JustCare

Tag: Medical errors

  • Real risk of medication errors at CVS and other chain pharmacies

    Real risk of medication errors at CVS and other chain pharmacies

    Ellen Gabler writes for The New York Times about the risk of medication errors from using chain pharmacies, such as CVS and Walmart. At a larger level, Gabler’s story highlights the dangers of for-profit health care. With a desire to maximize revenues, health care corporations aim to do more for less. But, in the process, more too often means more harm to Americans.

    Medication mix-ups have become increasingly common at chain pharmacies, which dispense about 70 percent of drugs in the US, along with supermarkets and megastores. Pharmacists have given people blood pressure medicine instead of asthma medicine, ear drops instead of eye drops and chemotherapy drugs instead of antidepressants. The chain pharmacies are very busy and understaffed, while under tremendous pressure to meet company quotes.

    To drive profits, chain pharmacies expect pharmacists to push refills on patients who don’t need them and dispense more drugs than people need. For example, CVS pharmacists have been requested to dispense three-month supplies of some medicines–more pills means more money–to people with mental health issues. The American Psychiatric Association worries that dispensing so much medicine can lead to overdosing.

    State pharmacy boards are hard-pressed to oversee these chain pharmacies to the extent necessary. They have little power to begin with. Often, representatives of the chain pharmacies sit on their boards. This creates conflicts of interest. Pharmacists fear losing their jobs if they speak up about issues. State legislatures do not seem to have the ability to regulate the pharmacies appropriately either.

    Chain pharmacies, such as CVS, deny there is a problem. Shockingly, there is no way to know the frequency or gravity of medication errors. As with most health care information, reporting is not what it needs to be and a lot of errors never become public. They are settled between pharmacy and patient, with an agreement on the part of the patient to not disclose the settlement terms.

    But, one Institute of Medicine study on medication errors conducted in 2006 found that they hurt at least 1.5 million Americans a year. And, Gabler compiled a long list of grievances filed by pharmacists to state boards, suggesting that pharmacists face grave difficulties ensuring they are filling prescriptions appropriately.

    At the end of the day, it’s probably advisable to steer clear of chain pharmacies. In addition to evidence suggesting that they put you at greater risk of receiving the wrong medicines, they tend to be the most expensive place to get your drugs.

    If you do use a chain pharmacy and your pharmacy misfills your prescriptions, do what you can to publicize it. Call your local newspaper and ask for an investigation. No company wants these errors broadcast. Over time, it could help lead to the company addressing the problem or new consumer protections.

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  • Second opinions can be extremely important

    Second opinions can be extremely important

    A new study from the Journal of Evaluation in Clinical Practice shows how getting second opinions can be extremely important before deciding on treatment for a complex condition. Researchers looked at the cases of several hundred patients who visited the Mayo Clinic for a second opinion. In nearly nine out of ten instances, the doctors providing the second opinion either offered an entirely different diagnosis or a modified diagnosis.

    While we may think of the practice of medicine as a science, different doctors may offer very different diagnoses for the same patients. As a result, patients can be given the wrong treatment for their conditions. Regrettably, misdiagnosis happens more often than most people may realize. Medical errors are the third leading cause of death.

    Of the 286 patients studied, only 12 percent were told that their original diagnosis and plan of care was correct. More than one in five patients (21 percent) were told that the original diagnosis was incorrect. According to a 2015 National Academy of Medicine report, most Americans will get a misdiagnosis at some point in their lives.

    There is a need for improved processes for arriving at a diagnosis and reducing errors. For now, if you receive a diagnosis for a complex or serious condition, get a second opinion from an expert before getting treatment.

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  • Medical error: Third leading cause of death

    Medical error: Third leading cause of death

    Sixteen years ago, the Institute of Medicine Committee on the Quality of Health Care in America issued a blockbuster report highlighting the numerous opportunities for error in our complex health care system, To Err is Human: Building a Safer Health System. Today, medical error is the third leading cause of death in the US, according to a new analysis in the BMJ.

    To be clear, doctors and other providers do not attribute death to medical error on death certificates. The Centers for Disease Control and Prevention (CDC) bases its analysis of the most common causes of death on death certificates completed by doctors, coroners and funeral directors. And, the form completed requires them to attribute death to a particular disease or ICD code. So, the CDC does not report non-disease related causes of death.

    Yet, medical error can be the cause of death, speeding it up or ending life immediately. To ensure that research is undertaken to address patient safety and reduce the likelihood of medical error, death certificates should include medical error as a reason for death.

    Medical error can happen for a variety of reasons. A medical provider can perform a procedure in an unintended way, or not follow through appropriately with or finish a procedure; or, the provider might choose the wrong intervention for a patient. The error can be at the patient level or the institution level.

    Based on the best available data today, there are likely more than 400,000 in-hospital deaths each year from medical errors. This number does not include deaths from medical errors in an outpatient setting, the home, or a nursing home.

    In 1999, the Institute of Medicine (IOM) reported that 44,000-98,000 people in the U.S. die from medical error each year, based on studies from 1984 and 1992. That’s a small fraction–between 11 percent and 25 percent–of the deaths from medical errors that the BMJ reports. In 2004, the Agency for Healthcare Research and Quality estimated some 195,000 deaths from medical error each year. More recently, the department of Health and Human Services Office of the Inspector General in 2008 reported 180,000 deaths in hospital from medical error for people with Medicare alone.

    It’s not clear whether the number of deaths from medical errors is growing or whether the IOM significantly underreported the number of deaths resulting from medical error, as some later studies suggest. What is clear is that we don’t have a good handle on the total number of deaths from medical errors or their causes. We need to understand the causes of these errors in order to improve patient safety. And, whatever the number, it is way too high.

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