Tag: medical errors

Bioethics Blogs

End-of-Life Healthcare Sessions at ASBH 2017

The 2017 ASBH
conference
 in October 2017 includes over 400 workshops, panels, and
papers in bioethics and the health humanities.  Here are ones that pertain
to end-of-life issues.


THURSDAY, OCTOBER 19


THU 1:30 pm:  End-of-Life Care and Decision-Making in the ICU – Limited
English Proficiency as a Predictor of Disparities (Amelia Barwise)


Importance: Navigating choices in predominantly English-speaking care settings
can present practical and ethical challenges for patients with limited English
proficiency (LEP). Decision-making in the ICU is especially difficult and may
be associated with disparities in health care utilization and outcomes in critical
care. 


Objective: To determine if code status, advance directives, decisions to limit
life support, and end-of-life decision-making were different for ICU patients
with LEP compared to English-proficient patients. 


Methods: Retrospective cohort study of adult ICU patients from
5/31/2011-6/1/2014. 779 (2.8%) of our cohort of 27,523 had LEP. 


Results: When adjusted for severity of illness, age, sex, education, and
insurance status, patients with LEP were less likely to change their code
status from full code to do not resuscitate (DNR) during ICU admission (OR,
0.62; 95% CI, 0.46-0.82; p


Conclusion: Patients with LEP had significant differences and disparities in
end-of-life decision-making. Interventions to facilitate informed
decision-making for those with LEP is a crucial component of care for this
group.


THU 1:30 pm:  “But She’ll Die if You Don’t!”: Understanding and
Communicating Risks at the End of Life (Janet Malek)


Clinicians sometimes decline to offer interventions even if their refusal will
result in an earlier death for their patients. For example, a nephrologist may
decide against initiating hemodialysis despite a patient’s rising creatinine
levels if death is expected within weeks even with dialysis.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Medical errors is now the third cause of death in the United States

“Researchers: Medical errors now third leading cause of death in United States” (Washington Post, jun. 3 2016)

A problem that fully affects biomedical ethics is medical errors, which can even lead to death of the patient involved. A recently published article in American newspaper The Washington Post (3-V-2016) analysed the frequency of them, using as a source an article from the British Medical Journal of 3rd May, which stated that  “medical errors in hospitals and other health-care facilities are incredibly common and may now be the third-leading cause of death in the United States – claiming 251,00 lives every year, 700 per day, more than respiratory disease, accidents, stroke and Alzheimer’s” (read the article HERE). We do not need to highlight the ethical component that such carelessness entails, and the need to promote measures to help to reduce them.

La entrada Medical errors is now the third cause of death in the United States aparece primero en Bioethics Observatory.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

The Deadly Business of an Unregulated Global Stem Cell Market

Guest Post: The deadly business of an unregulated global stem cell industry

Tereza Hendl and Tamra Lysaght

In our paper, we report on the case of a 75-year old Australian woman who died in December 2013 from complications of an autologous stem cell procedure. This case was tragic and worth reporting to the medical ethics community because her death was entirely avoidable and the result of a pernicious global problem – doctors exploiting regulatory systems in order to sell unproven and unjustified stem cell interventions.

The patient at the centre of this case, Sheila Drysdale, underwent a liposuction procedure administered by cosmetic surgeon, Dr Ralph Bright, at his private Sydney clinic. Dr Bright did not perform this procedure for cosmetic reasons, but rather to ‘treat’ her advanced dementia with adipose (fat) derived stem cells. Mrs Drysdale died within ten hours of the surgery. Following an inquest into her death, the New South Wales Deputy Coroner stated that the utilisation of stem cells to ‘treat’ dementia was “highly questionable” and displayed “some of the hallmarks of ‘quack’ medicine,” particularly owing to the lack of scientific evidence supporting such ’therapy.’ The Coroner, thus, called for a more rigorous regulation of ‘innovative’ medical procedures in Australia that would protect vulnerable patients. Sadly, the relevant regulatory authorities have done very little to bring about any justice for Mrs Drysdale, or to address the systemic problems in Australia’s legislative framework that allows medical professionals to offer unproven stem cell-based interventions to patients without any accountability.

This case came to our attention as part of the work being done on an Australian Research Council funded Linkage Project “Regulating autologous stem cell therapies in Australia.”

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Two Words Can Soothe Patients Who Have Been Harmed: We’re Sorry

When Donna Helen Crisp, a 59-year-old nursing professor, entered a North Carolina teaching hospital for a routine hysterectomy in 2007, she expected to come home the next day. Instead, Crisp spent weeks in a coma and underwent five surgeries to correct a near-fatal cascade of medical errors that left her with permanent injuries

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Doctor as Data Entry Drone

by Craig Klugman, Ph.D.

Most people choose to go into the health professions to help others, to make a secure living, and to challenge themselves on a daily basis. Few people would rank “doing paperwork” as a reason to choose a career in health. However, according to a new study in the Annals of Internal Medicine, paperwork in the form of electronic health records (EHR) might be the activity on which doctors spend the most time. According to Sinsky et. al, who conducted direct observations, motion studies, and self reports of 57 physicians in 4 specialties in 4 states, doctors spent over 49% of their time on record keeping and 27% on direct patient care.

Two decades ago, physicians only spent one-fifth of their time on record keeping. A 1998 study of emergency departments found 21% of time was spent on records and 32% on patient care. As recently as 2014, another study found that administrative work occupied only one-sixth of physician time. This same study also found that the more time spent on administration, the less happy physicians were in their work. Perhaps this is one reason for the dramatic decline in physician satisfaction of their work life. The trend is clear: Doctors are spending less time with patients and more time with computer records.

The main move to electronic health records came about as part of the Affordable Care Act. A provision in the ACA aimed to “reducing paperwork and administrative costs” began in October 2012: “Using electronic health records will reduce paperwork and administrative burdens, cut costs, reduce medical errors and most importantly, improve the quality of care.”

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Order vs Chaos in Medical Practice

As patients look at their experiences within the medical system and profession, do you think they find a system that is well thought out and is practiced in an orderly fashion to facilitate the basic premise of medicine to care appropriately for those who are ill?  On the other hand, there is always the potential for chaotic disorder when dealing with uncertainties of disease and humans on both sides of the medical relationship. Is there evidence of chaos characterized by unsystematic medical practice which can lead to serious medical errors, higher cost of medical care and inattention to humanistic aspects of patient care?  If patients find significant chaos imbedded within the medical system, what might the patients’ opinions be regarding the cause of chaos and what might be the remedy to establish order?  Do you think that something is missing in student medical education or the medical system itself to properly deal with the aspects of diagnosis, treatment and general patient  care which, if attended to might diminish the effects of such lack of order? 

On the other hand, does the medical system seem quite properly functioning with signs of disorder either absent or properly managed to the benefit of the patient?  What is a patient’s view?  ..Maurice.
Graphic: Order and Chaos painted by me 2916 with ArtRage

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Enlisting Patients to Reduce Medical Errors

by Jennifer P. Cohen

Two recent reports on patient safety reinforce a compelling yet fairly obvious claim: doctors can reduce medical error by enlisting patients as participants in that process. Such a participation would mean more frank, proactive disclosure by healthcare professionals of the risks of medical error to patients, but by doing so, patients themselves may improve the chances of error-free care.  

Medical error made headlines this summer when a team at Johns Hopkins University claimed that 250,000 deaths per year are attributable to medical error.[i] If this claim is true,[ii] medical error would be the third leading cause of death in the United States, surpassed only by heart disease and cancer. A recent piece in JAMA explained that it is difficult to measure the magnitude of this issue because “there is no comprehensive, nationwide system for reporting or capturing all types of medical errors.”[iii] Even defining what constitutes medical errors is controversial. A 2006 report by the Institute of Medicine (IOM) concluded that “there are at least 1.5 million preventable [adverse drug events] that occur in the United States each year.”[iv] Should these events be counted as “errors”? Although there is still debate regarding how to define, quantify, and regulate this problem, all stakeholders agree that medical errors need to be reduced.

Much of the literature surrounding disclosure of error to patients, including the AMA’s Code of Ethics, is premised on three concerns: the ethical duty related to the patient’s autonomy, i.e., full disclosure of an error allows a patient “to make informed decisions regarding future medical care,”[v] the maintenance of trust in the doctor-patient relationship, and the reduction of legal liability.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Medical Errors – The Third Leading Cause of Death in the US

John James, PhD, became involved in the movement to bring greater attention to patient safety and rampant medical errors by way of tragedy. In 2002, Dr. James lost his 19-year-old son as a result of problematic care provided by cardiologists at … Continue reading

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Invited Guest Post: Healthcare professionals need empathy too!

Written by Angeliki Kerasidou & Ruth Horn, The Ethox Centre, Nuffield Department of Population Health, University of Oxford

 

Recently, a number of media reports and personal testimonies have drawn attention to the intense physical and emotional stress to which doctors and nurses working in the NHS are exposed on a daily basis. Medical professionals are increasingly reporting feelings of exhaustion, depression, and even suicidal thoughts. Long working hours, decreasing numbers of staff, budget cuts and the lack of time to address patients’ needs are mentioned as some of the contributing factors (Campbell, 2015; The Guardian, 2016). Such factors have been linked with loss of empathy towards patients and, in some cases, with gross failures in their care (Francis, 2013).

We recently argued for the importance of professionals’ emotional wellbeing in the development and exercising of empathy (Kerasidou, Horn, 2016). Empathy is the ability to comprehend another person’s experience, and the capacity to understand the world from their perspective. Feeling empathy towards someone is also what motivates positive action and the desire to help. The beneficial effects of empathy on patient care are well researched. It has been shown to improve adherence to therapy, increase patient satisfaction, decrease medical errors, and lead to fewer malpractice claims (Hickson et al. 2002). However, very little attention has been given to the moral and emotional labour empathy requires from physicians. In order for medical professionals to be able to develop and exercise empathy, they themselves need access to support and the right work conditions to be in place (Eichbaum, 2014).

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Medical errors is now the third cause of death in the United States

“Researchers: Medical errors now third leading cause of death in United States” (Washington Post, jun. 3 2016)death usa

A problem that fully affects biomedical ethics is medical errors, which can even lead to death of the patient involved. A recently published article in American newspaper The Washington Post (3-V-2016) analysed the frequency of them, using as a source an article from the British Medical Journal of 3rd May, which stated that  “medical errors in hospitals and other health-care facilities are incredibly common and may now be the third-leading cause of death in the United States – claiming 251,00 lives every year, 700 per day, more than respiratory disease, accidents, stroke and Alzheimer’s” (read the article HERE). We do not need to highlight the ethical component that such carelessness entails, and the need to promote measures to help to reduce them.

La entrada Medical errors is now the third cause of death in the United States aparece primero en Observatorio de Bioética, UCV.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.