Health care reform is all over the news, and while the politicians argue about controlling costs, public insurance options and the impact on business, the real dangers to patients go unnoticed. Experts at the National Institute of Medicine report that as many as 98,000 Americans die each year as a result of preventable medical errors. And this rate is on the rise.
A mandatory, nationwide reporting system for such errors is not part of the Obama administration plan though it surely should be. As the daughter of a nurse who worked in a city hospital for over 25 years, I have a “trust yet verify” attitude toward medicine. There are working doctors (nurses too) who my mother to this day will not allow to treat her (or any of us). She’s instilled in me the idea that my health is as my responsibility as any doctor’s.
It’s not surprising, the power we give to medical professionals. After all, they can (and do) save our lives. We often see them in our most vulnerable moments… desperate, terrified times when we’re in no position to ask questions or make demands. The trouble is, not all doctors are good at what they do. Just as with any profession there are the good and the bad — only these bad ones bury their mistakes.
The number one rule of good medicine is first do no harm. Second to that, is the tacit agreement among doctors to keep each other’s secrets — forbidding them to speak ill of a fellow physician.
This was supported by one of the first large surveys to look at doctors and their attitudes conducted by Columbia University’s Institute on Medicine as a Profession that found a full 46% of the over 1600 doctors surveyed had seen “serious” medical errors by colleagues and hadn’t reported them. Makes me shudder to think of the families… the lives… that have been changed by those errors. It’s not that physicians don’t believe in reporting incompetence or mistakes by peers… they just don’t act on that belief. Even if a doctor is disciplined, the action has no teeth… for few feel comfortable taking away a fellow doctor’s livelihood.
The survey also found that doctors also ordered unnecessary tests (36%), chose to “manage” conflicts of interest, and didn’t disclose patients of these conflicts (25%). Only 69% of respondents accept uninsured patients, despite the widespread belief that doctors should provide care regardless of ability to pay.
So what’s a patient to do? Start by being your own advocate. While you’re healthy take the time to research potential physicians. Ask those you know for recommendations, and watch for repeating names. There are ample online resources to help you — HealthGrades, mydochub or revolutionhealth are all good places to start.
Visit the practice… check out the waiting room. If you can afford it, make an initial appointment so you and the doctor you’re considering can meet. And remember, he or she works for you… your insurance is paying for the care you get. If you don’t feel comfortable, don’t get the sense you’re a priority to this practitioner, keep looking.
And while Board Certified doctors have extra training beyond medical school and must pass an exam that certifies them as a specialist, this is no guarantee of good care. It may be of more value in a specialist than in a doctor you see regularly… all other things being equal.
A good doctor never makes you feel rushed or insignificant… he or she takes the time to listen and answer questions. There’s regular eye contact. He or she will never be insulted by your request for a second opinion. Good doctors welcome this, knowing another pair of eyes is ultimately for your benefit. He or she will encourage you to be part of your own healthcare.
A bad doctor is cold and distracted, rarely makes eye contact or seems impatient with questions or concerns. The physician gives the impression you must trust in his/her knowledge or skill without question. Calls go unreturned. You wait to be seen as if your time has no value.
Never forget that any doctor you see is working for you… not the other way around. The money to pay for their time comes out of your pocket, one way or another. You owe them nothing… no loyalty, no allegeance and no respect save what they’ve earned in the course of your care. As much as society endows medical men (and women) with almost super-human qualities, they are, after all, only human.
You may find it helpful to monitor bad doctors in your state. Do this by contacting Patty Skolnik, a one-person clearinghouse, who knows first hand what it is to lose a loved one to a medical mistake. Her son Michael was mis-diagnosed by a Denver doctor and endured a 6 hour surgery that left him paralyzed, partially blind and psychotic. Her efforts may keep another mother’s child (or loved one) from facing this same horror.
While healthcare reform would be nice, a more important issue — a reliable way to keep track of medical mistakes — hasn’t made it into the national discussion. As patients, all of us need to fight hard, ignore the medical profession’s inbred desire to guide and tolerate, but never partner with us in terms of our care. Never hesitate to ask questions. To trust your instincts. To be open to alternatives.