A national panel of medical experts proposed significant and costly changes for training new doctors in the nation’s hospitals, recommending mandatory sleep breaks and more structured shift changes to reduce the risk of fatigue-related errors.

The report, issued by the Institute of Medicine, focused on the grueling training of medical residents, the recent medical school graduates who care for patients under the supervision of a fully-licensed physician. The medical residency, which aims to educate doctors by fully immersing them in a particular specialty and all aspects of patient care, is characterized by heavy patient workloads, 80-hour workweeks and sleep deprivation.

But while popular television shows like “Grey’s Anatomy” glamorize residency training as a gratifying rite-of-passage for doctors, the worry is that the massive workload imposed on residents poses a risk to patient safety. The grueling hours of often unsupervised residents were found to have contributed to the 1984 death of 18-year-old Libby Zion in New York, a finding that eventually led to a series of reforms, including limiting residents to an 80-hour workweek and 30-hour shifts. Read more…

A simple Sharpie pen is emerging as an effective tool to prevent surgical errors and infections.

Surgeons typically use marking pens to ensure they operate on the correct part of a patient’s body. But one concern is that the germs from the pen could pose a risk for infection. As a result, many hospitals use sterile pens once and throw them away, a practice that costs thousands of dollars a year.

Infection control experts from the University of Alberta decided to study pens used to mark up surgical patients. They compared a one-use sterile surgical pen to a standard Sharpie — the brand name for a line of no-smudge permanent markers favored by everyone from autograph-writing football stars to President Bush.

In a controlled experiment, the tips of both kinds of pens were heavily contaminated with four types of bacteria that can cause surgical site infections, including two germ types that are resistant to antibiotics. The researchers recapped the markers and allowed them to sit for 24 hours. Read more…

Parents take their children to the doctor to help keep them well. So it’s always chilling to read stories about children who are harmed as a result of medical care.

Today’s story called “Small Patients, Big Consequences in Medical Errors,” by Laurie Tarkan, is a must-read for any parent and explains why children are at higher risk for medical mistakes that result in more serious consequences. You may recall how the actor Dennis Quaid’s newborn twins nearly died last year after receiving 1,000 times the prescribed dose of a blood thinner. A study in the journal Pediatrics in April found that problems due to medications occurred in 11 percent of children who were in the hospital, and that 22 percent of them were preventable.

Medical mistakes are a greater threat to kids than adults because they are physically smaller and their organs are still developing, which means even a small mistake in a medication dose can have profound effects. Children also are less able to communicate what they are feeling, making it more difficult to identify a problem when it occurs. Doses of pediatric medications also often must be calculated based on height and weight, increasing the risk for error.

To learn more about pediatric medical mistakes and read a helpful checklist of precautions parents can take, read the full story here.

Many patients count on their doctors to get back to them with test results, but new research suggests that’s a mistake.

This week on the Best of Well podcast, I talked with Dr. John Hickner, professor of family medicine at the University of Chicago and lead author of a new report about medical testing mistakes. His study showed that sometimes patients aren’t notified of test results because labs failed to return the results to their doctors. But when patients don’t hear back from the doctor’s office, they often assume there’s nothing wrong.

I spoke with Dr. Hickner about why these slip-ups happen and the small steps patients can take to lower the risk of testing mistakes. To hear our conversation, listen to the podcast below.

Listen to the Podcast (mp3)

Ordering the wrong test, missing results and forgetting to notify patients are among the many testing mistakes that occur routinely at the offices of family doctors, a new study shows.

The report, published in the journal Quality & Safety in Health Care, looked at testing procedures and mistakes that were reported anonymously by 243 doctors, nurses and staff members in eight small and large family physician practices in seven states. During an eight-month period, researchers from the University of Chicago analyzed the error reports related to medical testing, including ones they observed “should not have happened and that you don’t want to happen again.” The tests included lab work, diagnostic imaging and other procedures like pulmonary function tests and electrocardiograms.

Nearly 1,000 testing mistakes involving 590 patients were reported during the collection period. Read more…

A secret shopper may be lurking in the waiting room. (Erik S. Lesser for The New York Times)

The nation’s leading doctor group has temporarily shelved a plan to allow so-called “secret shoppers” to monitor patient care in hospital waiting rooms and doctors’ offices.

The proposal was being considered by the policy-making arm of the American Medical Association. The group’s Council on Ethical and Judicial Affairs asked the A.M.A.’s House of Delegates to endorse the practice as a way to help doctors improve patient care. But after hearing testimony from its members during a meeting yesterday in Chicago, the group referred the measure back to a committee. Read more…

Despite national campaigns encouraging patients to take an active role in improving hospital safety, many patients aren’t comfortable asking doctors challenging questions about their care, a new report shows.

(Jeff Swensen)

British researchers gave surveys to about 80 surgical patients asking them how they would feel about asking doctors or nurses various questions. The questions ranged from simple factual questions like, “How long will I be in the hospital?” to more challenging questions such as, “Have you washed your hands?” The patients were asked to rate their level of willingness to ask the questions on a scale of 1 to 4, with 4 indicating they would be very willing to pose the question to their doctor or nurse. Read more…

Two decades ago, an anesthesia catastrophe at a Wisconsin hospital killed a pregnant woman named Joy.

The young mother-to-be was undergoing a scheduled C-section, but a series of mistakes by the nurse anesthetist led to a tragic end, leaving the baby brain damaged and the family devastated.

There was another victim that day. Dr. Gary Brandeland didn’t make the mistake, but Joy was his patient. Her death sent him on his own downward spiral of grief and gave him a first-hand view of how doctors and hospital workers react to medical errors.

Dr. Brandeland, now an emergency room physician in Minnesota, has chronicled the tragedy in a moving article in a 2006 issue of the journal Medical Economics. What’s so fascinating about Dr. Brandeland’s story is that it explores the emotional toll medical mistakes have on doctors and nurses who witness them, and looks at the economic factors that he says often are ultimately responsible for medical errors. Read more…

You’d expect a Hollywood star like Dennis Quaid to get the best hospital care money can buy. But as he recounted last night on the CBS news program “60 Minutes,” medical mistakes can happen to anyone.

As has been widely reported, Mr. Quaid’s infant twins almost died after they were given an adult dose of a blood thinner. The babies had been hospitalized for an infection but were doing well. Mr. Quaid and his wife Kimberly had left to get a few hours of sleep. When they returned in the morning, they learned a nurse had misread a label and given the babies what amounted to a massive overdose of the drug.

What is so troubling about the family’s description of the ordeal is the hospital’s reaction. Read more…

When is the best time to check into the hospital? (Lee Celano/Reuters)

Hospital patients who suffer cardiac arrest at night are more likely to die than patients whose hearts stop on the day shift, a new study shows.

The study, published today in The Journal of the American Medical Association, is the latest to show that patient care and survival appears to be profoundly affected by hospital timing and staffing issues. Other studies have shown that patients who receive hospital care on weekends do worse than patients treated during the regular workweek.

Cardiac arrest occurs when the heart stops beating suddenly, and it can be triggered by a heart attack or other emergencies like blood loss or respiratory problems. When a patient suffers cardiac arrest in a hospital, a “Code Blue” is typically called, and a team of doctors and nurses rushes to the bedside with a “crash cart” equipped with a defibrillator, drugs and other tools used to restart a stopped heart. Read more…

Doctors are said to make the worst patients. But does becoming a patient make someone a better doctor?

Dr. Robert Klitzman (Charles Manley)

Columbia University Medical Center psychiatrist Dr. Robert Klitzman explores that question in his latest book, “When Doctors Become Patients.” It’s based on Dr. Klitzman’s own experience as a patient, and on interviews with more than 70 men and women who have experienced both sides of medicine, as doctors and as patients. Some had to cope with depression or cancer; others with heart disease, H.I.V., hepatitis or various other illnesses.

When doctors get sick, they discover fissures in the health system that they didn’t know existed. They learn that seemingly small annoyances they never paid attention to as doctors — like long waiting times or a broken television in a hospital room — really are a big deal when you are the patient. Even doctors who thought of themselves as compassionate recognize they can do better once they experience life as a patient.

Dr. Klitzman starts the book with his own poignant tale of illness. His sister worked on the 105th floor of the World Trade Center and died on Sept. 11, 2001. After the funeral, his body gave out. He couldn’t get out of bed. He developed what felt like the flu. Even though he’s a psychiatrist, he resisted the notion that he was depressed. Later, after acknowledging his illness, he gained new insight into his own patients. He was amazed at how pronounced the physical symptoms of depression really were. “I felt weak and ashamed, and began to appreciate, too, the embarrassment and stigma my patients felt,” he writes.

I spoke with Dr. Klitzman this week about what he and other doctors learned after becoming patients themselves. Read more…

In most businesses, customers don’t pay for a vendor’s mistakes. But when hospitals make errors, they charge patients additional money to fix the problem.

The perverse economics of hospital charges were outlined yesterday in a fascinating article in the Journal of the American Medical Association. The story focused on one common but largely preventable medical error: urinary tract infections associated with the use of a catheter. It showed how in some ways, the medical system has built-in financial incentives for bad care.

Hospitals use urinary catheters more than almost any other medical device, and they account for 40 percent of all hospital-acquired infections — about one million annually. A urinary tract infection can add a day to a hospital stay; sometimes it can lead to a more serious infection, even death.

At one Colorado hospital, the article noted, Medicare would pay $5,436.66 for the care of a heart attack patient who recovered without complications. But if the patient developed a urinary tract infection related to use of a catheter, the hospital would receive $6,721.44. If the patient developed a more serious infection after a catheter was used, the hospital collected $8,905.43. That means the hospital would earn 63 percent more by providing inferior care. Read more…

Nearly half of doctors in a recent survey admit to witnessing a serious medical error but not reporting it.

That is one of the findings in a new survey aimed at measuring how well doctors conform to guidelines on medical professionalism, reported today in The Annals of Internal Medicine. The survey, led by researchers from Massachusetts General Hospital, surveyed nearly 1,700 doctors about their beliefs and practices regarding medicine. Over all, the survey shows that most doctors adhere to strict standards of professionalism regarding medical mistakes, patient privacy and appropriate patient relationships.

But what is surprising about the research is how many doctors are willing to look the other way when rules are broken. For instance, 93 percent of doctors agreed that physicians should report all serious medical errors they observe. And 96 percent said physicians who are significantly impaired or incompetent should be reported to the authorities. But when doctors were asked about their personal experiences witnessing medical errors and bad doctors, 46 percent said they had firsthand knowledge of medical mistakes but didn’t report them. And 45 percent said they were aware of bad behavior by doctors that they didn’t report. Read more…

Your left or my left? (AP Photo/Paul W. Gillespie)

It sounds like something out of a horror movie, but wrong-sided surgery happens more often than you think.

Concerns about surgeons operating on the wrong part of the body made headlines this week after The Providence Journal reported that on three separate occasions this year, surgeons at Rhode Island Hospital operated on the wrong side of a patient’s head. The most recent case happened last Friday, when the chief resident started to cut on the head of an 82-year-old patient. The resident, a doctor in the seventh year of specialty training, realized the error before reaching the skull and closed the wound with a single stitch. The procedure was done on the correct side, “with good results,” according to a statement from the hospital, which was fined $50,000 by the state health department. Read more…

The physical consequences of medical errors are obvious. One well-known study estimated that as many as 98,000 hospital deaths a year stem from mistakes by health care workers. But what about the less visible emotional costs of these missteps?

The New England Journal of Medicine tackled the issue yesterday in a moving commentary called “Guilty, Afraid and Alone: Struggling with Medical Error.’’ The writers, Dr. Tom Delbanco and Dr. Sigall K. Bell of the Harvard Medical School, note that while the medical community has focused largely on reducing error rates, hospitals also need to address the “human dimensions” of treatment blunders and to assist in the emotional recovery of patients and families.

The doctors, who are making a documentary film on the subject, talked to numerous patients and families affected by medical errors. The authors found that family members often feel guilty for not having protected loved ones from the caregivers’ mistakes and that many feared retribution if they did complain. And Dr. Delbanco and Dr. Bell note that physicians who err often shut out patients and their families, “isolating them just when they are most in need.’’ Read more…