What mistakes do doctors make?

What Happens When Your Doctor Makes a Mistake?

When your doctor makes an error in treating you, he or she could face liability for a medical malpractice lawsuit. All medical providers, including doctors, surgeons, anesthesiologists, physiatrists, nurses and therapists a have a legal responsibility to prevent harm to their patients.

However, an error does not automatically equal medical malpractice. If you are considering a medical malpractice lawsuit, understanding the differences between “medical errors”, “known and acceptable complications” and “medical negligence” is key to knowing whether or not you have a case.

What is a Medical Error?

Medical errors are the third leading cause of death and account for 251,000 deaths in the United States each year. These errors result in billions of dollars of preventable healthcare expenditures and 28% of hospital medical errors are preventable. It is estimated that 35 percent of American patients experience some form of treatment, medication, and/or laboratory error; and most go unreported!

The term “medical error” captures all unintended events that occur within a patient’s care cycle. These can be as innocent as the wrong doctor’s name getting placed into a chart, or a missed dose of medication that has no consequences to the patient. Some medical errors are discovered before any harm occurs, and some are so benign they go completely unnoticed.

However, there are times when the error has serious consequences. Such as, when a patient gets the wrong medication, or receives the wrong procedure. These are called “errors of commission” because someone took an action (“committed”) that was not indicated. There are also medical errors of “omission”. These occur when a health care provider does not take the action he/she should have. If your case involves one of these types of errors, AND it caused harm to you, you have met the first two criteria for a possible lawsuit.

Medical Malpractice vs. Known Complication

Now that we have established a medical error has caused harm, the law requires that we determine whether the error was the result of the healthcare professional failing to meet the “standard of reasonable care”, or if it was a “known and acceptable complication and/or risk” of the care you required.

If a healthcare professional fails to act “as a reasonably competent provider would under like or similar circumstances” and the patient is harmed in a way that would not have otherwise occurred due to their underlying condition, the error may qualify as medical negligence under the law.

Similar to proving negligence in a personal injury claim, in a medical malpractice claim you must prove several elements to succeed with a medical malpractice lawsuit.

• The plaintiff must prove an official doctor-patient relationship existed with the defendant. The defendant must have agreed to treat the plaintiff and the plaintiff must have agreed to the defendant’s treatment.
• The plaintiff must show how the defendant failed to meet the standard of care in the given situation.
• The plaintiff must have suffered some kind of measurable harm or loss resulting from the defendant’s failure to meet the standard of care.

Let’s Consider an example:

Two patients’ lab results get mixed up with each other. Due to the mix-up, one patient receives a medication he did not need. The other fails to receive the medicine she needed. The medical error is discovered quickly. The patient who missed a dose is not affected and receives her medication the next day without suffering any harm. This medical error did not result in any harm to the patient, therefore, it is not considered “medical negligence” under the law.

However, the other patient happened to be severely allergic to the medication that was mistakenly prescribed to him. The single dose received before the discovery of the medical error resulted in his suffering a cardiac arrest that was directly linked to the medication error. If it can be shown (which it probably can) that a reasonable hospital system acting under like or similar circumstances would have measures in place to ensure this mix up did not happen, then this would be considered medical malpractice.

Other common examples of medical malpractice include:

• A doctor neglects to review a pathology report showing her patient has cancer, causing a missed or delayed diagnosis that would have prompted curative treatment.
• A surgeon operates on an incorrect organ or body part.
• A surgeon leaves an instrument, or piece of gauze inside a patient.
• A patient is prematurely discharged due to missing or unreviewed information in their medical charting.
• A doctor neglects to review the patient’s allergies and prescribes a medication that a patient is allergic to.
• A doctor deviates from “duty of care” and prescribes incorrect medication or dosages.
• A patient experiences bedsores during a hospital stay because the nursing staff failed to take proper precautions.
• A doctor omits information to the patient about risks and potential adverse consequences of a planned operation or procedure.
• A doctor was negligent during prenatal care, and the baby suffered deformities or experienced organ damage before birth.
• A baby’s lack of oxygen before or during the birth process goes unnoticed and untreated by the doctors and nurses, resulting in a birth injury or Cerebral Palsy.

The “Known and Acceptable Risk/Complication” Exception.

Not all bad medical outcomes are “malpractice.” Even things that “should not happen” or “were not intended” can still fall into the “known and acceptable risks/complications” exception. This exception actually allows medical providers to commit errors that cause harm without being responsible for that harm.

Some examples of known and acceptable complications are:

• Injuries to nearby organs during certain surgical procedures
• Burns during radiation treatment for cancer
• Infections acquired during a hospital admission
• Excessive blood loss during surgery and
• A damaged nerve from an IV insertion

Of course, there are exceptions to the exceptions. So, whether a specific event qualifies as a “known complication” will vary on a case by case basis. It is always best to speak with an experienced medical negligence attorney whenever you or a loved one has suffered an unexpected medical outcome.

Electronic Health Records(EHR) System.

Health care in the United States has experienced a remarkable transition from paper to electronic health record (EHR) systems during the past decade. The goals set by the Federal Health IT Strategic Plan and financial incentives provided through the ARRA/HITECH act in 2009, are responsible for more than 75% of physician practices and 92% of eligible hospitals receiving incentives to adopt certified EHR technologies through 2014.

The EHR system was designed to do a lot: make medicine safer, bring higher-quality care, empower patients, and yes, even save money. In turn, patients would have portable medical records they could share instantly with any doctors and hospitals anywhere — essential when life and death decisions are being made in the ER.

Medical Errors Involving the EHR System.

«While digitization of medicine has improved patient safety, it also has a dark side—as evidenced by the emergence of new kinds of errors,» said University of California San Francisco Department of Medicine Chair and Professor Robert M. Wachter, MD.

A recent study in the Journal of Patient Safety, revealed that 62% of all EHR-related claims involved medication errors and complications with treatment, respectively. The remaining 28% arose from diagnostic errors. The Researchers examined 248 cases and found 63% of EHR-related claims were caused by user-related errors, while 58% percent arose from problems with the technology itself.

A flaw in the EHR design contributed to a patient who had complained of “sudden onset of chest pains with burning epigastric pain, some relief with antacid”; Because the ‘complaint’ field in the EHR was too small, the entry was noted only as “epigastric pain”; no electrocardiogram was done and the patient experienced a cardiac event days later.

A user-related error occurred where a patient developed amiodarone toxicity because the patient’s history and medications were copied from a previous note that did not document that the patient was already on the medication.

Ultimately, researchers cautioned that EHR-related patient harm can occur in any healthcare setting and during any clinical service.

What to do if you believe you have been the victim of a medical error or medical malpractice

Patient safety improves when medical professionals are held accountable for avoidable harm. When hospitals commit to performing a root-cause-analysis to guide system changes, medication errors can be reduced by 70 percent. Even if the doctor cannot be held legally responsible as the event that occurred was a medical error and not medical malpractice, an experienced medical malpractice attorney can help you take action to improve patient safety for others.

Our experienced medical malpractice attorneys will help you get your life back. We used to represent the same hospitals and insurance companies we now hold accountable for our clients pain, suffering, lost income and medical expenses. We are here 24/7 and there is no fee unless we win your case.

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Why Doctors Stay Mum About Mistakes Their Colleagues Make

Telling a patient about another doctor’s medical error can mean losing business or suffering retribution. Now, some physicians are looking for ways to break the code of silence.

Nov. 8, 2013, 8:37 a.m. EST

Series: Patient Safety

Exploring Quality of Care in the U.S.

Patients don’t always know when their doctor has made a medical error. But other doctors do.

A few years ago I called a Las Vegas surgeon because I had hospital data showing which of his peers had high rates of surgical injuries – things like removing a healthy kidney, accidentally puncturing a young girl’s aorta during an appendectomy and mistakenly removing part of a woman’s pancreas.

I wanted to see if he could help me investigate what happened. But the surgeon surprised me.

Before I could get a question out, he started rattling off the names of surgeons he considered the worst in town. He and his partners often had to correct their mistakes — “cleanup” surgeries, he said. He didn’t need a database to tell him which surgeons made the most mistakes.

By some estimates, medical errors are one of the leading causes of death in the United States. Physicians often see the mistakes made by their peers, which puts them in a sticky ethical situation: Should they tell the patient about a mistake made by a different doctor? Too often they do not.

A new report in The New England Journal of Medicine, “Talking With Patients About Other Clinicians’ Errors,” suggests it’s a common problem.

The report’s lead author, Dr. Thomas Gallagher, an internist and professor at the University of Washington School of Medicine, said he conducted a survey of doctors in which more than half said that, in the prior year, they identified at least one error by a colleague. (The survey, unrelated to the NEMJ report, did not ask what the doctors did about it, Gallagher said.)

There’s wide agreement in the medical community that doctors have an ethical duty to disclose their own errors to patients, Gallagher said. But there’s been less discussion about what physicians should do when they discover that someone else’s mistake.

For the NEJM report, Gallagher led a team of 15 experts who discussed the problem. They identified many reasons why doctors may want to stay silent about errors by their peers.

One is that doctors depend on each other for business. So a physician who breaks the code of silence may become known as a tattler and lose referrals, a financial penalty. Or maybe they aren’t sure exactly what happened to the patient and don’t want to take the time to try and unravel it. In some cases, issues related to cultural differences, gender, race and seniority come into play.

The report notes that doctors also may be wary of becoming entangled in a medical malpractice case, or of causing a colleague to face legal consequences.

Dr. Brant Mittler, a cardiologist who now works as a medical malpractice attorney in Texas, told me that he frequently saw errors made by other physicians during almost four decades in medicine.

Mittler remembers a scan read by a radiologist that said a patient had an “ejection fraction” — the amount of blood pumped by the heart with each beat — of zero. But that would only be possible if the patient was dead, he said. He noted the error to the radiologist, who thanked him.

Many times Mittler stayed quiet, he said. He saw many errors reading electrocardiograms at a 500-bed hospital in San Antonio. He said he didn’t know the details of each case, so he couldn’t tell if the errors affected the outcome for the patient. But he did not go to the other doctors to point out the errors — there would have been hostility if he had, he said.

“There’s not a culture where people care about feedback,” Mittler said. “You figure that if you make them mad they’ll come after you in peer review and quality assurance. They’ll figure out a way to get back at you.”

Gallagher said physicians experience the normal range of human emotions when they find a colleague’s error. They wonder if they can keep it to themselves or whether they’re compelled to tell someone. Or they consider what they would want to happen if they had made the error.

That results in too much leniency toward mistakes, he said.

The bottom line: Too often doctors aren’t learning from errors, Gallagher said. Nor are patients getting the information they need to receive proper treatment or compensation when the outcome is harmful, he said.

Even after patients do learn about an error, the lack of communication by doctors often continues.

Almost 400 people who have completed the ProPublica Patient Harm Questionnaire, and more than 1,800 are members of ProPublica’s Patient Harm Facebook Community. Many reported that they experienced the silent treatment from doctors after experiencing harm during medical care.

The NEJM report stresses that patients come first and recommends that doctors should explore, not ignore, a colleague’s error. They should start by collecting the facts, starting with a one-on-one conversation with the physician who made the error so they can decide how to inform the patient.

Hospitals and other health-care institutions must lead by supporting such conversations, the NEJM group reported.

Dr. David Mayer is vice president of quality and safety at Medstar Health, which runs 10 hospitals in Maryland and Washington, D.C. Mayer said reporting of medical errors is a top priority at the organization so everyone can learn from mistakes.

When doctors identify an error, made by themselves or a colleague, they’re required to tell their supervisor, whether the error resulted in harm to the patient or not, he said.

Each month there are about 1,400 reported safety events, Mayer said. Most are “near misses,” though some involve actual harm to a patient (Medstar declined to disclose how many).

The safety events are analyzed for trends that need to be corrected or that need immediate attention to protect patients, Mayer said. Cases in which a patient was harmed are investigated so that the cause can be disclosed to the patient and family, an apology can be made, and compensation can be offered, he said.

Mayer and Larry Smith, Medstar’s vice president of risk management, said their organization is unusual for its proactive approach to reporting medical errors. Smith said most institutions seem to only report them when it’s obvious the harm will be discovered by some other means.

“Far fewer are doing this kind of work when the information would never surface,” Smith said.

Dr. Humayun Chaudhry, president and CEO of the Federation of State Medical Boards, which provides guidance for how state boards regulate doctors, said that physicians and health-care organizations need to be more assertive about reporting errors.

Failing to divulge another doctor’s mistake undermines the doctor-patient relationship, Chaudhry said. “It makes patients wonder if they can trust their own physicians,” he said, “and the profession of medicine.”

Have you worked in the health-care industry? Please help ProPublica’s reporting on patient safety by completing the ProPublica Provider Questionnaire.

DISCUSSION: On Monday, November 11th, reporter Marshall Allen, the study’s lead author Dr. Thomas Gallagher, cardiologist and medical malpractice attorney Brant Mittler and patient safety advocates Patty Skolnik and Helen Haskell joined us for a discussion on why doctors stay silent. See a video recap below:

Marshall Allen was previously a reporter at ProPublica investigating the cost and quality of our health care.

• Marshall Allen
• @marshall_allen
• 917-512-0214

I help doctors open private practices and resuscitate failed ones. Here are the 3 biggest mistakes I see them make.

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• Lisa McDonald is the founder of Integrated Connections, a healthcare consultancy.
• She says a big challenge in starting one’s own private practice is unrealistic expectations.
• Here’s her advice for overcoming these issues, as told to writer Robin Madell.
• This article is part of Talent Insider, a series containing expert advice to help small business owners tackle a range of hiring challenges.

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This as-told-to essay is based on a conversation with Lisa McDonald, the founder of Integrated Connections, a national medical-practice consultancy based in Fort Collins, Colorado. It has been edited for length and clarity.

Opening a practice can be stressful for doctors — especially since many medical schools tend to overlook the business side of medicine.

Since founding my consulting company in 2009, I’ve worked with hundreds of private-practice physicians and aspiring business owners. Here are three common challenges I see doctors face when going off on their own.

1. Unrealistic expectations

Many physicians come to me after opening a practice and discovering it wasn’t what they’d hoped for. They weren’t prepared and thought they could open a practice without sufficient capital or support staff, or they were fed up with corporate medicine and wanted to make a change immediately, but didn’t put the appropriate time and effort into properly vetting the resources, the systems, or the software required to run a medical practice efficiently and effectively.

One physician I worked with thought he could start a practice with just himself and his spouse working part-time for the practice. They worked on a shoestring budget and their spouse was trying to manage the marketing, billing, patient visits — everything. They didn’t reach their forecasted revenue because they weren’t able to build a patient list as quickly as they’d planned. He also wasn’t able to maintain a salary that would support his family and lifestyle, and the administrative burden negatively impacted his quality of life because he couldn’t hire any additional support. He eventually came to me seeking employment when he determined he had to close the practice.

2. Being afraid to spend a lot in the beginning

Physicians often view spending money as a hit to their bottom line rather than a necessary investment to fuel future growth of the business.

I’ve worked with physicians who hadn’t developed a proper business plan. They struggled with marketing and staff expenditures, or looked for the best price as opposed to the best value. It’s understandable given that many physicians are swimming in student-loan debt, but I’ve seen this mindset damage a business beyond repair.

Doing marketing work, using social media, creating programming, writing articles or a book, and hiring the right support staff are all things that physicians may not immediately consider to be revenue generators, but investing in the right professionals to help get these aspects running smoothly sooner will help grow your patient base faster.

3. Not hiring help or budgeting properly for staff

When they’re just starting out with opening a new medical practice, physicians often don’t understand the importance of hiring quality candidates — and how difficult it can be to find these candidates. This goes for both clinical and nonclinical staff.

For example, many physicians will try to open a practice with little to no administrative staff. They think they can do it all, but soon learn that trying to do everything involved in running a practice — on top of treating patients — is a fast way to get burned out. Managing staff is one of the biggest complaints I hear from business owners, but if you have effective processes in place to hire the right people, it’s a huge payoff in the long run.

Many also underestimate hiring costs. For example, clinic owners are often excited to grow their new practice and want to hire an advanced-practice provider such as a nurse practitioner or physician’s assistant to help see more patients — yet they aren’t aware of how much these professionals can earn elsewhere (often six figures).

Here are a few key strategies for dealing with these mistakes before opening a practice

1. Define your objectives: Some physicians may be particularly focused on making as much money as possible, while others may value the autonomy and flexibility that can come with being self-employed. Physicians need to prioritize which factors are most important to them so that they can build and shape their practice around those priorities. The highest-paying practice opportunity may not be the one with the three-day work week located in your hometown or on your favorite beach or ski resort, for example.
2. Do your research: There’s a plethora of information online regarding the challenges of owning and operating a medical practice in today’s environment. Physician professional associations, local physician meetings, and online healthcare-networking groups on LinkedIn and Facebook are also great places to find practice owners or vendors willing to share their knowledge and expertise. When setting a budget, think about all the costs involved in starting a business — things like office space, staff, IT, marketing, and administrative tools, among others.
3. Hire based on character and loyalty: You can teach new skills, but you can’t teach personality, emotional intelligence, or purpose. You also want to hire for tenure, as significant turnover can be detrimental to a private practice. To gain insight into how candidates think, problem solve, and interact with patients and peers, I use open-ended and behavioral interview questions like: «How do you adapt to working at a new practice?» «What do you believe are the three most important aspects of a successful patient encounter?» «What do you think are the top challenges in healthcare now, and how do you overcome them?» and «Where do you see yourself in five years?» One client I work with likes to ask office-support candidates: «What would you do in the last 15 minutes of the day when all of your work is done?» Some candidates reply with answers like, «Just hang out,» while others answer with examples demonstrating initiative like, «Clean around my work area,» or, «Ask my colleagues if they need help.»