My Turn: Good Doctors Spot Mistakes, Save Lives

The reasons for medical error are varied and complex. But that doesn't make them acceptable.
By Richard C. Karl, M.D.
Newsweek
Sept. 24, 2007 issue - Where the devil is that thing?" I hear myself saying. It is almost noon, and I'm finishing a surgical procedure to remove a cancer of the esophagus from a 54-year-old man. I've already brought his stomach up into his chest to replace the esophagus. He should be able to eat normally within a week. Only our "sponge count" is incorrect, and I can't close the chest until we find the six-by-six-inch piece of cloth we call a "lap pad."
The nurses have turned the operating room upside down. They've emptied all the "biological" waste baskets, searched the floor, rustled all the sterile drapes and recounted the used lap pads.
Additional help has been summoned to the room while I am looking in the chest for the missing pad and seeing only the patient's steadily beating heart.
Everybody in the room knows that prolonging the operation has a deleterious effect on the man who has entrusted us with his care.
Body fluids evaporate from open cavities, and the patient's core temperature falls because of evaporation and the cool room temperature. Yet we can't close until we find the damn thing.
How can anybody lose a sponge the size of a dinner napkin inside a human being? It is easier than you might think. In fact, medical harm is more common than those of us who celebrate the "most advanced health-care system in the world" would like to admit.
In 2000, the Institute of Medicine published a book called "To Err Is Human," which claimed that as many as 100,000 patients are killed each year by medical error. A death from error is one thing; leaving a sponge behind is a less fatal but still stunning mistake.
The Institute for Health Care Improvement calculated last year that the medical profession inflicts 15 million "incidents of harm" (like a retained sponge) per year in this country.
The reasons for these almost unbelievable figures are multiple and interrelated. Medicine today is complex. Because medicine is a "profession" and many years of training are required to practice it, it is assumed that doctors have the patients' best interests at heart. But without any central database for our care, a patient I plan to operate on next week may be, right now, in a doctor's office getting a prescription for a drug that will make the proposed operation more dangerous. Unless I ask, I'll never know.
In addition, there are many more drugs, procedures and techniques today than when I graduated from medical school in 1970, yet we haven't learned how to keep up with it all. Information travels remarkably slowly in medicine.
Then there is the culture of the medical profession. Uncooperative behavior by physicians has been tolerated by frustrated nurses and hospital administrators whose bonuses are tied to the hospital revenue generated by these doctors. Intimidating behavior has long been a facet of surgical training. I learned from the best: surgeons who would slap residents during a case, intimidate nurses or throw instruments. Most didn't, but some did.
Recently a cardiac-catheterization-lab nurse told me she'd tried to get a cardiologist to use the right "guide wire" for an arterial catheter. He ignored her hint and perforated the patient's aorta, then told the family that the accident and subsequent emergency surgery were the nurse's fault. "Do you think I'll ever try to help him again?" she asked.
Most everybody I know in medicine is bright, hardworking and altruistic. Many, though, have been beaten down by hundreds of urgent pages, middle-of-the-night phone calls, decreasing reimbursement, more paperwork and less grateful patients. These doctors have become less careful, and their patients suffer as a result.
It is time for my colleagues and me to reclaim our profession. It is time for doctors and nurses to work together, time for electronic records to actually work in providing the right information to the right person, time for pharmacists and nurses and social workers and doctors to see patients together.
You'll notice I didn't say it is time to pay doctors more money. If we can see and help our patients in a more efficient and supportive way, we'll have all the compensation we need.
It turns out that the sponge had accidentally been sent to the pathology lab. An alert nurse, a longtime colleague of mine, thought to call the lab. It all ended well. I hope my profession does, too.
Karl lives in Tampa, Fla.