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Hospital & Medical Errors

Quick Facts

Being a Patient Advocate

Steps to Determine Medical Errors

Recent Medical Error Articles

Types of Doctors

About Insurance

Finding a Doctor Who is Right for You

Referrals and Recommendations

Questions to Ask When Considering a Doctor 

Getting the Care You Need

Top Six Hospital Risks

Top Medical Errors by Doctors and Health Care Providers

Patient Advocate Guide:
You Have the Right to Question those involved in your care

Be Involved.  For Yourself.  For Your Loved One.

The single most important way to help prevent medical errors is to be an active member of the health care team—be a patient advocate.  No one should be in the health care system without a patient advocate.

REMEMBER:  You have a right to question anyone who is involved with your care or the care of a loved one.

That means taking part in every medical decision whether in a doctor's office, a clinic, or a hospital. Research shows that patients who are more involved with their care tend to get better results.

This guide starts from choosing a doctor and ends with what you should expect from follow-up care. It also includes steps to take if you suspect an error has occurred in your treatment.

Types of Doctors

Overall, doctors are classified as "generalists" or "specialists." Generalists are doctors who are concerned with overall health. These are called primary care doctors and include internal medicine, family practice and general medicine doctors. Although all doctors have generalist training, specialists are doctors who focus on a particular field of medicine like gynecology, neurology, or cardiology.

A new trend in hospitals is to employ doctors who practice only in the hospital.  One of these "hospitalists", as they're called, may coordinate your hospital care.

Some of the most common medical specialties are:

• Allergy and immunology — allergies and other disorders involving the immune system
• Anesthesiology — administration of medications (anesthetics) to prevent pain or induce unconsciousness during surgical or diagnostic procedures
• Cardiovascular or Cardiology — the heart and blood vessels
• Dermatology — the skin, hair and nails
• Endocrinology — the internal (or endocrine) glands such as the thyroid and adrenal glands, and disorders such as diabetes
• Family medicine/family practice — broad-based health care of the individual and the family
• Gastroenterology — the digestive tract (stomach, intestines, liver, gallbladder, and related organs)
• Hematology — the blood and blood-forming parts (such as bone marrow) of the body
• Internal medicine — diagnosis and non-surgical treatment of diseases in adults
• Nephrology — the kidneys
• Neurology — the brain, spinal cord, and nerves
• Obstetrics and gynecology — women's health, pregnancy, and childbirth
• Oncology — all types of cancer as well as other benign and malignant tumors
• Ophthalmology — vision problems and other disorders of the eye
• Orthopaedics — the muscles, bones, and joints
• Otolaryngology — the ears, respiratory and upper alimentary systems, and related structures
• Pathology — examination and diagnosis of organs, tissues, and body fluids
• Pediatrics — the health care of children from birth to young adulthood
• Podiatry — treatment of disorders of the foot, ankle, and sometimes knee, leg and hip (collectively known as the lower extremity)
• Psychiatry — mental, emotional, and/or behavioral disorders
• Pulmonary diseases — the lungs and other chest tissues
• Radiology — study and use of various types of radiation, including X-rays, and imaging systems in the diagnosis and treatment of disease
• Rheumatology — the joints, muscles, and tendons, including arthritis
• Surgery — treatment of diseases, injuries and other conditions using operative or manual procedures
• Urology — the urinary system and the male reproductive organs

About Insurance

Most people begin their search for a doctor or health care provider by looking at the "approved provider" lists in their health insurance plan. These lists are not based on the performance of the doctor, but on an agreement between the insurance carrier and the individual doctor about what to charge patients.  If you go outside the insurance company's approved list, you will probably have to pay more.

Many insurance companies operate what is known as a "Gatekeeper System", where every patient has a general doctor known as a Primary Care Provider (PCP).  If you do not select a PCP from their approved list, you may be assigned one.  Depending on your insurance company, you may be able to switch to another PCP or you may have to wait a year to do so.  The Gatekeeper System was developed to prevent patients from going directly to specialists. The only way you can see a specialist is to go through the PCP, who may refer you to a specific specialist.

REMEMBER:  You don't have to take the recommendation and can ask for other specialists. 

Finding a Doctor Who is Right for You

Location, specialty, reputation, and cost are all part of the decision when selecting a doctor.

Referrals and Recommendations

Another good place to find referrals and recommendations are friends, family, and co-workers.  Ask them about their doctors and what they like or dislike about them.  Hospitals also provide referrals and information on the doctors that serve that hospital.  Your insurance company should have information about the doctors in your plan including location, specialty, and costs. 

Another good place to check on the doctors reputations is the State Medical Board.  Any complaints against doctors are listed with them.  The access to this information varies by state.  Some states will only release information on cases that have been resolved and none that are under investigation.  Another source is  www.HealthGrades.com which rates many doctors; however, there is a charge for this.

Questions to Ask When Considering a Doctor 

REMEMBER:  You will be paying for this service—both with money and your own health.

• Is the doctor/hospital/clinic on your health plan, or are you willing to pay what your insurance won't cover?
• What training and background does the doctor have?
• If you are going in for a specific purpose (for instance, heart problems), how long has the doctor been diagnosing and treating the condition?  Is it the primary focus of their practice?
• Is preventative medicine emphasized?
• Does the doctor have privileges at a hospital that you prefer?
• How much time will the doctor spend with you?
• Are you encouraged to ask questions?
• Does the health care provider listen to you and explain things in a way you understand?
• What services do nurses, nurse practitioners, and physician assistants provide? How frequently will you be seen by the doctor and how often by staff members?

Once you've narrowed your search down to two or three doctors, ideally you could arrange to meet face-to-face to see what you think.  However, many doctor's offices don't provide such informational meetings.  Your best option may be to call the office and talk to a nurse or other medical staff member.  If this is the case, following are some questions to ask.

• When are office hours? How is after-hours care provided? What if I'm sick and there aren't any available appointments?
• Are most of the visits with the doctor or with someone else, such as a nurse practitioner?
• How important is preventative medicine and what services does the doctor offer for health maintenance?
• What approach will the doctor take if I have any special health needs? Is he/she familiar with these conditions? How many does he/she treat per month, or per year?

Getting the Care You Need

REMEMBER:  You have a right to all of your medical records. Let the doctor, hospital, or other healthcare provider know that you want a copy of your medical records.  This will also help when you are moving to a new place or healthcare provider: No waiting for your records to be transferred.

Once you choose your doctor, the next step is making sure the doctor gives you the care you need.  When you go in for your examination, remember that the doctor is there to provide a service to you.  Remember that you BOTH need to have as much information as possible to make this happen.

REMEMBER:  The health care provider and you need to work together to make sure that your healthcare needs are met.

The most important thing you can do for your health is to ask questions!  Make sure you understand what the health care provider is doing, what he/she is talking about, and what you are supposed to do after you leave the office.

The only stupid question is the one not asked.  It is helpful to write down your questions before you go to the doctor so you do not forget.  To help guide you, here is a list of questions.

Understand your diagnosis:

• What is wrong with me?
• What do I need to do to get better?
• Where can I get more information about my condition?
• What else could my symptoms mean?

If you receive a prescription for a new medicine, ask your doctor and the pharmacist:

• What is the name of the medicine?
• What is it supposed to do?
• When should I take the medicine, and how much should I take?
• Do I have to finish all of the medicine?
• Does my insurance cover this?
• Can I substitute this for a generic brand?
• What is the difference between this brand name and the generic?
• Does the medicine have any side effects?
• What are alternative treatments?

If you need a lab test, an x-ray, or another kind of test, ask your doctor:

• How will the test be done?
• How accurate will the results be?
• What are the benefits and risks of the test?
• When and how will I receive the results?
• What should I do if I don't receive the results?
• What are alternative treatments?  

If you need surgery, ask the doctor:

• What is the operation (procedure) that is recommended?
• Is it necessary or elective to improve health?
• What are the alternatives?
• What is the surgeon's experience with this procedure? How many procedures like this have you done?
• Why is the procedure necessary at this time?
• What are the options if this procedure is not done?
• What is the anticipated outcome of the procedure?
• What are the specific risks of this procedure?
• What is the cost of this procedure and is it covered by my insurance plan?
• What about a second opinion?
• What kind of anesthesia is required for the procedure?
• Who else might be involved with my anesthesia care?
• Will I meet with an anesthesiologist before surgery?
• How will I know that the right body part is being operated on?  Will a health care worker mark the spot of the surgery?
• What is the recovery process after this procedure?
• Do you monitor my heart and breathing? What else?
• Do you have a 24-hour recovery room? If not, where will I recover?
• What are the qualifications of the personnel in the recovery room, and is an anesthesiologist on call to respond to the recovery room?
• Who will manage my pain control needs after surgery?

• How long will recovery take?
• What will happen after I'm discharged?
• What role should my family play in reducing hospital risks?
• If I have concernsabout my care, whom should I consult?

Remember that these lists are only a guide.  If you have more questions, ask away.  It is important, even vital, that you understand your doctor and his/her recommended treatment for you. 

Top Six Hospital Risks

REMEMBER:  If something goes wrong, don't expect health care providers to be totally forthcoming about it.

All hospital patients face risks, and it's important not to be passive about them. There's always a danger of medical complications, like bleeding or infection. Then there are the human errors, like getting the wrong drug or dosage. All these hospital risks can seem far beyond your control. It can leave you feeling pretty helpless. But you aren't. Here's a list of the six top hospital risks -- and more importantly -- what you can do to help avoid them.

Hospital Risk No. 1: Medication Errors

A 2006 report from the Institute of Medicine estimated that every year, there are 450,000 injuries resulting from medication errors in hospitals, and perhaps many more that go unreported. What's especially frightening about these hospital risks is they "seem" completely beyond your control, but there are steps you can take:

Before surgery. Make sure that your doctor, your surgeon, and everyone else involved in your care know about every single medicine -- whether prescription, over-the-counter, or herbal supplement -- that you use. To make it easier, you can just stick all of your medicines in a bag and bring them to the hospital.

After surgery. Ask questions. When a nurse comes to give you medicine, ask what it is and why you need it. Make sure the nurse checks your ID bracelet against the name on the prescription. Ask a family member or friend to stay with you in the hospital so they can do this for you if you can't.

REMEMBER: If you ever feel like something's wrong, speak up!

Hospital Risk No. 2: MRSA and Other Hospital-Acquired Infections

Another top hospital risk is infection with bacteria or a virus. Hospitals are loaded with nasty bugs. According to the CDC, there are 1.7 million healthcare-associated infections every year; 22% are infections of surgical wounds. Even more -- 32% -- are urinary tract infections. The rest are infections of the lungs, blood, and other parts of the body.

One of the most frightening hospital infections you can pick up is MRSA (methicillin-resistant Staphylococcus aureus) -- a type of staph infection that's resistant to many antibiotics. A 2007 study by the Association for Professionals in Infection Control and Epidemiology (APIC) suggested that almost one out of every 20 hospital patients is either infected with MRSA or carries it.

Before Surgery.  Ask whether you'll be getting antibiotics before and after surgery to lower your risk.

Any Hospital Stay. The best protection is simple: don't let people touch you until you have seen them wash their hands. That goes for everyone -- including doctors and nurses.

Hospital Risk No. 3: Pneumonia

Although some might think of pneumonia as a minor complication, it can be quite serious. After urinary tract infections and wound infections, it's the most common hospital-acquired infection. According to the CDC, estimates of hospital pneumonia's mortality rate are as high as 33%. It's most common in people who are in the intensive care unit or on ventilators.

Pneumonia is a common hospital risk after surgery for several reasons. During recovery, you might naturally take shallow breaths, since you're on your back and breathing deeply may be painful. After surgery, many people also have a partial collapse of the lung tissue -- called alectasis -- which further weakens lung function. All of this can make it easier for bugs that cause pneumonia to gain a foothold.

Deep Breathing.  Try to take 10 to 15 really big breaths every hour.  If you smoke, you should quit or at least stop for a week or two before surgery.  This short break can make a big difference in the health of your lungs.

Don't Drink or Eat Before Surgery.  Anesthesia tends to suppress normal coughing reflexes. Aspiration pneumonia develops when you breathe in fluids, like vomit, and you can't cough it up so it settles in your lungs. The best way to avoid this type of pneumonia is by not eating or drinking after midnight the day before your surgery. If you don't have anything in your stomach to vomit up, the danger of aspiration pneumonia is quite low.

Hospital Risk No. 4: Deep Vein Thrombosis (DVT)

DVT -- or deep vein thrombosis -- is the development of a blood clot, typically deep in the veins of the leg. If the clot breaks free and travels through the bloodstream, it can get lodged in the arteries of the lungs, cutting off the blood's supply of oxygen. This complication, called a pulmonary embolism, can be fatal.

Without preventative treatment, the odds of getting DVT after a prolonged major surgery are 25%. For some surgeries, like joint replacement, the odds of DVT are more than 50%.

Before Surgery.  Ask about the risk of DVT after your specific surgery, and what preventative measures will be taken, and for how long."

Use of Blood Thinners.  Careful use of blood thinners can slash the risk of DVT without increasing your risk of bleeding. But as effective and safe as this preventative treatment is, studies have shown that these precautions are often ignored. Always ask about it.

Start Moving.The sooner you can start moving around, the lower your risk of DVT.  Stretching and -- when your doctor gives you the OK, getting up and walking -- will get your circulation back to normal.

Hospital Risk No. 5: Bleeding After Surgery

While clotting is a risk for DVT, uncontrolled bleeding after surgery causes problems of its own.

Make sure the health care providers know every medication -- vitamins, supplements, or homeopathic medication -- that you use. Common medicines -- like the painkillers aspirin and ibuprofen -- can thin your blood, increasing the risk of bleeding. Your doctor will probably tell you to stop taking any medicine that might have this effect a week or two before surgery.

If you forget and take one of these drugs, say something. There's a simple blood test that can be done to check if your blood is too thin for surgery, but your doctor might not think to do the test unless you tell him or her.

Mention any previous bleeding.  If you've ever had excessive bleeding before, even for something minor, like the removal of wisdom teeth, be sure to tell the doctor.

Hospital Risk No. 6: Anesthesia Complications

While the risk of problems is low, there are still precautions you should take. First, ask to meet with your anesthesiology team to discuss your options. Some procedures only require a local or regional anesthetic, while others will need full general anesthetic. Go over the benefits and risks of each one.  Although rare, some people have allergies to certain anesthetics. Rare genetic conditions can also trigger anesthesia complications. Check and see if any other family members have had a bad reaction to anesthesia. If you suspect you might be at risk, you may have testing done before the surgery.

REMEMBER:  Questioning authority is never easy, but remember it's your body, your health, and your life. If you ever have questions or concerns about anything during your hospital stay, you have to speak up.

Top Medical Errors by Doctors and Health Care Providers

Prescription Errors

Prescribing the wrong type of drug, ordering an improper dose, giving a patient a drug that he or she is allergic to, or combining medications that are incompatible, can lead to deadly consequences.  While medical errors may be more easily detected in hospitals, they afflict every health care setting: day-surgery and outpatient clinics, retail pharmacies, nursing homes, as well as home care.

Some typical medication mistakes include:

• failing to adjust dosages due to a decline in the patient's kidney or liver function;
• failing to inquire about the patient's history of drug allergies;
• illegible handwriting;
• transcribing the wrong drug name on the prescription pad; and
• calculating the wrong dose for the patient's physical and medical condition.

Misdiagnosis or Failure to Diagnosis Conditions and Diseases

A doctor is required to use his or her best judgment to determine the cause of a patient's complaints or abnormal test results. The patient is entitled to an expanded physical examination and, where necessary, additional laboratory tests or a referral to a specialist.

Approximately 40 percent of medical malpractice claims are now based on a failure to diagnose a medical problem or failure to diagnose a problem in a timely fashion.

Other Medical Errors that can cause serious injuries or even death:

• Failure to establish a plan for appropriate follow-up care.
• Failure to obtain an adequate patient history or perform an adequate physical examination.

• Improper interpretation of or failure to order diagnostic tests.
• Failure to obtain and/or monitor laboratory test results
• Failure to address multiple positive toxicology screensfor drugs that could indicate abuse
• Changing medications without consulting with or notifyingother treating physicians
• Rapidly starting and stopping medicationsor making large dosage adjustments.

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Copyright © 2007 Janet, Jenner & Suggs, LLC, Attorneys At Law.
Attorneys admitted in multiple states and the District of Columbia. Practicing nationwide on a Pro Haec Vice basis.
Law Offices in: Maryland • South Carolina • North Carolina • Washington, D,C. • Pennsylvania • Georgia • Minnesota 
The facts of every case are different and prior results do not guarantee a similar outcome on any particular case. Additional information and representative cases handled by Janet, Jenner & Suggs, LLC are available on www.MedLawLegalTeam.com and will be provided to you free of charge upon request.