Living with medical errors

I have a picture some place of when I went for knee surgery in 2001 of me home from the hospital with a big bandage on my right knee and the word "NO" scrawled in big letters on  my right knee. This was written by the surgeon after triple confirming with me.

Then I have the memory of me after gall bladder surgery in 2008 where I heard the nurses talking about the excessive bruising on my abdomen after a laproscopic procedure. Basically I heard the doctor must have been really rough on me because of the size and speed at which the bruise arrived - and ho w long it hurt afterwards.

In the past few years the state of Massachusetts has started requiring hospitals to report medical incidents - anything from a fall, surgery problem, wrong medicine, bedsores - annually. In the past three years - 2011-2013 - the rate has risen extensively from 366 incidents to 444 to 753 in 2013. And you say 'why the increase?' How about the electronic reporting system was adopted in 2012.

This all makes me say hmmmm..... Its nice the state wants the data reported and is requiring the electronic reporting system so that things can't be swept under the rug, so to speak. But what about me as a patient?

There is all sorts of advice given but I think it goes down to your comfort level. Lets face it, errors happen in life, 'to err is human'. But as patients we need to speak up and ask questions - what will happen, what should I expect, and communicate with family members so they can ask questions.

I would like to say that of the 753 events in 2013, 282 or 37.5% were from falls. The next largest group was 230 or 30.5% were from bedsores. The leading number after that was 44 serious injury or death from medication error.
 

I'm not that standardized

Here's a new proposal. Give surgeon's a black box to help prevent medical errors, like they have in air planes.

The proposal:

"Inside the operating room, video cameras track every movement. Outside, a small computer-like device analyzes the recordings, identifying when mistakes are made and providing instant feedback to surgeons as they operate.

This is the dream of the surgical "black box." Operations could become flawless. Post-operative complications could be significantly reduced. Surgeons could review the footage to improve their technique and prep for the next big case."

The goal is so a surgeon learns of a mistake when it can be corrected and not after the fact. They get a computer assist. And more significantly they could be adopted in the US without FDA approval as they are not a device or anything.

I'm not saying that I am against improving medical errors or anything. I have myself dealt with a few mishaps in the OR but I do not think the human body is standard enough for this. Each human is unique. That's it. We are all one of a kind.

If someone wants to operate on me, I have many issues - from lack of thyroid, previous surgeries which have left scars, and more. I know they can be programmed into a computer before hand but still.  An individual human being is needed who can interpret the information and unique qualities of the body they have opened up in front of them.

I think of it this way. You are going to a strange place and you program the address into your GPS and start on your merry way. But then the GPS sends you to a road which has a detour and it recalculates around it, so you keep going. It even tells you when you are speeding to give you additional information and recalculates your arrival time. Then it forgets to tell you that the off ramp is on the left and not the right. And then there is an accident ahead so you try to get off the highway and make another detour. And then your GPS sends you down a one way street in the wrong direction.

You needed a human there to guide you to read the signs and notice the detour ahead. Or to tell you about a new problem the patient is having.

A friend had a bad colonscopy and had to have a colectomy. The surgery took much longer than expected because the doctor who removed the polyp at the colonscopy did not note correctly where it was that it happened so the surgeon had to spend quite a bit of time looking for the exact spot. What would that little black box do then? React like the robot in "Lost in Space"? 'Danger, Will Robinson, danger!' That wouldn't exactly prevent much of anything.

There is research going on with these currently in Canada with plans to test them in Canada, Denmark and South America.

But I am really not ready for them to be used on me anytime soon. I would rather have a better trained surgeon than a computer assisted surgeon operating on me.

Why do they do that?

I have a policy with myself for when to call my back pain doctor. When I get to the point of needing 2-3 breakthrough pain pills to get through the day, its time to make the call for an appointment. I have been at that point for a while and got in to see him yesterday afternoon.

My points of discussion with him were two: My right SI joint is in serious need of having its nerves killed off and my varying total back pain needs to be discussed. We don't always change my pain meds at a single appointment, we often discuss them over a few appointments before making changes.

My right SI joint (which is the long seam joint down the side of your tailbone if you are wondering) has been giving me problems for months. We have had the treatment discussion before but previously we have focused on other pain areas.

Yesterday afternoon, he  had me lie on the exam table and he moved my legs around and pressed on my hip. That hurt. Then he had me lie on my side and he pressed right on the SI joint. That was like a live wire running through me. I had to catch my breath after.

I think he realized how much it hurt and said he would send the nurse in to schedule my treatment. It took a while for me to recover from the amount of pain. I know he had to make sure he knew where the pain was coming from before heated needles to kill the nerves - because you really don't want to kill the wrong nerves.... But, yowza!

October 25 is the date for the treatment... It will be three years from the last one, which was the second one on the same place. These treatments (radiofrequency) can be repeated over and over again and each time the nerves come back, it takes longer and longer and they are weaker and weaker so the pain levels are less and less.

On a side note, my pain management doctor says I can actually take up to 8 break through pain pills a day and he considers 2-3 a day a very low dose. But my rheumatologist tells me that from her point of view, 3 should be the maximum because of convulsions. Its the different perspective from the two doctors that gets damn confusing.

Better than a sharp stick in the eye

Or whatever that saying is. This morning I am off to another medical adventure. I love these medical adventures that involve needles first thing in the morning. Well its not first thing first thing. I get breakfast first after sleeping in a little bit.

The reason I am having this is because I have a bony growth on my neck between C4 and C5. As a result I have a pain in my neck and problems with my shoulders and top half of my arms. It lines up exactly with this picture below.

I don't have pain in my arms and shoulders but they don't seem to work always and are uncomfortable. So after discovering this new issue which is life long, not curable by surgery, but only treatable for the symptoms. So I am off to have this wonderful procedure this morning.

I can't wait. It sounds like so much fun.I even watched the video after convincing myself it was okay. But then I'll lie around and be justifiably lazy for the rest of the day.

Practice makes perfect

And why its a medical practice. I have had eight surgeries and a billion medical (mis)adventures but I have NEVER asked this question of the person doing the procedure: how many times have you done this procedure? I have never asked that. And this is scary.

A couple of weeks ago I had a filling, a rather large filling to be precise, which is/was borderline for turning into a root canal. I hate the dentist. I hate the drilling and the needles and the potential pain. I am a weinie and have been know to take an ativan pre-procedure to get me through it.

The dentist and I had a big conversation as we waited for the Novocain to kick in. She said if it turned out I needed a root canal she would send me to an endodontist because she didn't do root canals any more. She told me that she said an endodontist would have me in and out  in and hour because that is what they did all day long and they were very good and had the right tools and microscopes and all sorts of fun things I didn't want to hear about it.

Doctors who do the same procedure day in and day out have a much lower rate of errors and mistakes. You really want the doctor who does the same surgery again and again. Go read that article if you don't believe me. But I think its time I start asking questions....

Stupid stomach flu or how having ailments complicates everything.

I woke up at 430 this morning running to the bathroom in one of the inglorious sprints that have happened to all of us. Eventually I returned to bed and informed my husband I was going nowhere today. And the delicate cat wanted to sit on my stomach.

My husband was concerned but went out the door and I went back to sleep until 830 where I struggled mightily to be functional and eventually called work to inform them I would not be available today. My coworker who answered the phone recommended warm flat ginger ale. That sounded very good. I did try some ginger tea but it just wasn't the same. I normally try to live on the BRAT diet when not feeling well but the tea did not sit in my stomach and I tried a tiny nibble of a banana with the same result.

Between bathroom sprints I came up with two things I needed - warm flat ginger ale and something OTC that I could take to stop my sprints - that hadn't expired in 2008 or 2009 which is what we had in the bathroom. Between dashes, I was returning to bed in my pjs.

With that decision made, the next one was 'can I really go to Walgreen's in my PJs with a fleece over them'? I made the executive decision that I wasn't THAT sick and did manage clean clothes.

Its approximately 200 yards from my front door to Walgreen's. But I drove. I stumbled around the store looking for  the digestive ailments aisle where there are two options - Immodium and Kaopectate. I tried reading the labels but there were all sorts of conflicting things on them

One said not to take without consulting a physician if you are on arthritis medications and the other said not to take if you have liver disease. I don't have liver disease but my liver numbers are closely supervised because of my other health ailments.

I went off to ask the pharmacist where I was told I can't take Kaopectate because it conflicts with my arthritis medication. And Imodium is not that good an idea because of liver issues that I can take it but the least dose possible.

One item down, I went to look for ginger ale. I checked the cold beverage section and it was full of Pepsi Cola products and Coca Cola products and a bunch of weird 'waters'. They didn't have any ginger ale. How can that be? I checked the shelves in the food and beverage section and none there either. I left astonished. Ginger ale is a healthful beverage for upset digestion systems.

Out in the parking lot, I thought where to next? The grocery store would have it but that was a whole mile and I really didn't think I want to deal with a big store. There is a smaller convenience store right up the road that might have it. If not, I was willing to bet that the liquor store had it for mixers.

The convenience store did have it. I grabbed three bottles and went to pay. $5.40 and I had no cash. The little sign said '$7.00 minimum on cards'. Crap. I thought about buying another but the owner had sympathy.

Home at last where I downed my child's portion of Imodium and opened my ginger ale to warm up and go flat during my next nap. After more naps, I am beginning to feel more human. The warm flat ginger ale seems to be staying in place.

I am exhausted. Why isn't my life ever easy?

Better than a sharp stick in the eye

Or whatever that saying is. This morning I am off to another medical adventure. I love these medical adventures that involve needles first thing in the morning. Well its not first thing first thing. I get breakfast first after sleeping in a little bit.

The reason I am having this is because I have a bony growth on my neck between C4 and C5. As a result I have a pain in my neck and problems with my shoulders and top half of my arms. It lines up exactly with this picture below.

I don't have pain in my arms and shoulders but they don't seem to work always and are uncomfortable. So after discovering this new issue which is life long, not curable by surgery, but only treatable for the symptoms. So I am off to have this wonderful procedure this morning.

I can't wait. It sounds like so much fun.I even watched the video after convincing myself it was okay. But then I'll lie around and be justifiably lazy for the rest of the day.

I'm not that standardized

Here's a new proposal. Give surgeon's a black box to help prevent medical errors, like they have in air planes.

The proposal:

"Inside the operating room, video cameras track every movement. Outside, a small computer-like device analyzes the recordings, identifying when mistakes are made and providing instant feedback to surgeons as they operate.

This is the dream of the surgical "black box." Operations could become flawless. Post-operative complications could be significantly reduced. Surgeons could review the footage to improve their technique and prep for the next big case."

The goal is so a surgeon learns of a mistake when it can be corrected and not after the fact. They get a computer assist. And more significantly they could be adopted in the US without FDA approval as they are not a device or anything.

I'm not saying that I am against improving medical errors or anything. I have myself dealt with a few mishaps in the OR but I do not think the human body is standard enough for this. Each human is unique. That's it. We are all one of a kind.

If someone wants to operate on me, I have many issues - from lack of thyroid, previous surgeries which have left scars, and more. I know they can be programmed into a computer before hand but still.  An individual human being is needed who can interpret the information and unique qualities of the body they have opened up in front of them.

I think of it this way. You are going to a strange place and you program the address into your GPS and start on your merry way. But then the GPS sends you to a road which has a detour and it recalculates around it, so you keep going. It even tells you when you are speeding to give you additional information and recalculates your arrival time. Then it forgets to tell you that the off ramp is on the left and not the right. And then there is an accident ahead so you try to get off the highway and make another detour. And then your GPS sends you down a one way street in the wrong direction.

You needed a human there to guide you to read the signs and notice the detour ahead. Or to tell you about a new problem the patient is having.

A friend had a bad colonscopy and had to have a colectomy. The surgery took much longer than expected because the doctor who removed the polyp at the colonscopy did not note correctly where it was that it happened so the surgeon had to spend quite a bit of time looking for the exact spot. What would that little black box do then? React like the robot in "Lost in Space"? 'Danger, Will Robinson, danger!' That wouldn't exactly prevent much of anything.

There is research going on with these currently in Canada with plans to test them in Canada, Denmark and South America.

But I am really not ready for them to be used on me anytime soon. I would rather have a better trained surgeon than a computer assisted surgeon operating on me.

Why do they do that?

I have a policy with myself for when to call my back pain doctor. When I get to the point of needing 2-3 breakthrough pain pills to get through the day, its time to make the call for an appointment. I have been at that point for a while and got in to see him yesterday afternoon.

My points of discussion with him were two: My right SI joint is in serious need of having its nerves killed off and my varying total back pain needs to be discussed. We don't always change my pain meds at a single appointment, we often discuss them over a few appointments before making changes.

My right SI joint (which is the long seam joint down the side of your tailbone if you are wondering) has been giving me problems for months. We have had the treatment discussion before but previously we have focused on other pain areas.

Yesterday afternoon, he  had me lie on the exam table and he moved my legs around and pressed on my hip. That hurt. Then he had me lie on my side and he pressed right on the SI joint. That was like a live wire running through me. I had to catch my breath after.

I think he realized how much it hurt and said he would send the nurse in to schedule my treatment. It took a while for me to recover from the amount of pain. I know he had to make sure he knew where the pain was coming from before heated needles to kill the nerves - because you really don't want to kill the wrong nerves.... But, yowza!

October 25 is the date for the treatment... It will be three years from the last one, which was the second one on the same place. These treatments (radiofrequency) can be repeated over and over again and each time the nerves come back, it takes longer and longer and they are weaker and weaker so the pain levels are less and less.

On a side note, my pain management doctor says I can actually take up to 8 break through pain pills a day and he considers 2-3 a day a very low dose. But my rheumatologist tells me that from her point of view, 3 should be the maximum because of convulsions. Its the different perspective from the two doctors that gets damn confusing.

Practice makes perfect

And why its a medical practice. I have had eight surgeries and a billion medical (mis)adventures but I have NEVER asked this question of the person doing the procedure: how many times have you done this procedure? I have never asked that. And this is scary.

A couple of weeks ago I had a filling, a rather large filling to be precise, which is/was borderline for turning into a root canal. I hate the dentist. I hate the drilling and the needles and the potential pain. I am a weinie and have been know to take an ativan pre-procedure to get me through it.

The dentist and I had a big conversation as we waited for the Novocain to kick in. She said if it turned out I needed a root canal she would send me to an endodontist because she didn't do root canals any more. She told me that she said an endodontist would have me in and out  in and hour because that is what they did all day long and they were very good and had the right tools and microscopes and all sorts of fun things I didn't want to hear about it.

Doctors who do the same procedure day in and day out have a much lower rate of errors and mistakes. You really want the doctor who does the same surgery again and again. Go read that article if you don't believe me. But I think its time I start asking questions....

Stupid stomach flu or how having ailments complicates everything.

I woke up at 430 this morning running to the bathroom in one of the inglorious sprints that have happened to all of us. Eventually I returned to bed and informed my husband I was going nowhere today. And the delicate cat wanted to sit on my stomach.

My husband was concerned but went out the door and I went back to sleep until 830 where I struggled mightily to be functional and eventually called work to inform them I would not be available today. My coworker who answered the phone recommended warm flat ginger ale. That sounded very good. I did try some ginger tea but it just wasn't the same. I normally try to live on the BRAT diet when not feeling well but the tea did not sit in my stomach and I tried a tiny nibble of a banana with the same result.

Between bathroom sprints I came up with two things I needed - warm flat ginger ale and something OTC that I could take to stop my sprints - that hadn't expired in 2008 or 2009 which is what we had in the bathroom. Between dashes, I was returning to bed in my pjs.

With that decision made, the next one was 'can I really go to Walgreen's in my PJs with a fleece over them'? I made the executive decision that I wasn't THAT sick and did manage clean clothes.

Its approximately 200 yards from my front door to Walgreen's. But I drove. I stumbled around the store looking for  the digestive ailments aisle where there are two options - Immodium and Kaopectate. I tried reading the labels but there were all sorts of conflicting things on them

One said not to take without consulting a physician if you are on arthritis medications and the other said not to take if you have liver disease. I don't have liver disease but my liver numbers are closely supervised because of my other health ailments.

I went off to ask the pharmacist where I was told I can't take Kaopectate because it conflicts with my arthritis medication. And Imodium is not that good an idea because of liver issues that I can take it but the least dose possible.

One item down, I went to look for ginger ale. I checked the cold beverage section and it was full of Pepsi Cola products and Coca Cola products and a bunch of weird 'waters'. They didn't have any ginger ale. How can that be? I checked the shelves in the food and beverage section and none there either. I left astonished. Ginger ale is a healthful beverage for upset digestion systems.

Out in the parking lot, I thought where to next? The grocery store would have it but that was a whole mile and I really didn't think I want to deal with a big store. There is a smaller convenience store right up the road that might have it. If not, I was willing to bet that the liquor store had it for mixers.

The convenience store did have it. I grabbed three bottles and went to pay. $5.40 and I had no cash. The little sign said '$7.00 minimum on cards'. Crap. I thought about buying another but the owner had sympathy.

Home at last where I downed my child's portion of Imodium and opened my ginger ale to warm up and go flat during my next nap. After more naps, I am beginning to feel more human. The warm flat ginger ale seems to be staying in place.

I am exhausted. Why isn't my life ever easy?

Living with medical errors

I have a picture some place of when I went for knee surgery in 2001 of me home from the hospital with a big bandage on my right knee and the word "NO" scrawled in big letters on  my right knee. This was written by the surgeon after triple confirming with me.

Then I have the memory of me after gall bladder surgery in 2008 where I heard the nurses talking about the excessive bruising on my abdomen after a laproscopic procedure. Basically I heard the doctor must have been really rough on me because of the size and speed at which the bruise arrived - and ho w long it hurt afterwards.

In the past few years the state of Massachusetts has started requiring hospitals to report medical incidents - anything from a fall, surgery problem, wrong medicine, bedsores - annually. In the past three years - 2011-2013 - the rate has risen extensively from 366 incidents to 444 to 753 in 2013. And you say 'why the increase?' How about the electronic reporting system was adopted in 2012.

This all makes me say hmmmm..... Its nice the state wants the data reported and is requiring the electronic reporting system so that things can't be swept under the rug, so to speak. But what about me as a patient?

There is all sorts of advice given but I think it goes down to your comfort level. Lets face it, errors happen in life, 'to err is human'. But as patients we need to speak up and ask questions - what will happen, what should I expect, and communicate with family members so they can ask questions.

I would like to say that of the 753 events in 2013, 282 or 37.5% were from falls. The next largest group was 230 or 30.5% were from bedsores. The leading number after that was 44 serious injury or death from medication error.