Tackling rising cases of deaths by medical mistakes
In the past several years, it has been estimated that avoidable errors contributed possibly up to five to 10 per cent of hospital deaths in the United States (U.S.). This definitely is undesirable and has been highlighted mainly so it could be improved upon. This number translating to almost 220,000 deaths a year is calculated form decisions made by doctors, nurses, ambulance-men, laboratory tests, drug adverse reactions and so many other variables where humans have to make life-saving judgment calls while caring for the critically ill.
Hospital errors are decisions made by competent hospital workers adversely affecting the outcome of a patient and on which the person who took the decision could have done better with the benefit of hindsight. It does not make the operator incompetent nor the decision uninformed. The causes could be from the decision maker, the environment where he operates or from the patient himself.
A mistake on the other hand is when a patient is harmed from not doing what you should have known and which an average doctor or nurse would have done given the same circumstances. In other words, the patient suffers harm because the operator’s performance fell short of what the average professional would have done in his or her shoes. It is called negligence and the medical personnel is legally liable.
A paediatric Surgeon and Chief Medical Director of Lagos University Teaching Hospital (LUTH) Idi-Araba, Prof. Chris Bode, told The Guardian: “An overworked nurse working in a poorly lit ward who gives an injection of a pain-killer meant for patient A to Patient B person has committed an error.
“The reasons may be over-work, poor lighting on that ward, and the person’s poor eye-sight.
“The outcome may be not more serious than a pain-free night rest. On the other hand, if the patient already had other issues contraindicating that drug, outcome may be fatal if not detected on time, depending on dosage given. What to do?
“That person should quickly report the incident and call in the team managing the patient and many times, the day is saved. The team should voluntarily report the case to a body in charge of such cases so it can be investigated and the above reasons that led to this error may be identified and corrected to prevent future occurrence.
“Most importantly, this self-reporting should attract no punishment because it was an accident waiting to happen, given the systemic problems of poor lighting, understaffing and defective eyesight. Once these are identified and corrected, better care is assured.”
Bode said a good hospital will learn from these and take corrective measures, but fear of punishment and fear of being shamed cause many not to report. “Any doctor, nurse and seasoned worker in the hospital must have come across many such situations. An integral part of training in the medical disciplines emphasizes how to identify systemic defects and openly defend it through regular and periodic open audits at ward rounds, special rounds and forensic performance reviews,” he said.
The paediatrician further explained: “By its very nature, medicine deals with biological systems where measurements are seldom the same across any spectrum. Thus while astrophysicists can tell precisely to the minute when next the Haley comet will pass over the sky, biologist can only give a range.
“No two persons are the same in all parameters we observe and measure. Doctors therefore make deductions based on what is the most likely outcome given a set of biological observations. Luckily, those decisions are correct most of the times. Computerized algorithms are only beginning to assist in this complex decision making process but the human operator, imperfect as he may be, is still superior. It will therefore to condemn the inherent imperfections in the way doctors, nurses, pharmacists and other decision makers manage their cases. An analogy Often used is that in spite of many killed daily in motor accidents, it is still safer to travel by car or autobus from Lagos to Akure, rather than walk.”
The LUTH boss said Nigeria is still grappling with communicable diseases, lack of access to medical care, competitors to orthodox medicine who still peddle old beliefs and serve as barriers to access, poverty etc. He said many patients come to hospital with advanced conditions with complications and the hospital setting is not as advanced as you obtains in America. Bode said it is therefore difficult to estimate what proportion of the patients reaching the hospital may suffer from medical errors.
The paediatrician said it is however pertinent to say that in Nigeria, many who reach the hospital become better while those who choose alternate care are worse. “As we improve on our poverty indices, access to primary, secondary and tertiary healthcare institutions, health insurance and other winning strategies, we shall eventually be able to calculate our own rates and further improve on them,” he said.
Reacting to a report that specialist public hospitals are being besieged by patients as cost of medical care rises, Bode said: “I am not sure of the source and veracity of this information. I know however that many more patients besiege specialist tertiary centres with ailments that could otherwise be treated at the health centres and general hospital levels. A patient with a rash, cough, diarrhea, or suffering from malaria should be easily and effectively treated in a primary health centre or private hospital/clinic. If there are persisting symptoms or impending complications, they should be referred to a general hospital. Many common surgeries and conditions requiring routine management can be safely managed at the general hospital (secondary care) level. Major cases and complicated conditions are then left for tertiary hospitals such as Federal medical Centres and Teaching Hospitals.”
The LUTH boss said the collapse of the Primary Health Centres (PHCs) under the care of the local governments and the moribund state of most general hospitals in the purview of state governments have therefore led to a situation whereby patients who otherwise would have gone to the local health centre or the state general hospital
He said all head for the teaching hospitals, clogging up the system. It is known that patients who can afford the fees also patronize private hospitals. Bode, however, said the renewed determination of the Federal Government to empower the local government health centres and other tiers of healthcare will thus go a long way to correct these anomalies.
Also, reacting on another report that private clinics five times more expensive than government-owned, Bode said: “Again I cannot vouch for the accuracy of this assertion. However, the arithmetic is simple: A private investor builds or rents the business space while government hospitals carry no such overhead. The private investor pays salaries each month while the salaries of workers in government hospitals are paid by government.
“The private hospital buys drugs and has various other overhead costs. The costs of these are subsidized in government hospitals. Overall, the drive for operating a private hospital is to make profit. Government hospitals were established primarily to provide services at affordable cost to a larger segment of the population. It is therefore understandable that the cost of the same service is higher in a private hospital than in a government hospital.”
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