In this three-part series, EMS World examines medical errors and preventable harm in the prehospital and in-hospital settings. Medical errors are preventable events caused by procedural or communicative mistakes resulting in physical harm to or death of the patient. This series covers root causes of medical errors and how to implement measures to prevent them from occurring. The criticality of this systemic problem is indicated by a 2016 study conducted by Johns Hopkins University School of Medicine, which contends that medical errors are the third-leading cause of death in the U.S., citing “communication breakdowns, diagnostic errors, poor judgment, and inadequate skill” as primary causes of error. The study’s data revealed an estimated 400,000 deaths occur every year in the U.S. as a result of medical error.
Has the people-centered approach to healthcare fallen to the wayside? In Part 3 of the “Preventing Medical Errors” series, Bob Waddell, EMT-P (ret.), BS, argues that healthcare professionals’ stray from the relational part of patient care has partially contributed to the prevalence of medical errors. This seemingly lost art has turned patients into tasks instead of people, anonymized by high volumes of calls run by medics and cases handled by emergency medicine physicians. Medical education, especially prehospital, scarcely covers the soft skills of patient care, and the ever-specializing of physician practices limits some doctors’ abilities to see the full picture when diagnosing patients. If your work ethic has been reduced to filling out ICD-10 codes secondary to checking off the box of assessing and treating the patient on the daily to-do list, the desire to genuinely care about them will fade, ultimately diminishing the awareness that you are responsible for advocating for their well-being.
After 44 years in the profession, Waddell strives to learn the art of patient care. Currently he is training manager for SAM Medical and a long-time proponent of patient advocacy, encouraging providers to listen—really listen—to their patients, and for patients to take charge of their care and not be afraid to challenge a medic, nurse, or doctor on why they’re choosing a particular treatment or diagnosis. It’s their health at stake, after all, not the provider’s. As EM docs or nurses run in and out of ED rooms, patients are told what will be done to them—a flurry of blood and imaging tests, prescription medication treatments or therapies—sometimes without being told exactly why. Other times their symptoms are dismissed entirely, leaving patients feeling deflated or embarrassed for asking for help with a legitimate medical issue the doctor tells them is nonexistent or harmless. Granted, many patients accept these instructions without the why, because the American cultural mindset perceives healthcare providers as omniscient caregivers with superior knowledge who should remain unchallenged. And yet medical errors are estimated to be the third leading cause of death in the U.S. What’s the disconnect here?
The Gods of Modern Medicine
Tragically, Waddell witnessed medical errors take the lives of his mother and sister, a major contributor to his work in educating providers on safety culture. “I have always tried to advocate for my patients and do what’s right for them, whether it’s the medical process or the caring part, but those events really reinforced that,” he says. “There's still hundreds of thousands of people that are killed or injured at the hands of modern medicine in this country every year and in 38 years nothing's changed,” referencing the number of years since his sister died.
“None of those people woke up that morning saying, ‘Let's find the patient that we're going to maim today,’” he says. “I don't think healthcare providers—whether it's the EMT or the neurosurgeon—intend to cause an error, but they get complacent or lazy.” Most physicians coming out of med school today are “analysts instead of diagnosticians,” who analyze imaging and blood tests instead of noting the patient’s presentation or taking time to listen to their concerns.
The medical community operates under the “Do no harm” principle, but many errors are not reported or insufficiently addressed if they are. With so many patients suffering health consequences from medical errors, why isn’t this issue garnering more attention to determine efficient corrective measures to avert preventable injury or death?
“We have put medical practitioners on this high pedestal and some of them have put themselves there,” Waddell says. “Patients viewing doctors as god-like over the last three, four or ten generations is catching up with us,” he says. “They think, ‘If they have MD or DO after their name, they must be right. How could that doctor make a mistake?’
Waddell described a recent conversation with his wife’s new doctor, whom they requested to interview before “hiring” her. She grew defensive when they asked that she justify why her choices of treatment for his wife were optimal, but a week later thanked them for keeping her on her toes. She said it was refreshing to have a patient challenge her and make her prove her point. This is what Waddell sees as a partnership in healthcare, rather than a dictatorship of the doctor presiding over a subservient patient. Gender or age was irrelevant here, he adds, emphasizing the discussion simply exemplified patient-centered care.
“Part of that is questioning. What are you doing or why are you doing it? If you ask for a second opinion and the doctor or nurse practitioner gets irritated, fire them. Find somebody new,” he says. “Because if they're challenged by you questioning them, it's like going out on a bad date. Why would you go out on two bad dates?”
Other causes of frequent medical errors are overworked physicians and the growing complexity of healthcare, says Waddell.
“We've gotten so specialized, and there's a lot of value in that, but it also makes a very complex spider web to navigate. So, it's multifaceted, but we have to start taking responsibility for our care and the care of our loved ones, which means we have to partner with the healthcare providers at every level, from the first responder to the neurosurgeon, whenever we interface with them,” he says.
Advocacy in the Ambulance
Waddell says there isn’t really a difference between advocating for patients in the prehospital setting and the hospital setting because it ultimately comes down to prioritizing your patient’s well-being. He recounted a graduation speech delivered by one of his paramedic students who graduated at the top of his class with a score of 97 percent. The student acknowledged that while he may provide outstanding care to 97 out of 100 patients, what scared him most was the fact that he would fail the remaining three. Waddell admired the astute observation.
If you lack proficiency in one type of care more than others, whether it be airway management, pediatrics or something as simple as splinting, “it's up to you to be the lifelong learner and get better at that topic.” Adeptness in all patient care skills, from assessment to resuscitation, creates a confident provider. Learning how to take a deep breath and manage your adrenaline rush is crucial to keeping both you and your patient safe, says Waddell—without mastering your skills, you’ll be more likely to forget your training in the midst of a critical incident.
“That patient should be your number one priority on the planet for the time that you have them prisoner in the back of your ambulance,” he says. “You know you can care about somebody but if you're called to respond, now you're caring for them. Providers, regardless of the initials after their name, have to care for their patients—we have to be in it as advocates for them.”