Internal Bleeding by Robert M. Wachter and Kaveh G. Shojania

Aimee Hernandez

Professor Evert Villarreal

English 1301.25

26 March 2014

Internal Bleeding by Robert M. Wachter and Kaveh G. Shojania

        In 1999 a medical report stated that roughly 98,000 patients a year will die to due medical mistakes.  Robert Wachter’s and Kaveh Shojania’s Internal Bleeding digs deeper into medical mistakes and explain how these could have avoided.  Internal Bleeding is divided into four sections: The System, The Errors of Our Ways, Consequences, and Cures.  This paper will be concentrating on chapters 12, 14, and 19.

        The main ideas in chapter 12 are hubris and teamwork in hospitals.  Wachter  and Shojania give examples of poor teamwork that resulted in the loss of a patient’s life and the excessive pride of some physicians.  This chapter is structured well.  The authors tell a story of a patient who was mistaken for a DNR (do not resuscitate) patient and lost his life because he was identified too late as the wrong patient.  Then give examples of where the situation went wrong.  The main cause of the mistake was the lack of communication between the nurse in charge of the patient and the Code team.  This is where the issue of team work comes in.  The lack of teamwork may come from the “professional hierarchy” (216).  Nurses are afraid to question doctors and their orders because of the prestigious degree differences.  And most doctors would be offended by a nurse questioning their methods. So when it comes to working as a team it can be described more as nurses taking orders from doctors whether they are right or wrong.  Such is the case with hubris as well.  Most nurses would rather quit their jobs than work with egotistical physicians.  The increasing demand for nurses exceeds the supply by several thousand and one in seven hospitals is short staffed.  The main idea is the lack of collaboration in hospitals between nurses and doctors, and doctors not seeing themselves as the most important person in the hospital.

        Chapter 14 is titled Spilling the Beans.  This chapter concentrates on what happens when medical mistakes are leaked to the media and the benefits the consequences might have on healthcare safety.  

        This chapter revolves around one story: the story of Jesica Santillan.  Jesica was born with restrictive cardiomyopathy, “a disorder of the heart that limits its ability to accept blood from the lungs and pump it effectively to the rest of the body” (253).  After Jesica was smuggles into the United States she went to live with family in North Carolina.  There her story caught the eye of a wealthy man, Mark Mahoney, who raised the money for Jesica’s procedure. The transplant would be performed by Dr. James Jaggers, lead pediatric surgeon at Duke Medical Center.  When Dr. Jaggers received word that organs were available for Jesica’s transplant, he forgot to confirm the blood type.  The United Network of Organ Sharing (UNOS) did not confirm the blood type nor did Dr. Shu Lin, the surgeon Dr. Jaggers sent to pick the organs up from Boston.  The blood type of the organs was not known until they had already been transplanted into Jesica’s body.  Dr. Jaggers’s OR team worked hard to keep Jesica alive until a new set of organs of the correct blood type were found.  She was put at the top of the donor recipient list.  She received a second heart-lung transplant on February 20th but died shortly after the surgery was complete.

        A main idea in this chapter is whether revealing medical mistakes will make it more or less likely of a lawsuit to happen.  Most doctors feel it is ethically right to inform patients if a mistake as occurred but most do not because of the effect it can have on their incomes and reputations.

“Everything you need and everything that you’re told says that you are supposed to tell what errors you make as soon as you can.  Let [patients] know what your thinking is, what you are going to do about it.  And your chances of having as adverse litigation are less if you take that approach.  Now, the question is, how many of us believe that?” (263)

        In most surveys conducted on physicians, most say they would disclose a medical mistake to a patient unless it was life threatening.  And only about 30 percent of patients were told by doctors of a mistake if the patients were suspicious they had been victims.  Still no laws have been passed regarding doctors disclosing medical mistakes to their patients.  Most doctors are too afraid of risking their reputation.

        In the case of Jesica Santillan, Dr. Jaggers did tell the family of the error right away.  But Jaggers’s honesty did not “quell” the family’s anger.  Jesica’s sponsor, Mark Mahoney, accused the doctor of murder.  And in turn it was Mahoney’s anger that the press turn.

        Another main idea in this chapter is why do some medical mistakes the news and most do not.  It is not the type of medical mistake; some fatalities make news over others; some stories of medication mistakes surpass others.

The top ten medical mistakes over the past twenty years were observed and a common trait was most of them: the deceased was either famous or had some sort of connection to the media.  And most of the cases all took place in teaching hospitals on the East coast.

But in the end cases like these help make our health system safer and better. Most hospitals will make sure errors, like the one Jesica Santillan suffered, will not happen and triple for crucial information such as blood type.

“It was the mirror help up to the profession by news media coverage that finally penetrated the self-protective shell of rationalizations, subverted the old paradigm, and prompted the current effort to develop a systems-oriented patient safety approach… In the case of medical errors, public scandal and the concomitant fear of public shaming finally broke through professional complacency.” (270)

It is no doubt that media coverage over medical mistakes affect the reputations of doctors, but overall the discovery of these mistakes help make our health system safer for future patients.