In this must-read story in the Washington Post, a man developing septic shock goes back home after waiting several hours in the emergency department. When he returns to the ED the following morning, he quickly develops multisystem organ failure and nearly dies. This could have been prevented with, among other things, early and appropriate treatment for a severe medical condition, whose warning signs were present from the beginning.

“I figured they knew what they were doing and we just had to wait our turn.” Actually, no. Medical errors often happen because practitioners have a wrong concept or because they are missing key information. The assumption that people knew what they were doing, combined with many other systems and communication failures, almost cost this man his life.
The Washington Post story illustrates how system failures on multiple levels–including not having a primary care physician and a streamlined electronic health record–led to actual harm. It will take time to change the health care system to focus more on efficient delivery and patient safety as well as compliance.

But here’s something you can do today:

  1. Advocate for yourself and your loved ones by speaking up and speaking often. This can be life-saving.
  2. If something bothers you, tell someone. If something concerns you, ask.
  3. Medication_History
    An example medical history that everyone can keep.

    Be polite, clear, and concise. Carry a typed one-page medical history when you visit a physician, acute care clinic, or emergency room.

  4. Lastly, but importantly: Recognize your own stress. Stress is normal, but understand that your communication will be more effective if it is non-accusatory, if it conveys specific concerns, and if it demonstrates some restraint.

This is not easy.

Point number 4 requires a fair amount of emotional competence. This means we must recognize emotions, regulate them, and leverage them to bring a desired effect. It also means recognizing that health care providers are neither angels nor robots, but actual people with their own set of emotions and natural responses to you. The short-term goal should be to interact in a way that helps to improve your care. No matter how lazy, incompetent, or uncaring you perceive someone to be, treating him or her like a hard-working, qualified, and compassionate person is more likely to get that person on your side. After all, getting the care you need is more important in the moment than pointing out someone’s deficiencies.
Stress can be channeled into productive interactions. As a cardiac anesthesiologist and critical care physician, my advice is this: Take a deep breath, count to ten, and consider phrases like, “I’m frazzled with everything that’s going on, but I want to tell you something I’m concerned about right now…” Ask if the clinician can help with the concern, and seek a clear action plan with a time frame. If concerns are not being addressed, politely and firmly ask to speak to a patient services representative.
We cannot anticipate when an emergency will come up. But we can anticipate that there will be emergencies, and it’s important to be prepared by being ready to speak up, being able to effectively convey important information, and being able to understand how emotions can work either for or against us.

2 thoughts on “Speak Up: It can Save Your Life

  1. My problem actually is that most of my patients take the idea of a focused, tightly-written one page history to extremes. I ask, “Have you ever had back surgery before?” The patient will frown, brow furrowed for a moment, before saying, “No, unless you mean my L4-5 discectomy and L4 laminectomy with instrumentation from L4-S1” and will gesture to the one page history in his other hand without ever breaking eye contact.

    “Oh, I see. I see here you have hyperlipidemia. What can you tell me about that?”

    “Well, my HDL is actually too high. I’m trying to cut back on the dried nuts.”

    “Heart surgery?”

    “CABGx3 1 year ago with LIMA to LAD, sequential vein graft to OM1 and diag. Heart cath 2 months ago revealed patent grafts.”

    “Do you take plavix for that still?”

    “Clopidogrel 75mg daily.”

    Liked by 1 person

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