Clinical Oncology and Error Reduction (eBook)

A Manual for Clinicians

Antonella Surbone, Michael Rowe (Autoren)

eBook Download: EPUB

2015 | 1. Auflage
208 Seiten
Wiley-Blackwell (Verlag)
978-1-118-74904-3 (ISBN)

Infos

Clinical Oncology and Error Reduction is the first single-source reference to address the vital topics of recognizing, preventing, and responding to medical errors in clinical oncology.

• Filled with practical information for immediate clinical application
• Covers topics such as patient safety, error prevention, quality improvement, errors disclosure and apology, and the impact of errors on patients and doctors     
• Each chapter contains special ‘take home’ points that highlight issues of particular clinical relevance and application
• Prepared by an expert, multidisciplinary, international team of physicians, nurses, researchers, hospital administrators, bioethicists, patients and patient advocates

Antonella Surbone, MD PhD FACP, is a medical oncologist, Adjunct Professor of Medicine at New York University, where she serves as Ethics Editor of NYU Clinical Correlations. Dr. Surbone is on the Faculty on MD Anderson I*Care Program, and Lecturer in moral philosophy and medical ethics at the Universities of Bologna, Rome, Turin and Verona, Italy, and various European universities. She has published in the fields of medical oncology and bioethics, with special focus on truth-telling, cultural competence, ethical implications of genetic testing for cancer predisposition, and medical errors.
Michael Rowe, PhD, a medical sociologist, is Associate Professor of Psychiatry at the Yale School of Medicine. Dr. Rowe conducts research and writes in the areas of medical humanities and bioethics, narrative medicine and medical errors, and community mental health. He is the author of several books including The Book of Jesse: A Story of Youth, Illness, and Medicine; Crossing the Border: Encounters Between Homeless People and Outreach Workers; Transforming mental health care: A practical guide to recovery-oriented practice, and Classics of Community Psychiatry; and Citizenship and Mental Health.

Inhalt

List of contributors vii

Foreword ix

Preface xiii

Acknowledgment xv

1 Introduction to oncology and medical errors 1
Antonella Surbone and Michael Rowe

Part I Medical errors and oncology: background and context

2 Recognizing and facing medical errors: the perspective of a physician who is also the patient 17
Itzhak Brook

3 Psychological and existential consequences of medical error for oncology professionals 29
Mary J. Chalino, Evelyn Y.T. Wong, Bradley L. Collins, and Richard T. Penson

4 To sue or not to sue: restoring trust in patient-doctor-family relationships 51
Michael Rowe and Antonella Surbone

Part II Improving patient safety in clinical oncology practice

5 Prevention of errors and patient safety: oncology nurses' perspectives 67
Martha Polovich

6 Prevention of errors and patient safety from the oncologist's perspective 87
Meghan E. C. Shea, Nie Bohlen, and Inga T. Lennes

7 Disclosing harmful medical errors 101
Walter F. Baile and Daniel Epner

8 Do cross-cultural differences influence the occurrence and disclosure of medical errors in oncology? 111
Lidia Schapira, Joseph R. Betancourt, and Alexander R. Green

Part III Cancer patients, oncology professionals, and institutions against medical errors

9 Prevention of errors and patient safety: institutional perspectives 127
Eric Manheimer

10 Professional and ethical responsibilities in adverse events and medical errors: discussions when things go wrong 145
Patrick Forde and Albert W. Wu

11 Medical error and patient advocacy 158
Juanne N. Clarke, PhD

12 Conclusion: the "given" and "therefores" of clinical oncology and medical errors 172
Antonella Surbone and Michael Rowe

Index 181

Textauszug

Chapter 2
Recognizing and facing medical errors: the perspective of a physician who is also the patient

Itzhak Brook

Department of Pediatrics, Georgetown University School of Medicine, USA

Key Points

• Medical and surgical errors are very common in the hospital and medical office setting.
• Errors are made by all members of the healthcare providers and include physicians, nurses, medical technicians, food handlers, secretaries, and speech and language pathologists.
• Medical errors generate medical malpractice law suits and increase the cost of medical care, patient stay in the hospital, and patient morbidity and mortality.
• Steps should be made to prevent medical errors that include improved training, awareness, and education of both the medical personnel and patients.

Medical and surgical errors are very common in the hospital and medical office setting. [1] Recent studies have shown that errors occur in up to 40% of individuals hospitalized for surgery and up to 18% of them experienced complications because of these mistakes. [2] These errors generate medical malpractice law suits and increase the cost of medical care, patient stay in the hospital, and patient morbidity and mortality. [3] The recent implementation of a mandatory bedside checklist is a simple, cost-effective method to prevent and reduce many of these mistakes. [4]

As a physician and an infectious diseases specialist for over 40 years, I was not aware how of how frequently these errors occur until I became a patient myself. This became evident to me after being diagnosed with throat cancer (hypopharyngeal carcinoma), when I had to deal with these errors as a patient – not as a physician. [5, 6]

Initially, the small cancer was surgically removed and I received local radiation. However, after 20 months a local recurrence at a different location, a short distance away from the original one, was discovered. Unfortunately, my surgeons were unable to completely excise the cancer by laser after three attempts. At that point, I had to undergo complete pharyno-laryngectomy with free flap reconstruction at a different medical center with greater experience with this type of cancer. The tumor was completely removed and no local or systemic spread has been noted to date (after six years). [7]

Although the medical care I received at all the hospitals was overall very good, I realized that mistakes were being made at all levels of my care. They ranged from minimal to serious ones, and were made by all of the medical providers – physicians, nurses, medical technicians, and speech and language pathologists. Despite these adverse experiences I feel great gratitude to the physicians, nurses, and other healthcare providers that cared for me throughout my difficult and challenging surgeries and hospitalizations.

This chapter describes the medical and surgical errors I personally experienced in my care during my hospitalizations at three medical centers and how the medical staff responded to them. In each instance I will discuss the optimal approach of handling communication of these errors with the patient. What made it difficult for me to prevent and abort many of these errors was my frailty and inability to speak after I underwent laryngectomy. Fortunately, I was able to abort many of these mistakes, though not all of them.

Failure to diagnose the cancer recurrence

My surgeons failed to detect the recurrence of my cancer in a timely manner although they examined me using an endoscope on a monthly basis after my initial operation. This is despite the fact that I had been complaining of sharp and persistent pain in the right side of my throat for over seven months. The otolaryngologists kept reassuring me that since they did not observe any cancer-like findings, the pain was most likely by the irritation of the irradiated airway mucosa by reflux of stomach acid. Even after they increased the acid-reducing medication I was taking, the pain did not go away.

The cancer recurrence was finally discovered by an astute surgical resident who was the first otolaryngologist who, while performing an endoscopic examination, asked me to do a Valsalva maneuver (closing the mouth while exhaling). This maneuver enables visualization of the pyriform sinus where the tumor was present. I was surprised that my experienced head and neck surgeons failed to perform such a basic procedure on my previous visits to the clinic. Should they have done it earlier, my tumor (that was already 4 × 2 cm in size) would have most likely been found and taken out at an earlier stage.

I was also examined by a radiation oncologist just three weeks earlier who had seen no abnormality when he performed an endoscopic examination of my upper airway. He also did not ask me to perform a Valsalva maneuver. This specialist confessed to me at a later date that he actually did not look down into the area where the new cancer was found because his instrument malfunctioned during the examination. Although I was disappointed and angry at his failure to perform the test appropriately, which delayed the diagnosis of the recurrence, his honesty and willingness to admit that his endoscopic examination was incomplete made it easier for me to forgive him. I also had deep appreciation for his kindness, compassion, and care and kept coming to him for my medical care. I did not appreciate until that time that radiation oncologists are less experienced in performing endoscopic examination of the airways than otolaryngologists.

Failure to remove the recurrent tumor using laser

The first mistake that occurred during my initial hospitalization was when my surgeons, using laser, mistakenly removed scar tissue instead of the cancerous lesion. The cancerous lesion was farther down my airway. It took a week before the error was recognized by the pathological studies. This mistake could have been prevented if frozen sections of the suspicious lesion, not just of the margins, had been analyzed. This mistake meant that I had to undergo an additional laser surgical procedure ten days later in a second attempt to remove the cancer.

Initially, after the surgery, my otolaryngologists had informed me they were able to remove the tumor in its entirety by using the laser, and all the margins of the removed area were clear of cancer. This meant that I was spared from undergoing a more extensive surgery, which would have included total or partial laryngectomy and removal of tissues in my neck, requiring their replacement by tissues transplanted from my thighs or shoulder areas (free flap). I felt great relief when I heard the good news and felt very fortunate. Even though there was still much uncertainty about the final pathological results, the alternative was much worse.

The circumstances that lead to the physicians informing me about the mistake were very upsetting for me. The day of my discharge from the hospital finally arrived a week after my surgery and I was waiting to hear from my surgeons about the final pathological report before going home. The last day was dragging on and on, and my discharge papers were not in yet. Finally about 4.30 p.m., the chief otolaryngology resident, accompanied by a junior one, walked into my hospital room and asked me to follow them to the otolaryngology clinic. I was surprised because all I expected to receive from them were my discharge orders. They informed me that they wanted to reexamine my upper airway one more time before my discharge using endoscopy. This made sense and seemed reasonable to me because I assumed that they wanted to perform a final otolaryngological examination prior to my discharge. I expected this would take only a few minutes, and I would be allowed to finally leave the hospital.

In the clinic, the residents directed me to an examination room. I sat on the examination chair and the senior resident numbed my upper airway and inserted the endoscope through my nose. He seemed to concentrate on one region and asked the junior resident to also observe it as well. They mumbled something incoherent to each other and nodded their heads in agreement. When I asked them if everything was okay, they did not respond. After completing their examination, the residents left the examining room without uttering a word and closed the door. It felt strange to sit on the examination chair waiting for their return, but no one came back to the room for a long time.

After about 30 minutes, I left the examination room and searched the clinic to no avail, finding no one there. The long wait was very unnerving and did not make any sense to me. However, I had no suspicion that something was wrong.

After about 50 minutes, the two residents, accompanied by the two senior surgeons who performed my surgery, walked into the examining room and delivered to me the most distressing and upsetting news.

The head surgeon began: “I would like to discuss with you the results of the pathological examinations. I have some good and some bad news. The good news is that there are no signs of cancer spreading into the lymph glands on the right side of the neck. The bad news is that the tumor is still in your hypopharynx. We have not yet removed it. The endoscopic examination done today confirmed that it is still where it was before.”

Words cannot express the extent of my feelings when I heard the message. I was stunned. My first response was utter surprise and disbelief. Anger and loss of trust followed. Accepting the reality of my situation and making decisions for the best course of action came last.

The surgeon proceeded and explained that the tissue...

Produkt-Details

• Erscheint lt. Verlag: 13.2.2015
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Onkologie
• Schlagworte: Allgemeine u. Innere Medizin • General & Internal Medicine • Gesundheitspolitik, Risiken, Sicherheit des Patienten • Health Policy, Health Risk & Patient Safety • Medical Science • Medizin • Oncology & Radiotherapy • Onkologie u. Strahlentherapie
• ISBN-10: 1-118-74904-9 / 1118749049
• ISBN-13: 978-1-118-74904-3 / 9781118749043