Medical Associates Clinic

 Quality Care Close To Home

     One of the very first general rules a medical student learns is, “primum non nocere”. Loosely translated this means, “first, do no harm”.  While this would seem to be a truism for healthcare providers, it is not that easy.  Before a surgeon can take out an infected gallbladder, a surgical incision on the abdomen has to be made.  Before a dislocated fracture can be healed, the broken pieces have to be brought together and that is extremely painful.  Chemotherapy to treat certain types of cancer can lead to very disturbing side effects.  Thus, it appears that the most basic rules of medical care are very frequently broken.

     While the above examples represent situations in which the harm is intrinsic in the treatment, the problem of “medical mistakes” is getting a lot of press lately.  The spectacular mismatch of a blood type resulting in a young lady’s death at Duke University Hospital stayed in the headlines for almost a week.  It was a very spectacular medical mistake.  But it exemplifies a curious property of our society.  If Tiger Wood misses a putt, or loses a match, it is nowhere near the headlines that the Duke University mistake generated.  If Brent Farve throws an interception for the Green Bay Packers, it doesn’t seem to be that big of a problem.  If Michael Jordan misses a basket, it seems a minor disappointment.  Individuals in our sports industry generate salaries that make income for medical personnel seem like chump change.  Our sport industry personnel don’t get sued if they drop the ball.  Somehow our society recognizes that the endeavors of our athletes are directed against very difficult tasks and constant success is not expected.

     The standard for the healthcare industry is quite different.  Perfection is the expectation.  Mistakes are not tolerated.  If a mistake is made litigation is a very common subsequent event.  Yet the tasks faced by modern day surgeons, cardiologists, and critical care specialists are much more complex and demand much more training than trying to make a three-point basket or hit a fast ball.  The disparities in our society certainly should give one pause.

     After my little digression, I want to return to the question of patient safety.  A study was published this week in the Journal of the American Medical Association that analyzed adverse drug events in a Medicare population.  They studied a very large group of patients that were associated with a single health maintenance organization (HMO).  They noted the number of different types of medications these individuals took and recorded the side affects that occurred.  By my value system, the results were stunning.  The authors of this study found 1580 adverse drug effects in 30,000 patient years.  In other words, on the average there was one adverse drug effect for every twenty years that a person took a medication.  I had no idea that the rate of side affects was really that low.

    The second question that the article addressed was how many of the side effects resulted from “medical mistakes” and how many were quirks of fate that were not predictably avoidable.  To my surprise only 18% of the adverse drug effects noted resulted from medical mistakes such as the physician prescribing the wrong medicine, the pharmacist dispensing a wrong medicine, or dosing errors in the prescriptions.  Instead, 82% of adverse drug effects recorded in this study were problems such as a rash that occurs with certain antibiotics or abdominal discomfort/diarrhea that can occur with certain medications.  These latter types of problems are predictable and a risk one takes when using antibiotics for various purposes.

     In this time when our television, magazines, and newspapers tend to distort our values by spectacularizing certain events, I think it is important that one keep perspective.  Disease is dangerous.  With relatively infrequent exceptions, medications and treatments are not dangerous.  The healthcare services available at your local clinics are well aware of the guiding principle recorded more than 2,500 years ago in the Greek Hippocratic Corpus. Note, the Hippocratic Oath is but a small part of a large group of writings by many ancient Greek physicians at the time of Hippocrates.  This body of writings is named the Hippocratic Corpus and laced throughout its entirety is the concept of patient safety.  That same concept is pursued with all effort by today’s healthcare providers.  Our patient’s safety and beneficence is always our primary goal.