Ward B. Buckingham: Patients need to be involved in safety

My paternal grandmother died in 1929 because of “wrong-side surgery.” Decades before dialysis became available, her healthy kidney was removed instead of the nonfunctioning one.

This story was passed on to me by my grandfather and his four children (my father was the youngest), who were ages 11-28 years at the time of this egregious medical error. In the past 35 years, both of my parents, both brothers, my daughter and father-in-law all experienced medical errors but survived.

I share these vignettes, as well as the fact that I delivered primary care internal medicine and noninvasive cardiology for three decades, to give some background on why the issue of patient health care safety is important to me. And it should be for you, too.

Doctors are human … so why worry?

A Time magazine cover story in 2006 asked: “What scares doctors?” The answer was “being the patient.” I was a doctor, but I came to realize the need for patients, families and advocates to become actively involved in their health care.

Reliable data are sobering at best and downright scary if ignored. The Health Grades Patient Safety in American Hospitals study found 195,000 preventable patient deaths annually, from 2000 to 2002, due to hospital medical errors. I cite the Health Grades study rather than the seminal 1999 Institute of Medicine study showing much lower figures, because I believe the former to be more accurate. It was based on all 50 states’ records, whereas the IOM study extrapolated data from just three states’ records.

Furthermore, the Agency for Healthcare Research and Quality (AHRQ), a branch of the Public Health Service, published in September 2011 its advice on how you can prevent errors by being an active member of your health care team. This report noted that “one in seven hospitalized Medicare patients will experience a medical error.”

Unfortunately, deaths due to medical errors have changed little nationally since the problem was first publicized in 1999. One major reason is the increasing complexity of effective diagnostic and therapeutic approaches in medicine.

The aviation industry led the way in striving for better safety, motivated by the 1977 Tenerife island runway collision of two Boeing 747s (my father was a senior Pan Am captain flying 747s at that time, but was not involved in that collision).

The term “crew resource management” was coined in 1979, referring to cockpit hierarchy changes, which encourage anyone present to speak up to help prevent mistakes. The operating room “time out” is patterned after this, and, where applied, should prevent wrong-side surgery mistakes.

Historically, the most common way medical providers have dealt with their safety shortcomings is denial – a “circle the wagons” approach that has fostered justifiable public mistrust. A family member’s recent Spokane hospital experience of deficient care resulted in stonewalling behind the lame “it met the standard of care” defense.

Thankfully, medical providers are increasingly embracing a “culture of safety,” and the Spokane community is moving in that direction. But providers have a long way to go.

My purpose in speaking and writing about patient safety is to inform and motivate consumers and providers to take actions that lead to improvement. I urge people to make use of free patient education resources online at engagedpatients.org.

Our very lives depend on it.

Ward B. Buckingham of Spokane is a retired internist who speaks on patient safety.