health matters

What we have here is a failure to communicate: Understanding and preventing medical errors

What we have here is a failure to communicate: Understanding and preventing medical errors

Austin Photo Set: News_jeff_failure to communicate_medical errors_jan 2012_doctor and patients

Preventable medical errors are the third leading cause of death in the U.S. We’re talking about 250,000 lives lost, trailing only heart disease and cancer. If you think these errors are confined to hospitalized patients, you’d be wrong. About half of them are the result of mistakes in the outpatient setting (read: doctors’ offices).

By medical errors, I’m talking about misdiagnoses, medication errors, wrong site surgery and poor hygiene resulting in fatal infections. A report by the Institute of Medicine attributed the astronomical number of medical mishaps directly to miscommunication or a failure to communicate; doctors sometimes fail to communicate with colleagues as well as patients. and this failure to communicate is the root cause of medical mistakes.

One way to avoid miscommunication would be to replace commonly used medical jargon, most of which many patients cannot understand, with plain language.

Here are some examples of what I mean by "miscommunication":

Former New York mayor Rudy Giuliani, after hearing that his prostate biopsy was “positive,” shouted with joy, incorrectly interpreting “positive” as good news (I guess he never watched Grey’s Anatomy).

An elderly woman sent home from hospital develops a life-threatening infection because she doesn’t understand the warning signs listed in the discharge instructions.

A man confused by a form in a doctor’s office reflexively writes “no” to every question because he doesn’t understand what is being asked.

A young mother pours an antibiotic for an ear infection that is supposed to be taken orally into her baby’s ear, perforating the eardrum.

And a man in his 70s, preparing for his first colonoscopy, uses a suppository as directed, but without first removing it from the foil packet.

Believe me, these are not isolated events.

A 2006 study by the U.S. Department of Education found that 36 percent of adults have only basic or below-basic skills for dealing with health materials, which means that 90 million Americans can understand discharge instructions written only at a fifth-grade level or lower. About 52 percent had intermediate skills, which means they could figure out what time a medication should be taken if the label says “take two hours after eating.” The remaining 12 percent were deemed proficient because they could search a complex document and find the information necessary to define a medical term. (I’m not sure where Giuliani fits?)

Poor health literacy has been linked to higher rates of hospital readmission, expensive and unnecessary complications and premature death. A 2007 study estimated the problem also cost the U.S. economy as much as $238 billion annually. This problem will surely become even more severe in 2014, when tens of millions become insured.

In an effort to improve communication, The Joint Commission, which accredits hospitals, is requiring the use of plain-language materials and to “communicate in a manner that meets the patients oral and written communication needs” in providing care. For example, instead of “myocardial infarction,” use heart attack; instead of “febrile,” use fever; replace “hyperlipidemia” with high cholesterol.

Doctors are also encouraged to replace “diet” with food, because many folks, when they hear "diet," believe doctors want them to lose weight. They also recommend replacing “exercise” with walking; when patients hear that term, they sometimes run out and join a gym. 

If you want to be sure you’re getting the right care, you have to be able to understand what the doctors, nurses or pharmacists are telling you. Speak up if you don’t understand! This is not the time to be embarrassed; your life, or the life of a loved one, may be at stake.