Q: What Scares Doctors? A: Being the Patient

What insiders know about our health-care system that the rest of us need to learn

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The introduction of computerized patient information and medication orders is meant to reduce "adverse drug events" and ensure that the patient's history and treatment notes are available to everyone who needs them. But progress does not always equal safety. "Technology should remove the burden, but you can get problems. You can hide behind technology and spend more time talking to your computer than to your patients," says Dr. Albert Wu, a professor of medicine at Johns Hopkins. "And as with any new thing, people screw things up worse before they make things better." Doctors say there is a temptation to trust computers too much: they seem objective and infallible, but if the wrong information is entered in the first place, or the bar-coded wristband is put on the wrong patient, it can be harder to prevent mistakes down the line. In one case study, a patient with pneumonia had his wristband mixed up with a diabetic patient and came very close to being given a fatal dose of insulin.

This is why doctors are reluctant to be hands-off when it comes to a loved one's care. Until proper safeguards are built into the system, what a patient needs most, many doctors agree, is a sentinel--someone to take notice, be an advocate, ask questions. Now that the family doctor has been squeezed out of that role, someone else has to step in. But even a doctor--family member may not be able to counter the complexity of the system. Dr. Berwick of the Institute for Healthcare Improvement tells the story of his wife Ann's experience when she developed symptoms of a rare spinal-cord problem at a leading hospital. His concern was not just how she was treated; it was that so little of what happened to her was unusual. Despite his best efforts, tests were repeated unnecessarily, data were misread, information was misplaced. Things weren't just slipping through the cracks: the cracks were so big, there was no solid ground.

An attending neurologist said one drug should be started immediately, that "time is of the essence." That was on a Thursday morning at 10 a.m. The first dose was given 60 hours later, on Saturday night at 10 p.m. "Nothing I could do, nothing I did, nothing I could think of made any difference," Berwick said in a speech to colleagues. "It nearly drove me mad." One medication was discontinued by a physician's order on the first day of admission and yet was brought by a nurse every single evening for 14 days straight. "No day passed--not one--without a medication error," Berwick remembers. "Most weren't serious, but they scared us." Drugs that failed to help during one hospital admission were presented as a fresh, hopeful idea the next time. If that could happen to a doctor's wife in a top hospital, he says, "I wonder more than ever what the average must be like. The errors were not rare. They were the norm."

After he publicized his experiences, Berwick was besieged by other doctors saying, "If you think that's terrifying, wait until you hear my story." One distinguished professor of medicine whose wife was hospitalized in a great university hospital was too frightened to leave her bedside. "I felt that if I was not there, something awful would happen to her," he told Berwick. "I needed to defend her from the care."

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