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Doing No Harm: Building a better system An occasional series on health care Tuesday, May 29, 2001 By Christopher Snowbeck, Post-Gazette Staff Writer
Imagine you have been hospitalized with a rare neurologic disorder and a doctor tells you that you should not receive certain drugs that are used for sedation or pain control and have risky side effects.
Then, later that same day, a different doctor prescribes for you the medicine you were told to avoid.
Let's say your spouse is a doctor so you're able to derail this medication error before it happens, but the problems with your care continue.
Could the health care system work better for you? Your Health's "Doing No Harm" is an ongoing series about local programs to improve health-care quality -- be they hospital pharmacy systems that prevent medical errors or scheduling changes that reduce waiting time.
Another doctor orders that a crucial and potentially toxic drug be administered immediately. But you aren't actually given the medicine for another 60 hours.
Then, a drug discontinued by a physician's order on the first day of hospitalization is brought by a nurse every single evening throughout a 14-day admission. Every day the pill ends up in the garbage and, every day, the hospital bills the insurance company for the cost.
The longer you stay in the hospital, the more you realize that the mistakes go beyond medicine.
The most depressing thing is that the health-care system that surrounds you seems to make little room for humanity: One day after a surgical procedure, you awaken in the recovery room and immediately start asking for your spouse to be at your side. Yet your spouse isn't allowed in the room for another 90 minutes.
These aren't hypothetical problems.
They are just a few examples culled from a litany of mistakes described in 1999 by a New England physician who spoke publicly about the care his wife received during a total of 60 days at some of the best hospitals in the country.
Of the last example -- when the physician wasn't allowed to go by his wife's side and hold her hand -- he had this to say: "By what right do that staff and that institution willfully separate a man and his wife at a time when they can comfort each other? To whom must the case be made before a nurse or a doctor or a manager can inflict that violence against comfort and human spirit? I gave no such permission, nor did my wife."
More broadly, the doctor offered this critique: "I tell you from my personal experience: Not one day passed -- not one -- without a medication error. Most weren't serious, but they scared us."
The doctor's story is not an isolated case.
The federal Institute of Medicine estimated in 1999 that 98,000 people die each year from medication errors. That report prompted a follow-up study from the IOM that called for a massive overhaul of the way doctors and hospitals provide care to patients.
More specifically, the report said patients must have more control over their medical information and must be consulted as partners in medical decision-making. Also, doctors and hospitals should put more emphasis on the safety of patients staying in hospitals. Moreover, doctors should provide therapies because the treatments are supported by scientific evidence, not just because doctors are in the habit of providing them.
The new report released in March called on Congress to spend $1 billion to make the new health-care system work without flaws.
Your Health today begins an occasional series called "Doing No Harm" that will chronicle efforts by local medical groups to position Pittsburgh as a leader in this quality improvement movement.
The stories will profile several issues, including attempts to prevent infections acquired in the hospital, the shift to electronic medical records and the time patients spend waiting to see their doctors.
Several of the stories will touch on the work of the Pittsburgh Regional Healthcare Initiative, which is one of the more high-profile attempts to boost quality. Backed by the Jewish Healthcare Foundation and supported by doctors, hospitals and insurers throughout the region, the initiative's model for working with all providers in the community has attracted attention from the Bush administration, and experts say it could serve as a national model for how to fix health care.
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