When We Do Harm: A Doctor Confronts Medical Error

This is a 10-star book. There are 17 chapters in this book, each addressing different issues that cause medical error which is a euphemism for doctors making you much sicker than you were when you went to see them about a problem. You may even find that along with a cessation in the troublesome symptoms there is a cessation of life. The medics have killed you!<br /><br />The book is loosely hung around several cases of medical error, this provides a human context, stories to follow. But from those stories and a discussion of legal issues and trying to find out if the medic is guilty involuntary manslaughter or gross negligence, forget it. Unless you are a millionaire your chances of finding out anything, even something as small as an extra pill being given that actually didn't contribute to the harm, is almost nil. <br /><br />Hospitals, medical insurance companies and doctors themselves are absolutely ruthless in their treatment of their victims. They will prevaricate, outright lie, cover up, close ranks, keep the case going until you've sold the house and your children's birthright. Or if things look like they are getting out of hand, try to settle for as small a sum as they can get away with and no explanation as to what happened. So, prevention is better than cure:<br /><br />1. Have your entire medical history and all the medications you are presently taking on a single page to present to your doctor. They aren't going to read a file. Remember that the doctor isn't that interested in what happened to you 30 years ago, "Appendicitis" will do rather than the circumstances surrounding it and what medications you took. Leave out 'stubbed toe! If you have complex issues like chemotherapy, summarise it on the firsts page but you can have a second sheet with the nitty-gritty.<br /><br />Compare your medication list with your doctor's at every visit to make sure that the medications, brands, doses are always up to date. <br /><br />2. If you are in hospital, ask what medications you are being given and why, Write it in a notebook. If you aren't well enough, ask the nurse to write it for you.<br /><br />3. If you don't think the doctors (it is usually the doctors) are being hygenic enough and you are really unwell and just lying there, fix a little sign on your chest, "Wash your hands first".<br /><br />4. The most important tool you and the doctor have is personal conversation. If the doctor has not unglued their eyes from the computer say, that you know they have to write everything down, but "if you could just have one minute of their full attention, you will tell them the important stuff as concisely as possible."<br /><br />If the doctor says, "I think you have X", ask them what makes them think that? Then ask, "Is there anything else it could be?" This will provide insight into the doctor's differential diagnosis and, if the treatment isn't successful, give you other avenues to consider.<br /><br />There is a major issue that medics have. Whenever they prescribe anything, they have screens and screens of possible side effects (including extremely rare ones) to scroll through. These are supposed to be patient-specific, as in 56+ patient who has normal blood pressure and no symptoms other than .... but they aren't. This is the insurance companies trying to cover their asses. So the doctor may have to spend hours a day checking each box for each medication for each patient as well as much more "necessary" guff, that takes away time from the patients. The author says that for a prescription of Warfarin at Bellevue hospital she had 241 alerts of side effects, interactions and anything else the insurance company thought would protect them. To click each one of those.... so she got out her prescription pad and wrote it by hand (which took 7 seconds).<br /><br />Some of the "guff" is the endless alerts from machines are meaningless. Alarms in the US are set to "cast the net as widely as possible because even one bad outcome could incur liability costs in the hundreds of millions of dollars to the manufacturers of these devices, the hospitals and EMRs. " An investigative report by the Boston Globe uncovered more than 200 deaths over 5 years related to alarm fatique. It found that nurses were bombarded with alarms, the vast majority of which were false. There were just so many alarms that they were losing their ability to alarm anyone and had become background noise<br /><br />It's all about the money. This is what you get when you involve insurance companies aka legal protection rackets see <a href="https://goodreads.com/book/show/36896199.Organized_Crime_A_Very_Short_Introduction" title="Organized Crime A Very Short Introduction by Georgios A. Antonopoulos" rel="noopener">Organized Crime: A Very Short Introduction</a> . They are in it to make money, you are in it for your health these two objectives are frankly not compatible, although I don't suppose most of the US, including doctors, will agree with that. Not unless you've been refused the money for a treatment or a medication you need, then you will.<br /><br /><b>Notes on reading</b> <input type="checkbox" class="spoiler__control" aria-label="The following text has been marked spoiler. Toggle checkbox to reveal or hide." onchange="this.labels[0].setAttribute('aria-hidden', !this.checked);" id="ce1c1ece-d7b7-406d-b44e-7e0844cefa9c" /><label aria-hidden="true" class="spoiler" for="ce1c1ece-d7b7-406d-b44e-7e0844cefa9c">There is so much to write, so much necessary information about doctor error and why it happens and to some extent how to prevent it. But it's not a self-help type book, very far from it. This is an extremely detailed, deeply-researched, beautifully-written and unusual in this day of mass information, unique.<br /><br />Review to come, but it needs some thinking about.<br /><br />If you like these sort of books, exhaustively investigative and illuminating an aspect of 21st century life we scarcely think about (unless it affects us or our friends or family) in a very thought-provoking way, and decide to read it, you will get much from it. And because it is so well-written, enjoy it too.</label>

This is an extremely scary book – so much so I had to read it in small doses.<br /><br />Administrators, the people at the top who run institutions that deal with people’s lives, literally life and death situations every day, have a number one priority: Guess what it is?? Bottom Line. $$$$$$<br /><br />Here are a few things that stuck out for me (a few among many):<br /><br />Pg. 70: Dr. Ofri says “Improving communication between doctors and patients would be an excellent investment for preventing diagnostic errors.” A sentiment that is repeated several times throughout.<br /><br />Pg. 125-6: “…adequate nurse staffing is critical……Skimping on nursing is a patient-safety hazard.”<br /><br />The more medicine involves technology the more it offers the game of man vs machine. When the technology is not user friendly for medical staff – what then??<br />Pg. 186-7: “There is a growing sense that rather than these technologies helping us to serve our patients, the tables have turned so that ‘we’ have to serve the ‘technology’”.<br /><br />Pg. 244: “Mandatory reporting [of medical error] would likely backfire…The only way to make such a system workable and accurate is to create a culture in which reporting an adverse event is a routine and ordinary event for medical professionals…”<br /><br />After closing the book I said a prayer that I would not have to be anywhere near a hospital anytime soon…or ever! And most certainly never on July 1st.<br /><br />This book is chilling, but so much of it is informative and may very well be helpful to you or a loved one at some point.<br /><br /><br />

A devastatingly sad and meticulous account of the human side of medical error.<br /><br /><i> <b>"It may seem a strange principle to enunciate as the very first requirement in a Hospital that it should do the sick no harm." - Florence Nightingale</b> </i><br /><br />I've worked in pharmacy since 2013. One of the first things you are taught is that <b> <u>you are going to fuck up</u> </b>. It's not an if, it's a when. You do your best to reduce the risk and keep patient safety front and center, but it's a horrific inevitability.<br /><br />Of course from the patient side of things, this is terrifying. I had to be admitted to the hospital for the first (and hopefully last) time, coincidentally, a year ago today. The fact that I worked three floors down and knew what meds I was being given and how to operate my IV pump didn't make it easier. Being woozy and nauseated and being wheeled into unplanned surgery is fundamentally <i>frightening</i>. Being in that OR room to work vs being on the table about to be knocked out is completely different.<br /><br />And obviously I'm okay now, as I'm alive and well to write this review. But the idea of medical error hiding around every corner is real and scary no matter which side of the error you're on.<br /><br />In <i>When We Do Harm</i> <a href="https://goodreads.com/author/show/86158.Danielle_Ofri" title="Danielle Ofri" rel="noopener">Danielle Ofri</a>, an experienced physician and medical writer, tackles medical error and adverse events from both sides. Through her personal experiences and detailed heart-wrenching stories from patients' families, as well as reviews of published studies and talks with other professionals, Ofri takes us through a hazy and difficult to traverse world, where the stakes are high and the opportunities for error are seemingly endless.<br /><br />This is NOT an easy read. And if you've had a loved one die recently, or traumatically in a hospital, I'd advise a heaping cup of caution heading into this. The patient stories are told remarkably well, but damn are they sad. They needed to be emotionally effective for this book to have the right impact, and it's successful in that. But I fucking cried, y'all. Jay's story especially made me heartsick.<br /><br />All in all, <i>When We Do Harm</i> is a bit of a niche book I suppose. The statistics and safety initiatives around medical error don't exactly have mass appeal. But <a href="https://goodreads.com/author/show/86158.Danielle_Ofri" title="Danielle Ofri" rel="noopener">Danielle Ofri</a> adds in the necessary humanity to make what could be an emotionless recital of statistics into a nuanced blend of fact and emotion.<br /><br />It's a hard read, but an ultimately worthwhile one.<br /><br /><i>Thanks to Edelweiss and Beacon Press for the review copy!</i>

Excellent, as a healthcare provider I related viscerally so much to this author and book. I think it’s an important read for any consumer (read: all of us) of American medicine to understand just how easy it is to make medical error, and understand how to best prevent it in your own care. The case studies, especially of Jay, were gripping, informative, shocking and heartbreaking. This book will certainly change how I approach my practice and how I approach my own healthcare.

4.5 stars<br /><br />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.<br /><br />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.<br /><br />Here are some things I learned:<br /><br />- 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. <br /> <br />- 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. <br /> <br />- Don't get me started on malpractice lawsuits.<br /> <br />- Procedural errors can be fixed with checklists, but diagnostic errors are cognitive errors, and "fixing" how a doctor thinks is much, much harder.<br /> <br />- Hospital culture matters. Do the nurses feel comfortable speaking up when they see something wrong? Are patients' families listened to or dismissed? <br /><br />- Many proposed solutions assume slow, methodical thinking when much of what doctors do is in the moment, under time pressure.<br /><br />I love Ofri's writing style - suspenseful narrative nonfiction when going through a case, introspective and insightful when discussing her own experience with error. <br /><br /><blockquote>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.</blockquote><br />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.<br /><br />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 <a href="https://goodreads.com/book/show/6667514.The_Checklist_Manifesto_How_to_Get_Things_Right" title="The Checklist Manifesto How to Get Things Right by Atul Gawande" rel="noopener">The Checklist Manifesto</a> as Gawande only scratches the surface.

From a deeply personal level, knowing Jay for almost 20 years of my life, reading this was heart breaking. Being on the supportive side (gosh, I thought I was - but, I had NO clue what support meant in this case) and not knowing how alone Tara was and how hard she fought was difficult to read. But her, along with the other families, bravery to share their horrific pain needs to be known. I am far from clinical, and would have absolutely assumed that if I or my loved one was in the hospital - not even in the BMTU with extreme complications (still can’t believe it all), that I was in the right place. Like said in the book, if I was having a baby and needed a c-section - damnit, I would be immediately wheeled in for a c-section.<br /><br />I hope this book gets read and helps all of those - patients, providers, caregivers - to take a look at the person. And never, ever stop fighting. People are imperfect, but every single person deserves to be seen.<br /><br />Jay, you are so deeply missed and I know you know Tara did not fail you.

Great book. Very well written, informative and engaging. I would give it 4 1/2 stars if I could, with the slight flaws being -<br />1) She tries a little too hard to be funny, and it sometimes lands wrong when she is writing about serious things.<br />2) While I appreciate her focus on systems and on reducing error by changing the systems, she goes a little easy on individual doctors. In Jay's case in particular, the errors came about because the doctors were arrogant and obnoxious. I think she does see this but is trying to look at all the possible causes of error and ways to avoid it, and maybe there's some professional courtesy involved in not being too hard on them. But sometimes it is actually a person's fault.

Rating: 3.5<br />

A should-be read for anyone in the medical field, anyone who has had medical care, or anyone who has had a loved one who has required care. In other words, most. As a retired nurse, I have both seen and personally experienced medical errors. I've also witnessed an error of negligence that forever changed my late mother's life and felt the resistance (paranoia) when I requested copies of her medical records. To err IS human but to expect healthcare providers to never commit an error is unreasonable but they can be reduced. I used to tell my childbirth clients to remember, THEY hired their doctor and chose the hospital setting so they can change their minds as they are the "customer". Never be afraid to speak up, ask for 2nd opinions, or change providers.

This book has a lot of good information about medical errors and their causes, and some information on how they can be avoided. It includes several patient stories, and one main, horrific story in detail. <br /><br />But the book seemed scattered to me. I ended up skimming a lot of it; I could see the each subject, and could tell whether it had already been covered in the book and, if not, whether I found it of interest. There was a lot of unnecessary wordiness and a lot of repetition. The same material was covered in several different places in the book. Some of it was also details of inner hospital workings, computerized charting user interface design, insurance company policies, etc. These subjects are relevant, but for some of them, an overview is enough, and the details are overkill. <br /><br />