>> >>PEGGY: YOU MAY RECALL THE RECENT HIGH PROFILE SURGICAL MISTAKE WHERE A LOCAL KAISER
SURGEON REMOVED A HEALTHY KIDNEY AND LEFT THE ONE WITH THE CANCEROUS TUMOR IN PLACE.
THERE ARE THOUSANDS OF LESS TRAUMATIC BUT STILL SERIOUS MISTAKES EVERY YEAR.
MY GUEST IS MARTIN MAKARY.
DR.ÊMAKARY, THANKS SO MUCH FOR BEING HERE.
YOUR BOOK FOCUSES ON NEVER EVENTS AS THEY'RE CALLED.
GIVE US A FEW EXAMPLES OF WHAT NEVER WERE.
YOU NAMED A FEW.
>> >>: THESE ARE THINGS THAT ARE ENTIRELY PREVENTIBLE, OPERATING ON THE WRONG ARM, OR
THE WRONG PATIENT.
NOW, PEOPLE SHOULD KNOW THEY SHOULDN'T BE ALARMED SURGERY IS SAFE.
THESE ARE THE EXTREMES.
BUT MINOR MISTAKES THAT HARM PATIENTS OCCUR ONE IN FOUR TIMES IN THE HOSPITAL, ACCORDING
TO THE NEW ENGLAND JOURNAL OF MEDICINE.
>> >>PEGGY: WHEN YOU SAY MINOR MISTAKES, ARE YOU TALKING ABOUT UNNECESSARY SURGERIES?
>> >>: WE'RE USUALLY TALKING ABOUT GETTING AN UNNECESSARY TEST DONE OR AN UNNECESSARY
BLOOD TEST, AN IV THAT HAD AN INFECTION OR SOMETHING LIKE THAT.
THESE ARE NOT LIFE THREATENING, BUT THESE ARE MINOR AND THEY OCCUR ONE IN FOUR TIMES
IN THE HOSPITAL, ACCORDING TO THE NEW ENGLAND JOURNAL OF MEDICINE.
>> >>PEGGY: YOU AND SOME OTHER RESEARCHERS IDENTIFIED THAT IN THE U.S. MORE THAN 9700
MAL PRACTICE PATIENT OVER THE 24 YEAR PERIOD FOR THIS REPORT, AMONG THOSE THE MOST COMMON
NEVER OR CATASTROPHIC EVENTS WERE ABOUT 49% OR ABOUT HALF OF LEAVING A FOREIGN OBJECT
INSIDE A PATIENT.
ABOUT A QUARTER WAS THE WRONG PROCEDURE.
ANOTHER QUARTER OPERATING OP THE WRONG SITE.
AND THEN LESS THAN A HALF A PERCENT, 0.3%, THE SURGEONS OPERATED ON THE WRONG PATIENT.
THE AMERICAN HOSPITAL ASSOCIATION SAYS THAT THINGS ARE BETTER NOW.
DO YOU AGREE WITH THAT?
>> >>: WE DEVELOPD A CHECK LIST AT JOHNS HOPKINS TO TRY TO PREVENT THESE PROBLEMS.
THIS CHECK LIST HAS BEEN ADAPTED BY THE WORLD HEALTH ORGANIZATION AND IT'S USED AROUND THE
WORLD NOW.
WE'RE DOING THINGS THAT ARE BETTER.
DOWNLOADING A CHECK LIST IS NOT GOING TO SOLVE HEALTHCARE'S PROBLEMS.
THE CULTURE OF MEDICINE NEEDS TO CHANGE.
WE'VE GOT AN ENDEMIC OF MISTAKES.
WE CAN DEVELOP BERT TECHNOLOGY TO ENGINEER THIS OUT OF THE SYSTEM, BUT MEDICAL PIS ACHES
ARE THE NUMBER THREE CAUSE OF DEATH IN THE UNITED STATES.
WE SPEND A LOT OF TIME AND ENERGY ON NUMBER 1, HEART DISEASE, AND CANCER NUMBER 2, AND
NUMBER THREE WE'RE JUST NOW RECOGNIZING IT'S A PROBLEM OF THIS MAGNITUDE.
>> >>PEGGY: DO YOU THINK THAT HOSPITALS OR I DON'T KNOW THE AMA, ARE WE PROTECTING SURGEONS
FOR PROFITS AND SO THEY ALLOW THESE SURGEONS LET'S SAY WHO MAKE NUMEROUS MISTAKES TO CONTINUE
PRACTICE SING.
>> >>: WE DO KNOW THERE'S VERY LITTLE EXTERNAL PEER REVIEW.
DOCTORS GROUPS ARE SAYING WE NEED TO IMPROVE QUALITY BY MEASURING WHAT WE DO USING PHYSICIAN
AUTHORED DEFINITIONS SO WE DON'T PUNISH DOCTORS WHO TAKE ON HIGH RISK CASES.
I'M ONE OF THOSE SURGEONS, AND WE NEED TO THINK CAREFULLY ABOUT MEASURING THIS PROBLEM.
ANY BUSINESS CEO SAYS WHY DON'T YOU FOLKS IN HEALTH CARE MEASURE THE PROBLEM IN ORDER
TO FIGURE OUT THE SOLUTION.
>> >>PEGGY: TELL US WHY IN YOUR BOOK YOU MENTIONED THAT MASSIVE FINES MIGHT HELP THE SITUATION?
>> >>: IT TURNS OUT THAT WHEN THINGS ARE OUT THERE IN THE PUBLIC, HOSPITALS RESPOND QUICKLY.
WHEN THERE ARE INCENTIVES, READMISSION RATES OR SOMETHING ELSE, THEN THEY RESPOND.
THEY PUT A LOT OF RESOURCES INTO THE PROBLEM.
AND THEY COME TO THE DOCTORS AND NURSES ON THE FRONT LINES AT THEIR HOSPITALS AND THEY
SAY WHAT DO YOU GET TO DO YOUR JOB BETTER AND GET THIS PROBLEM FIXED.
>> >>PEGGY: EVERYBODY KNOWS ABOUT HIPA LAWS AND HAS EXPERIENCED THAT, BUT WHEN IT COMES
TO GETTING THE INFORMATION ABOUT LET'S SAY HOSPITAL MIST MISTAKES OR SURGICAL MISTAKES
WE FOUND IT VERY DIFFICULT TRYING TO GET PER HOSPITAL LIST IN SAN DIEGO, WE WERE TOLD THEY
DON'T COMPILE THEM.
UNLESS YOU PUT IN A PUBLIC HEALTHÊ I MEAN A PUBLIC INFORMATION REQUEST.
HOW CAN PATIENTS GET THIS INFORMATION?
>> >>: I MEAN, YOU HAVE TOÊ IT'S NO SURPRISE I'M HEARINGÊ YOU HAVE TO ESSENTIALLY DONATE
A KIDNEY AND GIVE UP AN ARM AND A LEG JUST TO GET SOME INFORMATION FROM THESE STATE HEALTH
DEPARTMENTS SOMETIMES.
YOU KNOW, I BELIEVE THE PUBLIC HAS A RIGHT TO KNOW ABOUT THE QUALITY OF THEIR HOSPITALS.
YOU HAVE MORE INFORMATION ABOUT THE RESTAURANTS YOU GO TO THAN YOU DO ABOUT THE HOSPITALS
YOU GO TO.
THERE'S NO REASON WHY WE CAN'T PUT SOME OF THE INFORMATION THAT'S ALREADY COLLECTED IN
A NATIONAL CLINICAL REGISTRY, OFTEN FUNDED BY TAX PAYERS, UP ON THE WEB FOR EVERYBODY
TO SEE.
WE'RE TALKING ABOUT BASIC STUFF.
INFECTION RATES, READMISSION RATES, RISK ADJUSTMENT COMPLICATIONS, NEVER EVENTS.
>> >>PEGGY: PLEASE GIVE NEE TOP THREE THINGS PATIENTS CAN DO TO PROTECT THEMSELVES.
SHOULD YOU WRITE ON THE LEG YOU'RE GETTING OPERATED ON?
>> >>: I THINK THE MOST IMPORTANT QUESTION A PATIENT SHOULD ASK IS WHAT IF I DON'T HAVE
THIS DONE?
WHAT ARE THE ALTERNATIVES AND GET A SECOND OPINION.
THIRTY PERCENT OF SECOND OPINIONS ARE DIFFERENT THAN THE FIRST OPINION THERE ARE SOME GOOD
WEBSITES, HOSPITAL COMPARE.HSS.GOV, CONSUMERREPORTS.ORG, THESE ARE GOOD BRANDS HOUSING SOLID DATA FOR
PATIENTS.
>> >>PEGGY: THANKS SO MUCH FOR TALKING WITH US.