Ep 8. Medical Errors

Eve: 0:00

Learning that that type of doctor patient relationship could exist. That made me realize this is what anybody deserves.

Heather Johnston: 0:14

This is doctor patient, a podcast that examines all the aspects of the patient provider relationship. I'm your host, Heather Johnston, MD, a real life doctor and patient. In 2016, researchers from Johns Hopkins conducted a study looking at cause of death in patients in the US, and found that medical errors accounted for almost a quarter million in the year, making it the third leading cause of death in the US. This isn't reported regularly since those cause of death charts and tables calculate the tallies based off of billing codes, and there isn't a billing code for medical error. Then in 2018, researchers at Stanford Medical Center found a strong correlation between doctor burnout, which we talked about last week, and medical errors. I'm putting all of these references in the show notes, by the way. Today, we'll be hearing a couple of stories of medical errors and their consequences. My first guest is Eve from Chicago. A couple notes ahead of time first, this is a tough story to hear, and I recommend you grab some Kleenex. Second, I need to tell you a couple of medical facts ahead of time so that you understand the story better. There is a medical condition some pregnant women develop called preeclampsia. It's characterized by high blood pressure, protein in the urine, visual loss or flashes of light, headaches, and more. One certain type of preeclampsia is called HELLP syndrome, which has a similar presentation, but also rarely bleeding and easy bruising. Both are very serious and dangerous. Here's Eve.

Eve: 1:51

So I was pregnant with twins. And you know, I'm pretty petite. But we were thinking this is a healthy pregnancy all along. I was enormous. And towards the end of the pregnancy, I started getting symptoms like black hands, palms of my hands, soles of my feet. So it was circulation. And when I had gone in for my regular weekly checkups with the doctor, he for that specific symptom, he said, oh, the babies must be sitting on something, don't worry about it. Then I had bloody noses, bleeding gums, a low grade fever of 99. And he said, you know, those are all normal and the fever, don't bother calling me unless it's over 100. And headaches, I did call him and he said, with along with the fever and he said, yeah, just take some Tylenol. So all of these things were happening within, you know, maybe the last couple of weeks, but because every time I had a symptom or something, it would be like 'suck it up, you're pregnant with twins', quote unquote. Or you're small. And you know, there's not a lot of room, which obviously is true.

Heather Johnston: 3:25

Was this your first pregnancy Eve?

Eve: 3:26

Yeah, it was my first pregnancy. And so I didn't know what was normal and not normal. Anyway, then. There was an afternoon while I was out running errands, and I just I had to, I was in Whole Foods getting soup because I really couldn't eat a lot of food anymore. So I thought well soup at least I might be able to just kind of get something in my in my system. And I was squatting in line because I could barely stand. And after that there was a flash in my eye, like a strobe light. And my immediate thought was like, Oh, that's weird, but went away as fast as it came and went away. So I recognized it. But you know, when you read What to Expect When You're Expecting and all the notes that the doctors gave you, it's a few vision issues. And I kept on thinking vision issues, like if you blurry vision or something extended. This is just a really fast flash. So and because of the two weeks prior, every other symptom that I was calling him about he was, I'm sorry to say, felt being blown off, that I didn't bother calling because it didn't stay. We went home. It was a very, very stormy night. And I just was like, I said to my husband, I just don't feel well. I just don't feel well. He said just you know, get a good night's sleep and, you know, call the doctor in the morning. Anyway, so I started feeling menstrual cramps, my mom said, Let's time them tell me when you have the next one. So I called the doctor. And it took them an hour to find him and call me back. So I told him that I had seen this flash the night before, and that I was having contractions. And he said, Oh, it's probably Braxton Hicks or something. But if you want to get checked out, come to the hospital and go to the whatever area and they'll they'll check you out. So, by the time my husband got home, from work, we went to the hospital. By the time I got there, like I had, no, this is not a visual thing. This is all words, but I was holding on to the counter at the check in the nurse's station, with my legs spread apart, like bracing myself. And they said, alright, well, we'll just get you, you know, looked at and hook you up to the fetal heart or fetal monitoring strip. So when they got me into a room, set me up, and they couldn't find the heartbeat for one of the twins. So then they immediately went into just lots of examinations and everything. And the doctor finally came in and he said, we lost our little girl. So I already knew I was having a C section that was going to happen. And so now it turned into an emergency situation. And so I had undiagnosed preeclampsia, which at this point now had turned into full blown HELLP syndrome, which I hadn't really read very much about. So they explained that they had to deliver the babies immediately, and to save my life and obviously the life of our surviving twin, who is now my beautiful son. So we had the surgery, and then I went into ICU and had plasma, transfusion transfusions. And I was monitored for solidly for 24 hours and ended up being in the hospital for eight days. And my son is very, very happy, beautiful, healthy boy. And our daughter was stillborn. And that's the story.

Heather Johnston: 7:53

Okay, hold on. Let me just wipe all these tears. Oh, my. God, that's, that's so awful. And I'm glad that [beep] is okay, but that's such an awful, awful situation. So I have a couple of questions about it. Yes. How long did you know that doctor before this pregnancy,

Eve: 8:21

So I moved to Chicago in 1996. He was referred to me by a friend. And this happened in 2001. So five years, four and a half to five years.

Heather Johnston: 8:38

And during those first four or five years before the pregnancy, what was your relationship like with him?

Eve: 8:46

It was literally an annual gynecological visit. We tried really, really hard to get pregnant. So this was actually getting pregnant with twins was our second round of IVF. In retrospect, you know, he was always late for doctor's appointments. And I just thought well, he was always had an excuse. So I was delivering a baby, I'm 45 minutes late or an hour and a half late. That's just the way his office was. And I just kept on thinking, that's the way it is here in Chicago. I'm originally from New York. I loved my OBGYN in New York. Never had to wait 45 minutes to see him. Maybe, you know, a little bit but and then the other really interesting thing that I'll say is in New York, it's a law or at least at the time, that there'll be somebody else present in the room, if you had a male got a gynecologist. It's not the law in Chicago, so there was never anybody else in number. And, again, in retrospect, had there been somebody else in the room, maybe they would have heard my, you know, like the time that I went in with the black hands and black feet, maybe my voice would have been heard if there was somebody else or I would have felt empowered to say something. But the relationship I had with him was nothing special. And while they were things that now I look back at back on, were not great. I just well, that's the way it is. And nobody should just say that's the way it is.

Heather Johnston: 10:37

During that visit, where your hands and feet were black, and you're saying that you were concerned, how did you feel during that visit? And at the end of the visit, like do you remember back that far, what was on your mind?

Eve: 10:53

So he said, the babies must be sitting on something cutting off my circulation. And I didn't feel empowered to question it any more than that, because he was very quick to have that as an answer. And very end, he would say these responses very confidently and like, in a brushed off manner, like it's nothing you're making a big deal about it kind of tongue.

Heather Johnston: 11:20

So did you feel like you trusted him? Like he was giving you the answer, it's not worrisome, and you trusted him? Or was it that you were still worried, but you didn't feel like you could say something?

Eve: 11:30

No, I've always trusted doctors. So I felt like he's, he should know, he's, you know, a very well respected doctor at [beep] Hospital.

Heather Johnston: 11:45

So when you're at home, after that visit, and things were not feeling right, do you remember back that far? Do you remember what what were you thinking at home, like, I'm not feeling well, and I keep calling. And they're saying it's okay, what was in your mind.

Eve: 12:08

So had it been my second pregnancy, I would have immediately just gone into [beep] or gone to see a different doctor because he wasn't listening to me. But at the time, I felt like I should be able to trust my doctor. So I didn't, I didn't think that I needed to because I felt like I should be in good hands. When when I was in the ICU and ended up being in the hospital for eight days, he delivered the babies, never came back to see me until the day I was discharged. My staples for the C section weren't closing and so I was sorry, this is probably a little graphic, but I was leaking through my abdomen. And so his partner had to come in, he didn't not come in to do this. And he ripped out my staples. That was I like shutter thinking about and saying it again. That was probably the most painful experience of my life. He had no bedside manner either. But I felt like I was in an army tent. And there's no there's no supplies, and there's no way to kind of triage you. And it was like, Okay, we've got the basic.

Heather Johnston: 13:41

Like you're on the frontlines.

Eve: 13:45

Yeah. And he just ripped them out, put some tape on and, and left. So that was another part of this experience of the healing. So not only the emotional healing of losing a child, but the physical healing. So that took a really, really long time. So even after I got home, I was dealing with wound care for that for the incision. And then on day eight, he came in and I was really really sick. Again, I'm, I'm a small person, but giving me adult doses of painkillers and all the other things that they give you in the hospital were really, really messing up my system. And by day eight, I was vomiting. And they he was just like, well, you just need to go home. And so after two days of being home and I couldn't breastfeed, no milk was being produced, but I was pumping pumping every day to try to force it to come out. After two days of being home, I said to my, my husband and I was still vomiting. I said, I just need to stop. I need to stop the pumping, I need to stop the medication, the painkillers. I said, you just need to stop everything.

Heather Johnston: 15:19

Oh my god. How were you mothering? How were you dealing with that?

Eve: 15:28

The first day, two days, I came home not feeling well forcing, like by thought my priority was to force this milk so I could nurse my son. I would give him bottles. I was in bed, because I really couldn't walk around because the incision was partially open. I had the drapes closed, I just wanted to sleep. And I'll never forget my husband just saying, just coming in like opening up the drapes, and then saying come downstairs. I sat outside, you know, it's June night the weather's nice and sat outside with a plate of saltine crackers. And holding my son, I think I even have a picture of it. And that was just the beginning of okay, I'm gonna work hard on getting through this. I wanted to be a mother so badly, it was the greatest greatest gift.

Heather Johnston: 16:33

You told me that later on, you guys had considered a malpractice suit. And there's something about the records that I wanted to hear you say again, that when you got a hold of the medical records, what was in it?

Eve: 16:51

That the day that I had gone in to have my the hands and feet and that was just a weekly checkup, there were no results of the protein and for the urine test, There was no results for that in the records and I know that that was done. And oh, also that he had written no complaints, patient complaints.

Heather Johnston: 17:22

Eve actually gave me all of the medical records that were collected during her pregnancy. And they were what her lawyers were looking at when they told her that there was not really a case to be made. The reason why, I was shocked to find, is that there was no notation anywhere in her chart that she had ever called with concerns or problems. On top of that there were no urine protein results anywhere in the chart. This is totally weird. Every pregnant woman gets a urine protein test at just about every visit. And there were very few blood pressures recorded, also very standard at every visit, and weird to be missing. Eve reports that her blood pressure and urine were tested at every visit but they just weren't recorded, or something happened to the records. Either way, it's another piece of evidence that things just weren't right. If the you today could go back and tell the you back then something about what to do you know, what would it be?

Eve: 18:22

It's okay to second guess somebody that you feel like you're supposed to listen to? That's okay. Go get a second opinion. I mean, go into the hospital just say you know what, I don't feel right. Can you just check me out? It's okay. And do it. Better be safe than sorry.

Heather Johnston: 18:45

Yeah, I really feel like it is okay for patients to express frustration with a doctor or to say, Hey, I know you're telling me it's okay. But I'm really uncomfortable with this. It is okay. Although I think most people even now still don't feel empowered to do that.

Eve: 19:03

Yeah. And and you're right. I mean, just being able to say to him, I am not accepting your answers. I'm not accepting the way you're treating me. I would never have thought to speak to a doctor like that. Now, I totally, totally would.

Heather Johnston: 19:27

That was my next question. How has this impacted your relationship with doctors that you see now?

Eve: 19:33

It's your body, it's a service, it's your life. And you should be treated with respect you should be listened to. And if you're not getting it, then it's not the right person for you. The doctor that I changed to because he knew my experience, but he was had such great bed manner, bedside manner and just held my hand through the whole thing. Said, here's my cell phone. If you're not feeling well at night, I want you to call me directly. I mean, this was, like, just totally the opposite. So learning that that type of doctor patient relationship could exist. That made me realize like, this is what anybody deserves.

Heather Johnston: 20:28

Eve did that doctor ever apologize?

Eve: 20:31

No, I went back for one visit, like the first follow up visit. And this is really creepy. I was sitting. And again, I go back to this, it's weird being in a examining room with a male doctor without anybody else there. But maybe it was him. I was sitting on the examination table. He hugged me, I did not hug him back. His leg was in between my legs. And I recoiled. And I thought to myself, I need to get out of here as soon as I can. [Wow] And he, I think he apologized for the loss of a child for the loss of my child, but not apologizing, that he had anything to do with it. It was just more like, I'm so sorry, you lost your daughter, like you would, I'm so sorry you lost your father Heather. Like that. It wasn't any more than that. And then. I mean, I immediately called someone for reference for another doctor, so I could do my next follow up with somebody else. In the meantime, I visited a friend who had given birth about a month later at the hospital and ran into him in the hallway, which was weird. And then he said, Oh, I should be seeing you again soon. And I said, No, you're never going to see me again. And I got the elevator.

Heather Johnston: 22:08

Good for you. I have been thinking a lot about a lot lately just about access with doctors and finding doctors that you like, and what do you do if you don't like somebody? Because for so many people, they're really limited by insurance. Who can you see? Are you allowed to switch? How many visits get covered? If you have an annual visit with somebody and you don't like them, do you have to wait a whole year to find someone else and then give them another try with an annual visit. So my friend and I were laughing last week that we really should create like Tinder for doctors. So people doctors could upload like a video of themselves talking about what their practice style is like and how they talk to patients. And then you could feel like it's a good match for me or not a good match. Because it's really hard to know, until you get in there. And it's such a big deal to go in for doctor appointments.

Eve: 23:02

Yeah, no, that's a really, really, really great point. But I've also found that the, the doctor that I went to after this experience, I loved, loved loved him and he retired. And then so when the doctor retires, then you get you know, then I went to see somebody else in his practice, who was a wonderful woman. I really, really liked her, no nonsense. I'm a no nonsense kind of person. I just like tell me the way, tell me how it is. And then she retired. So now I'm like, so just in the matter of a few years now I'm on to, you know, doctor number three, so.

Heather Johnston: 23:45

When I was diagnosed with breast cancer, and I had the surgery, I was having like a consultation with the surgeon at [beep] (name of hospital). They said okay, we need to make an appointment for you with the medical oncologist to talk about chemotherapy. And I didn't know anybody there. It wasn't the hospital where I worked. So I said, Okay, who do you recommend? And the nurse said, Oh, I love this guy. I'm gonna put you with him. And I went for the visit. And I disliked him intensely. I found him to be cold, unemotional, disinterested in why I was sobbing. And I left the room and I said to Matt, that I can't. That can't be my doctor. I can't go through something so awful with somebody who won't hug me. That's just who I am, I like to be hugged. And so I went and found the nurse manager again. I said, Hey, I need to switch. And she said, Oh, you can't, it's our office policy. [Oh] and I said well, I'm switching. So find me whoever is in charge of I don't know the entire breast center and have them call me. And they did, and we talked it over and they said we'll make a special exception because you're a physician. You can you can switch, but this is the last time, you're not allowed to switch again. And I, this has not left my mind since it happened. I can't believe what an awful policy it is. It's so impersonal, it's terrible for the doctor patient relationship. It's bad for patient care. I can't. You know, I just can't imagine why that happens except that I guess people want to switch around. Because, you know, it's an awful thing to go through, and you want to have somebody who matches you personality wise. So back to my Tinder idea. Tinder for doctors.

Eve: 25:36

No, and that's a great point. Would it, if doctors, and I wonder if doctors knew that it was easier for patients to choose their doctors and change, that they may take that extra moment to really think about how am I caring for my. Am I doing my job, medically? And then am I also caring for the patient? You know, it's, you know, better than anybody. It's a multifaceted role. So [it is], Are you are you really doing the full service? Are you doing everything you're supposed to do as a doctor? And maybe if they knew that you could switch, and you're not just a cog in a wheel, I'm getting through to you, and then I'm going on to the next patient. You know, take that moment, although I know it's hard to fit everybody in and taking that extra time takes time away from somebody else.

Heather Johnston: 26:33

Eve, thank you so much for talking with me today.

Eve: 26:37

Well, thank you for giving me the opportunity to share the story and I hope it helps someone.

Heather Johnston: 26:44

It will. Thanks for sharing your heartbreak.

Eve: 26:46

Thank you, Heather.

Heather Johnston: 26:55

There are all sorts of medical errors that occur. After all, medicine is both a science and an art practiced by regular human beings. Oftentimes as doctors, we're making decisions based on our knowledge, experience, and sometimes even gut instinct about things. And all of those factors are subjective and vary from person to person. The reason why I'm covering this topic, medical errors, is because while having a strong relationship with your doctor obviously doesn't guarantee there won't be an error. Having a good line of communication and a healthy dose of trust, seems like it would help cut down on them. My next guest is Randi from Florida, talking about the ripple effects of a small medical records error.

Randi: 27:38

I recently went to my primary care doctor for an annual exam. And in chatting, I happened to bring up the fact that I felt my anxiety was a little bit out of control, that the Celexa medication that I have been on for years was perhaps not working as effectively as it used to. And the doctor suggested that a micro dose of Abilify might be just the trick in combination with the Celexa. I immediately turned down that suggestion, stating that I would, that I was sure of the fact that there were other ways. And then I remembered Abilify with my father being a very strong drug used for dementia, depression, et cetera, none of which I am challenged with. And the doctor insinuated that just a micro dose could be the trick. I refused, never filled the prescription that he gave me at that appointment. Kind of simultaneously, my husband and I were in the midst of seeking long term care insurance through a company. And when filling out the application and submitting it. I, you know, I was fairly sure that there would be no snags and upon receiving a letter back from the insurance company stating that I was immediately rejected because of a notation of Abilify in my chart. So, I was very shocked by this because a) I never took the Abilify b) I had no idea that from this casual chat and suggestion with my physician that such a notation was going to be in my chart. So, in continuing to pursue the long term care plan, I needed to begin trying to get this notation off of my medical chart, ask the doctor for a letter of correction, and was told that he could not remove the Abilify from my medical chart, because it was suggested by him. And he did provide a letter to me for the insurance company stating that I never took the Abilify and that the Celexa was continuing to adequately control my anxiety.

Heather Johnston: 31:17

Wow. So, jeez, insurance companies. Was there a diagnosis attached with the Abilify in his medical records? Or was the whole thing just simply related to the word Abilify?

Randi: 31:34

I did notice in my chart, when I went online, one of the first things I saw in my chart was depression. And I was shocked by that because that depression, I've never been through any testing. No one has ever. I have never said to a doctor, I'm depressed. Doc, let's deal with that. No.

Heather Johnston: 32:04

Was that part of that same visit?

Randi: 32:06

I think it landed on my chart after that visit, when I spoke of anxiety.

Heather Johnston: 32:14

But that doctor did not ask you to screening depression questions?

Randi: 32:18

Absolutely not. Absolutely not.

Heather Johnston: 32:22

It's really a problem, how much insurance companies have their finger in the pot of health care. Because while their public mission is to provide people with a security blanket for the cost of medical care, their fundamental behind the scenes goal is simply to make money and save money. Those are for profit companies that want to make money. And the only way an insurance company makes money. Well, there are several ways. Number one, try not to pay for things. Number two, try not to cover people who might have problems. And when you think about those issues, they're just completely at odds with the concept of healthcare delivery. It's bizarre to me, it's bizarre to me how much insurance companies run the daily lives of doctors and hospitals.

Randi: 33:22

Scary. Scary.

Heather Johnston: 33:25

It's terrifying. So I want people to hear mother's story related to this, because I'm hoping that providers will listen to it and just, you know, give an extra minute of caution when they're taking notes.

Randi: 33:37

Absolutely. And I plan to be a much more astute patient, if you will, when I'm in that office, inquiring as to what's going into that computer that they're clicking away on as they document my visit. As well as what I say to them. So to me, it's a little scary that we have to be guarded as to what we share with our physician for fear that it's gonna come back to bite us instead of perhaps helping a need that we are expressing to a physician. This is a perfect example of that.

Heather Johnston: 34:29

That'd be terrible to feel that way. Yeah, I could see, you know, I could see especially in your case, having gone through this now that you you might think twice about saying something. That would be awful.

Randi: 34:41

I just I haven't gone back to this physician yet. The jury is still out. Until this I really liked him. You know, but I just worry about a doctor who sees, in my opinion, and I might be A little biased, you know, a highly functioning, individual, working, etc, etc, etc. and making a suggestion of something like Abilify when anxiety is mentioned. It was just such an absurd incident that I felt it was needed to be heard by people.

Heather Johnston: 35:31

Well, it's interesting that you left with a prescription even though you said no.

Randi: 35:36

Not my doing not my doing. It was kind of like

Heather Johnston: 35:39

No, yeah, I mean, I'm saying, why did he write the prescription if you said no?

Randi: 35:43

Yeah, exactly. And I mean, literally, like when I sat in my car, and I looked at, okay, here's the bill. And I'm like, Why do I have this prescription? I said, No.

Heather Johnston: 35:54

Oh you didn't even know that he was writing the prescription.

Randi: 35:56

No. It was kind of when I checked out and paid, it was giving given to me in the little stack of papers. So

Heather Johnston: 36:07

Wow. Well, that also means that he didn't talk to you about it, about probably you guys did not go through the level of detail you'd want to know about starting a new medication, since you said, no.

Randi: 36:18

No, it's got. I mean, if I have had the time then I, so much I would have done now that hindsight is 2020. Right, then gone back in. Why do I have this prescription? Is that notation in my chart? Why? I refused it, et cetera, but never imagined this.

Heather Johnston: 36:46

Unfortunately, I have a story to add to this episode. I've been going back and forth about sharing it. But I'm becoming increasingly emboldened as I go forward with this podcast. Back in 2020, when I was diagnosed with breast cancer, I had a lumpectomy at big hospital number one in Chicago. I got the call from the surgeon A few days later, good news, there was no cancer in the sample. I replied, gosh, I was really hoping for a call saying we got it all. I felt very worried about this because I had had a really tricky time in the preoperative area, with them getting what's called a guide wire into place. That's a physical wire that they put into the breast that basically points the surgeon to where they should cut. I called the surgeon twice over the month after the surgery to ask him to review all of the pre-surgery scans to make sure that the wire had been put in the right place. At some point, he even called me his trouble patient, which will likely become a whole other episode someday. But moving on. I even had a call with one of the head radiologists there who assured me that all of the scans were normal looking. To make a very long story short, it turns out that they had in fact missed a little bit of cancer that was just outside the surgical area. We figured it out on a mammogram one month after the surgery. So after much deliberation, I went in for a second opinion at big hospital number two in Chicago. I brought all my records over there and they reviewed it and told me unequivocally that this was straight up a medical error on the part of big hospital number one, no doubt about it. That extra spot of cancer had been clearly visible on multiple scans prior to the surgery. And also yes, in fact, the last mammogram that they did of the wire just before the surgery suggested that the wire was in the wrong place. I let big hospital number to do a second lumpectomy and that was that. Here's what's on my mind about it. When I heard this news from big hospital two I was furious. But to be clear, I was not furious that an error had occurred. I completely understand that mistakes happen. Medicine is after all an art that is practiced. Doctors are human and fallible. I was furious that I had given them so many choices to come clean and admit that something had gone wrong and they just wouldn't. All I wanted was a little closure. I would have liked to have heard. Jeez, we can't believe it. This almost never happens, but it looks like that wire slipped and we just missed a part. We're really sorry. I now have about eight patients, including myself that I know have gone through medical errors. And in my teeny tiny sample size I can attest that not one of us has ever heard a doctor involved apologize or even own up to the error. Perhaps they're advised not to by some medical legal team. I'm not sure. But I know that it's directly the opposite from what I've been teaching my own children their whole lives. Don't lie. Be honest. admit your mistakes and talk to people Thanks for listening today. To catch up on more episodes and to get new ones delivered directly to you. Subscribe wherever you find your podcasts, Apple, Google, Spotify, iHeartRadio and more. If you'd like to be a guest or have an idea for an episode, let me know at www.drpatientpodcast.com That's doctor patient podcast.com. Here's the disclaimer. Even though I am a doctor, I'm not your doctor. These stories, my comments and all discussion is purely reflection about what's working in the health care system and what isn't. Don't use any medical information that you hear in these episodes to diagnose or treat yourself. If you have a question about your health, get in touch with your doctor or local health clinic