When a Windsor, Ont., surgeon misread the pathology report and removed 44-year-old Laurie Johnston’s left breast and six lymph nodes’despite the fact that she didn’t actually have cancer‘it made news-paper headlines across the country in February. Johnston’s was a particularly horrific case of hospital error, but misdiagnoses, equipment malfunction and mistakes during testing, surgery and treatment are by no means unusual in our country’s hospitals.
Alarmingly, preventable medical errors (or "adverse events" in medi-speak’whether ER mistakes, equipment failure, prescription errors or misread medical tests) contribute to between 9,000 and 24,000 deaths a year in Canada, according to the most recent comprehensive study, which appeared back in 2004 in the Canadian Medical Association Journal. Progress has been made in some areas since then, according to a report by the Canadian Institute for Health Information. Anesthesia, for example, is much safer than it used to be. But there’s room for improvement. In a 2006 survey, approximately three quarters of health system managers and nurses said they thought it likely they would experience a serious medical error if they were treated in a Canadian hospital‘and they should know.
"I don’t know any healthcare provider who deliberately goes in to work with the thought that they’re going to harm somebody," says Hugh MacLeod, CEO of the Edmonton-based Canadian Patient Safety Institute (CPSI). "But when you combine the pace and complexity of health care today with the kinds of potentially risky interventions we do, errors happen."
The good news? You can take a proactive role to get the hospital care you need and minimize your risk. Here’s how:
1. Keep asking questions
If there’s one thing Jayne Chong of Brampton, Ont., has learned, it’s this: "You have to be a pain in the ass." A series of misdiagnoses resulted in her needing a heart and kidney transplant at age 26. A correct diagnosis earlier might have saved her from this major surgery. "Just keep saying, ‘There’s something wrong,’" she advises. If the ER doc can’t come up with a diagnosis, ask to see another doctor. Michael Decter, co-author of Navigating Canada’s Health Care, agrees. And if doctors seem uncertain of what ails you, he adds, ask questions like: What else could this illness be? What other tests can you do? What symptoms should I worry about?
2. Bring an advocate
"You need someone to ask the important questions," says Decter, "to represent your interests and make sure the continuity of care is there." The more serious the problem, the more crucial it is to have representation, points out Kate Pocock of Toronto, who advocated for her sister Mary when she was going through cancer treatments (sadly, Mary died in 2004). Pocock advises bringing a tape recorder or notebook so you can review it later when you’re considering your next step.
3. Keep your medical history handy
"Most people have a file folder ‘at home with their insurance policies and financial records," says Decter. "But we don’t take the same care with our medical history and records." To lessen your risk of dangerous drug interactions and to avoid unnecessary tests, he suggests keeping a file folder about medical treatments and care you’ve received, as well as a list of any allergies, a printout of your prescriptions and insurance medicals, if any, and test results. That way, if you need emergency medical care and you’re not thinking clearly, you’ve got all the details in black and white.
4. Get a second opinion
Dr. Anne Doig, past president of the Canadian Medical Association, suggests that patients should be "unafraid" to ask for a second opinion. The problem, of course, is that just getting a first opinion can be difficult due to long wait times in parts of this country. But you do have some options:
‘ If you’re uncomfortable asking a specialist for a referral for another opinion, ask your family doctor for another specialist.
‘ Best Doctors Canada is available through many employee benefit plans and critical insurance policies. Individuals can also purchase memberships to access its services for a fee of $150 per year per person or $225 per year per family.
‘ Several U.S.-based companies specialize in offering second opinions. For example, ConfirmPath charges US$150 to $175 to review pathology reports.
5. Recognize that ‘practice makes perfect’
Research that compares volume of surgeries to outcomes has made it clear that this old adage is true. If you’re facing surgery, advises Decter, “ask your referring physician good, practical questions, like ‘Is this procedure something that is done frequently at this hospital? Which doctor/hospital in this city, province or country is doing the highest volume of these procedures?'”
6. Get a Safety Checklist
Download the Safe Surgery Saves Lives checklist from the CPSI website. Meant for use by hospitals, it prompts the surgical team to check everything from the anesthesia equipment to the surgery site. It’s intended to prevent error by ensuring everyone pauses and considers the next step. "It’s smart to familiarize yourself with the checklist and talk to your doctor about using it," says MacLeod.
7. Wash your hands’and make sure everyone else does, too
Every year, about 220,000 people in Canada develop healthcare-associated infections; most are spread through hand-to-hand contact, says a study in the American Journal of Infection Control. More than 8,000 people die as a result. Make sure that the patient, visitors and care providers all wash their hands.
8. Something not right? Tell everyone
When Jayne Chong was in hospital after her kidney transplant, her catheter became blocked. She told everyone, even the cleaning staff, that she felt pressure in the area of the catheter. It took two days, she says, but "finally I found this doctor who listened. I’d never seen him before and I never saw him after that, but he got it fixed."
When MacLeod talks to people who have lost a loved one because of a medical error, many have one thing in common, he says. "They tell me they knew intuitively that something was wrong. But they didn’t speak up. And they’re going to carry that for the rest of their lives. That haunts me."
This article was originally titled "Rx for the Best Care," in the November/December 2010 issue of Best Health. Subscribe today to get the full Best Health experience’and never miss an issue!’and make sure to check out what’s new in the latest issue of Best Health.