When We Do Harm: A Doctor Confronts Medical Error by Danielle Ofri

53625428._SY475_Patients enter the medical system with faith that they will receive the best care possible, so when things go wrong, it’s a profound and painful breach. Medical science has made enormous strides in decreasing mortality and suffering, but there’s no doubt that treatment can also cause harm, a significant portion of which is preventable.

Drawing on current research, professional experience, and extensive interviews with nurses, physicians, administrators, researchers, patients, and families, Dr. Ofri explores the diagnostic, systemic, and cognitive causes of medical error. She advocates for strategic use of concrete safety interventions such as checklists and improvements to the electronic medical record, but focuses on the full-scale cultural and cognitive shifts required to make a meaningful dent in medical error.

4.5 stars

So many things can go wrong in modern medicine, from misdiagnosing a disease to administering the wrong medicine with disastrous results. While there’s all kinds of research about medical error most of it concentrates on procedural errors in inpatient settings, such as doctors forgetting to wash their hands before approaching a patient’s bed. The literature ignores that most medical care is given in outpatient settings (doctors’ offices, acute care) and many, many errors take place when a doctor tries to figure out what’s wrong with you in the first place.

Add in mistakes caused by the computerized charting system, exacerbated by poor hand offs, and ignored by know-it-all doctors and we have a mess. Ofri leads us through it all in her approachable, engaging, and beautifully written style.

Here are some things I learned:

  • According to one study (everything is clearly end noted, by the way) over 80 percent of errors are related to a problem in doctor-patient communication. Ofri points out that nearly every error she reviewed for the book could have been prevented, or had its harm minimized, had there been better doctor-patient communication.
  • Capitalism in health care messes up so much stuff. Electronic medical records started as a billing system. Diagnoses are connected directly to billing codes, and there is no billing code for uncertainty. If there’s a set of interrelated problems the doctor has to pick one as the diagnosis, risking that later doctors won’t grasp the complexity of the issue.
  • Don’t get me started on malpractice lawsuits.
  • Procedural errors can be fixed with checklists, but diagnostic errors are cognitive errors, and “fixing” how a doctor thinks is much, much harder.
  • Hospital culture matters. Do the nurses feel comfortable speaking up when they see something wrong? Are patients’ families listened to or dismissed?
  • Many proposed solutions assume slow, methodical thinking when much of what doctors do is in the moment, under time pressure.

I love Ofri’s writing style – suspenseful narrative nonfiction when going through a case, introspective and insightful when discussing her own experience with error.

There are days when I envy Sisyphus: at least it’s the same stinking boulder he’s pushing up the hill every day. For a doctor, it’s a sea of boulders, any one of which – if missed – could come crashing down on one of my patients. Or on me, in the form of a lawsuit.

Make no mistake, many cases in this book are hard to read. A wife watching her husband die before her eyes without the medical staff doing anything to stop it. Mistreatment of a burn victim leading to his death, despite the efforts of nursing staff to get him better care. But the last couple of chapters give us hope, as well as concrete things a patient and their family can do to prevent medical error. Websites, professional organizations to contact, laws to be aware of, how to word requests to doctors, it’s all here.

This is my favorite Ofri book to date, which is saying a lot. A must read if you have any kind of interest, and a natural follow-up to The Checklist Manifesto as Gawande only scratches the surface.

Thanks to Beacon Press and Edelweiss for providing a review copy.

Nonfiction November – Be the Expert

This week’s Nonfiction November topic gives us lots of choice!

NonfictionNovember-e1506979820517Three ways to join in this week! You can either share three or more books on a single topic that you have read and can recommend (be the expert), you can put the call out for good nonfiction on a specific topic that you have been dying to read (ask the expert), or you can create your own list of books on a topic that you’d like to read (become the expert).

I have decided to Be the Expert in medicine, more specifically “books by doctors doing their thing awesomely”.  I’m a medical interpreter and work in hospitals, so it’s a topic that’s close to my heart.  After I made the list I realized all the authors are women – extra bonus!  The titles link to my full reviews.

15998346 What Doctors Feel: How Emotions Affect the Practice of Medicine by Danielle Ofri, MD

Each chapter covers an emotion doctors deal with on a near-daily basis, from empathy and fear to sadness and shame.  Good practices are shared and less than ideal situations analyzed in solid, assured prose that is still honest about the author’s misgivings and failings. The feelings behind what your doctor is thinking.

29955558Committed: The Battle Over Involuntary Psychiatric Care by Dinah Miller, MD and Annette Hanson, MD

Involuntary care is a a minefield of ethical conundrums and this book covers as many points of view as possible, from pro-involuntary treatment groups to anti-anything-psychiatry groups like Scientology. Thorough, well-considered, and fascinating.

19967171Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner by Judy Melinek, MD and T.J. Mitchell

The training and most memorable cases of a medical examiner.  While the jacket copy teases the stories around terrorist attacks my favorites were more commonplace – injuries that only show up after a day has passed, how to figure out which stab wound came first, pinning down someone’s age thanks to a single rib bone. Riveting and perfect for anyone who perks up when Law and Order heads to the morgue.

I’m always on the lookout for more medical nonfiction – what’s your favorite?

What Patients Say, What Doctors Hear by Danielle Ofri

32820244Despite modern medicine’s infatuation with high-tech gadgetry, the single most powerful diagnostic tool is the doctor-patient conversation, which can uncover the lion’s share of illnesses. However, what patients say and what doctors hear are often two vastly different things.

Patients, anxious to convey their symptoms, feel an urgency to “make their case” to their doctors. Doctors, under pressure to be efficient, multitask while patients speak and often miss the key elements. Add in stereotypes, unconscious bias, conflicting agendas, and the fear of lawsuits and the risk of misdiagnosis and medical errors multiplies dangerously.

Though the gulf between what patients say and what doctors hear is often wide, Dr. Danielle Ofri proves that it doesn’t have to be. Through the powerfully resonant human stories that Ofri is celebrated for, she explores the high-stakes world of doctor-patient communication that we all must navigate. Reporting on the latest research studies and interviewing scholars, doctors, and patients, Ofri reveals how better communication can lead to better health for all of us.

Review:

I’m a Japanese⇔English medical interpreter so when I saw the title of Ofri’s latest book I cheered.  Doctor-patient communication – she’s talking about my life!

Medical conversations are examined from all sides.  Is it better to let a complaining patient get their whole litany out at once, or should each point be addressed as it comes up?  Can the placebo affect be utilized in conversation?  How can stereotypes be overcome?  Is it ever okay to lie to a patient?

Each topic is covered with both anecdotes based on Ofri’s patients (vignettes!) and research studies.  All kinds of strategies to improve communication are covered, from how to listen actively to when disclosing personal details is a good idea. I especially like how the studies are dissected journal club style, with weaknesses pointed out along with the strengths.  For example, one study found that doctors that scored low on an empathy test had patients with worse outcomes, but:

Maybe the low-empathy doctors had dismal hygiene and the resulting BO was too distracting for the patients to pay attention to their diabetes.  Maybe the offices of the high-empathy doctors offered cloth gowns rather than paper gowns, so their patients weren’t experiencing frostbite and thus better able to hear what the doctor was saying.  You never know what the confounding factors might be…

As an interpreter I enjoyed the stories and insight but didn’t come away with many pearls I can use myself.  It’s part of the job – I speak other people’s words and can’t outright change the direction of the conversation.  I did pick up some tips, though, particularly how using different wording can change how information is received.

What Patients Say, What Doctors Hear is a trove of information for healthcare professionals, who can expect to learn practice-changing pearls, and frequent patients will appreciate the peek into their doctor’s head. If you are not one of those two groups, though, you may want to start with a different Ofri book.

Thanks to Beacon Press and Edelweiss for providing a review copy.

What Doctors Feel by Danielle Ofri

Synopsis:

15998346Physicians are assumed to be objective, rational beings, easily able to detach as they guide patients and families through some of life’s most challenging moments. But doctors’ emotional responses to the life-and-death dramas of everyday practice have a profound impact on medical care. And while much has been written about the minds and methods of the medical professionals who save our lives, precious little has been said about their emotions. In What Doctors Feel, Dr. Danielle Ofri has taken on the task of dissecting the hidden emotional responses of doctors, and how these directly influence patients.

How do the stresses of medical life—from paperwork to grueling hours to lawsuits to facing death—affect the medical care that doctors can offer their patients? Digging deep into the lives of doctors, Ofri examines the daunting range of emotions—shame, anger, empathy, frustration, hope, pride, occasionally despair, and sometimes even love—that permeate the contemporary doctor-patient connection. Drawing on scientific studies, including some surprising research, Dr. Danielle Ofri offers up an unflinching look at the impact of emotions on health care.

Review:

A wonderful book for doctors, doctor wannabes, and anyone else involved in medicine. Continue reading “What Doctors Feel by Danielle Ofri”