Earlier this month, the admission of my friend “Don” to a community hospital promised to be routine. He would be observed in the hospital for three days while a powerful new drug was introduced to address his irregular heart beat, or arrhythmia.
After going through the hospital’s admission procedure, Don was taken to his room. There, his nurse, “Karen,” introduced herself . He said, “I’ve got a question. I’ve been trying to get an answer from my doctor, but I haven’t been able to.”
“What’s your question?”
“I don’t know whether I’m supposed to be taking my regular daily medication while I’m here,” said Don.
“Are you concerned about something?”
“Nobody’s told me whether I’m supposed to continue to take my usual drug for arrhythmia. Or, would that, combined with the new drug, amount to a double dose?”
Picture Karen rushing from the room, other staff members piling in, and Don discharged immediately, before the new drug is administered. It turns out that use of the old drug is supposed to be discontinued two days before the new drug is given. Oops.
Don thinks, with good reason, that this kind of medication error is typical. That’s why he raised the question in the first place. His alertness prevented a potentially serious reaction.
Now comes the part I find most appalling. Did Don’s cardiologist, who arranged for the hospital stay and was in charge of it, get in touch with Don, apologize, explain the communication failure, and assure Don that he was implementing new safeguards to assure that this sort of thing will not happen again? No.
Did the hospital reach out to Don, apologize, explain the communication failure, and seek his input into how to prevent similar occurrences in the future? No.
The usual excuse given for the lack of this kind of followup communication–called “apology,” “disclosure,” and “explanation” in the literature–is that doctors and hospitals fear that if they raise the issue, the patient might sue for malpractice. Don, though, couldn’t sue, because he suffered no ill effects–the mistake was caught in time. Thanks to him.
So why didn’t the doctor and hospital come forward? There are many possible reasons, but certainly a poor sense of how to communicate effectively with patients is part of the mix.
Their first mis-communication was the failure to advise Don to discontinue his drug before being admitted. Their second mis-communication was the failure to ask him about any drugs he was taking on admission, rather than relying on him to raise the issue. Their third mis-communication was to fail to follow up appropriately. Badly done, all around. The only hero is Don.
Moral: Be like Don. Ask your questions. Maybe more than once. Don’t assume everything is under control. Expect little in the way of communication from physicians, hospitals, and nurses, unless you initiate the conversation. Protect yourself.