up to the chair to the pot and to get dressed for the doc appt, I told him that Tommy was there.. He smiled and said “thank you”. He saw my relief cuz I guess it was obvious.. He was happy to see his brother and I think it lifted his spirits..

When we saw the Doc he was shocked at how far Brian had slid.. Hospice was ordered. They came Friday.. Another brother arrived Saturday. And another Sunday. I stayed. I was happy to have the help and and was so very protective of Brian at the same time, I think I pissed off a couple of the brothers.. Sunday March 19th 2011 was an unusually warm day and we were all outside on the screened in porch, Brian included.. Was was not able to talk above a whisper but he talked and the brothers bonded.. It was beautiful.. About 5 pm we went back in and Brian settled into his favorite chair and dozed off.. He didn’t wake up again.. About 7pm, while Tommy & I was in the room watching tv, we heard Brian say, “home? This is home?” Tommy and I both said, “yeah, this is home” and he said “ahhh ok…” and kinda smiled.. at 12:02am March 20th, he took a big inhale of a breath. Head went back, eyes opened a bit and there was no visible or audible exhale and he was gone.. I think he left his body at 7 when he asked “this is home?” and his body lived on another 5 hours..

I had no idea of the effect it would have on me and I still don’t think it’s done… I had 3 months to process the last 9 months of Brian’s life, which passed like a blur, when my Mom was diagnosed with the big C.. She lived 6 months before dying at home. The treatment for her was chemo only. I had plenty of help with Mom. I, having just gone thru it, was considered the expert.

My Dad and Sister were the primary caregivers for Mom and I found myself looking after them more than anything.. Caregivers need care too.. I’ll say that again, caregivers need care too.. I wish I had some advise on how to prepare for that role in life. I could say “ be sure to take time for yourself too” but I know from experience, I could not take my own advise. Nothing else in my life mattered. I was laser focused on taking as much stress off those going through the horrors of cancer treatment as I could. Nothing else mattered.

S. Oxford – Friend of Ashley’s Voice

Difference Between Alzheimer’s and Dementia

Please be an advocate for other caregivers that are assisting loved ones with Alzheimer’s or Dementia. Add your comments to this post or let us connect to your posts.

Alzheimer’s disease and dementia are often used interchangeably as many people believe  that one means the other. In fact, the distinction between the two diseases often causes confusion on the behalf of patients, families and caregivers. Discover how the two diagnoses, while related, are remarkably different.
What Is The Difference Between Alzheimer’s and Dementia?

Alzheimer’s and dementia are still a mystery in many ways. This is why the two similar diseases are often mixed up in every day conversation and understanding. According to the National Institute on Aging (NIA), Dementia is a brain disorder that affects communication and performance of daily activities and Alzheimer’s disease is a form of dementia that specifically affects parts of the brain that control thought, memory and language.

Read on to discover more particulars on how the two diseases vary and why there’s still a lot of scientific research needed—as well as public awareness—around these world-wide epidemics.

What is dementia?

Dementia is an umbrella term for a set of symptoms including impaired thinking and memory. It is a term that is often associated with the cognitive decline of aging. However, issues other than Alzheimer’s can cause dementia. Other common causes of dementia are Huntington’s Disease, Parkinson’s Disease and Creutzfeldt-Jakob disease.

What is Alzheimer’s Disease?

According to the Center for Disease Control, Alzheimer’s disease is a common cause of dementia causing as many as 50 to 70% of all dementia cases. In fact, Alzheimer’s is a very specific form of dementia. Symptoms of Alzheimer’s include impaired thought, impaired speech, and confusion. Doctors use a variety of screenings to determine the cause of dementia including blood tests, mental status evaluations and brain scans.

How Are They Different?

When a person is diagnosed with dementia, they are being diagnosed with a set of symptoms. This is similar to someone who has a sore throat. Their throat is sore but it is not known what is causing that particular symptom. It could be allergies, strep throat, or a common cold. Similarly, when someone has dementia they are experiencing symptoms without being told what is causing those symptoms.

Another major difference between the two is that Alzheimer’s is not a reversible disease. It is degenerative and incurable at this time. Some forms of dementia, such as a drug interaction or a vitamin deficiency, are actually reversible or temporary.

Once a cause of dementia is found appropriate treatment and counseling can begin. Until a proper diagnosis is made, the best approach to any dementia is engagement, communication and loving care.

The Need for More Public Awareness and Research Funding

While the differences between Alzheimer’s disease and dementia are clear to families dealing with the diseases, more public awareness is needed to differentiate between the two. Further understanding of what exactly causes Alzheimer’s disease will help to clear any confusion and hopefully lead to better treatments plans and, ultimately, a cure.

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