Have a Story to Tell? Had a medical error?

This blog is about patient safety, medical malpractice, staying healthy, and preventing future errors. Help & empower someone else, Teach a lesson, Bear witness, Build our community - Email us or call 781-444-5525.

Frustrated with a health problem?

Need an ally in your health crisis? Call 781-444-5525, or learn more.

Thursday, January 31, 2008

As if it never occurred: Pain medication errors affecting a nurse patient

Laura's Story
I herniated a disc in my back when I was very young and, although I was diligent with my physical therapy exercises and had tried many healing modalities, nothing helped my chronic and debilitating back pain. Still in my twenties, I was told to have breast reduction surgery to help my back. Although I didn't particularly care about the cosmetic effects, overall I was hopeful that the surgery would help and thus increase my enjoyment of my life. The health insurance I had at the time of the initial recommendation would not cover the surgery, but I was finally able to have it a few years later when I changed companies and the new one was willing to cover it.

Because of restrictions imposed by my health insurance, I was required to go to a hospital that, even then, I could not strongly recommend even though it is a major Boston teaching hospital (I worked in healthcare so have some knowledge). I did not have anyone to stay with me because my father had recently died, my mother was dying, and my friends were busy during the day with work or children. Still, I was reassured that I would be ok because I trusted and liked my surgeon, I would only be in the hospital one night, and my surgeon had come up with a strict pain management plan for after the surgery. I would have strong pain medication available to me every two hours, as well as Tylenol in case I needed it in between.

Unfortunately my trust was misplaced. Still sedated, disoriented, and numb immediately after four hours under general anesthesia, I was allowed by the orderlies and nurses to lift my entire body weight from the gurney to the hospital bed, despite orders that I not use my arms or lift heavy weights for a month. As a result, by the next morning, I was in agony. I had had my chest spliced open, very tender body parts were stitched back together. Yet my nurse refused me any pain medication at a time I should have been able to get it, and said I was not allowed Tylenol. She left and did not return, despite repeated calls from me, through the floor secretary, to her (which I overheard through the intercom). I was left crying, sweating from pain, my heart pounding, frightened. I felt trapped and vulnerable because I could not get out of the bed due to the pain. I was helpless.

At least two hours elapsed with me in this difficult state. Towards the end, growing desperate, I attempted to page my surgeon from my bedside phone but was told by the operator it was not allowed, and I should ask my nurse to page him (!). Later I called back and, explaining my plight to the operator, was connected with a helpful hospital employee who then reached various nursing supervisors, resulting in a parade of nurses of various levels coming to my bedside. My nurse told me she had not come because I wasn't due for my medication; I said she should have come to see me anyway, because I had a right to know why no one was responding to me. She and her supervisors seemed angry and hostile to varying degrees, which I found upsetting at that vulnerable time. No one took responsibility; in fact my nurse blamed the innocent secretary for not relaying my pleas for help. She did not tell the truth, which I found alarming in itself.

I was discharged home without my pain under control and thus suffered from severe side effects from taking the maximum dose of oral pain medication; I almost landed in the emergency room. I was in too much pain to change my bandages as required so I had to have a visiting nurse come to my home to help me, which I am told is very unusual after this procedure. A year later, I had to have my scars re-excised because they were so severe; my surgeon thought that could be due to having lifted myself after surgery. At that time, along with a kind outpatient surgical nurse, I reread the medical chart from that hospitalization. It was clear to that nurse that the medication orders in the chart, readily available to my nurse on the day after my first surgery called for strong pain medication every two hours if I needed it. The Tylenol order was also spelled out in black and white; all just as my surgeon had stated to me beforehand. My nurse the day of surgery seemingly had lied to protect herself and had not bothered to even re-check the orders as they were clear even to me. There was no notation at all in the medical record of me lifting myself or my multiple calls for help, or my severe pain that morning. It was as if it never occurred.

Worse than the physical scars are the emotional ones for me. Something happened in my soul when that nurse left me so vulnerable and helpless. To this day I have trouble with trusting healthcare providers and hospitals, which is unfortunate for me because I have some minor but chronic health problems that require regular visits to such places. Additionally, I used to work in healthcare and find that I am less interested in working in such settings due to the unpleasant feelings that come up. It is remarkable how one person's unprofessional behavior can impact your life when you are a patient and thus intrinsically more helpless, vulnerable, and reliant on others.

Advice: Even nurses need a patient advocate when they are hospital patients themselves.

Browse for similar stories in our index at the very bottom of this page, or read a pain management story.

Wednesday, January 30, 2008

A higher power: Pres. Bush and alcoholism

"Addiction is hard to overcome. I drank too much at one time in my life," said President Bush on Tuesday to an audience at the Jericho program of the Episcopal Community Services of Maryland. Pres. Bush gave up alcohol at age 40, nine years after a conviction for driving while intoxicated.

"I understand faith-based programs. Sometimes you can find the inspiration from a higher power to solve an addiction problem," Pres. Bush added.

In his State of the Union address on Monday, Pres. Bush had asked Congress to guarantee permanent financing for religion-based groups. In Maryland, he used his personal story to make the case.

Advice to people who drink a lot: Religious faith, and a counselor in your faith, can help you overcome problems.

Browse for related stories in the index at the very bottom of this page, or read a kick-butt chaplain’s faith-based recovery story.

Thanks to Reuters for the source story in today's New York Times.

Tuesday, January 29, 2008

Those patients are going to do much better: Cancer patient navigators

Grace Stachlinski said she was diagnosed with breast cancer in October. She had surgery and is currently having radiation treatments.

"She told me if there was ever anything I needed to let her know and she'd be on top of it," Grace said of her patient navigator, Stacey Huber, at Mercy Medical Center in Baltimore.

Huber said that patients don't know what their issues and needs are until they're faced with cancer.

"Transportation and financial support are two of our biggest concerns, but there are organizations out there who offer grants," Huber said.

Huber said she helps patients obtain and fill out the proper paperwork. Mercy radiologist Dr. Maria Jacobs said it can make a difference in a patient's outcome.

"Because that helps with compliance of daily treatments. Patients who get radiation daily five days a week for six weeks can complete their course of treatment. Those patients are going to do much better," Dr. Jacobs said.

Patients will have to qualify for those programs, but the patient navigator can help figure that out as well, Huber said.

Advice to cancer patients:
Get the help of a patient advocate or navigator.

Browse for similar stories in our index at the very bottom of this page, or read a cancer survivor story.

Thanks to WBAL-TV Baltimore for the source story.

Monday, January 28, 2008

I’ve never received a thank-you note: A lupus patient's advice

Christine Miserandino has learned a thing or two from her frequent doctor's appointments for lupus. She writes about her illness on her web site, and says that before each appointment, she fills out three index cards: one with any new problems she needs to tell her doctor about, one describing her current symptoms, and a third with specific questions for the doctor.

She says this gets her better care. "My doctor is busy, and I have to respect that he has 40 patients in one day," she says. "If I don't go in with all my questions written down, I'd be rambling all over the place."

Doctors often schedule appointments in 15-minute increments. Sometimes you'll need much more than that. Christine says she always warns the appointment secretary when she'll need extra time, and asks whether a certain time of day (such as the last appointment) would be better.

Christine says she doesn't shy away from asking tough questions -- on the contrary, she asks lots of them and sometimes questions her doctor's recommendations -- but she always does it politely. Plus, she fosters a relationship with her doctor because she knows that to a great extent, her health depends on him.

"I do care, because I want him to care about me. I do bring cookies at Christmastime. It's a relationship you have to foster like any other."

Once, when her doctor went above and beyond what he had to do by visiting her in the hospital twice in one day, she wrote him a thank-you note. "He said to me, 'In the 20-odd years I've been doing this, I've never received a thank-you note. I always hear the negative, never the positive.'"

Browse for similar stories in our index at the very bottom of this page, or read a patient-physician miscommunication story.

Thanks to Elizabeth Cohen and Jennifer Pifer for the source story via CNN.

Saturday, January 26, 2008

The team doctor cleared him to play: Laveranues Coles' concussion treatment

New York Jets football player Laveranues Coles had sustained a concussion on Oct. 28 in a loss to the Buffalo Bills. The Jets coaches held him out for one game, and he presumably passed the neuropsychological tests that the league made mandatory this year. Apparently the team doctors cleared him to play, and he returned to the football field for several games.

While discussing his reputation for playing hurt, he said, "Sometimes I may need somebody to step in there at certain times and say, 'Laveranues, I think you need to do what's best for you.' But it is what it is."

Pete Kendall, a former Jets lineman now with the Washington Redskins, said he was "concerned for Laveranues. He seemed more subdued [when playing later that season] than normal." Lethargy is a common sign of an unhealed concussion.

Pete questioned whether critical decisions should be made by team-employed doctors, saying "I see guys playing in games that I don't think a personal advocate would allow them to do. The doctor who is supposed to be looking out for you is also the same guy who may put you into a game that the team has to win. You're mixing business with medicine."

Advice to the parents of injured athletes: Get a second opinion to verify the team doctor's opinion of your athlete's readiness to play.

Browse for similar stories in our index at the very bottom of this page, or read a athlete’s story.

Thanks to Alan Schwarz for the source story in the Dec. 22 issue of the New York Times.

Thursday, January 24, 2008

I was supposed to live, at best, 3 years: a myeloma foundation

She had graduated from Harvard Business School, and was on the fast track for a leadership position at Searle, the pharmaceutical giant. For four years, Kathy Giusti oversaw the marketing of Searle’s arthritis drugs. In 1995, at age 37, she was married, and had an 18-month old baby girl. In December that year, seeing her doctor for help in getting pregnant again, she learned she had myeloma, a cancer of plasma cells found in bone marrow.

She met with seven myeloma specialists and received contradictory advice. She ultimately chose the most conservative approach, partly because she greatly wanted another baby, and didn't want toxic drugs to interfere with her conception and pregnancy. "I put a plan together, and I went through the whole I.V.F. program to get pregnant."

By 1997, she had quit her job at Searle, and had given birth to a healthy boy.

The previous summer, she had attended a patient seminar sponsored by the International Myeloma Foundation. The foundation's directors asked her to be on their board. She agreed, and wrote a business plan for them. "But I was challenging them about where they were heading and what they are doing with research and funding research. [They were] getting annoyed with me. So they booted me off the board."

In October 1997, she and her sister held a dinner for wealthy friends near her new home in Connecticut, to raise money for myeloma research. It must have been quite delicious; they raised $450,000. She distributed most of it to research, and used the rest to set up the Multiple Myeloma Research Foundation.

She realized that in order to accelerate the development of new myeloma drugs, she needed to foster greater collaboration between researchers and different academic institutions. In 2002, she decided to assemble a consortium of scientists who would be required to submit their research proposals to a steering committee for approval, and to publish their results jointly. In exchange, the scientists would receive access to a tissue bank of myeloma blood cells and bone marrow, as well as administrative and organizational support for lab tests and clinical trials.

Since 1998, the foundation has raised $92 million. Since 2001, 21 drugs derived in part from research funded by the foundation have entered clinical trials, and eight are now in Phase 2 – a track record that pharmaceutical companies would envy.

Dr. Ken Anderson, Kathy's doctor, says, "Myeloma is now a paradigm for new drug development, because of partnerships that occur between academics, large pharmaceutical companies, small biotech, the FDA, the National Cancer Institute, and foundations. And, frankly, Giusti's foundation has been a catalyst that created the urgency and awareness to make this progress possible."

Kathy had a bone marrow transplant in 2006, and her cancer is in remission.

Advice to people struggling with grave diseases: Take heart from Kathy's example, and help as much as you can.

Browse for related stories in the index at the very bottom of this page, or read a story about a similar visionary nonprofit health entrepreneur hero.

Thanks to Dr. Jerome Groopman for the source article in the Jan. 28 issue of the New Yorker.

Wednesday, January 23, 2008

I was pushed aside: Waiting in the Emergency Department

Dear Mr. Porter:

This letter is to make you aware about my experience at your Emergency Department on March 13.

I am a college-educated, married, mother of two, and have been suffering from post-partum depression since the birth of my second daughter five months ago. On the evening of March 13, I became extremely overwhelmed with anxiety and stress and voluntarily called 911 to be taken to your Emergency Department. Had I even been able to imagine the experience I would have in the next 24 hours, I would have literally been more afraid to go to your E.D. than I would be had I stayed at home and "waited it out."

On the morning of March 14, I met with a member of the crisis team, who informed me that I would need to be hospitalized on an inpatient basis so that I could be evaluated. That being said, one can imagine that my emotional state was not so great. At 9 am, I was moved to the "family room" of the E.D. because of a lack of beds, which is understandable. I was shaking and crying, and dressed in only a "johnny." I was put in a room with a Certified Nursing Assistant (CNA) and a woman who was delusional, psychotic and combative. She was urine soaked and spitting and coughing uncontrollably. The CNA was pushy, miserable, and cold. I felt so unsafe being in the same room as that patient that I sat out in the hallway.

After about an hour of sitting in the hallway, I asked the charge nurse if there was somewhere I could sit that was a little more private (not to mention safer) than the hallway. The charge nurse said she would "find me a home," but never came back to even let me know that she couldn't accommodate me. What is worse, four hours went by and no one let me know what was going on. What could be worse than being alone without your family, with no one around in the most horrible time in your life, and then having no idea what's going to happen next?

Your nurses were all abrasive, and apathetic. I felt as though I was pushed aside, and then my problems didn't count. I felt like I was being treated like a criminal basically.

If your hospital and staff do not have the capacity, much less the compassion, to look at psychiatric illness the same as a medical illness, then I suggest you divert your "Section 12's”"and mentally ill to another hospital that can treat them with respect and compassion.

My experience in your E.D. was nightmarish. There is no other word to describe it.

Thank you for your time.


Mrs. Elizabeth DeCoste

Advice: If care in the hospital is disrespectful, and you get no response from the nurse or charge nurse, contact the hospital's patient advocate, ombudsman, or president.

Browse for related stories in the index at the very bottom of this page, or read a waiting time story.

Tuesday, January 22, 2008

Now it’s up to us to use the information: Hospital quality ratings on bedsores et al

Naomi Press' family said her life dramatically changed after she entered the hospital on her 85th birthday for a partial hip replacement. Naomi ended up dying 11 days after her release from the hospital.

Her death certificate blames a hospital-acquired bedsore, malnutrition and sepsis, which is an infection that can cause organ failure. Documents obtained from the Department of Public Health state the timeline. The hip surgery was on Jan. 10, 2006 and two days later doctors discovered she had a stroke. Then on Feb. 3, after several weeks in the hospital, nurses documented a stage three bedsore.

Under state law, it should have been reported to the Department of Public Health, but was not.

Hospitals in Massachusetts now report their rates of bedsores in a publicly available database organized by the Massachusetts Hospital Association. Now it's up to us to start using the information to get our family members into the safest hospitals when they need it. If Naomi's family could have used such a database, they might have gotten her into a safer hospital.

Of course, the decision of where to admit our family member is usually largely the doctor's decision.

Advice for Massachusetts residents: Email your doctor with this story, and suggest your doctor look up the quality ratings of the hospitals he or she admits patients to.

Browse for similar stories in our index at the very bottom of this page, or see the video.

Thanks to NBC30.com for the source story.

Monday, January 21, 2008

Wrong drug, wrong patient, or just wrong?: Roger Clemens' claims of Vitamin B12 and Lidocaine use

The only people who legitimately might need vitamin B12 injections would be those with diagnoses of pernicious anemia, according to Dr. George Blackburn, Director of the Center for the Study of Nutrition Medicine at Beth Israel Deaconess Medical Center in Boston. It’s "virtually impossible" to get pernicious anemia in America nowadays, because of our ready access to fish, eggs, and dairy products

The New York Yankees baseball pitcher Roger Clemens has claimed that the injections that he received in his buttocks contained B12, and Lidocaine. "I don't why you would inject Lidocaine deep into this muscle," said Dr. Gary Wadler, a spokesman for the American College of Sports Medicine and a member of the World Anti-Doping Agency. In general, pain-killers like Lidocaine are used specifically to block nerves, and therefore pain, in a specific part of the body, such as teeth during dental procedures, or around aching joints, and are not properly used as Clemens claims.

It's more likely that Clemens is using these claims as a sneaky way of masking his illicit steroid use. If he used B12 and Lidocaine in these ways, they were the wrong drugs, for the wrong patient.

Advice: Think of yourself as a role model when you choose drugs.

Browse for related stories in the index at the very bottom of this page, or read a story about a former Yankees pitcher.

Thanks to Judy Foreman for the source article in today's Boston Globe.

Saturday, January 19, 2008

They're printing money: HIFU prostate cancer care

Some weekends, more than a dozen American men wait at beachfront hotels, anxious for their turns in the treatment room at a small private hospital in Puerto Vallarta, Mexico. They are medical tourists with prostate cancer, waiting for the latest therapy, high-intensity focused ultrasound (HIFU). It attacks the cancerous tissue by heating the prostate to temperatures near boiling, rather than using surgery or radiation.

But its long-term effects, and effectiveness, are unknown. And US HIFU, the company that promotes it, is attracting attention for its aggressive recruiting of doctors. "The people doing the treatments, they're just printing money," says Dr. Thomas Gardner. Though the urologist at Indiana University School of Medicine is enthusiastic about its potential, he adds, "Anytime anyone's printing money, doing what's right for the patient gets a little blurry."

"The US HIFU web site makes it all sound rosy; they give you none of the side effects and none of the bad results," said Fred Gillick, a Park Ridge, Illinois real estate executive who received the treatment in April 2006.

He says the procedure left him impotent and in need of a catheter at all times. Worse yet, the treatment did not eliminate his cancer. "Guys, there's a reason HIFU isn't approved here [in the U.S.]," he wrote.

Advice to men looking into prostate cancer treatment: Research all your options aggressively.

Browse for similar stories in our index at the very bottom of this page, or read a prostate cancer screening story.

Thanks to Stephanie Saul for the source story in the Jan. 18 issue of the NY Times.

Friday, January 18, 2008

The Animal House of drug research units: Human subjects – guinea pigs

On Sept. 11, 2001, James Rockwell was camped out in a clinical-research unit on the 11th floor of a Philadelphia hospital, where he had enrolled as a subject in a high-paying drug study. As a rule, studies that involved invasive medical procedures are more lucrative – the more uncomfortable, the better the pay – and in this study, subjects had a fiber-optic tube inserted in their mouths and down their esophaguses so that researchers cold examine their gastrointestinal tracts.

James had enrolled in many previous studies at corporate sites at places like Wyeth and GlaxoSmithKline. But the atmosphere there felt professional, bureaucratic, and cold. This unit was in a university hospital, not a corporate lab, and the staff had a casual attitude toward regulations and procedures. "The Animal House of research units" is what James calls it. "I'm standing in the hallway juggling," he says. "I'm up at 5:00 in the morning watching movies." Although study guidelines called for stringent dietary restrictions, the subjects got so hungry that one of them picked the lock on the food closet. "We got giant boxes of cookies and ran into the lounge and put them in the couch," James says. "This one guy was putting them in the ceiling tiles." James has little confidence in the data that the study produced. "The most integral part of the study was the diet restriction," he says, "and we were just gorging ourselves at 2 am on Cheez Doodles."

On the morning of Sept. 11, nearly a month into the five-week study, the subjects gathered around a TV and watched the news of the terrorist attack through a drug-induced haze. "We were all high on Versed after getting endoscopies," James says. He and the other subjects began to wonder if they should go home. But a mass departure would have ruined the study. "The doctors were, like, 'No, no!'" James recalls. "No one's going home, everything’s fine!" James stayed until the end of the study and was paid $7,500. He used the money to make a down payment on a house.

Over the years, James has enrolled in more than 20 studies for money. Today, fees as high as he received aren't unusual. Some people enroll in one drug study after another. For them, "guinea pigging" has become a job.

Browse for similar stories in our index at the very bottom of this page, or read another human guinea pig story.

Thanks to Carl Elliott for the source story In the Jan. 7 issue of the New Yorker.

Thursday, January 17, 2008

Do my breast implants have a warranty?

"My plastic surgeon told me that my saline implants should last forever," said Krista Schell.

Krista, age 29, lives in Thornton, Colorado, and works for the state. She had breast enhancement surgery in 2003 by a California doctor. The same doctor performed a second operation in April to replace a deflated saline implant that had collapsed and made her left breast look "hollow." Her implants were still under warranty. In November, she had a third operation, by a Denver surgeon, who removed both implants and extensive scar tissue. The implants had also caused rippling, a lump around one nipple, and pain. "If you look at the negatives, you would talk yourself out of getting implants," she said.

About a third of patients had a second operation within four years of their initial surgery, according to a study by Allergan, a maker of breast implants.

"With breast implants, informed consent is much more fuzzy because each doctor has his own perspective on how long they last, making it difficult for patients to realistically calculate the risks and benefits," said Dr. Eugene Goldberg, a biomaterials professor at the University of Florida, Gainesville. He teaches a class in which he uses breast implants as a case study of a badly engineered medical device.

Dr. Linda Huang, a plastic surgeon in Denver, tells patients their implants should be removed after ten to 15 years. She has removed implants from more than 1,000 patients.

Advice to women considering breast implants: Consider that you may well need more operations than the initial implant surgery itself.

Browse for related stories in the index at the very bottom of this page.

Thanks to Natasha Singer for the source article in today's New York Times.

Wednesday, January 16, 2008

We gave our own orders: Dignity in the hospital

Kathleen Kalt's story:

Patients have no obligation to the "health-care community." In fact, more patients need to know that they do not have to comply with every doctor’s request.

My daughter had leukemia at age 10 and clear-cell sarcoma at 17. She was treated by outstanding doctors, but we all knew she would not survive the second cancer. When she had to be admitted to a major teaching hospital for surgery, it seemed she was on all the grand rounds; everyone wanted to see this rare case and hear her medical history. We didn't think she needed to relive constantly the worst moments of her life. She needed dignity and control. We gave our own orders: "No one will touch her except her primary doctors. She won't answer any more questions. Read her chart for yourself." After seven years dealing with the medical establishment, we knew that the best patients were their own advocates.

Advice to parents:
To preserve your child's dignity, you can give your own orders to guide the learning of interns and residents in the teaching hospital.

Read another of our stories about a death with dignity.

Tuesday, January 15, 2008

Managers threatened to have them deported: Human guinea pigs

The most notorious recent disaster affecting healthy human "guinea pigs" took place in March 2006, at a testing site run by Parexel at Northwick Park Hospital, outside London. Parexel offered human subjects 2,000 British pounds to enroll in a Phase I trial of a monoclonal antibody, a possible treatment for rheumatoid arthritis and multiple sclerosis. Six human subjects required care in the Intensive Care Unit (ICU) after suffering life-threatening reactions, e.g., severe inflammation and organ failure. They were hospitalized for weeks. One subject's fingers and toes had to be amputated. All of them have long-term disabilities.

It's not clear whether Parexel is paying for the required health care for the injured human subjects. At least some contract research organizations do not do so.

SFBC International offers one such example. It conducted a two-month study of the pain medicine Palladone, offering subjects $2,400. SFBC reserved the right to penalize subjects whom it dropped from the study because of the drug's side effects. SFBC (now known as PharmaNet Development Group) paid their human subjects most of their compensation only after they completed all four of the study's confinement periods. When its undocumented immigrant guinea pigs talked to the press, managers threatened to have them deported, according to Bloomberg Markets. PharmaNet settled a lawsuit for $29 million in August.

Advice to those considering whether to be human subjects in clinical drug trials: Read other guinea pigs' stories first.

Browse for related stories in the index at the very bottom of this page, or read a shocking story about a human guinea pig.

Thanks to Carl Elliott for the source article in the Jan. 7 issue of the New Yorker.

Monday, January 14, 2008

Lisa's Story: A video on Reflex Sympathetic Dystrophy misdiagnosis

This short video was prepared for Health Care for All:

For a questionable diagnosis, ensure that the second opinion you get is truly independent of the first doctor's opinion.

Please share this video with your friends.

Sunday, January 13, 2008

Ginny's Video: Staph infection from a broken ankle

She's walking again, 28 surgeries later. See Ginny's short video.

Ginny is a member of the Consumer Health Quality Council of Health Care for All. She told her story of a broken ankle, the staph infection, leg amputation, brain aneurysm and her recovery to the filmmakers Madhavi Bezwada, Meredith Mueller, and Hsiang-Yin Yeh of the Boston University of Public Health.

Advice: Please share her story widely.

Thursday, January 10, 2008

Linda's Mother: A video on fatal medical errors

Three graduate students at Boston University School of Public Health made this short video as part of the Storybank Project of the Consumer Health Quality Council of Health Care for All:

Health Care for All organized a program at the Massachusetts Statehouse today, which publicly aired this video and two others for the first time. Legislation that is now pending in the Massachusetts Legislature would reduce medical errors by requiring hospitals to report certain infection rates, involve patients more formally in hospital councils, encourage doctors and nurses to apologize for errors, and make a number of other positive changes.

Share this with your friends and legislators.

Wednesday, January 9, 2008

As if they were old friends: Compassionate physicians' cancer care

Four years ago, my sister found out she had two types of cancer at the same time. It was like being hit by lightning twice.

She needed chemotherapy and radiation, a huge operation, more chemotherapy and then a smaller operation. All on all, the treatment took about a year. Thin to begin with, she lost 30 pounds. The chemo caused cracks in her fingers, dry eyes, anemia and mouth sores so painful they kept her awake at night. A lot of her hair fell out. The radiation burned her skin. Bony, red-eyed, weak and frightfully pale, she tied scarves on her head, plastered her fingers with Band-Aids and somehow toughed it out.

She saw two doctors quite often. The radiation oncologist would sling her arm around my sister's frail shoulders and walk her down the corridor as if they were old friends. The medical oncologist kept a close watch on the side effects, suggested remedies, reminded my sister she had good odds of beating the cancer and reassured her that the hair would grow back. (It did.)

People in my family aren’t huggy-kissy types, but my sister greatly appreciated the warmth and concern of those two women. She trusted them completely, and their advice. Now healthy, she says their compassion played a big part in helping her get through a difficult and frightening time.

Bedside manner can go a long way toward helping people with cancer understand their treatment, stick with it, cope better and maybe even fare better medically.

Advice: Find a doctor whose skill set includes compassion.

Browse for related stories in the index at the very bottom of this page, or read a story on the role of compassion in healing.

Thanks to Denise Grady for the source story in the NY Times of Jan. 8.

Tuesday, January 8, 2008

I had failed my first test of leadership: Tracheotomy error

Dr. Gerald Healy's story
When I was a young surgeon, one of my patients nearly died and I was responsible. The incident had nothing to do with my surgical skills and everything to do with my lack of leadership.

The patient's airway was obstructed by a massive tumor and he needed an emergency tracheotomy. Flush with confidence from five years of surgical training and two years in the military, I could foresee no problems that I couldn't handle. Why bother going over my plan of care with the nurses or the anesthesiologist?

Just as the patient was being prepped for surgery, he went into cardiac arrest. The anesthesiologist, inexperienced in the procedure, was helpless to reestablish an airway. The regular nurses were unavailable, and their hastily selected replacements had never worked together in the operation suite on this procedure. I found myself marooned, shouting a flurry of commands at a team too paralyzed to act.

In the end, I was able to open an airway by performing a tricky and dangerous throat operation, and then restore our patient’s heart function. I helped save him but I was no "hero." The untenable situation I had faced was largely of my own making. I had neglected to evaluate the skills of my team, prepare the team members, and plan for contingencies. I had failed my first test of leadership.

Medical errors are often caused by a lack of communication, inattention to details, poorly coordinated resources, and inadequate planning. While we surgeons are trained to be outstanding technicians, little has been done to teach us effective leadership and communication skills.

Commercial airlines excel in safety. Flight crews have learned to make fewer errors, due to a leadership and team training approach called "crew resource management."

Dr. Healy is otolaryngologist in chief at Children's Hospital in Boston, professor of otology and laryngology at Harvard Medical School, and President of the American College of Surgeons.

Browse for related stories in the index at the very bottom of this page, or read a sadder story by a crew resource management expert.

Thanks to Dr. Healy for the source article in today's Boston Globe.

Monday, January 7, 2008

I am even going to be drinking decaf: Om Malik's heart attack

Om Malik, 41, suffered a heart attack on Dec. 28. He's now recovering, and says that he will be OK.

Om, a blogger who writes GigaOm about the technology industry, blamed a variety of vices. Om says, "Friends and family have purged my apartment of smokes, Scotch and all my favorite fatty foods – I am even going to be drinking decaf."

Om's incessant smoking of cigars and cigarettes likely led to the heart attack, according to Giga Omni Media's Chief Operating Officer, Paul Walborsky.

Other friends and colleagues cited the daily stress of blogging as a likely contributor to his heart attack. "If you come back to blogging before I give you permission, I'll be at your door to take away your MacBook," said his friend Paul Kedrosky.

Advice: Get your network of friends to help you take your New Year's Resolutions seriously.

Browse for similar stories in our index at the very bottom of this page, or read a story of a friend's help.

Thanks to Dan Fost for the source story in today's New York Times.

Sunday, January 6, 2008

The blunderer must bear the cost: A drug error

When my husband developed a leg infection, his physician prescribed the wrong antibiotic. The insurance company, recognizing the mistake, refused to cover the prescription's $573 cost. But I had already filled it, and my husband had taken a dose. I think our doctor should reimburse us. (The correct treatment for this common infection was immediately prescribed by two other doctors.) My husband demurs. You?
-Name withheld, Los Angeles.

Answer by Randy Cohen, the NY Times Magazine Ethicist:

The doctor should take responsibility, including financial responsibility, for his error. This is not to demand omniscient physicians or mistake-proof medicine. Everyone is fallible on the job. But acknowledging human fallibility does not mean abandoning all professional standards. It this was, as it seems, a genuine blunder, then it is the blunderer who must bear its cost.

Update: Acknowledging his error, the doctor agreed to waive all future fees up to the amount of the erroneous prescription.

Advice to victims of a medical error: Insist that the doctor bear the cost of the error.

Browse for related stories in the index at the very bottom of this page, or read an insurance company denial story.

Thanks to Randy Cohen for the source article in today's New York Times Magazine.

Saturday, January 5, 2008

39 times an hour: Late diagnosis of sleep apnea

Eric Diehl got tired of waking up weary and napping at midday, but he never dreamt he had a life-threatening condition.

"I'm a retired judge from the provincial court and I found that I was having to rest a lot between noon and the reconvening of court at 2 o'clock," he said. "My wife was also telling me that I was a very, very heavy snorer, but I didn't take it seriously and let appointments drift by when I shouldn't have."

When he was finally diagnosed with sleep apnea, tests showed Diehl was waking up 39 times an hour overnight.

"I wasn't conscious of that but obviously when you're waking up like this you're suffering all of the impacts of lack of sleep," he said. "Your powers of concentration go down, your ability to read well just drops."

Sleep apnea is a condition where the airway collapses during sleep. Loud snoring can mark the condition followed by lapses, where there's no sound and then a great gasp as breathing resumes.

After he was diagnosed, Diehl was fitted with continuous airway pressure equipment (CPAC) in 2004.

"Once I was put on this equipment, I was able to put in a regular night's sleep without any trouble at all," said Eric, who serves on the board of the Lung Association of Saskatchewan.

During the day, his endurance and energy has improved "beyond all expectation," he's more relaxed, his risk of heart attack and stroke is reduced and his driving habits and memory have improved.

The untreated condition can lead to many problems.

"During the time that breathing isn't occurring, the body gets very excited, the heart tries to beat faster and it leads to things like high blood pressure, heart attacks and stroke," Dr. Brian Graham, the President of the Lung Association of Saskatchewan, said.

Falling asleep behind the wheel is another deadly consequence.

"There's a huge increase in traffic collisions for people with sleep apnea," he said. "In various studies, it's anywhere from three to seven times as high."

That's important because sleep apnea is more common than you might think: obstructive sleep apnea (OSA) is the most common category of sleep-disordered breathing. The prevalence of OSA among the adult population in western Europe and North America is estimated to be 3-4% of women and 6-7% of men, according to Wikipedia.

Advice to partners of snorers:
Show them this.

Browse for related stories in the index at the very bottom of this page, or read a late diagnosis story.

Thanks to the Saskatoon Star-Phoenix of Jan. 2 for the source story.

Friday, January 4, 2008

I was obviously wrong: A misdiagnosed heart attack

Dr. Sandeep Jauhar's story:
I got a call from the E.R. at my hospital. A young intern who had been on rounds that morning had been admitted with chest pains. He was 30, a Pakistani man with a long face and a disconnected look, which I attributed to anxiety. I asked him about the pain. It had started after dinner the night before, lasting about 10 minutes. The pain had recurred the next morning for almost an hour. It was a dense pressure in the center of his chest, so he had come to the E.R.

His blood tests were normal, as was his first electrocardiogram (EKG). I suspected he was suffering from acute pericarditis, a usually benjgn inflammation of the membrane around the heart, treated with over the counter drugs.

Before I left the hospital that evening, a physician's assistant asked me whether the intern should get an angiogram to rule out artery blockage. I told him any work-up could wait until morning, and assured him that a 30-year-old with no risk factors did not have coronary artery disease.

My patient had chest pains throughout the night. Further blood tests then showed evidence of continuing heart muscle injury. An EKG the following morning showed signs consistent with a heart attack. Though I still doubted that he had coronary disease, I reluctantly sent him to the cardiac catheterization lab for an angiogram.

The angiogram showed a comlete blockage of the left anterior descending artery, the "widow-maker" lesion. Within minutes, a balloon and stent opened the blockage.

I knew I had to explain myself, but how much should I say? Like all doctors, I had made errors before, but never one this big – and in my own specialty.

I couldn't bring myself to talk to my patient in the cath lab, while everyone was watching, so I decided to wait until he got to the recovery room, where it was more private.

I found him there lying on a stretcher. The pain in his chest was gone, he happily informed me. "I thought you had pericarditis," I said carefully. "I was obviously wrong. I’m sorry."

He seemed embarrassed. "No, no please, the past is finished," he said. "I am more interested in the future."

He asked about his prognosis. I told him that I thought it was good, though he would have to be on medications for the rest of his life. He nodded, looking disappointed.

A few days later, before he was discharged, I stopped by his room. I asked him with whom he was going to follow up He told me that he had been given the name of another cardiologist but that he had decided to go with me. "You have been terrific," he said. "Thank you."

Browse for related stories in the index at the very bottom of this page, or read an apology story.

Thanks to Dr. Sandeep Jauhar for the source story in the NY Times of Jan. 1.

Thursday, January 3, 2008

With great enthusiasm and conviction: The placebo effect

His late mother-in-law, Sarah, had been a concert pianist who developed painful arthritis in her old age and found her doctors to be generally useless when it came to satisfactory pain control. "So, being an independent, take-charge individual, she subscribed to Prevention magazine, in order to learn more about the multiple remedies suggested in each month's issue" for symptoms like hers.

Predictably, every couple of months Sarah would make a triumphant phone call and announce with "great enthusiasm and conviction" that a new food or supplement or capsule had practically cured her arthritis. Unfortunately, each miracle cure was regularly replaced by a different one, in a cycle her son-in-law ruefully breaks down for detailed analysis in his book, Snake Oil Science.

He makes it clear exactly how the natural history of most painful conditions conspires with the placebo effect to make almost any treatment appear to work, so long as the recipient hopes and believes it will.

Placebos sometimes work. Their effects are characteristically mild and temporary. They are more or less indistinguishable from the effects of most alternative treatments, as Dr. Bausell describes.

R. Barker Bausell's advice: If you're bent on trying alternative medicine, find an appealing therapy and an enthusiastic practitioner, then plunge in wholeheartedly to maximize the placebo effect and prolong its duration.

Browse for related stories in the index at the very bottom of this page, or read a contrary story about the value of traditional non-scientific methods.

Thanks to Dr. Abigail Zuger for the source story in the Dec. 25 issue of the New York Times.

Wednesday, January 2, 2008

He was found dead at his computer: A Fentanyl overdose

Adam Hendelson had been in a car accident as a teenager. For years, on his right arm he had worn a Duragesic patch, containing Fentanyl gel, to manage his chronic hip pain. In December 2003, at age 28, he was found dead at his computer. The cause was traced to a leak in the patch that had given him a fatal overdose. In June 2007, a Florida jury awarded his family $5.5 million.

Last week, noticing that hundreds of people had died from similar accidents, the Food and Drug Administration issued a warning about the use of Fentanyl. The FDA warned doctors against prescribing Fentanyl patches to anyone new to opioids, the family of painkillers that includes morphine. The drug is only to be used for chronic pain in people who are used to using narcotics, such as cancer patients. Fentanyl can cause other people to have trouble breathing.

Advice to those with family members using Fentanyl patches: Read the FDA warning.

Browse for related stories in the index at the very bottom of this page, or read a less harmful story about conscious sedation.

Thanks to Lauran Neergaard of the Associated Press and Kenneth Reid for the source stories in the Dec. 22 issue of the Boston Globe and the June 18 issue of Adverse Event Reporting News, respectively.

Tuesday, January 1, 2008

Ripple effects as far as Portugal: An organ donor

Christopher Field was a history buff and a Godzilla fan. The 16-year-old youth suffered since birth from scoliosis and an unidentified condition that left his muscles weak. But he led a largely unimpaired life, using a wheelchair only for long walks.

At an appointment in the summer of 2005, doctors noted that his spinal scoliosis had worsened, and suggested immediate surgery to save his internal organs. Nine days after the 14-hour surgery, Christopher developed pneumonia, and his breathing grew labored. He was brought to the Intensive Care Unit (ICU). He suffered a fatal blood clot in his lungs (a "pulmonary embolism").

His mother decided to donate his organs to needy patients, setting in motion a ripple effect of tissue donations that have reached as far as Portugal. Two people now can see, with his corneas. His bones have been used to prepare 39 bone grafts, with two transplanted already. Doctors have used his heart tissue to repair a defect in a young Massachusetts boy's heart. The New England Organ Bank counts almost 50 people who will ultimately benefit from Christopher's tissue donation.

To honor his legacy, a float in today's Rose Bowl will bear his picture, and that of 39 other organ donors. The floats will also carry 24 people whose lives were saved and aided by organ, eye, tissue, and blood donors. OneLegacy, a nonprofit organ and tissue recovery agency serving Greater Los Angeles, organized the floats along with sister organizations.

Every once in a while, Christopher's mother receives a letter announcing that another piece of his tissue has been used for transplant. "When I get the letters, I cry," she said. "But I know it's good."

Advice: Sign an organ donor card and keep it in your wallet.

Browse for related stories in the index at the very bottom of this page, or read an organ recipient story.

Thanks to Sarah Schweitzer for the source article in today's Boston Globe.

Six pack? I have a keg: Vince Wilfork, diet and diabetes

Vince Wilfork plays nose tackle for the New England Patriots. He's listed at 325 pounds. That girth is needed to hold his ground – a key responsibility for the nose tackle.

"Six pack? I have a keg and I’m proud of it," he says.

But in the off-season he read "The Abs Diet." His wife grabbed it before he could read it, and she began conducting weigh-ins and demanding three workouts a day, starting at 5 am. He lost weight, but kept his strength. Indeed, without his normal girth he has been just as strong, he realizes, if not stronger, and quicker too.

As of mid-December, he had made 64 tackles while anchoring the New England Patriots' fourth-rated defense. He earned his first Pro Bowl (all-star) berth on Dec. 18. He says he owes the honor to his wife's nudging.

He'll keep working at controlling his weight after this season ends. "I know that overnight it's not going to happen. It's going to take time, and every year we're going to attack that."

Vince's father had diabetes and died at 48. His mother died at 46 from complications of a stroke. Now, Vince and his wife host an annual NFL draft party to raise funds for the Diabetes Research Institute.

Advice: Be as unyielding as Vince Wilfork in defending against the strong pushes you feel toward binging. Good luck with the New Year's Resolution!

Browse for related stories in the index at the very bottom of this page, or read an athlete story.

Thanks to Christopher Gasper for the source article in the Dec. 20 issue of the Boston Globe.