Hospital Discharge Is One of the Most Dangerous Times for Patients
Mexican Indigenous Immigrants' Dire Need for Medical Interpreters
How Rudeness in Health Care Can Hurt Patients
Miscommunication A Major Cause of Medical Error, Study Shows
Rarely Mentioned Medical Mistake: Patients Harmed by High Rates of Misdiagnosis
Doing Things Right: Why Three Hospitals Didn't Hurt My Wife
Something's Been Bugging Me
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KQED","description":null,"ogImgSrc":"https://secure.gravatar.com/avatar/66de4bf6d331fa7402bba1ffe8135e17?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/66de4bf6d331fa7402bba1ffe8135e17?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/state-of-health"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"firebase":{"requesting":{},"requested":{},"timestamps":{},"data":{},"ordered":{},"auth":{"isLoaded":false,"isEmpty":true},"authError":null,"profile":{"isLoaded":false,"isEmpty":true},"listeners":{"byId":{},"allIds":[]},"isInitializing":false,"errors":[]},"navBarReducer":{"navBarId":"home","fullView":true,"showPlayer":false},"navMenuReducer":{"menus":[{"key":"menu1","items":[{"name":"News","link":"/","type":"title"},{"name":"Politics","link":"/politics"},{"name":"Science","link":"/science"},{"name":"Education","link":"/educationnews"},{"name":"Housing","link":"/housing"},{"name":"Immigration","link":"/immigration"},{"name":"Criminal 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FM","link":"/"}},"stateofhealth_179751":{"type":"posts","id":"stateofhealth_179751","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"179751","score":null,"sort":[1462299741000]},"guestAuthors":[],"slug":"hospital-discharge-is-one-of-the-most-dangerous-times-for-patients","title":"Hospital Discharge Is One of the Most Dangerous Times for Patients","publishDate":1462299741,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Within two weeks of Joyce Oyler’s discharge from the hospital, sores developed in her mouth and throat, and blood began seeping from her nose and bowels.\u003c/p>\n\u003cp>Her daughter traced the source to the medicine bottles in Oyler’s home in St. Joseph, Missouri. One drug that keeps heart patients like Oyler from retaining fluids was missing. In its place was a toxic drug with a similar name but different purpose, primarily to treat cancer and severe arthritis. The label said to take it daily.\u003c/p>\n\u003cp>“I gathered all her medicine, and as soon as I saw that bottle, I knew she couldn’t come back from this,” said the daughter, Kristin Sigg, an oncology nurse. “There were many layers and mistakes made after she left the hospital. It should have been caught about five different ways.”\u003c/p>\n\u003cp>Oyler’s death occurred at one of the most dangerous junctures in medical care: when patients leave the hospital. Bad coordination often plagues patients’ transitions to the care of home health agencies, as well as to nursing homes and other professionals charged with helping them recuperate, studies show.\u003c/p>\n\u003cp>“Poor transitional care is a huge, huge issue for everybody, but especially for older people with complex needs,” said Alicia Arbaje, an assistant professor at the Johns Hopkins School of Medicine in Baltimore. “The most risky transition is from hospital to home with the additional need for home care services, and that’s the one we know the least about.”\u003c/p>\n\u003cfigure id=\"attachment_179754\" class=\"wp-caption aligncenter\" style=\"max-width: 1600px\">\u003cimg class=\"size-full wp-image-179754\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/042216-Health-Meds-3.jpg\" alt='Joyce Oyler, left, died because of medication mistakes by a Missouri pharmacy and home health agency. Her daughter, holding the photo of her mother and aunt, says the error \"should have been caught about five different ways.\" ' width=\"1600\" height=\"1068\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-3.jpg 1600w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-3-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-3-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-3-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-3-1440x961.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-3-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-3-960x641.jpg 960w\" sizes=\"(max-width: 1600px) 100vw, 1600px\">\u003cfigcaption class=\"wp-caption-text\">Joyce Oyler, left, died because of medication mistakes by a Missouri pharmacy and home health agency. Her daughter, holding the photo of her mother and aunt, says the error \"should have been caught about five different ways.\" \u003ccite>(Travis Young/Austin Walsh Studio/2016 for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Medication mistakes like the one in Oyler’s case — which, according to court records, slipped past both her pharmacist and home health nurses — are in fact one of the \u003ca href=\"https://psnet.ahrq.gov/primers/primer/11\" target=\"_blank\">most common complications\u003c/a> for discharged patients. The \u003ca href=\"http://health.gov/hcq/ade-action-plan.asp\" target=\"_blank\">federal government views\u003c/a> them as “a major patient safety and public health issue,” and a Kaiser Health News analysis of inspection records shows such errors are frequently missed by home health agencies.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Between January 2010 and July 2015, the analysis found, inspectors identified 3,016 home health agencies — nearly a quarter of all those examined by Medicare — that had inadequately reviewed or tracked medications for new patients. In some cases, nurses failed to realize that patients were taking potentially dangerous combinations of drugs, risking abnormal heart rhythms, bleeding, kidney damage and seizures.\u003c/p>\n\u003cp>The variety of providers that patients may use after a hospitalization — including pharmacies, urgent care clinics and a range of specialists — creates fertile ground for error, said Don Goldmann, chief medical and scientific officer at the nonprofit Institute for Healthcare Improvement. “This episodic care at different places at different times is not designed to keep the overall safety of the patient in mind,” Goldmann said.\u003c/p>\n\u003cp>One factor is the lack of organization and communication among these other parts of the medical system. Of the $30 billion that Congress appropriated to help shift the system to electronic medical records — to ensure better coordination of care and reduce errors across the board — none went to nursing homes, rehabilitation facilities or providers working with individuals in their homes.\u003c/p>\n\u003cfigure id=\"attachment_179755\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-179755\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/042216-Health-Meds-4-400x599.jpg\" alt=\"Sigg says many people don’t know that lapses in communication sharing among doctors can lead to danger for patients.\" width=\"400\" height=\"599\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-4-400x599.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-4-800x1199.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-4-768x1151.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-4-960x1438.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-4.jpg 1068w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Sigg says many people don’t know that lapses in communication sharing among doctors can lead to danger for patients. \u003ccite>(Travis Young/Austin Walsh Studio/2016 for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"In retrospect, that might have been a mistake,” said Robert Wachter, a professor at the University of California, San Francisco who studies patient safety. “The systems are not adequately connected.”\u003c/p>\n\u003cp>At any point, problems can occur:\u003c/p>\n\u003cp>— At hospitals, where federal data show that fewer than half of patients say they confidently understood the instructions of how to care for themselves after discharge.\u003c/p>\n\u003cp>— In nursing homes, where case management frequently comes up short. A \u003ca href=\"http://oig.hhs.gov/oei/reports/oei-02-09-00201.pdf\" target=\"_blank\">2013 government report\u003c/a> found more than a third of facilities did not properly assess patients’ needs, devise a plan for their care and then follow it through.\u003c/p>\n\u003cp>— At pharmacies, where counseling and reviewing drugs with patients is often pro forma, and better exertions do not always help. A \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22751755\" target=\"_blank\">2012 study\u003c/a> in the journal Annals of Internal Medicine found that half of patients had a clinically significant medication error within a month of discharge from two highly regarded academic medical centers. The study found that these errors persisted even when pharmacists took a more active role in counseling the patient and reviewing the prescription.\u003c/p>\n\u003cp>— And at home health agencies, where failures to create and execute a care plan are the most common issues government inspectors identify, followed by deficient medication review, according to KHN’s analysis. Over the first half of this decade, 1,591 agencies — one in eight — had a defect inspectors considered so substantial that it warranted the agencies’ removal from the Medicare program unless the lapses were remedied.\u003c/p>\n\u003cp>\u003cstrong>‘Devastating’ Cancer Drug\u003c/strong>\u003c/p>\n\u003cp>Oyler’s death in October 2013 shows how a fatal mistake can slip by multiple checkpoints. The 66-year-old retired safety manager left Heartland Regional Medical Center in St. Joseph after being treated for \u003ca href=\"https://www.nlm.nih.gov/medlineplus/heartfailure.html\" target=\"_blank\">congestive heart failure\u003c/a>, in which the heart fails to pump effectively, causing fluid build-up in the lungs, shortness of breath and swelling in the feet. She returned home as a hospital nurse telephoned the local Hy-Vee Pharmacy with eight new prescriptions. One was for the diuretic metolazone.\u003c/p>\n\u003cp>But the medications a pharmacy technician wrote down did not include metolazone. Instead it listed \u003ca href=\"https://www.nlm.nih.gov/medlineplus/druginfo/meds/a682019.html\" target=\"_blank\">methotrexate\u003c/a>, which can damage blood cell counts, organs and the lining of the mouth, stomach and intestines. The drug is so potent that the Institute for Safe Medication Practices includes it among\u003ca href=\"https://www.ismp.org/communityRx/tools/ambulatoryhighalert.asp\" target=\"_blank\"> eight “high-alert” medications\u003c/a> with consequences so “devastating” that they warrant \u003ca href=\"https://www.ismp.org/hazardalerts/ha.pdf\" target=\"_blank\">special safeguards\u003c/a> against incorrect dispensing.\u003c/p>\n\u003cp>Oyler’s prescription included daily dosage instructions for the diuretic. Methotrexate is never supposed to be taken more than once or twice a week for patients not being treated for cancer, and almost always at a much lower dose.\u003c/p>\n\u003cfigure id=\"attachment_179781\" class=\"wp-caption alignleft\" style=\"max-width: 357px\">\u003cimg class=\"size-full wp-image-179781\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/Screen-Shot-2016-05-03-at-11.17.23-AM.png\" alt=\"Joyce Oyler’s prescription was written for a toxic drug instead of a common diuretic.\" width=\"357\" height=\"255\">\u003cfigcaption class=\"wp-caption-text\">Joyce Oyler’s prescription was written for a toxic drug instead of a common diuretic.\u003c/figcaption>\u003c/figure>\n\u003cp>“Here’s a drug that every patient, even if it’s on the refill, should get counseled on, why they’re taking methotrexate and how they’re taking it because of the mistakes of errors we’ve seen with the daily dosing rather than the weekly dosing,” said Allen Vaida, a pharmacist and executive vice president at the Institute for Safe Medication Practices.\u003c/p>\n\u003cp>In a court deposition taken as part of the lawsuit the family brought, Hy-Vee’s pharmacist blamed himself for not catching the error. “For whatever reason, on that certain day, that didn’t trigger with me,” he said. Hy-Vee argued that its safeguards were as strong as at other pharmacies, although the pharmacy manager admitted in a deposition that “quite honestly, there was a breakdown in the system.”\u003c/p>\n\u003cp>The family’s attorney, Leland Dempsey, said court evidence suggested the drug mix-up was made by the pharmacy technician who transcribed the prescription orders. “The pharmacy tech made numerous spelling errors on the drugs,” he said. “She had a dosage off on another drug.”\u003c/p>\n\u003cp>In February, a jury awarded Oyler’s family $2 million in damages from the pharmacy. The judge lowered the award to $125,000 because of Missouri’s cap for non-economic damages in medical malpractice cases. Hy-Vee declined to comment.\u003c/p>\n\u003cp>\u003cstrong>Nurses Overlook Prescription Mistake\u003c/strong>\u003c/p>\n\u003cp>Yet the error could have been caught right away as Oyler began getting care from Heartland’s home health care agency. Medicare requires home health agencies to examine details of a patient’s medications to ensure all the drugs match the prescriptions ordered, are being taken in the right dose and frequency, and don’t have negative interactions.\u003c/p>\n\u003cp>Less than a year before, Missouri state \u003ca href=\"http://health.mo.gov/cgi-bin/hcrs2.pl?facid=MO267064\" target=\"_blank\">inspectors had cited the agency\u003c/a> for inadequately reviewing medications for three patients, and the agency had pledged to make improvements, records show. Still, neither of two agency nurses who visited Oyler at home stopped her from taking the wrong drug.\u003c/p>\n\u003cp>“Why they didn’t catch it was beyond me,” her husband, Carl, said recently. “They had a printout from the hospital,” with every medication correctly listed. “It was all there,” he said.\u003c/p>\n\u003cfigure id=\"attachment_179753\" class=\"wp-caption aligncenter\" style=\"max-width: 1600px\">\u003cimg class=\"size-full wp-image-179753\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/042216-Health-Meds-2.jpg\" alt=\"Kristin Sigg looks at wedding photos that include her mother. \" width=\"1600\" height=\"1068\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-2.jpg 1600w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-2-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-2-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-2-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-2-1440x961.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-2-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-2-960x641.jpg 960w\" sizes=\"(max-width: 1600px) 100vw, 1600px\">\u003cfigcaption class=\"wp-caption-text\">Kristin Sigg looks at wedding photos that include her mother. \u003ccite>(Travis Young/Austin Walsh Studio/2016 for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>After 18 days, her family took her to North Kansas City Hospital, where doctors determined that the methotrexate had irreparably damaged her bone marrow’s ability to create blood cells. She died three days later of multiple organ failure.\u003c/p>\n\u003cp>“By the time we got her into the emergency room, essentially she had no blood cell count,” her husband recounted. “It was irreversible. It was a gruesome, slow, painful way to die.”\u003c/p>\n\u003cp>Heartland Regional Medical Center paid Oyler’s family $225,000 in a settlement, court records show. Mosaic Life Care, the name by which Heartland now operates, said in a statement that it is “consistently improving processes and adopting new technologies to further reduce risks of errors and to improve communication.”\u003c/p>\n\u003cp>Nonetheless, last November inspectors again cited Heartland for failing to properly review medications for two patients.\u003c/p>\n\u003cp>“Most people don’t know this is a problem,” Sigg said. “They assume doctors are talking to each other, until they experience it, and it’s not the case.”\u003c/p>\n\u003cp>\u003cem>If you’d like to share your reaction to this article and your experience with a home health agency, you can contact Kaiser Health News. Send an email to patients@kff.org.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org/\" target=\"\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Poor communication and coordination put patients at risk at a vulnerable time -- when they're discharged from the hospital.","status":"publish","parent":0,"modified":1462299741,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":36,"wordCount":1726},"headData":{"title":"Hospital Discharge Is One of the Most Dangerous Times for Patients | KQED","description":"Poor communication and coordination put patients at risk at a vulnerable time -- when they're discharged from the hospital.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Hospital Discharge Is One of the Most Dangerous Times for Patients","datePublished":"2016-05-03T18:22:21.000Z","dateModified":"2016-05-03T18:22:21.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"179751 http://ww2.kqed.org/stateofhealth/?p=179751","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/05/03/hospital-discharge-is-one-of-the-most-dangerous-times-for-patients/","disqusTitle":"Hospital Discharge Is One of the Most Dangerous Times for Patients","nprByline":"Jordan Rau\u003cbr />\u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>","path":"/stateofhealth/179751/hospital-discharge-is-one-of-the-most-dangerous-times-for-patients","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Within two weeks of Joyce Oyler’s discharge from the hospital, sores developed in her mouth and throat, and blood began seeping from her nose and bowels.\u003c/p>\n\u003cp>Her daughter traced the source to the medicine bottles in Oyler’s home in St. Joseph, Missouri. One drug that keeps heart patients like Oyler from retaining fluids was missing. In its place was a toxic drug with a similar name but different purpose, primarily to treat cancer and severe arthritis. The label said to take it daily.\u003c/p>\n\u003cp>“I gathered all her medicine, and as soon as I saw that bottle, I knew she couldn’t come back from this,” said the daughter, Kristin Sigg, an oncology nurse. “There were many layers and mistakes made after she left the hospital. It should have been caught about five different ways.”\u003c/p>\n\u003cp>Oyler’s death occurred at one of the most dangerous junctures in medical care: when patients leave the hospital. Bad coordination often plagues patients’ transitions to the care of home health agencies, as well as to nursing homes and other professionals charged with helping them recuperate, studies show.\u003c/p>\n\u003cp>“Poor transitional care is a huge, huge issue for everybody, but especially for older people with complex needs,” said Alicia Arbaje, an assistant professor at the Johns Hopkins School of Medicine in Baltimore. “The most risky transition is from hospital to home with the additional need for home care services, and that’s the one we know the least about.”\u003c/p>\n\u003cfigure id=\"attachment_179754\" class=\"wp-caption aligncenter\" style=\"max-width: 1600px\">\u003cimg class=\"size-full wp-image-179754\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/042216-Health-Meds-3.jpg\" alt='Joyce Oyler, left, died because of medication mistakes by a Missouri pharmacy and home health agency. Her daughter, holding the photo of her mother and aunt, says the error \"should have been caught about five different ways.\" ' width=\"1600\" height=\"1068\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-3.jpg 1600w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-3-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-3-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-3-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-3-1440x961.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-3-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-3-960x641.jpg 960w\" sizes=\"(max-width: 1600px) 100vw, 1600px\">\u003cfigcaption class=\"wp-caption-text\">Joyce Oyler, left, died because of medication mistakes by a Missouri pharmacy and home health agency. Her daughter, holding the photo of her mother and aunt, says the error \"should have been caught about five different ways.\" \u003ccite>(Travis Young/Austin Walsh Studio/2016 for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Medication mistakes like the one in Oyler’s case — which, according to court records, slipped past both her pharmacist and home health nurses — are in fact one of the \u003ca href=\"https://psnet.ahrq.gov/primers/primer/11\" target=\"_blank\">most common complications\u003c/a> for discharged patients. The \u003ca href=\"http://health.gov/hcq/ade-action-plan.asp\" target=\"_blank\">federal government views\u003c/a> them as “a major patient safety and public health issue,” and a Kaiser Health News analysis of inspection records shows such errors are frequently missed by home health agencies.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Between January 2010 and July 2015, the analysis found, inspectors identified 3,016 home health agencies — nearly a quarter of all those examined by Medicare — that had inadequately reviewed or tracked medications for new patients. In some cases, nurses failed to realize that patients were taking potentially dangerous combinations of drugs, risking abnormal heart rhythms, bleeding, kidney damage and seizures.\u003c/p>\n\u003cp>The variety of providers that patients may use after a hospitalization — including pharmacies, urgent care clinics and a range of specialists — creates fertile ground for error, said Don Goldmann, chief medical and scientific officer at the nonprofit Institute for Healthcare Improvement. “This episodic care at different places at different times is not designed to keep the overall safety of the patient in mind,” Goldmann said.\u003c/p>\n\u003cp>One factor is the lack of organization and communication among these other parts of the medical system. Of the $30 billion that Congress appropriated to help shift the system to electronic medical records — to ensure better coordination of care and reduce errors across the board — none went to nursing homes, rehabilitation facilities or providers working with individuals in their homes.\u003c/p>\n\u003cfigure id=\"attachment_179755\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-179755\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/042216-Health-Meds-4-400x599.jpg\" alt=\"Sigg says many people don’t know that lapses in communication sharing among doctors can lead to danger for patients.\" width=\"400\" height=\"599\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-4-400x599.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-4-800x1199.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-4-768x1151.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-4-960x1438.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-4.jpg 1068w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Sigg says many people don’t know that lapses in communication sharing among doctors can lead to danger for patients. \u003ccite>(Travis Young/Austin Walsh Studio/2016 for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"In retrospect, that might have been a mistake,” said Robert Wachter, a professor at the University of California, San Francisco who studies patient safety. “The systems are not adequately connected.”\u003c/p>\n\u003cp>At any point, problems can occur:\u003c/p>\n\u003cp>— At hospitals, where federal data show that fewer than half of patients say they confidently understood the instructions of how to care for themselves after discharge.\u003c/p>\n\u003cp>— In nursing homes, where case management frequently comes up short. A \u003ca href=\"http://oig.hhs.gov/oei/reports/oei-02-09-00201.pdf\" target=\"_blank\">2013 government report\u003c/a> found more than a third of facilities did not properly assess patients’ needs, devise a plan for their care and then follow it through.\u003c/p>\n\u003cp>— At pharmacies, where counseling and reviewing drugs with patients is often pro forma, and better exertions do not always help. A \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22751755\" target=\"_blank\">2012 study\u003c/a> in the journal Annals of Internal Medicine found that half of patients had a clinically significant medication error within a month of discharge from two highly regarded academic medical centers. The study found that these errors persisted even when pharmacists took a more active role in counseling the patient and reviewing the prescription.\u003c/p>\n\u003cp>— And at home health agencies, where failures to create and execute a care plan are the most common issues government inspectors identify, followed by deficient medication review, according to KHN’s analysis. Over the first half of this decade, 1,591 agencies — one in eight — had a defect inspectors considered so substantial that it warranted the agencies’ removal from the Medicare program unless the lapses were remedied.\u003c/p>\n\u003cp>\u003cstrong>‘Devastating’ Cancer Drug\u003c/strong>\u003c/p>\n\u003cp>Oyler’s death in October 2013 shows how a fatal mistake can slip by multiple checkpoints. The 66-year-old retired safety manager left Heartland Regional Medical Center in St. Joseph after being treated for \u003ca href=\"https://www.nlm.nih.gov/medlineplus/heartfailure.html\" target=\"_blank\">congestive heart failure\u003c/a>, in which the heart fails to pump effectively, causing fluid build-up in the lungs, shortness of breath and swelling in the feet. She returned home as a hospital nurse telephoned the local Hy-Vee Pharmacy with eight new prescriptions. One was for the diuretic metolazone.\u003c/p>\n\u003cp>But the medications a pharmacy technician wrote down did not include metolazone. Instead it listed \u003ca href=\"https://www.nlm.nih.gov/medlineplus/druginfo/meds/a682019.html\" target=\"_blank\">methotrexate\u003c/a>, which can damage blood cell counts, organs and the lining of the mouth, stomach and intestines. The drug is so potent that the Institute for Safe Medication Practices includes it among\u003ca href=\"https://www.ismp.org/communityRx/tools/ambulatoryhighalert.asp\" target=\"_blank\"> eight “high-alert” medications\u003c/a> with consequences so “devastating” that they warrant \u003ca href=\"https://www.ismp.org/hazardalerts/ha.pdf\" target=\"_blank\">special safeguards\u003c/a> against incorrect dispensing.\u003c/p>\n\u003cp>Oyler’s prescription included daily dosage instructions for the diuretic. Methotrexate is never supposed to be taken more than once or twice a week for patients not being treated for cancer, and almost always at a much lower dose.\u003c/p>\n\u003cfigure id=\"attachment_179781\" class=\"wp-caption alignleft\" style=\"max-width: 357px\">\u003cimg class=\"size-full wp-image-179781\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/Screen-Shot-2016-05-03-at-11.17.23-AM.png\" alt=\"Joyce Oyler’s prescription was written for a toxic drug instead of a common diuretic.\" width=\"357\" height=\"255\">\u003cfigcaption class=\"wp-caption-text\">Joyce Oyler’s prescription was written for a toxic drug instead of a common diuretic.\u003c/figcaption>\u003c/figure>\n\u003cp>“Here’s a drug that every patient, even if it’s on the refill, should get counseled on, why they’re taking methotrexate and how they’re taking it because of the mistakes of errors we’ve seen with the daily dosing rather than the weekly dosing,” said Allen Vaida, a pharmacist and executive vice president at the Institute for Safe Medication Practices.\u003c/p>\n\u003cp>In a court deposition taken as part of the lawsuit the family brought, Hy-Vee’s pharmacist blamed himself for not catching the error. “For whatever reason, on that certain day, that didn’t trigger with me,” he said. Hy-Vee argued that its safeguards were as strong as at other pharmacies, although the pharmacy manager admitted in a deposition that “quite honestly, there was a breakdown in the system.”\u003c/p>\n\u003cp>The family’s attorney, Leland Dempsey, said court evidence suggested the drug mix-up was made by the pharmacy technician who transcribed the prescription orders. “The pharmacy tech made numerous spelling errors on the drugs,” he said. “She had a dosage off on another drug.”\u003c/p>\n\u003cp>In February, a jury awarded Oyler’s family $2 million in damages from the pharmacy. The judge lowered the award to $125,000 because of Missouri’s cap for non-economic damages in medical malpractice cases. Hy-Vee declined to comment.\u003c/p>\n\u003cp>\u003cstrong>Nurses Overlook Prescription Mistake\u003c/strong>\u003c/p>\n\u003cp>Yet the error could have been caught right away as Oyler began getting care from Heartland’s home health care agency. Medicare requires home health agencies to examine details of a patient’s medications to ensure all the drugs match the prescriptions ordered, are being taken in the right dose and frequency, and don’t have negative interactions.\u003c/p>\n\u003cp>Less than a year before, Missouri state \u003ca href=\"http://health.mo.gov/cgi-bin/hcrs2.pl?facid=MO267064\" target=\"_blank\">inspectors had cited the agency\u003c/a> for inadequately reviewing medications for three patients, and the agency had pledged to make improvements, records show. Still, neither of two agency nurses who visited Oyler at home stopped her from taking the wrong drug.\u003c/p>\n\u003cp>“Why they didn’t catch it was beyond me,” her husband, Carl, said recently. “They had a printout from the hospital,” with every medication correctly listed. “It was all there,” he said.\u003c/p>\n\u003cfigure id=\"attachment_179753\" class=\"wp-caption aligncenter\" style=\"max-width: 1600px\">\u003cimg class=\"size-full wp-image-179753\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/042216-Health-Meds-2.jpg\" alt=\"Kristin Sigg looks at wedding photos that include her mother. \" width=\"1600\" height=\"1068\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-2.jpg 1600w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-2-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-2-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-2-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-2-1440x961.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-2-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-2-960x641.jpg 960w\" sizes=\"(max-width: 1600px) 100vw, 1600px\">\u003cfigcaption class=\"wp-caption-text\">Kristin Sigg looks at wedding photos that include her mother. \u003ccite>(Travis Young/Austin Walsh Studio/2016 for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>After 18 days, her family took her to North Kansas City Hospital, where doctors determined that the methotrexate had irreparably damaged her bone marrow’s ability to create blood cells. She died three days later of multiple organ failure.\u003c/p>\n\u003cp>“By the time we got her into the emergency room, essentially she had no blood cell count,” her husband recounted. “It was irreversible. It was a gruesome, slow, painful way to die.”\u003c/p>\n\u003cp>Heartland Regional Medical Center paid Oyler’s family $225,000 in a settlement, court records show. Mosaic Life Care, the name by which Heartland now operates, said in a statement that it is “consistently improving processes and adopting new technologies to further reduce risks of errors and to improve communication.”\u003c/p>\n\u003cp>Nonetheless, last November inspectors again cited Heartland for failing to properly review medications for two patients.\u003c/p>\n\u003cp>“Most people don’t know this is a problem,” Sigg said. “They assume doctors are talking to each other, until they experience it, and it’s not the case.”\u003c/p>\n\u003cp>\u003cem>If you’d like to share your reaction to this article and your experience with a home health agency, you can contact Kaiser Health News. Send an email to patients@kff.org.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org/\" target=\"\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/179751/hospital-discharge-is-one-of-the-most-dangerous-times-for-patients","authors":["byline_stateofhealth_179751"],"categories":["stateofhealth_13"],"tags":["stateofhealth_53","stateofhealth_2525"],"featImg":"stateofhealth_179752","label":"stateofhealth"},"stateofhealth_83818":{"type":"posts","id":"stateofhealth_83818","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"83818","score":null,"sort":[1443451543000]},"guestAuthors":[],"slug":"need-a-medical-interpreter-try-looking-in-californias-strawberry-fields","title":"Mexican Indigenous Immigrants' Dire Need for Medical Interpreters","publishDate":1443451543,"format":"image","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Imagine you are rushed to the hospital as pain radiates through your chest. Doctors whirl around you, but you don’t know what's happening because everyone is speaking a foreign language.\u003c/p>\n\u003cp>That’s what happened to farmworker Angelina Diaz-Ramirez, 50, after she had a heart attack in a Monterey County green bean field in 2012.\u003c/p>\n\u003cp>The foreman of her work crew took her to the main road and put her in an ambulance, alone. Diaz-Ramirez is an immigrant from Mexico, and while there were Spanish-speaking staff, she was still isolated by a language barrier.\u003c/p>\n\u003cp>That's because Diaz-Ramirez, like a third of California farmworkers, speaks a language indigenous to southern Mexico. She doesn’t understand Spanish. Her language, Triqui, is as different from Spanish as Navajo is from English.\u003c/p>\n\u003cp>https://vimeo.com/140479930\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>At the hospital, without a Triqui interpreter, “no one explained anything to me,” said Diaz-Ramirez.\u003c/p>\n\u003cp>“I was scared, but I didn’t have a choice,\" she said.\u003c/p>\n\u003cp>As anesthesia blotted out the operating room, Diaz-Ramirez had no idea a surgeon was about to cut open her chest to implant a pacemaker.\u003c/p>\n\u003cp>\u003cstrong>Medical Interpreters Are Key\u003c/strong>\u003c/p>\n\u003cp>Diaz-Ramirez’s case highlights the importance of trained medical interpreters, researchers say.\u003c/p>\n\u003caside class=\"pullquote alignright\">'No one explained anything to me. I was scared but I didn't have a choice.'\u003ccite>Angelina Diaz-Ramirez, Triqui farmworker who had heart surgery without an interpreter\u003c/cite>\u003c/aside>\n\u003cp>Interpreters are “absolutely necessary,” said Alicia Fernandez, a medical interpretation expert at UC San Francisco, because quality health care and basic informed consent are nearly impossible without one.\u003c/p>\n\u003cp>Interpreters “enormously increase patient understanding and satisfaction,” said Fernandez. She adds that interpreters also “increase physician satisfaction with the care they deliver.”\u003c/p>\n\u003cp>Medicine, she said, is not an antiseptic, scientific process. Doctors can’t just scan, medicate and operate. Clear communication is essential for accurate diagnosis and effective treatment.\u003c/p>\n\u003cp>[contextly_sidebar id=\"2KQd30QKKYZZL3bwvUkl6icTu31wfvST\"]\u003c/p>\n\u003cp>That’s why using improvised sign language, or asking a child to interpret -- just \"getting by\" -- is simply not good enough, said Fernandez.\u003c/p>\n\u003cp>“Getting by leads to mistakes,” she said. “And mistakes can be tragic, for both the patient and the physician.”\u003c/p>\n\u003cp>\u003cstrong>Indigenous Farmworkers Without Interpreters\u003c/strong>\u003c/p>\n\u003cp>Erica Gastelum, a pediatrician in Fresno, regrets that she rarely has access to an interpreter for her Mixteco-speaking patients. She says without one, “You're not able to provide equal care to all comers.”\u003c/p>\n\u003cfigure id=\"attachment_83923\" class=\"wp-caption alignleft\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Lagnuage-map.png\">\u003cimg class=\"wp-image-83923 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Lagnuage-map-400x225.png\" alt=\"This map shows where Mexican indigenous languages originate. Triqui and Mixteco belong to the oto-mangue family, in southwest of the country (Jeremy Raff/KQED). \" width=\"400\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">This map shows where Mexican indigenous languages originate. Triqui and Mixteco belong to the oto-mangue family, in the southwest of the country. (Jeremy Raff/KQED).\u003c/figcaption>\u003c/figure>\n\u003cp>She remembers a 1-year-old boy with fatal congenital heart disease. Doctors had exhausted every option, and the family was gathered in the intensive care unit.\u003c/p>\n\u003cp>“This is it, this is the moment where we’re going to disconnect the tubes,” said Gastelum. “It seemed like they understood. But in such a crucial moment like that, it would have been so much better to have a culturally sensitive, in-person interpreter.”\u003c/p>\n\u003cp>Most hospitals, including Gastelum’s, have telephone services that should let doctors call up an interpreter for any language. In practice, though, the system doesn’t always work for more unusual languages.\u003c/p>\n\u003cp>“When you try to use the phone interpreter line to get the indigenous speaker, you’ll be on hold for like two hours,” said Jasmine Walker, also a pediatrician in Fresno. “Then when you get them, they don't actually speak the language that you need.”\u003c/p>\n\u003cp>Seth Holmes is a physician who lived and worked alongside Triqui migrant farmworkers for 10 years and wrote about his experiences in the book \"\u003ca href=\"http://www.ucpress.edu/book.php?isbn=9780520275140\" target=\"_blank\">Fresh Fruit, Broken Bodies\u003c/a>.\" As the migrants followed crops up and down the West Coast, they often asked Holmes to accompany them to health clinics.\u003c/p>\n\u003cp>In dozens of clinics throughout California, Washington and Oregon, he said, “I have never seen any Triqui person get a medical interpreter.”\u003c/p>\n\u003cp>Hospitals may underestimate how many indigenous patients they have -- and how many interpreters they need -- because many providers assume all Mexicans speak Spanish. Some indigenous people may be afraid to call attention to themselves by asking for an interpreter because they are undocumented.\u003c/p>\n\u003cp>“They don't know that they’re entitled to someone who speaks their language,” said Leoncio Vasquez, who has been training interpreters for 15 years.\u003c/p>\n\u003cp>Any health care facility receiving public money has a legal obligation under both state and federal law to provide an interpreter to every patient who needs one. But only a few health care providers have made\u003ca href=\"http://www.indigenousfarmworkers.org/\" target=\"_blank\"> California’s 120,000 indigenous farmworkers\u003c/a> an explicit priority.\u003c/p>\n\u003cp>\u003cstrong>Interpreting a Big Opportunity for Some Farmworkers\u003c/strong>\u003c/p>\n\u003cp>Brigida Gonzalez, wearing a big \"Qualified Interpreter\" badge, hustles around Natividad Medical Center in Salinas. It's a big building and she’s needed all over.\u003c/p>\n\u003cp>Today she’s a professional employee at a big hospital. A year ago, she was picking strawberries nearby.\u003c/p>\n\u003cfigure id=\"attachment_83917\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Brigida-Patient3-e1443272915487.png\">\u003cimg class=\"wp-image-83917 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Brigida-Patient3-400x225.png\" alt=\"Interpreter Brigida Gonzalez\" width=\"400\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Before interpreter training, Brigida Gonzalez (R) worked in the strawberry fields nearby. \u003ccite>(Jeremy Raff/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In the fields one day, another picker noticed Gonzalez spoke English -- a rarity in agriculture -- and suggested she look into Natividad’s training program.\u003c/p>\n\u003cp>Staff at Natividad were thrilled to hear from Gonzalez, “because it was so hard to find someone who spoke English, Spanish and an indigenous language like Mixteco and Triqui,” she said.\u003c/p>\n\u003cp>Gonzalez completed Natividad's six-month training program for indigenous interpreters, the first of its kind, and now works there part time.\u003c/p>\n\u003cp>\u003cstrong>Not Just Hospitals\u003c/strong>\u003c/p>\n\u003cp>The need for trilingual interpreters like Gonzalez is growing, and it's not just hospitals.\u003c/p>\n\u003cp>Four hours down the coast in Oxnard, all three school districts have hired Mixteco interpreters, and the police have one on contract.\u003c/p>\n\u003cp>Altogether, there are about 20 Mixteco speakers making a good living with their language skills in Ventura County.\u003c/p>\n\u003cp>These opportunities are one reason why Argelia Zarate, the Oxnard school district’s first full-time Mixteco interpreter, encourages students to practice their Mixteco so they don’t lose it.\u003c/p>\n\u003cfigure id=\"attachment_83919\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-1-of-1-e1443466270661.jpg\">\u003cimg class=\"size-full wp-image-83919\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-1-of-1-e1443466270661.jpg\" alt=\"Argelia Zarate, a Mixteco interpreter at the Oxnard School District, encourages students to practice their native languages.\" width=\"1920\" height=\"1280\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Argelia Zarate, a Mixteco interpreter at the Oxnard School District, encourages students to practice their native languages. \u003ccite>(Jeremy Raff/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I didn't go to college, yet I have this job,” said Zarate, “because the community is growing so big that they don't need bilinguals-- they need trilinguals.”\u003c/p>\n\u003cp>The U.S. Bureau of Labor Statistics expects employment of interpreters and translators to grow by\u003ca href=\"http://www.bls.gov/ooh/media-and-communication/interpreters-and-translators.htm\" target=\"_blank\"> 46 percent between 2012 and 2022.\u003c/a> Driving that demand is the \u003ca href=\"http://www.census.gov/content/dam/Census/library/publications/2013/acs/acs-22.pdf\" target=\"_blank\">158 percent increase since 1980 \u003c/a>in the number of people who speak a language other than English at home.\u003c/p>\n\u003cp>Nationally, the median hourly wage for interpreters is $25, compared with $9.09 for farm work.\u003c/p>\n\u003cp>Zarate says the better pay, stable hours and a chance to serve her community all make interpreting a big step up from field work.\u003c/p>\n\u003cp>“Here everybody is nice to you: they talk to you, appreciate what you do,” Zarate said at the elementary school where she works. “In the fields, they treat you like you’re nothing, a slave working for a little bit of money.”\u003c/p>\n\u003cp>The Mixteco/Indigena Community Organizing Project has trained dozens of interpreters in Ventura County and has pressured public agencies to make use of them.\u003c/p>\n\u003cfigure id=\"attachment_83920\" class=\"wp-caption alignright\" style=\"max-width: 5010px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-2-of-2.jpg\">\u003cimg class=\"size-full wp-image-83920\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-2-of-2.jpg\" alt=\"Maria, 6, arrived in Oxnard, CA, from the Mexican state of Oaxaca recently and speaks only Mixteco (Jeremy Raff/KQED).\" width=\"5010\" height=\"3340\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2.jpg 5010w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-960x640.jpg 960w\" sizes=\"(max-width: 5010px) 100vw, 5010px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Maria, 6, arrived in Oxnard, CA, from the Mexican state of Oaxaca recently and speaks only Mixteco. (Jeremy Raff/KQED).\u003c/figcaption>\u003c/figure>\n\u003cp>Today, “Ventura County has invested in having better language access than most parts of California, and honestly most parts of Oaxaca,” said Margaret Sawyer, the group’s development director, referring to the Mexican state that many Mixteco migrants are from.\u003c/p>\n\u003cp>\u003cstrong>Barriers Remain\u003c/strong>\u003c/p>\n\u003cp>Not everyone trilingual can make the switch from farm work, though, because there are only a few full-time jobs.\u003c/p>\n\u003cp>Instead, most hospitals rely on freelance part-time interpreters, who have a hard time making a living.\u003c/p>\n\u003cp>“They will have you for two or three hours, then you’re done for the whole day,” said Israel Vasquez, a trilingual interpreter. “You can’t really live off that.” He eventually quit because he couldn’t get enough hours.\u003c/p>\n\u003cp>“Making a living specifically in health care interpreting right now is not really going to happen,” said Don Schinske, executive director of the California Healthcare Interpreting Association.\u003c/p>\n\u003cp>Part of the problem, Schinske said, is that even though federal law requires hospitals to provide interpreters, there is not a direct federal funding stream to pay for those services.\u003c/p>\n\u003cp>“You get a lot of this sentiment from hospitals: ‘Look, we’re trying to get people services in their language, but it is a nicety, not a necessity,’ ” said Schinske.\u003c/p>\n\u003cp>The indigenous interpretation programs at Natividad Medical Center are funded by private donations from agricultural businesses in the area, who have contributed $1.7 million since 2010.\u003c/p>\n\u003cp>Meanwhile, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160AB635\" target=\"_blank\">a bill \u003c/a>that would make it easier for hospitals to get federal money for medical interpreters has stalled in the California Legislature.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/225965640\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>\u003cstrong>Wasted Resource\u003c/strong>\u003c/p>\n\u003cp>Farmworker Angelina Diaz-Ramirez returned home after her surgery with a new pacemaker ticking in her chest -- and a stack of printed instructions that she couldn’t read.\u003c/p>\n\u003cp>“I didn’t know what to do,\" she said, through an interpreter. \"I had strong pain. Should I call them back?”\u003c/p>\n\u003cp>Diaz-Ramirez didn’t know who her cardiologist was, how to get an appointment or which medications to take. It's just the kind of confusion that a trained medical interpreter can prevent.\u003c/p>\n\u003cp>\"I just felt very sad,\" she said.\u003c/p>\n\u003cp>Every week, indigenous people with these same questions visit Leoncio Vasquez, the interpreter trainer in Fresno.\u003c/p>\n\u003cp>He looks through their paperwork, pieces together a backstory, and helps them figure out what to do next -- something that should have happened at the hospital or clinic, with one of the dozens of interpreters Vasquez has already trained.\u003c/p>\n\u003cp>But those interpreters “can’t find jobs related to interpreting,” said Vasquez. What do they do instead? “Some go back to the fields to do farm work.”\u003c/p>\n\u003cp>To Vasquez, it's a waste. He says that until more hospitals recognize these immigrants’ valuable language skills, trained interpreters will stay in the fields, picking strawberries.\u003c/p>\n\u003cp>\u003cem>This piece was produced with support from the Institute for Justice and Journalism.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ci>California has the seventh-largest economy in the world, and immigrants have a long history in building that prosperity. Today one out of every three working people in California is an immigrant — a share that has grown in recent decades. Our state is shaped by these workers and entrepreneurs — 6 million people who’ve found a job in the Golden State. In our series “\u003ca href=\"http://ww2.kqed.org/news/series/california-immigrants-at-work\">Immigrant Shift\u003c/a>,” KQED and The California Report explore the impact they have, the challenges they face and the policies that affect them.\u003c/i>\u003c/p>\n\n","blocks":[],"excerpt":"One in three California farmworkers speaks an indigenous language and barely understands Spanish. ","status":"publish","parent":0,"modified":1443477793,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":67,"wordCount":1896},"headData":{"title":"Mexican Indigenous Immigrants' Dire Need for Medical Interpreters | KQED","description":"One in three California farmworkers speaks an indigenous language and barely understands Spanish. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Mexican Indigenous Immigrants' Dire Need for Medical Interpreters","datePublished":"2015-09-28T14:45:43.000Z","dateModified":"2015-09-28T22:03:13.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"83818 http://ww2.kqed.org/stateofhealth/?p=83818","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/09/28/need-a-medical-interpreter-try-looking-in-californias-strawberry-fields/","disqusTitle":"Mexican Indigenous Immigrants' Dire Need for Medical Interpreters","path":"/stateofhealth/83818/need-a-medical-interpreter-try-looking-in-californias-strawberry-fields","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Imagine you are rushed to the hospital as pain radiates through your chest. Doctors whirl around you, but you don’t know what's happening because everyone is speaking a foreign language.\u003c/p>\n\u003cp>That’s what happened to farmworker Angelina Diaz-Ramirez, 50, after she had a heart attack in a Monterey County green bean field in 2012.\u003c/p>\n\u003cp>The foreman of her work crew took her to the main road and put her in an ambulance, alone. Diaz-Ramirez is an immigrant from Mexico, and while there were Spanish-speaking staff, she was still isolated by a language barrier.\u003c/p>\n\u003cp>That's because Diaz-Ramirez, like a third of California farmworkers, speaks a language indigenous to southern Mexico. She doesn’t understand Spanish. Her language, Triqui, is as different from Spanish as Navajo is from English.\u003c/p>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"vimeoLink","attributes":{"named":{"vimeoId":"140479930"},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>At the hospital, without a Triqui interpreter, “no one explained anything to me,” said Diaz-Ramirez.\u003c/p>\n\u003cp>“I was scared, but I didn’t have a choice,\" she said.\u003c/p>\n\u003cp>As anesthesia blotted out the operating room, Diaz-Ramirez had no idea a surgeon was about to cut open her chest to implant a pacemaker.\u003c/p>\n\u003cp>\u003cstrong>Medical Interpreters Are Key\u003c/strong>\u003c/p>\n\u003cp>Diaz-Ramirez’s case highlights the importance of trained medical interpreters, researchers say.\u003c/p>\n\u003caside class=\"pullquote alignright\">'No one explained anything to me. I was scared but I didn't have a choice.'\u003ccite>Angelina Diaz-Ramirez, Triqui farmworker who had heart surgery without an interpreter\u003c/cite>\u003c/aside>\n\u003cp>Interpreters are “absolutely necessary,” said Alicia Fernandez, a medical interpretation expert at UC San Francisco, because quality health care and basic informed consent are nearly impossible without one.\u003c/p>\n\u003cp>Interpreters “enormously increase patient understanding and satisfaction,” said Fernandez. She adds that interpreters also “increase physician satisfaction with the care they deliver.”\u003c/p>\n\u003cp>Medicine, she said, is not an antiseptic, scientific process. Doctors can’t just scan, medicate and operate. Clear communication is essential for accurate diagnosis and effective treatment.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>That’s why using improvised sign language, or asking a child to interpret -- just \"getting by\" -- is simply not good enough, said Fernandez.\u003c/p>\n\u003cp>“Getting by leads to mistakes,” she said. “And mistakes can be tragic, for both the patient and the physician.”\u003c/p>\n\u003cp>\u003cstrong>Indigenous Farmworkers Without Interpreters\u003c/strong>\u003c/p>\n\u003cp>Erica Gastelum, a pediatrician in Fresno, regrets that she rarely has access to an interpreter for her Mixteco-speaking patients. She says without one, “You're not able to provide equal care to all comers.”\u003c/p>\n\u003cfigure id=\"attachment_83923\" class=\"wp-caption alignleft\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Lagnuage-map.png\">\u003cimg class=\"wp-image-83923 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Lagnuage-map-400x225.png\" alt=\"This map shows where Mexican indigenous languages originate. Triqui and Mixteco belong to the oto-mangue family, in southwest of the country (Jeremy Raff/KQED). \" width=\"400\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">This map shows where Mexican indigenous languages originate. Triqui and Mixteco belong to the oto-mangue family, in the southwest of the country. (Jeremy Raff/KQED).\u003c/figcaption>\u003c/figure>\n\u003cp>She remembers a 1-year-old boy with fatal congenital heart disease. Doctors had exhausted every option, and the family was gathered in the intensive care unit.\u003c/p>\n\u003cp>“This is it, this is the moment where we’re going to disconnect the tubes,” said Gastelum. “It seemed like they understood. But in such a crucial moment like that, it would have been so much better to have a culturally sensitive, in-person interpreter.”\u003c/p>\n\u003cp>Most hospitals, including Gastelum’s, have telephone services that should let doctors call up an interpreter for any language. In practice, though, the system doesn’t always work for more unusual languages.\u003c/p>\n\u003cp>“When you try to use the phone interpreter line to get the indigenous speaker, you’ll be on hold for like two hours,” said Jasmine Walker, also a pediatrician in Fresno. “Then when you get them, they don't actually speak the language that you need.”\u003c/p>\n\u003cp>Seth Holmes is a physician who lived and worked alongside Triqui migrant farmworkers for 10 years and wrote about his experiences in the book \"\u003ca href=\"http://www.ucpress.edu/book.php?isbn=9780520275140\" target=\"_blank\">Fresh Fruit, Broken Bodies\u003c/a>.\" As the migrants followed crops up and down the West Coast, they often asked Holmes to accompany them to health clinics.\u003c/p>\n\u003cp>In dozens of clinics throughout California, Washington and Oregon, he said, “I have never seen any Triqui person get a medical interpreter.”\u003c/p>\n\u003cp>Hospitals may underestimate how many indigenous patients they have -- and how many interpreters they need -- because many providers assume all Mexicans speak Spanish. Some indigenous people may be afraid to call attention to themselves by asking for an interpreter because they are undocumented.\u003c/p>\n\u003cp>“They don't know that they’re entitled to someone who speaks their language,” said Leoncio Vasquez, who has been training interpreters for 15 years.\u003c/p>\n\u003cp>Any health care facility receiving public money has a legal obligation under both state and federal law to provide an interpreter to every patient who needs one. But only a few health care providers have made\u003ca href=\"http://www.indigenousfarmworkers.org/\" target=\"_blank\"> California’s 120,000 indigenous farmworkers\u003c/a> an explicit priority.\u003c/p>\n\u003cp>\u003cstrong>Interpreting a Big Opportunity for Some Farmworkers\u003c/strong>\u003c/p>\n\u003cp>Brigida Gonzalez, wearing a big \"Qualified Interpreter\" badge, hustles around Natividad Medical Center in Salinas. It's a big building and she’s needed all over.\u003c/p>\n\u003cp>Today she’s a professional employee at a big hospital. A year ago, she was picking strawberries nearby.\u003c/p>\n\u003cfigure id=\"attachment_83917\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Brigida-Patient3-e1443272915487.png\">\u003cimg class=\"wp-image-83917 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Brigida-Patient3-400x225.png\" alt=\"Interpreter Brigida Gonzalez\" width=\"400\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Before interpreter training, Brigida Gonzalez (R) worked in the strawberry fields nearby. \u003ccite>(Jeremy Raff/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In the fields one day, another picker noticed Gonzalez spoke English -- a rarity in agriculture -- and suggested she look into Natividad’s training program.\u003c/p>\n\u003cp>Staff at Natividad were thrilled to hear from Gonzalez, “because it was so hard to find someone who spoke English, Spanish and an indigenous language like Mixteco and Triqui,” she said.\u003c/p>\n\u003cp>Gonzalez completed Natividad's six-month training program for indigenous interpreters, the first of its kind, and now works there part time.\u003c/p>\n\u003cp>\u003cstrong>Not Just Hospitals\u003c/strong>\u003c/p>\n\u003cp>The need for trilingual interpreters like Gonzalez is growing, and it's not just hospitals.\u003c/p>\n\u003cp>Four hours down the coast in Oxnard, all three school districts have hired Mixteco interpreters, and the police have one on contract.\u003c/p>\n\u003cp>Altogether, there are about 20 Mixteco speakers making a good living with their language skills in Ventura County.\u003c/p>\n\u003cp>These opportunities are one reason why Argelia Zarate, the Oxnard school district’s first full-time Mixteco interpreter, encourages students to practice their Mixteco so they don’t lose it.\u003c/p>\n\u003cfigure id=\"attachment_83919\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-1-of-1-e1443466270661.jpg\">\u003cimg class=\"size-full wp-image-83919\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-1-of-1-e1443466270661.jpg\" alt=\"Argelia Zarate, a Mixteco interpreter at the Oxnard School District, encourages students to practice their native languages.\" width=\"1920\" height=\"1280\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Argelia Zarate, a Mixteco interpreter at the Oxnard School District, encourages students to practice their native languages. \u003ccite>(Jeremy Raff/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I didn't go to college, yet I have this job,” said Zarate, “because the community is growing so big that they don't need bilinguals-- they need trilinguals.”\u003c/p>\n\u003cp>The U.S. Bureau of Labor Statistics expects employment of interpreters and translators to grow by\u003ca href=\"http://www.bls.gov/ooh/media-and-communication/interpreters-and-translators.htm\" target=\"_blank\"> 46 percent between 2012 and 2022.\u003c/a> Driving that demand is the \u003ca href=\"http://www.census.gov/content/dam/Census/library/publications/2013/acs/acs-22.pdf\" target=\"_blank\">158 percent increase since 1980 \u003c/a>in the number of people who speak a language other than English at home.\u003c/p>\n\u003cp>Nationally, the median hourly wage for interpreters is $25, compared with $9.09 for farm work.\u003c/p>\n\u003cp>Zarate says the better pay, stable hours and a chance to serve her community all make interpreting a big step up from field work.\u003c/p>\n\u003cp>“Here everybody is nice to you: they talk to you, appreciate what you do,” Zarate said at the elementary school where she works. “In the fields, they treat you like you’re nothing, a slave working for a little bit of money.”\u003c/p>\n\u003cp>The Mixteco/Indigena Community Organizing Project has trained dozens of interpreters in Ventura County and has pressured public agencies to make use of them.\u003c/p>\n\u003cfigure id=\"attachment_83920\" class=\"wp-caption alignright\" style=\"max-width: 5010px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-2-of-2.jpg\">\u003cimg class=\"size-full wp-image-83920\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-2-of-2.jpg\" alt=\"Maria, 6, arrived in Oxnard, CA, from the Mexican state of Oaxaca recently and speaks only Mixteco (Jeremy Raff/KQED).\" width=\"5010\" height=\"3340\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2.jpg 5010w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-960x640.jpg 960w\" sizes=\"(max-width: 5010px) 100vw, 5010px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Maria, 6, arrived in Oxnard, CA, from the Mexican state of Oaxaca recently and speaks only Mixteco. (Jeremy Raff/KQED).\u003c/figcaption>\u003c/figure>\n\u003cp>Today, “Ventura County has invested in having better language access than most parts of California, and honestly most parts of Oaxaca,” said Margaret Sawyer, the group’s development director, referring to the Mexican state that many Mixteco migrants are from.\u003c/p>\n\u003cp>\u003cstrong>Barriers Remain\u003c/strong>\u003c/p>\n\u003cp>Not everyone trilingual can make the switch from farm work, though, because there are only a few full-time jobs.\u003c/p>\n\u003cp>Instead, most hospitals rely on freelance part-time interpreters, who have a hard time making a living.\u003c/p>\n\u003cp>“They will have you for two or three hours, then you’re done for the whole day,” said Israel Vasquez, a trilingual interpreter. “You can’t really live off that.” He eventually quit because he couldn’t get enough hours.\u003c/p>\n\u003cp>“Making a living specifically in health care interpreting right now is not really going to happen,” said Don Schinske, executive director of the California Healthcare Interpreting Association.\u003c/p>\n\u003cp>Part of the problem, Schinske said, is that even though federal law requires hospitals to provide interpreters, there is not a direct federal funding stream to pay for those services.\u003c/p>\n\u003cp>“You get a lot of this sentiment from hospitals: ‘Look, we’re trying to get people services in their language, but it is a nicety, not a necessity,’ ” said Schinske.\u003c/p>\n\u003cp>The indigenous interpretation programs at Natividad Medical Center are funded by private donations from agricultural businesses in the area, who have contributed $1.7 million since 2010.\u003c/p>\n\u003cp>Meanwhile, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160AB635\" target=\"_blank\">a bill \u003c/a>that would make it easier for hospitals to get federal money for medical interpreters has stalled in the California Legislature.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/225965640&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/225965640'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Wasted Resource\u003c/strong>\u003c/p>\n\u003cp>Farmworker Angelina Diaz-Ramirez returned home after her surgery with a new pacemaker ticking in her chest -- and a stack of printed instructions that she couldn’t read.\u003c/p>\n\u003cp>“I didn’t know what to do,\" she said, through an interpreter. \"I had strong pain. Should I call them back?”\u003c/p>\n\u003cp>Diaz-Ramirez didn’t know who her cardiologist was, how to get an appointment or which medications to take. It's just the kind of confusion that a trained medical interpreter can prevent.\u003c/p>\n\u003cp>\"I just felt very sad,\" she said.\u003c/p>\n\u003cp>Every week, indigenous people with these same questions visit Leoncio Vasquez, the interpreter trainer in Fresno.\u003c/p>\n\u003cp>He looks through their paperwork, pieces together a backstory, and helps them figure out what to do next -- something that should have happened at the hospital or clinic, with one of the dozens of interpreters Vasquez has already trained.\u003c/p>\n\u003cp>But those interpreters “can’t find jobs related to interpreting,” said Vasquez. What do they do instead? “Some go back to the fields to do farm work.”\u003c/p>\n\u003cp>To Vasquez, it's a waste. He says that until more hospitals recognize these immigrants’ valuable language skills, trained interpreters will stay in the fields, picking strawberries.\u003c/p>\n\u003cp>\u003cem>This piece was produced with support from the Institute for Justice and Journalism.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ci>California has the seventh-largest economy in the world, and immigrants have a long history in building that prosperity. Today one out of every three working people in California is an immigrant — a share that has grown in recent decades. Our state is shaped by these workers and entrepreneurs — 6 million people who’ve found a job in the Golden State. In our series “\u003ca href=\"http://ww2.kqed.org/news/series/california-immigrants-at-work\">Immigrant Shift\u003c/a>,” KQED and The California Report explore the impact they have, the challenges they face and the policies that affect them.\u003c/i>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/83818/need-a-medical-interpreter-try-looking-in-californias-strawberry-fields","authors":["230"],"categories":["stateofhealth_11"],"tags":["stateofhealth_280","stateofhealth_249","stateofhealth_407","stateofhealth_325","stateofhealth_53","stateofhealth_2519","stateofhealth_251"],"featImg":"stateofhealth_83922","label":"stateofhealth"},"stateofhealth_59882":{"type":"posts","id":"stateofhealth_59882","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"59882","score":null,"sort":[1439322380000]},"guestAuthors":[],"slug":"how-rudeness-in-health-care-can-hurt-patients","title":"How Rudeness in Health Care Can Hurt Patients","publishDate":1439322380,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Say you're at work, at a training workshop. You're told that a visiting expert will be observing you. Just before the training starts, he makes a brief statement, telling you and your colleagues that he's \"not impressed\" with the quality of work he's seen at your organization.\u003c/p>\n\u003cp>Rude, huh? Maybe upsetting? But would such behavior affect how you do your job?\u003c/p>\n\u003cp>A new analysis published Monday in the journal \u003ca href=\"http://pediatrics.aappublications.org/content/early/2015/08/05/peds.2015-1385.abstract\" target=\"_blank\">Pediatrics\u003c/a> found exactly that -- even mild rudeness can have \"adverse consequences\" on how medical teams diagnose and treat patients.\u003c/p>\n\u003cp>The experiment that they devised was quite specific: The researchers invited doctors and nurses from the neonatal intensive care unit to a training and disclosed that an outside expert would be studying them. Participants were split into two groups -- one group had the \"rudeness\" intervention, the other did not.\u003c/p>\n\u003cp>Ten minutes after delivering the statement above, the visiting expert also told the intervention group that judging from what he'd seen, the teams \"wouldn't last a week\" in his department at home.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Each group then worked on a mannequin of a 28-week premature infant who had developed \u003ca href=\"http://www.nlm.nih.gov/medlineplus/ency/article/001148.htm\" target=\"_blank\">necrotizing enterocolitis\u003c/a> -- death of intestinal tissue, a serious condition that kills one in four babies who develop it. Their tasks were to diagnose, rapidly and accurately, what was happening to the baby, to determine a course of treatment and correctly perform the treatments.\u003c/p>\n\u003cp>The team that had experienced rudeness performed worse than the control group across a variety of measures, including getting the diagnosis right, performing resuscitation, asking for the right lab tests and much more.\u003c/p>\n\u003cp>Such rudeness is a distraction and affect people's \"cognitive resources,\" said study author Peter Bamberger, a professor of organizational behavior at the Tel Aviv University School of Management. \"Negative interactions in the workplace draw from those resources and put patients at risk because those caring for (patients) just aren’t able to make decisions or process information the way they should,”\u003c/p>\n\u003cp>He said he was surprised by the magnitude of the finding.\u003c/p>\n\u003cp>“Rudeness is a very mild form of incivility,\" he said. \"The statements that were made [in this study] were kind of tactless. This rudeness was really mild -- and the effects were huge.\"\u003c/p>\n\u003cp>Bamberger and his colleagues put their study squarely in the frame of patient safety. They noted that while there had been \"some modest improvements\" since the seminal 1999 Institute of Medicine Report \"\u003ca href=\"http://iom.nationalacademies.org/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf\" target=\"_blank\">To Err Is Human\u003c/a>\" tallied as many as 98,000 deaths a year due to patients error, significant gaps in safety remain.\u003c/p>\n\u003cp>They wrote that they suspected that one major reason was because \"many of the improvements were directed at refining systems and technologies, while neglecting human/relational factors.\"\u003c/p>\n\u003cp>Dr. Calvin Chou is a professor of clinical medicine who \u003ca href=\"http://profiles.ucsf.edu/calvin.chou\" target=\"_blank\">teaches bedside manner courses\u003c/a> to physicians at UC San Francisco. Chou said that while many researchers are looking at ways to improve the quality of care, many efforts are simply window dressing.\u003c/p>\n\u003cp>“This [study] is just emblematic of how complicated health care is and the many different factors that can go into the quality of health care,\" Chou said, and added that \"interpersonal communication is key.\"\u003c/p>\n\u003cp>Bamberger said that it was not just physicians and nurses who need to watch their manners, but that rudeness from patients and families matters too -- although teaching staff to better handle negative interactions with patients and families could help.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“When people are in those kinds of situations where patients’ lives are at stake, emotions sometimes get the best of people,\" Bamberger said. \"Efforts have to be made to try to educate all of those involved in those situations to try to show a little bit more care towards one another.”\u003c/p>\n\n","blocks":[],"excerpt":"You \"wouldn't last a week\" in my department, doctors and nurses were told in a study -- then performed more poorly at diagnosis and treatment. ","status":"publish","parent":0,"modified":1439330761,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":18,"wordCount":633},"headData":{"title":"How Rudeness in Health Care Can Hurt Patients | KQED","description":"You "wouldn't last a week" in my department, doctors and nurses were told in a study -- then performed more poorly at diagnosis and treatment. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"How Rudeness in Health Care Can Hurt Patients","datePublished":"2015-08-11T19:46:20.000Z","dateModified":"2015-08-11T22:06:01.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"59882 http://ww2.kqed.org/stateofhealth/?p=59882","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/08/11/how-rudeness-in-health-care-can-hurt-patients/","disqusTitle":"How Rudeness in Health Care Can Hurt Patients","nprByline":"Alvin Tran","path":"/stateofhealth/59882/how-rudeness-in-health-care-can-hurt-patients","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Say you're at work, at a training workshop. You're told that a visiting expert will be observing you. Just before the training starts, he makes a brief statement, telling you and your colleagues that he's \"not impressed\" with the quality of work he's seen at your organization.\u003c/p>\n\u003cp>Rude, huh? Maybe upsetting? But would such behavior affect how you do your job?\u003c/p>\n\u003cp>A new analysis published Monday in the journal \u003ca href=\"http://pediatrics.aappublications.org/content/early/2015/08/05/peds.2015-1385.abstract\" target=\"_blank\">Pediatrics\u003c/a> found exactly that -- even mild rudeness can have \"adverse consequences\" on how medical teams diagnose and treat patients.\u003c/p>\n\u003cp>The experiment that they devised was quite specific: The researchers invited doctors and nurses from the neonatal intensive care unit to a training and disclosed that an outside expert would be studying them. Participants were split into two groups -- one group had the \"rudeness\" intervention, the other did not.\u003c/p>\n\u003cp>Ten minutes after delivering the statement above, the visiting expert also told the intervention group that judging from what he'd seen, the teams \"wouldn't last a week\" in his department at home.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Each group then worked on a mannequin of a 28-week premature infant who had developed \u003ca href=\"http://www.nlm.nih.gov/medlineplus/ency/article/001148.htm\" target=\"_blank\">necrotizing enterocolitis\u003c/a> -- death of intestinal tissue, a serious condition that kills one in four babies who develop it. Their tasks were to diagnose, rapidly and accurately, what was happening to the baby, to determine a course of treatment and correctly perform the treatments.\u003c/p>\n\u003cp>The team that had experienced rudeness performed worse than the control group across a variety of measures, including getting the diagnosis right, performing resuscitation, asking for the right lab tests and much more.\u003c/p>\n\u003cp>Such rudeness is a distraction and affect people's \"cognitive resources,\" said study author Peter Bamberger, a professor of organizational behavior at the Tel Aviv University School of Management. \"Negative interactions in the workplace draw from those resources and put patients at risk because those caring for (patients) just aren’t able to make decisions or process information the way they should,”\u003c/p>\n\u003cp>He said he was surprised by the magnitude of the finding.\u003c/p>\n\u003cp>“Rudeness is a very mild form of incivility,\" he said. \"The statements that were made [in this study] were kind of tactless. This rudeness was really mild -- and the effects were huge.\"\u003c/p>\n\u003cp>Bamberger and his colleagues put their study squarely in the frame of patient safety. They noted that while there had been \"some modest improvements\" since the seminal 1999 Institute of Medicine Report \"\u003ca href=\"http://iom.nationalacademies.org/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf\" target=\"_blank\">To Err Is Human\u003c/a>\" tallied as many as 98,000 deaths a year due to patients error, significant gaps in safety remain.\u003c/p>\n\u003cp>They wrote that they suspected that one major reason was because \"many of the improvements were directed at refining systems and technologies, while neglecting human/relational factors.\"\u003c/p>\n\u003cp>Dr. Calvin Chou is a professor of clinical medicine who \u003ca href=\"http://profiles.ucsf.edu/calvin.chou\" target=\"_blank\">teaches bedside manner courses\u003c/a> to physicians at UC San Francisco. Chou said that while many researchers are looking at ways to improve the quality of care, many efforts are simply window dressing.\u003c/p>\n\u003cp>“This [study] is just emblematic of how complicated health care is and the many different factors that can go into the quality of health care,\" Chou said, and added that \"interpersonal communication is key.\"\u003c/p>\n\u003cp>Bamberger said that it was not just physicians and nurses who need to watch their manners, but that rudeness from patients and families matters too -- although teaching staff to better handle negative interactions with patients and families could help.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“When people are in those kinds of situations where patients’ lives are at stake, emotions sometimes get the best of people,\" Bamberger said. \"Efforts have to be made to try to educate all of those involved in those situations to try to show a little bit more care towards one another.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/59882/how-rudeness-in-health-care-can-hurt-patients","authors":["byline_stateofhealth_59882"],"categories":["stateofhealth_13"],"tags":["stateofhealth_53","stateofhealth_456"],"featImg":"stateofhealth_60318","label":"stateofhealth"},"stateofhealth_22697":{"type":"posts","id":"stateofhealth_22697","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"22697","score":null,"sort":[1416935587000]},"guestAuthors":[],"slug":"miscommunication-a-major-cause-of-medical-error-study-shows","title":"Miscommunication A Major Cause of Medical Error, Study Shows","publishDate":1416935587,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_22701\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000002248844_Medium-e1416877660799.jpg\">\u003cimg class=\"size-large wp-image-22701\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000002248844_Medium-640x480.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Irene Noguchi\u003c/strong>\u003c/p>\n\u003cp>It seems almost unbelievable, but medical errors may be the third leading cause of death in America, after heart disease and cancer. That's according to \u003ca title=\"http://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Harms.2.aspx\" href=\"http://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Harms.2.aspx\" target=\"_blank\">an analysis\u003c/a> from Journal of Patient Safety. Could the key to change be in better communication? A \u003ca title=\"http://www.nejm.org/doi/full/10.1056/NEJMsa1405556\" href=\"http://www.nejm.org/doi/full/10.1056/NEJMsa1405556\" target=\"_blank\">new study from UC San Francisco\u003c/a> and eight other institutions, says yes. Researchers found that improving communication between health providers can reduce patient injuries from medical errors by 30 percent.\u003c/p>\n\u003cp>The team found that a highly risky period was when patients are transferred or “handed off” between medical providers. Critical information gets passed between doctors, nurses and pharmacists.\u003c/p>\n\u003cp>When there’s a shift change or a patient moves to another hospital, “there’s an opportunity for communication failure,” says Daniel West, professor of pediatrics and vice-chair at UCSF Benioff Children's Hospital.\u003c!--more-->\u003c/p>\n\u003cp>“When there’s a breakdown in communication, it sets the stage for potential errors,” West said recently on \u003ca title=\"http://www.kqed.org/a/forum/R201411130900\" href=\"http://www.kqed.org/a/forum/R201411130900\" target=\"_blank\">KQED’s Forum\u003c/a>. Those errors can lead to upwards of 1,000 deaths per day and cost trillions of dollars in health care costs each year.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Dr. West says there is no national standard for health care [health care is two words/AP style_] providers to follow when it comes to improving that handoff of information.\u003c/p>\n\u003cp>“Usually people learn on the job, what we call a ‘hidden curriculum,’” West says, where information is passed by word-of-mouth among colleagues. He wants to standardize that education with a set curriculum. Dr. West estimates that more than $1.5 billion in savings annually if every U.S. hospital adopted that curriculum.\u003c/p>\n\u003cp>Still, it’s hard to determine the exact number of deaths due to medical errors. In 1999, the Institute of Medicine stunned the public when it \u003ca title=\"http://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx\" href=\"http://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx\" target=\"_blank\">reported that 98,000 people per year\u003c/a> died from hospital mistakes. Last year, in its study, the Journal of Patient Safety found that rate was much higher -- between 210,000 and 440,000 patients suffer some preventable harm that leads to death, researchers found. The numbers vary widely, partly due to reticence in the medical community to report a colleague’s mistakes.\u003c/p>\n\u003cp>Dr. Tejal Gandhi, president of the National Patient Safety Foundation and a professor at Harvard, admits that’s largely due to what she called the “closed door” culture of hospitals. “[We should be] creating a culture where people feel comfortable talking about errors and not feeling they’re going to be fired,” she says. \"We need better systems than simply relying on reporting.”\u003c/p>\n\u003cp>California has laws pertaining to mistakes. Health care professionals are required to report errors to the Department of Public Health, and there are $100-per-day fines for non-reporting. “Laws and regulations can really incentivize people to do things differently,” says Betsy Imholz, an expert on health policy for Consumers Union.. But she admits enforcing those laws is “complicated. There isn’t one silver bullet for it.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Doctors don’t want to do badly, they go into the work to heal people,” Imholz says. But public exposure and transparency “can improve things as well.”\u003c/p>\n\n","blocks":[],"excerpt":null,"status":"publish","parent":0,"modified":1416931045,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":13,"wordCount":551},"headData":{"title":"Miscommunication A Major Cause of Medical Error, Study Shows | KQED","description":"By Irene Noguchi It seems almost unbelievable, but medical errors may be the third leading cause of death in America, after heart disease and cancer. That's according to an analysis from Journal of Patient Safety. Could the key to change be in better communication? A new study from UC San Francisco and eight other institutions,","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Miscommunication A Major Cause of Medical Error, Study Shows","datePublished":"2014-11-25T17:13:07.000Z","dateModified":"2014-11-25T15:57:25.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"22697 http://blogs.kqed.org/stateofhealth/?p=22697","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/11/25/miscommunication-a-major-cause-of-medical-error-study-shows/","disqusTitle":"Miscommunication A Major Cause of Medical Error, Study Shows","path":"/stateofhealth/22697/miscommunication-a-major-cause-of-medical-error-study-shows","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_22701\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000002248844_Medium-e1416877660799.jpg\">\u003cimg class=\"size-large wp-image-22701\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000002248844_Medium-640x480.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Irene Noguchi\u003c/strong>\u003c/p>\n\u003cp>It seems almost unbelievable, but medical errors may be the third leading cause of death in America, after heart disease and cancer. That's according to \u003ca title=\"http://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Harms.2.aspx\" href=\"http://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Harms.2.aspx\" target=\"_blank\">an analysis\u003c/a> from Journal of Patient Safety. Could the key to change be in better communication? A \u003ca title=\"http://www.nejm.org/doi/full/10.1056/NEJMsa1405556\" href=\"http://www.nejm.org/doi/full/10.1056/NEJMsa1405556\" target=\"_blank\">new study from UC San Francisco\u003c/a> and eight other institutions, says yes. Researchers found that improving communication between health providers can reduce patient injuries from medical errors by 30 percent.\u003c/p>\n\u003cp>The team found that a highly risky period was when patients are transferred or “handed off” between medical providers. Critical information gets passed between doctors, nurses and pharmacists.\u003c/p>\n\u003cp>When there’s a shift change or a patient moves to another hospital, “there’s an opportunity for communication failure,” says Daniel West, professor of pediatrics and vice-chair at UCSF Benioff Children's Hospital.\u003c!--more-->\u003c/p>\n\u003cp>“When there’s a breakdown in communication, it sets the stage for potential errors,” West said recently on \u003ca title=\"http://www.kqed.org/a/forum/R201411130900\" href=\"http://www.kqed.org/a/forum/R201411130900\" target=\"_blank\">KQED’s Forum\u003c/a>. Those errors can lead to upwards of 1,000 deaths per day and cost trillions of dollars in health care costs each year.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Dr. West says there is no national standard for health care [health care is two words/AP style_] providers to follow when it comes to improving that handoff of information.\u003c/p>\n\u003cp>“Usually people learn on the job, what we call a ‘hidden curriculum,’” West says, where information is passed by word-of-mouth among colleagues. He wants to standardize that education with a set curriculum. Dr. West estimates that more than $1.5 billion in savings annually if every U.S. hospital adopted that curriculum.\u003c/p>\n\u003cp>Still, it’s hard to determine the exact number of deaths due to medical errors. In 1999, the Institute of Medicine stunned the public when it \u003ca title=\"http://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx\" href=\"http://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx\" target=\"_blank\">reported that 98,000 people per year\u003c/a> died from hospital mistakes. Last year, in its study, the Journal of Patient Safety found that rate was much higher -- between 210,000 and 440,000 patients suffer some preventable harm that leads to death, researchers found. The numbers vary widely, partly due to reticence in the medical community to report a colleague’s mistakes.\u003c/p>\n\u003cp>Dr. Tejal Gandhi, president of the National Patient Safety Foundation and a professor at Harvard, admits that’s largely due to what she called the “closed door” culture of hospitals. “[We should be] creating a culture where people feel comfortable talking about errors and not feeling they’re going to be fired,” she says. \"We need better systems than simply relying on reporting.”\u003c/p>\n\u003cp>California has laws pertaining to mistakes. Health care professionals are required to report errors to the Department of Public Health, and there are $100-per-day fines for non-reporting. “Laws and regulations can really incentivize people to do things differently,” says Betsy Imholz, an expert on health policy for Consumers Union.. But she admits enforcing those laws is “complicated. There isn’t one silver bullet for it.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Doctors don’t want to do badly, they go into the work to heal people,” Imholz says. But public exposure and transparency “can improve things as well.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/22697/miscommunication-a-major-cause-of-medical-error-study-shows","authors":["8344"],"categories":["stateofhealth_14","stateofhealth_13"],"tags":["stateofhealth_53"],"label":"stateofhealth"},"stateofhealth_12574":{"type":"posts","id":"stateofhealth_12574","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"12574","score":null,"sort":[1367953485000]},"guestAuthors":[],"slug":"doctors-mistakes-in-diagnosis-rarely-mentioned-harm-patients","title":"Rarely Mentioned Medical Mistake: Patients Harmed by High Rates of Misdiagnosis","publishDate":1367953485,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>\u003cstrong>By Sandra G. Boodman\u003c/strong>, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/May/07/doctor-errors-misdiagnosis-more-common-than-known-serious-impact.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_12578\" class=\"wp-caption aligncenter\" style=\"max-width: 508px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/05/07/doctors-mistakes-in-diagnosis-rarely-mentioned-harm-patients/mistake_gettyimages_thinkstock/\" rel=\"attachment wp-att-12578\">\u003cimg class=\"size-full wp-image-12578\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/05/Mistake_GettyImages_Thinkstock.jpg\" alt=\"(Getty Images)\" width=\"508\" height=\"337\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/05/Mistake_GettyImages_Thinkstock.jpg 508w, https://ww2.kqed.org/app/uploads/sites/27/2013/05/Mistake_GettyImages_Thinkstock-400x265.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/05/Mistake_GettyImages_Thinkstock-320x212.jpg 320w\" sizes=\"(max-width: 508px) 100vw, 508px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Until it happened to him, Dr. Itzhak Brook, a pediatric infectious disease specialist at Georgetown University School of Medicine, didn't think much about the problem of misdiagnosis.\u003c/p>\n\u003cp>That was before doctors at a Maryland hospital repeatedly told Brook his throat pain was the result of acid reflux, not cancer. The correct diagnosis was made by an astute resident who found the tumor -- the size of a peach pit -- using a simple procedure. The experienced head and neck surgeons who regularly examined Brook had never tried it. Because the cancer had grown undetected for seven months, Brook was forced to undergo surgery to remove his voice box, a procedure that has left him speaking in a whisper. He believes that might not have been necessary had the cancer been found earlier.\u003c/p>\n\u003cp>\"I consider myself lucky to be alive,\" said Brook, now 72, of the 2006 ordeal, which he described at a \u003ca href=\"http://www.hopkinscme.edu/CourseDetail.aspx/80028747\">recent international conference\u003c/a> on diagnostic mistakes held in Baltimore. A physician for 40 years, Brook said he was \"really shocked\" by his misdiagnosis.\u003c/p>\n\u003caside class=\"pullquote alignright\">Misdiagnosis “happens all the time ... This is an enormous problem.\"\u003c/aside>\n\u003cp>But patient safety experts say Brook's experience is far from rare. Diagnoses that are missed, incorrect or delayed are believed to affect \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=1362034\">10 to 20 percent\u003c/a> of cases, far exceeding drug errors and surgery on the wrong patient or body part, both of which have received considerably more attention.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Recent studies underscore the extent and potential impact of such errors. To cite just two examples:\u003c!--more-->\u003c/p>\n\u003cul>\n\u003cli>In \u003ca href=\"http://archinte.jamanetwork.com/article.aspx?articleid=1108559\" target=\"_blank\">a 2009 report\u003c/a> of nearly 600 diagnostic mistakes, a full 28 percent of them were life-threatening or resulted in either death or permanent disability\u003c/li>\n\u003cli>Another \u003ca href=\"http://qualitysafety.bmj.com/content/early/2012/07/23/bmjqs-2012-000803.abstract\" target=\"_blank\">analysis last year\u003c/a> found that 40,500 people die annually due to fatal diagnostic errors in U.S. intensive care units. That's roughly equal to the number of deaths each year from breast cancer.\u003c/li>\n\u003c/ul>\n\u003cp>Misdiagnosis \"happens all the time,\" said \u003ca href=\"http://www.hopkinsmedicine.org/neurology_neurosurgery/experts/profiles/team_member_profile/516F40C024FCA3D4B4B633D0E080FE1B/David_Newman-Toker\">David Newman-Toker\u003c/a>, who studies diagnostic errors and helped organize the recent international conference. \"This is an enormous problem, the hidden part of the iceberg of medical errors that dwarfs\" other kinds of mistakes, said Newman-Toker, an associate professor of neurology and otolaryngology at the Johns Hopkins School of Medicine. Studies repeatedly have found that diagnostic errors, which are more common in primary-care settings, typically result from flawed ways of thinking, sometimes coupled with negligence, and not because a disease is rare or exotic.\u003c/p>\n\u003cp>Despite their prevalence and impact, such mistakes have been largely ignored, Newman-Toker and others say. They were mentioned only twice in the \u003ca href=\"http://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx\">Institute of Medicine's landmark 1999 report\u003c/a> on medical errors, an omission some patient safety experts attribute to difficulties measuring such mistakes, the lack of obvious solutions and generalized resistance to addressing the problem.\u003c/p>\n\u003cp>\"You need data to start doing anything,\" said internist \u003ca href=\"http://www.rti.org/newsroom/news.cfm?obj=EF576FDC-5056-B100-0C98FF173CFB5D3F\">Mark L. Graber\u003c/a>, founding president of the Society to Improve Diagnosis in Medicine and a leading errors researcher. Despite dozens of quality measures, Graber said, he is unaware of \"a single hospital in this country trying to count diagnostic errors.\"\u003c/p>\n\u003cp>In the past few years, a confluence of factors has elevated the long-overlooked issue. In his 2007 bestseller, \"\u003ca href=\"http://www.jeromegroopman.com/how-doctors-think.html\">How Doctors Think\u003c/a>,\" Boston hematologist-oncologist Jerome Groopman vividly deconstructed the flawed thought processes that underlie many diagnostic errors, including several he made during his long career.\u003c/p>\n\u003cp>More recently, an influential cadre of medical leaders has been pushing for greater attention to the problem. They cite concerns about the growing complexity of medicine and increasing fragmentation of the health-care system, as well as relentless time pressures squeezing doctors and the overuse of expensive, high-tech tests that have supplanted traditional hands-on skills of physical diagnosis.\u003c/p>\n\u003cp>Publicity about the death last year of 12-year-old \u003ca href=\"http://www.nytimes.com/2012/10/26/nyregion/tale-of-rory-stauntons-death-prompts-new-medical-efforts-nationwide.html\">Rory Staunton\u003c/a>, sent home from an emergency room in New York after doctors missed the raging systemic infection that quickly killed him, have put a human face on the problem.\u003c/p>\n\u003cp>\"One of the reasons it's time to begin looking at it is that so many of the quality measures we use now assume that the diagnosis is the right one in the first place,\" said Christine Cassel, president of the American Board of Internal Medicine.\u003c/p>\n\u003cp>But what if it's not?\u003c/p>\n\u003cp>In a much-cited essay, Robert Wachter, associate chair of the Department of Medicine at the University of California at San Francisco, wrote that a hospital could earn \"performance incentives for giving all of its patients diagnosed with heart failure, pneumonia and heart attack the correct, evidence-based and prompt care -- even if every one of the diagnoses was wrong.\"\u003c/p>\n\u003cp>\u003cstrong>No obvious fix\u003c/strong>\u003c/p>\n\u003cp>Unlike drug errors and wrong-site surgery -- mistakes that patient safety experts consider to be \"low-hanging fruit\" amenable to solutions such as color-coded labels and preoperative timeouts by the surgical team -- there is no easy or obvious fix for diagnostic errors. Many are complex and multifaceted, and may not be discovered for years if ever, said Graber, a senior fellow at RTI International, a research firm based in Research Triangle Park, N.C.\u003c/p>\n\u003cp>\"There is probably nothing more cognitively complicated\" than a diagnosis, he said, \"and the fact that we get it right as often as we do is amazing.\"\u003c/p>\n\u003cp>But doctors often don't know when they've gotten it wrong. Some patients affected by misdiagnosis simply find a new doctor. Unless the mistake results in a lawsuit, the original physician is unlikely to learn that he blew it -- particularly if the discovery is delayed. While diagnostic errors are a leading cause of malpractice litigation, the vast majority do not result in legal action.\u003c/p>\n\u003cp>There is another reason such mistakes have been long ignored: They are regarded as an unusually personal failure in a profession where diagnostic acumen is considered the gold standard.\u003c/p>\n\u003cp>\"This really gets to who we are as clinicians,\" said internist Robert Trowbridge, who directs the medicine clerkship program for Tufts University medical students at Maine Medical Center in Portland.\u003c/p>\n\u003cp>\"Overconfidence in our abilities is a major part of the problem,\" said Graber, who believes doctors have gotten a pass for too long when it comes to diagnostic accuracy. \"Physicians don't know how error-prone they are.\"\u003c/p>\n\u003cp>Many, he noted, wrongly believe that the problem is \"the other guy\" and that they don't make mistakes. A \u003ca href=\"http://www.quantiamd.com/q-qcp/QuantiaMD_PreventingDiagnosticErrors_Whitepaper_1.pdf\">2011 survey\u003c/a> of more than 6,000 physicians found that 96 percent felt that diagnostic errors are preventable; nearly half said they encountered them at least once a month.\u003c/p>\n\u003cp>At Maine Medical Center, Trowbridge spearheaded a pilot program launched in 2010 to persuade doctors to anonymously report diagnostic errors, which would then undergo comprehensive analysis. He said he had to \"hound\" his colleagues to report mistakes. During the first six months, 36 errors that would otherwise have gone unreported were identified; most were deemed to have caused moderate to severe harm.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Trowbridge said the program has changed how he practices. \"I'm much more reflective, much more attuned to the errors I'm prone to make. I work with checklists more.\"\u003c/p>\n\n","blocks":[],"excerpt":"Until it happened to him, Dr. Itzhak Brook, a pediatric infectious disease specialist at Georgetown University School of Medicine, didn't think much about the problem of misdiagnosis.\r\n\r\nThat was before doctors at a Maryland hospital repeatedly told Brook his throat pain was the result of acid reflux, not cancer. The correct diagnosis was made by an astute resident who found the tumor -- the size of a peach pit -- using a simple procedure. The experienced head and neck surgeons who regularly examined Brook had never tried it. Because the cancer had grown undetected for seven months, Brook was forced to undergo surgery to remove his voice box, a procedure that has left him speaking in a whisper. He believes that might not have been necessary had the cancer been found earlier.","status":"publish","parent":0,"modified":1368159957,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":27,"wordCount":1207},"headData":{"title":"Rarely Mentioned Medical Mistake: Patients Harmed by High Rates of Misdiagnosis | KQED","description":"Until it happened to him, Dr. Itzhak Brook, a pediatric infectious disease specialist at Georgetown University School of Medicine, didn't think much about the problem of misdiagnosis.\r\n\r\nThat was before doctors at a Maryland hospital repeatedly told Brook his throat pain was the result of acid reflux, not cancer. The correct diagnosis was made by an astute resident who found the tumor -- the size of a peach pit -- using a simple procedure. The experienced head and neck surgeons who regularly examined Brook had never tried it. Because the cancer had grown undetected for seven months, Brook was forced to undergo surgery to remove his voice box, a procedure that has left him speaking in a whisper. He believes that might not have been necessary had the cancer been found earlier.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Rarely Mentioned Medical Mistake: Patients Harmed by High Rates of Misdiagnosis","datePublished":"2013-05-07T19:04:45.000Z","dateModified":"2013-05-10T04:25:57.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"12574 http://blogs.kqed.org/stateofhealth/?p=12574","disqusUrl":"https://ww2.kqed.org/stateofhealth/2013/05/07/doctors-mistakes-in-diagnosis-rarely-mentioned-harm-patients/","disqusTitle":"Rarely Mentioned Medical Mistake: Patients Harmed by High Rates of Misdiagnosis","path":"/stateofhealth/12574/doctors-mistakes-in-diagnosis-rarely-mentioned-harm-patients","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By Sandra G. Boodman\u003c/strong>, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/May/07/doctor-errors-misdiagnosis-more-common-than-known-serious-impact.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_12578\" class=\"wp-caption aligncenter\" style=\"max-width: 508px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/05/07/doctors-mistakes-in-diagnosis-rarely-mentioned-harm-patients/mistake_gettyimages_thinkstock/\" rel=\"attachment wp-att-12578\">\u003cimg class=\"size-full wp-image-12578\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/05/Mistake_GettyImages_Thinkstock.jpg\" alt=\"(Getty Images)\" width=\"508\" height=\"337\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/05/Mistake_GettyImages_Thinkstock.jpg 508w, https://ww2.kqed.org/app/uploads/sites/27/2013/05/Mistake_GettyImages_Thinkstock-400x265.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/05/Mistake_GettyImages_Thinkstock-320x212.jpg 320w\" sizes=\"(max-width: 508px) 100vw, 508px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Until it happened to him, Dr. Itzhak Brook, a pediatric infectious disease specialist at Georgetown University School of Medicine, didn't think much about the problem of misdiagnosis.\u003c/p>\n\u003cp>That was before doctors at a Maryland hospital repeatedly told Brook his throat pain was the result of acid reflux, not cancer. The correct diagnosis was made by an astute resident who found the tumor -- the size of a peach pit -- using a simple procedure. The experienced head and neck surgeons who regularly examined Brook had never tried it. Because the cancer had grown undetected for seven months, Brook was forced to undergo surgery to remove his voice box, a procedure that has left him speaking in a whisper. He believes that might not have been necessary had the cancer been found earlier.\u003c/p>\n\u003cp>\"I consider myself lucky to be alive,\" said Brook, now 72, of the 2006 ordeal, which he described at a \u003ca href=\"http://www.hopkinscme.edu/CourseDetail.aspx/80028747\">recent international conference\u003c/a> on diagnostic mistakes held in Baltimore. A physician for 40 years, Brook said he was \"really shocked\" by his misdiagnosis.\u003c/p>\n\u003caside class=\"pullquote alignright\">Misdiagnosis “happens all the time ... This is an enormous problem.\"\u003c/aside>\n\u003cp>But patient safety experts say Brook's experience is far from rare. Diagnoses that are missed, incorrect or delayed are believed to affect \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=1362034\">10 to 20 percent\u003c/a> of cases, far exceeding drug errors and surgery on the wrong patient or body part, both of which have received considerably more attention.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Recent studies underscore the extent and potential impact of such errors. To cite just two examples:\u003c!--more-->\u003c/p>\n\u003cul>\n\u003cli>In \u003ca href=\"http://archinte.jamanetwork.com/article.aspx?articleid=1108559\" target=\"_blank\">a 2009 report\u003c/a> of nearly 600 diagnostic mistakes, a full 28 percent of them were life-threatening or resulted in either death or permanent disability\u003c/li>\n\u003cli>Another \u003ca href=\"http://qualitysafety.bmj.com/content/early/2012/07/23/bmjqs-2012-000803.abstract\" target=\"_blank\">analysis last year\u003c/a> found that 40,500 people die annually due to fatal diagnostic errors in U.S. intensive care units. That's roughly equal to the number of deaths each year from breast cancer.\u003c/li>\n\u003c/ul>\n\u003cp>Misdiagnosis \"happens all the time,\" said \u003ca href=\"http://www.hopkinsmedicine.org/neurology_neurosurgery/experts/profiles/team_member_profile/516F40C024FCA3D4B4B633D0E080FE1B/David_Newman-Toker\">David Newman-Toker\u003c/a>, who studies diagnostic errors and helped organize the recent international conference. \"This is an enormous problem, the hidden part of the iceberg of medical errors that dwarfs\" other kinds of mistakes, said Newman-Toker, an associate professor of neurology and otolaryngology at the Johns Hopkins School of Medicine. Studies repeatedly have found that diagnostic errors, which are more common in primary-care settings, typically result from flawed ways of thinking, sometimes coupled with negligence, and not because a disease is rare or exotic.\u003c/p>\n\u003cp>Despite their prevalence and impact, such mistakes have been largely ignored, Newman-Toker and others say. They were mentioned only twice in the \u003ca href=\"http://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx\">Institute of Medicine's landmark 1999 report\u003c/a> on medical errors, an omission some patient safety experts attribute to difficulties measuring such mistakes, the lack of obvious solutions and generalized resistance to addressing the problem.\u003c/p>\n\u003cp>\"You need data to start doing anything,\" said internist \u003ca href=\"http://www.rti.org/newsroom/news.cfm?obj=EF576FDC-5056-B100-0C98FF173CFB5D3F\">Mark L. Graber\u003c/a>, founding president of the Society to Improve Diagnosis in Medicine and a leading errors researcher. Despite dozens of quality measures, Graber said, he is unaware of \"a single hospital in this country trying to count diagnostic errors.\"\u003c/p>\n\u003cp>In the past few years, a confluence of factors has elevated the long-overlooked issue. In his 2007 bestseller, \"\u003ca href=\"http://www.jeromegroopman.com/how-doctors-think.html\">How Doctors Think\u003c/a>,\" Boston hematologist-oncologist Jerome Groopman vividly deconstructed the flawed thought processes that underlie many diagnostic errors, including several he made during his long career.\u003c/p>\n\u003cp>More recently, an influential cadre of medical leaders has been pushing for greater attention to the problem. They cite concerns about the growing complexity of medicine and increasing fragmentation of the health-care system, as well as relentless time pressures squeezing doctors and the overuse of expensive, high-tech tests that have supplanted traditional hands-on skills of physical diagnosis.\u003c/p>\n\u003cp>Publicity about the death last year of 12-year-old \u003ca href=\"http://www.nytimes.com/2012/10/26/nyregion/tale-of-rory-stauntons-death-prompts-new-medical-efforts-nationwide.html\">Rory Staunton\u003c/a>, sent home from an emergency room in New York after doctors missed the raging systemic infection that quickly killed him, have put a human face on the problem.\u003c/p>\n\u003cp>\"One of the reasons it's time to begin looking at it is that so many of the quality measures we use now assume that the diagnosis is the right one in the first place,\" said Christine Cassel, president of the American Board of Internal Medicine.\u003c/p>\n\u003cp>But what if it's not?\u003c/p>\n\u003cp>In a much-cited essay, Robert Wachter, associate chair of the Department of Medicine at the University of California at San Francisco, wrote that a hospital could earn \"performance incentives for giving all of its patients diagnosed with heart failure, pneumonia and heart attack the correct, evidence-based and prompt care -- even if every one of the diagnoses was wrong.\"\u003c/p>\n\u003cp>\u003cstrong>No obvious fix\u003c/strong>\u003c/p>\n\u003cp>Unlike drug errors and wrong-site surgery -- mistakes that patient safety experts consider to be \"low-hanging fruit\" amenable to solutions such as color-coded labels and preoperative timeouts by the surgical team -- there is no easy or obvious fix for diagnostic errors. Many are complex and multifaceted, and may not be discovered for years if ever, said Graber, a senior fellow at RTI International, a research firm based in Research Triangle Park, N.C.\u003c/p>\n\u003cp>\"There is probably nothing more cognitively complicated\" than a diagnosis, he said, \"and the fact that we get it right as often as we do is amazing.\"\u003c/p>\n\u003cp>But doctors often don't know when they've gotten it wrong. Some patients affected by misdiagnosis simply find a new doctor. Unless the mistake results in a lawsuit, the original physician is unlikely to learn that he blew it -- particularly if the discovery is delayed. While diagnostic errors are a leading cause of malpractice litigation, the vast majority do not result in legal action.\u003c/p>\n\u003cp>There is another reason such mistakes have been long ignored: They are regarded as an unusually personal failure in a profession where diagnostic acumen is considered the gold standard.\u003c/p>\n\u003cp>\"This really gets to who we are as clinicians,\" said internist Robert Trowbridge, who directs the medicine clerkship program for Tufts University medical students at Maine Medical Center in Portland.\u003c/p>\n\u003cp>\"Overconfidence in our abilities is a major part of the problem,\" said Graber, who believes doctors have gotten a pass for too long when it comes to diagnostic accuracy. \"Physicians don't know how error-prone they are.\"\u003c/p>\n\u003cp>Many, he noted, wrongly believe that the problem is \"the other guy\" and that they don't make mistakes. A \u003ca href=\"http://www.quantiamd.com/q-qcp/QuantiaMD_PreventingDiagnosticErrors_Whitepaper_1.pdf\">2011 survey\u003c/a> of more than 6,000 physicians found that 96 percent felt that diagnostic errors are preventable; nearly half said they encountered them at least once a month.\u003c/p>\n\u003cp>At Maine Medical Center, Trowbridge spearheaded a pilot program launched in 2010 to persuade doctors to anonymously report diagnostic errors, which would then undergo comprehensive analysis. He said he had to \"hound\" his colleagues to report mistakes. During the first six months, 36 errors that would otherwise have gone unreported were identified; most were deemed to have caused moderate to severe harm.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Trowbridge said the program has changed how he practices. \"I'm much more reflective, much more attuned to the errors I'm prone to make. I work with checklists more.\"\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/12574/doctors-mistakes-in-diagnosis-rarely-mentioned-harm-patients","authors":["8344"],"categories":["stateofhealth_14"],"tags":["stateofhealth_53","stateofhealth_456","stateofhealth_461"],"featImg":"stateofhealth_12578","label":"stateofhealth"},"stateofhealth_964":{"type":"posts","id":"stateofhealth_964","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"964","score":null,"sort":[1323210441000]},"guestAuthors":[],"slug":"doing-things-right-why-three-hospitals-didnt-hurt-my-wife","title":"Doing Things Right: Why Three Hospitals Didn't Hurt My Wife","publishDate":1323210441,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cdiv>\n\u003cfigure id=\"attachment_972\" class=\"wp-caption alignleft\" style=\"max-width: 176px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2011/12/Millenson_and_Susan.jpg\">\u003cimg class=\"size-full wp-image-972 \" title=\"Michael Millenson and his wife, Susan. (Photo: Michael Millenson)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2011/12/Millenson_and_Susan.jpg\" alt=\"Michael Millenson and his wife, Susan. (Photo: Michael Millenson)\" width=\"176\" height=\"250\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Michael Millenson and his wife, Susan. (Photo: Michael Millenson)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By: Michael Millenson\u003c/strong>\u003c/p>\n\u003cp>My wife was lying in the back of an ambulance, dazed and bloody, while I sat in the front, distraught and distracted. We had been bicycling in a quiet neighborhood in southern Maine when she hit the handbrakes too hard and catapulted over the handlebars, turning our first day of vacation into a race to the nearest hospital.\u003c/p>\n\u003cp>The anxiety when a loved one is injured is compounded when you know just how risky making things better can get. As a long-time advocate for patient safety, my interest in the topic has always been passionate, but never personal. Now, as Susan was being rushed into the emergency room, I wanted to keep it that way. \"Wife of patient safety expert is victim\" was a headline I deeply hoped to avoid.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"Wife of patient safety expert is victim\" was a headline I deeply hoped to avoid. \u003c/aside>\n\u003cp>In the weeks after the accident, we spent time at a 50-bed hospital in Maine; a Boston teaching hospital where Susan was transferred with a small vertebra fracture at the base of her neck and broken bones in her left elbow and hand; and a large community hospital near our suburban Chicago home. There were plenty of opportunities for bad things to happen -- but nothing did. As far as I could tell, we didn't even experience any near misses.\u003c/p>\n\u003cp>\u003c!--more-->What went right? After all, though our health care system knows how to prevent errors that kill 44,000 to 98,000 people in hospitals each year, that death toll \u003ca href=\"http://www.nytimes.com/2010/11/25/health/research/25patient.html\">has remained stubbornly constant\u003c/a>. Based on personal and professional observations, I'd simplify the formula that kept Susan safe into three variables: consciousness, culture and cash.\u003c/p>\n\u003cp>Consciousness of patient safety sounds easy, but it isn't. The harm caused patients is inadvertent and often occurs as part of complex interventions. As a result, \u003ca href=\"http://jama.ama-assn.org/content/301/12/1273.short\" target=\"_blank\">a 2009 JAMA commentary\u003c/a> pointedly noted, \"clinicians have labeled virtually all harm as inevitable for decades.\"\u003c/p>\n\u003cp>But today, the cloak of invisibility is being lifted. Twenty-six states require hospitals to report certain medical errors; Medicare and some private insurers won't pay for problems caused by a growing list of quality and safety lapses, and the government has launched the $1 billion Partnership for Patients to dramatically reduce avoidable harm.\u003c/p>\n\u003cp>Just as importantly, patients are worried. In a poll by Consumers Union, 77 percent of respondents expressed high or moderate concern that they might be harmed by a hospital infection and 71 percent had the same concern about medication errors. Inevitably, more patients and their families are speaking up -- as I most certainly did, albeit as politely as possible.\u003c/p>\n\u003cp>When the ER nurse at Maine's York Hospital gave Susan morphine, I asked about the dosage and timing. When she was transferred to Massachusetts General Hospital in Boston, I asked each medical professional to identify themselves and what they were doing. Although it's impossible to know if my questions had any positive impact, at a minimum they reinforced an existing safety consciousness.\u003c/p>\n\u003cp>Although consciousness of a problem can spur change, sustaining it requires a supportive culture. Can there be any more graphic expression of a safety culture commitment than Baylor Health Care System's mission to eliminate preventable deaths, preventable injuries and preventable risk? Or Ascension Health's \"healing without harm\" initiative and its goal of reducing preventable deaths by 900 each year? (They've reached a minimum of 1,500 so far.) Both organizations have published results in the peer-reviewed literature.\u003c/p>\n\u003cp>Glenbrook Hospital in suburban Chicago -- it's part of the NorthShore University HealthSystem -- isn't quite as ambitious in its objectives. Still, its culture was obvious even before I peeked at the monthly infection report left sitting on a reception desk. When the orthopedic surgeon was explaining the procedure he would be doing, he talked about safety. The consulting neurosurgeon (due to Susan's neck injury) talked about safety. The anesthesiologist talked about safety. Right before surgery, nurses fitted Susan with surgical stockings to prevent deep vein thrombosis -- an evidence-based guideline followed by fewer than half of hospitals. When I challenged the surgical team on appropriate prophylactic antibiotic use, a nurse indignantly cited a study showing I was mistaken.\u003c/p>\n\u003cp>I backed off, happy they'd thought about the issue seriously. But I did feel emboldened to ask whether the team in the operating room took time-outs before surgery (the evidence shows it helps make sure everyone's on the same page before you start cutting) and whether the team introduced themselves before proceeding (believe it or not, even the doctors may not be entirely certain who is behind those masks). Yes and yes, the answers came back.\u003c/p>\n\u003cp>Culture change at hospitals is easier these days with \u003ca href=\"http://www.implementationscience.com/content/4/1/25/\">role models\u003c/a> like Ascension and Baylor, and with safety checklists like the one developed by Johns Hopkins' critical care specialist \u003ca href=\"http://www.hopkinsmedicine.org/quality/safety/pronovost/index.html\" target=\"_blank\">Peter Pronovost\u003c/a>. But if consciousness is one barrier to culture change, another one of at least equal importance is cash.\u003c/p>\n\u003cp>There's a link between financial stress and patient distress. A recent study in \u003ca href=\"http://content.healthaffairs.org/content/30/10/1904.abstract\" target=\"_blank\">Health Affairs\u003c/a> found the 178 \"worst\" hospitals in the United States care for more than twice the proportion of elderly minority and poor patients as the nation's 122 \"best\" hospitals, where costs are lowest and quality highest. As one headline put it, \"Bad Hospitals, Poor Patients.\"\u003c/p>\n\u003cp>Money talks in other ways. I've written about how some hospitals implicitly see adverse events \u003ca href=\"http://healthaffairs.org/blog/2010/12/06/why-we-still-kill-patients-invisibility-inertia-and-income/\">as a way to keep beds filled\u003c/a> (although, of course, actual patient deaths thwart that goal). The hospitals where my wife was treated were all prosperous. Even without worrying about a reluctance to confront complications, would a cash-strapped York have transferred Susan to a tertiary care facility, or would they have assured a well-insured patient they could take care of her broken neck? Would a bottom line-driven Mass General or Glenbrook have angled for a longer hospital stay?\u003c/p>\n\u003cp>It's tough enough to change culture. It's even tougher if it you think you’ll lose money doing so. That's why Medicare is increasingly linking payment to explicit quality and safety indicators.\u003c/p>\n\u003cp>We ask a great deal of physicians, nurses and other professionals. Those whom we encountered juggled multiple roles -- healers attending to the ill and scared, prudent managers of health-care resources and team players in system improvement. For the skill and grace with which they performed all those roles we were deeply grateful. Thanks to them, Susan has now recovered to the point that to the casual observer there's no obvious evidence of her multiple injuries.\u003c/p>\n\u003cp>Our experience showed that \"doing the right thing\" -- appropriate care -- and \"doing the right thing right\" -- safe and effective care -- can become the norm at rural, suburban and big urban teaching hospitals alike. On a personal level for the two of us, and on a system level for all of us, that's very good news.\u003c/p>\n\u003cp>\u003cem>Michael L. Millenson is a Highland Park, Illinois-based consultant, a visiting scholar at the Kellogg School of Management and the author of \u003c/em>\u003ca href=\"http://www.press.uchicago.edu/Misc/Chicago/525872.html\" target=\"_blank\">\u003cem>Demanding Medical Excellence: Doctors and Accountability in the Information Age\u003c/em>\u003c/a>\u003cem>. This article first appeared in \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2011/December/05/millenson-first-person-patient-safety.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2011/December/05/millenson-first-person-patient-safety.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>.\u003c/em>\u003c/p>\n\u003c/div>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>[ad floatright]\u003c/p>\n","blocks":[],"excerpt":"My wife was lying in the back of an ambulance, dazed and bloody, while I sat in the front, distraught and distracted. We had been bicycling in a quiet neighborhood in southern Maine when she hit the handbrakes too hard and catapulted over the handlebars, turning our first day of vacation into a race to the nearest hospital.\r\n\r\nThe anxiety when a loved one is injured is compounded when you know just how risky making things better can get. As a long-time advocate for patient safety, my interest in the topic has always been passionate, but never personal. Now, as Susan was being rushed into the emergency room, I wanted to keep it that way. \"Wife of patient safety expert is victim\" was a headline I deeply hoped to avoid.","status":"publish","parent":0,"modified":1323210441,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":21,"wordCount":1233},"headData":{"title":"Doing Things Right: Why Three Hospitals Didn't Hurt My Wife | KQED","description":"My wife was lying in the back of an ambulance, dazed and bloody, while I sat in the front, distraught and distracted. We had been bicycling in a quiet neighborhood in southern Maine when she hit the handbrakes too hard and catapulted over the handlebars, turning our first day of vacation into a race to the nearest hospital.\r\n\r\nThe anxiety when a loved one is injured is compounded when you know just how risky making things better can get. As a long-time advocate for patient safety, my interest in the topic has always been passionate, but never personal. Now, as Susan was being rushed into the emergency room, I wanted to keep it that way. "Wife of patient safety expert is victim" was a headline I deeply hoped to avoid.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Doing Things Right: Why Three Hospitals Didn't Hurt My Wife","datePublished":"2011-12-06T22:27:21.000Z","dateModified":"2011-12-06T22:27:21.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"964 http://blogs.kqed.org/stateofhealth/?p=964","disqusUrl":"https://ww2.kqed.org/stateofhealth/2011/12/06/doing-things-right-why-three-hospitals-didnt-hurt-my-wife/","disqusTitle":"Doing Things Right: Why Three Hospitals Didn't Hurt My Wife","path":"/stateofhealth/964/doing-things-right-why-three-hospitals-didnt-hurt-my-wife","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cdiv>\n\u003cfigure id=\"attachment_972\" class=\"wp-caption alignleft\" style=\"max-width: 176px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2011/12/Millenson_and_Susan.jpg\">\u003cimg class=\"size-full wp-image-972 \" title=\"Michael Millenson and his wife, Susan. (Photo: Michael Millenson)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2011/12/Millenson_and_Susan.jpg\" alt=\"Michael Millenson and his wife, Susan. (Photo: Michael Millenson)\" width=\"176\" height=\"250\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Michael Millenson and his wife, Susan. (Photo: Michael Millenson)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By: Michael Millenson\u003c/strong>\u003c/p>\n\u003cp>My wife was lying in the back of an ambulance, dazed and bloody, while I sat in the front, distraught and distracted. We had been bicycling in a quiet neighborhood in southern Maine when she hit the handbrakes too hard and catapulted over the handlebars, turning our first day of vacation into a race to the nearest hospital.\u003c/p>\n\u003cp>The anxiety when a loved one is injured is compounded when you know just how risky making things better can get. As a long-time advocate for patient safety, my interest in the topic has always been passionate, but never personal. Now, as Susan was being rushed into the emergency room, I wanted to keep it that way. \"Wife of patient safety expert is victim\" was a headline I deeply hoped to avoid.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"Wife of patient safety expert is victim\" was a headline I deeply hoped to avoid. \u003c/aside>\n\u003cp>In the weeks after the accident, we spent time at a 50-bed hospital in Maine; a Boston teaching hospital where Susan was transferred with a small vertebra fracture at the base of her neck and broken bones in her left elbow and hand; and a large community hospital near our suburban Chicago home. There were plenty of opportunities for bad things to happen -- but nothing did. As far as I could tell, we didn't even experience any near misses.\u003c/p>\n\u003cp>\u003c!--more-->What went right? After all, though our health care system knows how to prevent errors that kill 44,000 to 98,000 people in hospitals each year, that death toll \u003ca href=\"http://www.nytimes.com/2010/11/25/health/research/25patient.html\">has remained stubbornly constant\u003c/a>. Based on personal and professional observations, I'd simplify the formula that kept Susan safe into three variables: consciousness, culture and cash.\u003c/p>\n\u003cp>Consciousness of patient safety sounds easy, but it isn't. The harm caused patients is inadvertent and often occurs as part of complex interventions. As a result, \u003ca href=\"http://jama.ama-assn.org/content/301/12/1273.short\" target=\"_blank\">a 2009 JAMA commentary\u003c/a> pointedly noted, \"clinicians have labeled virtually all harm as inevitable for decades.\"\u003c/p>\n\u003cp>But today, the cloak of invisibility is being lifted. Twenty-six states require hospitals to report certain medical errors; Medicare and some private insurers won't pay for problems caused by a growing list of quality and safety lapses, and the government has launched the $1 billion Partnership for Patients to dramatically reduce avoidable harm.\u003c/p>\n\u003cp>Just as importantly, patients are worried. In a poll by Consumers Union, 77 percent of respondents expressed high or moderate concern that they might be harmed by a hospital infection and 71 percent had the same concern about medication errors. Inevitably, more patients and their families are speaking up -- as I most certainly did, albeit as politely as possible.\u003c/p>\n\u003cp>When the ER nurse at Maine's York Hospital gave Susan morphine, I asked about the dosage and timing. When she was transferred to Massachusetts General Hospital in Boston, I asked each medical professional to identify themselves and what they were doing. Although it's impossible to know if my questions had any positive impact, at a minimum they reinforced an existing safety consciousness.\u003c/p>\n\u003cp>Although consciousness of a problem can spur change, sustaining it requires a supportive culture. Can there be any more graphic expression of a safety culture commitment than Baylor Health Care System's mission to eliminate preventable deaths, preventable injuries and preventable risk? Or Ascension Health's \"healing without harm\" initiative and its goal of reducing preventable deaths by 900 each year? (They've reached a minimum of 1,500 so far.) Both organizations have published results in the peer-reviewed literature.\u003c/p>\n\u003cp>Glenbrook Hospital in suburban Chicago -- it's part of the NorthShore University HealthSystem -- isn't quite as ambitious in its objectives. Still, its culture was obvious even before I peeked at the monthly infection report left sitting on a reception desk. When the orthopedic surgeon was explaining the procedure he would be doing, he talked about safety. The consulting neurosurgeon (due to Susan's neck injury) talked about safety. The anesthesiologist talked about safety. Right before surgery, nurses fitted Susan with surgical stockings to prevent deep vein thrombosis -- an evidence-based guideline followed by fewer than half of hospitals. When I challenged the surgical team on appropriate prophylactic antibiotic use, a nurse indignantly cited a study showing I was mistaken.\u003c/p>\n\u003cp>I backed off, happy they'd thought about the issue seriously. But I did feel emboldened to ask whether the team in the operating room took time-outs before surgery (the evidence shows it helps make sure everyone's on the same page before you start cutting) and whether the team introduced themselves before proceeding (believe it or not, even the doctors may not be entirely certain who is behind those masks). Yes and yes, the answers came back.\u003c/p>\n\u003cp>Culture change at hospitals is easier these days with \u003ca href=\"http://www.implementationscience.com/content/4/1/25/\">role models\u003c/a> like Ascension and Baylor, and with safety checklists like the one developed by Johns Hopkins' critical care specialist \u003ca href=\"http://www.hopkinsmedicine.org/quality/safety/pronovost/index.html\" target=\"_blank\">Peter Pronovost\u003c/a>. But if consciousness is one barrier to culture change, another one of at least equal importance is cash.\u003c/p>\n\u003cp>There's a link between financial stress and patient distress. A recent study in \u003ca href=\"http://content.healthaffairs.org/content/30/10/1904.abstract\" target=\"_blank\">Health Affairs\u003c/a> found the 178 \"worst\" hospitals in the United States care for more than twice the proportion of elderly minority and poor patients as the nation's 122 \"best\" hospitals, where costs are lowest and quality highest. As one headline put it, \"Bad Hospitals, Poor Patients.\"\u003c/p>\n\u003cp>Money talks in other ways. I've written about how some hospitals implicitly see adverse events \u003ca href=\"http://healthaffairs.org/blog/2010/12/06/why-we-still-kill-patients-invisibility-inertia-and-income/\">as a way to keep beds filled\u003c/a> (although, of course, actual patient deaths thwart that goal). The hospitals where my wife was treated were all prosperous. Even without worrying about a reluctance to confront complications, would a cash-strapped York have transferred Susan to a tertiary care facility, or would they have assured a well-insured patient they could take care of her broken neck? Would a bottom line-driven Mass General or Glenbrook have angled for a longer hospital stay?\u003c/p>\n\u003cp>It's tough enough to change culture. It's even tougher if it you think you’ll lose money doing so. That's why Medicare is increasingly linking payment to explicit quality and safety indicators.\u003c/p>\n\u003cp>We ask a great deal of physicians, nurses and other professionals. Those whom we encountered juggled multiple roles -- healers attending to the ill and scared, prudent managers of health-care resources and team players in system improvement. For the skill and grace with which they performed all those roles we were deeply grateful. Thanks to them, Susan has now recovered to the point that to the casual observer there's no obvious evidence of her multiple injuries.\u003c/p>\n\u003cp>Our experience showed that \"doing the right thing\" -- appropriate care -- and \"doing the right thing right\" -- safe and effective care -- can become the norm at rural, suburban and big urban teaching hospitals alike. On a personal level for the two of us, and on a system level for all of us, that's very good news.\u003c/p>\n\u003cp>\u003cem>Michael L. Millenson is a Highland Park, Illinois-based consultant, a visiting scholar at the Kellogg School of Management and the author of \u003c/em>\u003ca href=\"http://www.press.uchicago.edu/Misc/Chicago/525872.html\" target=\"_blank\">\u003cem>Demanding Medical Excellence: Doctors and Accountability in the Information Age\u003c/em>\u003c/a>\u003cem>. This article first appeared in \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2011/December/05/millenson-first-person-patient-safety.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2011/December/05/millenson-first-person-patient-safety.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>.\u003c/em>\u003c/p>\n\u003c/div>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/964/doing-things-right-why-three-hospitals-didnt-hurt-my-wife","authors":["240"],"categories":["stateofhealth_12","stateofhealth_14"],"tags":["stateofhealth_73","stateofhealth_53"],"label":"stateofhealth"},"stateofhealth_509":{"type":"posts","id":"stateofhealth_509","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"509","score":null,"sort":[1321913903000]},"guestAuthors":[],"slug":"somethings-been-bugging-me","title":"Something's Been Bugging Me","publishDate":1321913903,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>By: \u003ca title=\"http://www.thepatientpod.com/team.html\" href=\"http://www.thepatientpod.com/team.html\" target=\"_blank\">Pat Mastors\u003c/a>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>\u003cem>Editor's Note: Pat Mastors is CEO of Pear Health, LLC. She formed the company after her father's death, due to complications following a surgical procedure. CBS correspondent Andy Rooney's death earlier this month prompted her to write this in his voice.\u003c/em>\u003c/strong>\u003cbr>\n\u003c/em>\u003c/p>\n\u003cfigure id=\"attachment_519\" class=\"wp-caption alignleft\" style=\"max-width: 200px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2011/11/AndyRooney2.jpg\">\u003cimg class=\"size-medium wp-image-519 \" title=\"Andy Rooney, the CBS News Correspondent, in 2008. (Flickr: Stephenson Brown)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2011/11/AndyRooney2-300x450.jpg\" alt=\"Andy Rooney, the CBS News Correspondent, died following complications from minor surgery. (Flickr: Stephenson Brown)\" width=\"200\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Andy Rooney, the CBS News Correspondent, died following complications from minor surgery. (Flickr: Stephenson Brown)\u003c/figcaption>\u003c/figure>\n\u003cp>“I died last week, just a month after I said goodbye to you all from this very desk. I had a long and happy life – well, as happy as a cranky old guy could ever be. 92. Not bad. And gotta say, seeing my Margie, and Walter, and all my old friends again is great.\u003c/p>\n\u003cp>But then I read what killed me: ‘serious complications following minor surgery.’\u003c/p>\n\u003cp>Now what the heck is that?\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Nobody gets run over by a ‘serious complication.’ You don’t hear about a guy getting shot in the chest with a ‘serious complication.’ Sure, I didn’t expect to live forever (well, maybe only a little bit), but I was sorta going for passing out some Saturday night into my strip steak at that great restaurant on Broadway. Maybe nodding off in my favorite chair, dreaming of reeling in a 40-pound striper. You know, not waking up. This whole ‘death by complication’ thing is just so, I don’t know … vague and annoying.\u003c/p>\n\u003caside class=\"pullquote alignleft\">But then I read what killed me: ‘serious complications following minor surgery.’ Now what the heck is that?\u003c/aside>\n\u003cp>Here’s something else that bothers me. This note I got a few days ago from a lady who says she’s a fan. She talked to a reporter at a national newspaper the other day. Asked the reporter, basically, what kind of complication ‘did me in'? The reporter said, ‘No idea what killed him. Unless someone dies unusually young, we don’t deal with the cause of death.'\u003c/p>\n\u003cp>\u003c!--more-->Now I know reporters have lots to do. I was one myself before they started paying me to just say what I think. But I guess what this reporter means is, if I was 29 instead of 92, they mighta thought it was worth asking why I went in for minor surgery and died of 'serious complications.'\u003c/p>\n\u003cp>Remember a guy named John Murtha? A Congressman. Democrat from Pennsylvania. He made it to 77, a real spring chicken next to me. We were talking about this the other day, and guess what he told me? He went in the hospital last year to get his gallbladder taken out. A tiny incision, they said. Laparascopic surgery. Only he died, too. The reason, you guessed it: 'complications of surgery.' The docs looked really sad about it but they wouldn’t give out any details. They said they couldn’t, because of family privacy, and federal privacy laws. But you know, people talk. Someone on the inside came out with it: 'they hit his intestines.'\u003c/p>\n\u003cp>John figures it’s better that people know what happened. Maybe it’ll help docs figure out a way not to hit intestines when they do that surgery next time. Now what’s wrong with that?\u003c/p>\n\u003cp>I know what you’re thinking. That Andy Rooney – something’s always bugging him. Well, I guess it’s like my mom told me a zillion years ago, when she asked me at dinner if I knew anything about how the window in the garage got broken. I said no because I didn’t want to admit I’d been throwing a baseball with Tommy McNamara, and I guess my aim was really off. She looked at me with that look moms have … the one that makes you squirm and try to change the subject and finally offer to do the dishes if only she’ll stop looking at you like that. She said ‘Andy, just tell the truth.’\u003c/p>\n\u003cp>So … do me a favor. Something killed me. And it would be good to know what. You don’t have to squirm, or do the dishes.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Just tell folks what happened.”\u003c/p>\n\n","blocks":[],"excerpt":null,"status":"publish","parent":0,"modified":1322001415,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":15,"wordCount":716},"headData":{"title":"Something's Been Bugging Me | KQED","description":"By: Pat Mastors Editor's Note: Pat Mastors is CEO of Pear Health, LLC. She formed the company after her father's death, due to complications following a surgical procedure. CBS correspondent Andy Rooney's death earlier this month prompted her to write this in his voice. “I died last week, just a month after I said goodbye","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Something's Been Bugging Me","datePublished":"2011-11-21T22:18:23.000Z","dateModified":"2011-11-22T22:36:55.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"509 http://blogs.kqed.org/stateofhealth/?p=509","disqusUrl":"https://ww2.kqed.org/stateofhealth/2011/11/21/somethings-been-bugging-me/","disqusTitle":"Something's Been Bugging Me","path":"/stateofhealth/509/somethings-been-bugging-me","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>By: \u003ca title=\"http://www.thepatientpod.com/team.html\" href=\"http://www.thepatientpod.com/team.html\" target=\"_blank\">Pat Mastors\u003c/a>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>\u003cem>Editor's Note: Pat Mastors is CEO of Pear Health, LLC. She formed the company after her father's death, due to complications following a surgical procedure. CBS correspondent Andy Rooney's death earlier this month prompted her to write this in his voice.\u003c/em>\u003c/strong>\u003cbr>\n\u003c/em>\u003c/p>\n\u003cfigure id=\"attachment_519\" class=\"wp-caption alignleft\" style=\"max-width: 200px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2011/11/AndyRooney2.jpg\">\u003cimg class=\"size-medium wp-image-519 \" title=\"Andy Rooney, the CBS News Correspondent, in 2008. (Flickr: Stephenson Brown)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2011/11/AndyRooney2-300x450.jpg\" alt=\"Andy Rooney, the CBS News Correspondent, died following complications from minor surgery. (Flickr: Stephenson Brown)\" width=\"200\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Andy Rooney, the CBS News Correspondent, died following complications from minor surgery. (Flickr: Stephenson Brown)\u003c/figcaption>\u003c/figure>\n\u003cp>“I died last week, just a month after I said goodbye to you all from this very desk. I had a long and happy life – well, as happy as a cranky old guy could ever be. 92. Not bad. And gotta say, seeing my Margie, and Walter, and all my old friends again is great.\u003c/p>\n\u003cp>But then I read what killed me: ‘serious complications following minor surgery.’\u003c/p>\n\u003cp>Now what the heck is that?\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Nobody gets run over by a ‘serious complication.’ You don’t hear about a guy getting shot in the chest with a ‘serious complication.’ Sure, I didn’t expect to live forever (well, maybe only a little bit), but I was sorta going for passing out some Saturday night into my strip steak at that great restaurant on Broadway. Maybe nodding off in my favorite chair, dreaming of reeling in a 40-pound striper. You know, not waking up. This whole ‘death by complication’ thing is just so, I don’t know … vague and annoying.\u003c/p>\n\u003caside class=\"pullquote alignleft\">But then I read what killed me: ‘serious complications following minor surgery.’ Now what the heck is that?\u003c/aside>\n\u003cp>Here’s something else that bothers me. This note I got a few days ago from a lady who says she’s a fan. She talked to a reporter at a national newspaper the other day. Asked the reporter, basically, what kind of complication ‘did me in'? The reporter said, ‘No idea what killed him. Unless someone dies unusually young, we don’t deal with the cause of death.'\u003c/p>\n\u003cp>\u003c!--more-->Now I know reporters have lots to do. I was one myself before they started paying me to just say what I think. But I guess what this reporter means is, if I was 29 instead of 92, they mighta thought it was worth asking why I went in for minor surgery and died of 'serious complications.'\u003c/p>\n\u003cp>Remember a guy named John Murtha? A Congressman. Democrat from Pennsylvania. He made it to 77, a real spring chicken next to me. We were talking about this the other day, and guess what he told me? He went in the hospital last year to get his gallbladder taken out. A tiny incision, they said. Laparascopic surgery. Only he died, too. The reason, you guessed it: 'complications of surgery.' The docs looked really sad about it but they wouldn’t give out any details. They said they couldn’t, because of family privacy, and federal privacy laws. But you know, people talk. Someone on the inside came out with it: 'they hit his intestines.'\u003c/p>\n\u003cp>John figures it’s better that people know what happened. Maybe it’ll help docs figure out a way not to hit intestines when they do that surgery next time. Now what’s wrong with that?\u003c/p>\n\u003cp>I know what you’re thinking. That Andy Rooney – something’s always bugging him. Well, I guess it’s like my mom told me a zillion years ago, when she asked me at dinner if I knew anything about how the window in the garage got broken. I said no because I didn’t want to admit I’d been throwing a baseball with Tommy McNamara, and I guess my aim was really off. She looked at me with that look moms have … the one that makes you squirm and try to change the subject and finally offer to do the dishes if only she’ll stop looking at you like that. She said ‘Andy, just tell the truth.’\u003c/p>\n\u003cp>So … do me a favor. Something killed me. And it would be good to know what. You don’t have to squirm, or do the dishes.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Just tell folks what happened.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/509/somethings-been-bugging-me","authors":["240"],"categories":["stateofhealth_12","stateofhealth_15"],"tags":["stateofhealth_53"],"featImg":"stateofhealth_519","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? 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Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. 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As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. 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Plus, KQED’s Bianca Taylor brings you the local KQED news you need to know.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Consider-This-Podcast-Tile-703x703-1.jpg","imageAlt":"Consider This from NPR and KQED","officialWebsiteLink":"/podcasts/considerthis","meta":{"site":"news","source":"kqed","order":"7"},"link":"/podcasts/considerthis","subscribe":{"apple":"https://podcasts.apple.com/podcast/id1503226625?mt=2&at=11l79Y&ct=nprdirectory","npr":"https://rpb3r.app.goo.gl/coronavirusdaily","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM1NS9wb2RjYXN0LnhtbA","spotify":"https://open.spotify.com/show/3Z6JdCS2d0eFEpXHKI6WqH"}},"forum":{"id":"forum","title":"Forum","tagline":"The conversation starts here","info":"KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.","airtime":"MON-FRI 9am-11am, 10pm-11pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED Forum with Mina Kim and Alexis Madrigal","officialWebsiteLink":"/forum","meta":{"site":"news","source":"kqed","order":"8"},"link":"/forum","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/kqeds-forum/id73329719","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz","npr":"https://www.npr.org/podcasts/432307980/forum","stitcher":"https://www.stitcher.com/podcast/kqedfm-kqeds-forum-podcast","rss":"https://feeds.megaphone.fm/KQINC9557381633"}},"freakonomics-radio":{"id":"freakonomics-radio","title":"Freakonomics Radio","info":"Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. 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Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.","airtime":"MON-FRI 3am-9am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.npr.org/programs/morning-edition/","meta":{"site":"news","source":"npr"},"link":"/radio/program/morning-edition"},"onourwatch":{"id":"onourwatch","title":"On Our Watch","tagline":"Police secrets, unsealed","info":"For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. 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