The essence of medicine lies in its ability to heal, rather than harm. Yet, in accessing treatment, many barriers exist.
The World Health Organization refers to patient safety as the absence of preventable or unnecessary harm to an individual while seeking care. Globally, 2.6 million deaths occur each year due to adverse events. These include diagnostic and therapeutic errors, procedural complications and administrative challenges. These preventable events can be minimized by engaging patients in their own treatment, increasing collaboration among healthcare professionals and re-visiting institutional policies.
As privileged beneficiaries of healthcare, patients can help safeguard their well-being by involving themselves in the care they receive. In 2014, 15 per cent of Canadians aged 12 and over did not have a family doctor. Of these, nearly half reported that they had not sought one. The lack of access to a regular healthcare provider is concerning. While walk-in-clinics remain a viable option, they are merely accessed on patients’ own terms. This may cause patients to delay seeing a doctor, further exacerbating their conditions. Additionally, without a family physician, a patient’s health cannot be monitored over time. It is possible that the healthcare provider, when seeing a patient for the first time, may dismiss a potential red flag as usual pathology.
Patients should also partake in decisions concerning their care. This includes asking follow-up questions for clarification or informing the physician about their values and beliefs. Those who engage in their own treatment have better health outcomes, fewer complications and improved quality of life. Furthermore, time spent behind closed doors is important for both patients and physicians. For patients, it allows them to be transparent about their health issues while for physicians, it helps to better understand patients and their concerns.
Medicine traditionally has been characterized by a lack of transparency and cooperation among workers. To uphold patient safety, teamwork among healthcare professionals (HCPs) is needed. Yet, less than 50 per cent of all HCPs feel respected by doctors they work with; even fewer believe that doctors, nurses, and hospital staff work together as a coordinated unit. Healthcare workers should not feel reluctant to voice their concern for a patient, even if it involves consulting the physician in charge.
A major source of medical errors is miscommunication during handoffs – transitions in patient care among nurses, physicians, residents and other HCPs. One teaching hospital in San Francisco reported 4,000 handoffs daily, for a total of almost 1.6 million per year. Poorly executed handovers contribute to 20 per cent of malpractice claims and result in serious harm to patients. Mitigating errors during the transfer of responsibility is critical to reducing adverse events. Trainees should be taught how to effectively hand over patients from senior colleagues. For instance, they can be educated on the information to share to best prepare co-workers for the next shift. Teamwork among HCPs can be encouraged through frequent workshops that entail simulated group activities.
Adverse events in healthcare include diagnostic and therapeutic errors and contribute to half of all medical errors. Patient safety guidelines can be embedded early in the curriculum to better prepare future doctors. However, the existing medical curriculum is dense. Instead, an interprofessional approach to learning, along with training materials and guidance on how to integrate patient safety topics in residency, would help.
System-related changes represent one of the biggest impediments to patient safety. From surgical mishaps to faulty equipment, medical blunders are pervasive in healthcare. Data from the Institute of Medicine shows that up to 100,000 deaths occur annually in U.S. hospitals due to medical error. From 2000 to 2013, the Food and Drug Administration received 10,000 incident reports. Of these, 15 per cent involved broken equipment falling into the patient, 11 per cent involved electrical sparking, and nine per cent involved robots making unintended movements. Patients invest great trust in the healthcare system, hoping to be in safe hands when they enter the hospital. Occurrence of frequent and preventable error only aggravates this trust. Many patients are not even informed of procedural risks prior to undergoing treatment. While lapses in medical technology cannot be anticipated, they can be prevented through procedural changes. For example, hospitals can implement safety rounds for technicians to collect feedback from workers on safety issues they have encountered. In this manner, problems can be rectified immediately.
To err is to be human. Fatigue, stress, illness, and grief can all play a role in creating an unsafe environment. When preventable errors become recurrent, trust in the healthcare system dissipates. It is vital to acknowledge these events and work to eradicate them. In the words of Hippocrates, healthcare workers must “make a habit of two things – to help, or at least, to do no harm.”