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Is Patient Safety an Oxymoron?

A Cacophony of Crappy Patient Safety News

Patient Safety Month

Patient Safety Month (Photo credit: MilitaryHealth)

This week finds us with a cacophany of crappy patient safety news – a discordant blend of medical neglect, indifference, and ineptitude that should shake the faith of the most determined pollyannas among us. Let’s dig right in…

A recent report from the Joint Commission that accredits America’s hospitals suggests that alarms on patient monitors – intended to improve patient safety – have instead desensitized hospital caregivers and promoted a culture of patient neglect.

This so-called “alarm fatigue” has prompted some hospital personnel to ignore alarms indicating patients in acute distress, many with life-threatening emergencies. Some hospital personnel were reported to have even turned off the alarms because they’re just so darn annoying.

As appalling as this may seem, it’s but the tip of the iceberg. Apart from its direct and deadly consequences, it’s also symbolic of a more widespread neglect of patient safety that pervades healthcare practice in America – and not just in hospitals – where our death rate from medical mistakes is 50% higher than other developed countries.

Yet in the almost decade and a half since “To Err Is Human” – the Institute of Medicine’s seminal report on medical errors and patient safety that provoked so much defensive denial by the medical profession – little has changed. The medical profession’s clamor about medical malpractice lawsuits hasn’t diminished despite record low rates of such lawsuits, while its indifference to patient safety remains evident in our stubbornly high rate of medical mistakes.

The alarms about patient safety in our healthcare system are routinely ignored, as the following dismal reports from this week’s news will further illustrate.

Uninformed Consent

My comment in Our Healthcare Sucks about the legalistic process of gaining patients’ so-called “Informed Consent” prior to performing invasive medical procedures is that “Informed Consent is where the rubber meets the road in American healthcare”.

But maybe I was wrong. Because now we have another report about parents of premature infants enlisted for a clinical trial of varying levels of oxygen saturation for their premature infants who weren’t properly informed of the risks that too little or too much oxygen posed to their newborns. Those risks included blindness and death.

But medical researchers at 23 medical centers across America failed to disclose these risks to the parents of these extremely premature infants. According to this report of the complaint filed by the ever-vigilant watchdog group, Public Citizen…

“The results of the trial showed that infants in the lower-saturation group had a lower rate of severe retinal problems (8.6% versus 17.9%; RR 0.52, 95% CI 0.37 to 0.73), but a higher rate of death (19.9% versus 16.2%; RR 1.27, 95% CI 1.01 to 1.60) compared with those in the higher-saturation group.”

So more babies died with lower oxygen saturation, but fewer of those who survived were blind. Isn’t that a trade-off the parents of these infants should have been made aware of before their consent to participating in this trial was sought?

And was their consent, therefore, truly “informed”?

Risky Meds

Then there’s the report from researchers at Brown University that one-in-five seniors are on high-risk medications prescribed by their doctors. In some parts of the country, particularly the South, the rates were almost double this – with almost two-in-five seniors on high-risk medications.

This is consistent with data I reported in Our Healthcare Sucks. Here’s an excerpt:

“Consumer Reports’ ‘Best Buy Drugs’ [1] states:

“Half of people 60 and over take three or more prescription medicines…and 10% take seven or more medications…Studies found…17% were prescribed a drug they did not need (and) 37% were not prescribed a drug they did need (emphasis added).”

Another study found, ‘42% of patients were taking a drug they did not need and not taking one they should.  Think about that: almost half of American patients are victims of medical misprescribing.”  

Does this sound like patient safety is a priority in American medicine?

Docs in the Dark?

All this misprescribing of medications isn’t really surprising considering how our doctors “learn” about the medications they prescribe. Which brings me to yet another news report this week…

According to a report in Science Daily about a study of prescribing practices, the majority of family doctors receive little or no information about the risks of the medications they prescribe. This should come as no surprise given the source of their “education”: drug reps for the pharmaceutical companies that manufacture the drugs.

Consider this little nugget from this report:

“(Drug company) sales representatives failed to provide any information about common or serious side effects and the type of patients who should not use the medicine in 59 per cent of the promotions…

“‘Laws in all three countries (in the study, including the U.S.) require sales representatives to provide information on harm as well as benefits,’ says lead author Barbara Mintzes of the University of British Columbia. ‘But no one is monitoring these visits and there are next to no sanctions for misleading or inaccurate promotion‘…

“Serious risks were mentioned in only six percent of the promotions, even though 57 per cent of the medications involved in these visits came with…the strongest drug warning that can be issued.”

Now you’d think our doctors would be sophisticated enough to take what they hear from drug reps with a huge grain of salt. You might even expect them to do a little due diligence on their own to explore the risks of the medications they prescribe. They’re certainly aware that every medication poses some kind of risk, aren’t they?

The internet makes such independent verification of what drug sales reps tell them easier than ever. Yet, according to this report,

“The same doctors indicated that they were likely to start prescribing these drugs, consistent with previous research that shows prescribing behaviour is influenced by pharmaceutical promotion.”

Do you suppose they’ll be as unsuspecting when considering what their car salesman or saleswoman tells them when they’re buying their next new car?

Me neither.

They’re in the dark alright – and apparently too lazy, careless, or negligent to switch on the lights.

But just utter two magical words – “medical malpractice” – and watch them light up.

Painkillers Kill More Than Pain

The final installment in this week’s disconcerting patient safety news has to do with the related subject of non-medication approaches to pain management. Pain, of course, is the prime driver of doctors’ visits. And increasingly it’s chronic pain associated with our multiple epidemics of chronic disease.

I’ve written elsewhere about the hazards of prescribing addictive opioid drugs for chronic pain (see “Medical Marijuana vs. Prescription Opioids – Misplaced Perceptions and Priorities“). According to a study just announced by the American Pain Society, “Those who accept their pain condition are best able to tolerate pain, while distraction can be the way to lower pain intensity”.

This and related approaches to chronic pain management would greatly reduce our current reliance on high-risk opioid medications that not only lose their effectiveness over time, but – as noted in my post linked to above – have been shown to promote tumor growth in animal studies.

But pursuing such time-intensive alternatives to the ever-ready prescription pad would require taking some initiative – and ignoring the drug reps whose company profits, and their own bonuses, might suffer with less drug-centered approaches to pain management.

Patient Safety – or Endangerment?

I’ll close this sobering entry with the following excerpt from Our Healthcare Sucks, simply because it’s so relevant:

“An article in the Journal of Patient safety said this:

“‘When it is clear that our care has caused preventable harm and we allow a conspiracy of silence to betray those who have put their faith in us, we inflict the impact and pain that is nothing short of a ‘hit and run’ accident (emphases added).” [2]

“What’s important is realizing we’re all at significant risk every time we engage with the medical system

“Given these very real risks, a more accurate nomenclature for this phenomenon than ‘patient safety’ is ‘patient endangerment’ – at least until the industry starts to pay more than lip service to fixing the problems that are endangering its patient population.”

That, folks, means you and me.

And this week’s news provides little comfort that we’re on the right track.

Oh, by the way, last month was “Patient Safety Awareness Month” in America.

What do YOU think? Chime in below…

[1] Multiple Medicines, Consumer Reports Best Buy Drugs @

[2] Disclosure Through Our Eyes. Journal of Patient Safety. 4(1):18-26, March 2008.

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