Becoming Your Own Doctor (Or At Least Questioning Your Doctor's Recommendation)
How important is fasting before a routine blood test measuring cholesterol levels? Very important. You don't want to strictly follow your doctor's recommendations before a medical test? Fine. Then you run a high risk that the test will either be medically meaningless, or will be read improperly by your doctor.
It's no secret that patient non-compliance with pre-testing requirements as well as patient failure to follow instructions from doctors are major factors in the misdiagnosis of various medical conditions. According to a Johns Hopkins University School of Medicine study, diagnostic errors account for the deaths of 40,000 to 80,000 hospitalized patients annually. Dr. Peter Pronovost conducted the study. The reason for a misdiagnosis can be the center of debate in a typical medical malpractice claim. And a patient's non-compliance will certainly be raised as a defense.
How about not hearing from your doctor's office following a routine test? Does that mean everything is ok? Not necessarily. Your primary care doctor and the specialist who ordered the test may assume each is following up, when in fact they are not. Simply put, patients have to be empowered on their own (and bear some responsibility) for followup on the test results their doctors order. This may sound counterintuitive. After all, we rely on the expertise of our doctors to not only order the appropriate tests but also to diagnose our medical problem, as well as to report the results to us, accurately.
Protecting patients in the hospital setting, empowering patients to be more assertive in their own care, and evaluating medical malpractice claims for purposes of educating doctors in not only the avoidance of future claims, but also as a means to provide better care, has been the area of study to which Dr. Provonost has dedicated himself. Two recent articles, one in The Wall Street Journal (September 28, 2010 by Laura Landro) and one in The New York Times ( March 8, 2010 by Claudia Dreifus) highlight his views.
Malpractice claims on the basis of misdiagnosed tests are possibly indicative of overloaded primary care physicians and, some would argue, part of deeper problems in our health care delivery systems. Nevertheless, Dr. Pronovost 's take on the issue is to allow and encourage patients to be responsible for their own care in a hospital setting. This comment is from the New York Times article.
Q. WHAT CAN CONSUMERS DO TO PROTECT THEMSELVES AGAINST HOSPITAL ERRORS?
A. I’d say that a patient should ask, “What is the hospital’s infection rate?” And if that number is high or the hospital says they don’t know it, you should run. In any case, you should also ask if they use a checklist system.
Once you’re an in-patient, ask: “Do I really need this catheter? Am I getting enough benefit to exceed the risk?” With anyone who touches you, ask, “Did you wash your hands?” It sounds silly. But you have to be your own advocate.
Dr. Pronovost's approach is counter to the trend of the medical community and counter to the views typically espoused by insurance companies that insure doctors and hospitals. But he certainly provides a refreshing voice. If we are to see the improvement in the delivery of medical care in this country, the reduction of medical mistakes, as well as the reduction of medical malpractice claims, doctors, hospitals and their insurers are going to have to listen to what Dr. Pronovost says, and are going to have to embrace his approach.
