The Medical Minute: Patient safety is everybody's business

By John Messmer, M.D.
Penn State Milton S. Hershey Medical Center

This is Patient Safety Awareness week. When the Institute of Medicine (IOM) of the National Academy of Sciences published its report, "To Err Is Human: Building a Safer Health System," in 1999, it caused quite an uproar. Medical errors were listed as the eighth leading cause of death in the United States, higher than motor vehicle accidents, breast cancer and AIDS.

If the medical system were indeed statistically more dangerous than operating a motor vehicle, one would have to question the wisdom of being a patient in our health care system at all. But, as Mark Twain once said, "there are lies, damn lies and statistics." The statistics in the IOM study measure any unplanned outcome as an error, even if no mistakes were made and no harm was done.

Medicine has evolved into a more complicated discipline than ever. People who are extremely ill are having extraordinary interventions with very high risks. In many cases, these interventions have a high risk of failure because they are desperate attempts to help. Just having a bad result does not mean errors were made.

Nonetheless, the report has given impetus to hospitals, physicians and health systems to evaluate errors and analyze problems so that as many errors as possible are prevented and patient safety is improved. However, we also share in the responsibility of ensuring that our care is safe. As patients, all of us can contribute to improved safety for ourselves and our friends and relatives.

Medication errors are probably the most frequent problem. Patients should be certain they know the names and doses of their medications and the reasons they are prescribed. Since several doctors may prescribe for one person, take all your medications, or at least an up to date list, to each physician visit. Be sure to include any vitamins, supplements, herbal products and over-the-counter medications you use. Ask your primary care physician to review all medications you take for potential interactions and to keep his or her records current.

Know your allergies and check these against any new medications. When you receive a new medication, ask why it is being prescribed and what result is expected. Many medications can be used for a variety of conditions so your doctor is the best person for this information.

Can you read the prescription? Handwriting is getting serious attention in hospitals and computerized order entry is being instituted to avoid misunderstandings. Computerized systems for outpatient treatment are less common so most prescriptions are still handwritten. If you can't read it, it's possible your pharmacist will not be able to either. Ask your doctor to write it again. When it is filled, check with the pharmacist to be certain you received the correct medication and that you understand the directions. If it is liquid, be sure you have the proper measuring device.

You should discuss potential side effects with your doctor. Many of the prewritten patient education forms list every potential side effect ever associated with the medication, even ones that are rare. Your doctor can tell you about the common side effects and what to do if you experience one. Discontinuing the medication may not be a good idea; your doctor may simply change the treatment if a side effect occurs.

In or out of the hospital, find out who is in charge of your care. Do not assume each person knows everything the other person knows. The caregiver making a decision now may not know your latest information, so find out. Consider having one person from your family with you to help you remember details and take notes to help your memory. If you are having surgery, ask about signing your initials at the site of the surgery to avoid mix-ups.

If you have a test, do not assume no news is good news. Occasionally, the test result does not get to the doctor. Remember that more is not necessarily better when it comes to tests. Sometimes more tests give more confusing and irrelevant information that can lead to interventions and treatments that can cause harm. Find out why a test or treatment is needed -- you may be better off without it. One source of standards for treatment and evaluation is at http://www.guideline.gov

To reduce the risk of infection, use antibiotics only as prescribed. Do not take "left over" antibiotics for another infection and do not pressure your doctor for unneeded antibiotics. Particularly in hospitals, ask healthcare workers involved in your care if they have washed their hands or used a sanitizer.

Patient safety is everybody's business. As partners, you and the medical profession can reduce risks and make health care as safe as it can be.