In the week or so following my last
post, a number of stories came out that might help explain why healthcare workers
are so stressed, and offer some constructive direction for improving the
practice of medicine.
“Medical error – the third leading
cause of death in the US.”
http://www.bmj.com/content/353/bmj.i2139
The first story came out on May 3,
2016, and was quickly picked up by STATnews, TV news, CNN, USAToday, etc. A study by researchers at Johns Hopkins
University School of Medicine, published in the BMJ, estimates that
approximately 251,000 deaths per year are due to preventable medical errors.
This makes medical errors the number three cause of death in the US, behind
heart disease and cancer, a far cry from “first do no harm.” The article
includes three recommendations: “make errors more visible; respond to error;
and make errors less frequent.” Precisely what I was getting at in my prior
post. What is lacking currently is a feedback loop for identifying and sharing mistakes
so that changes can be made to prevent them from happening again.
“Prevalence of Inappropriate
Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011”
This story also came out on May 3,
2016, and was published in the Journal of
the American Medical Association. Researchers evaluated antibiotic
prescribing practices and based on their analysis of the data (from 2010-2011),
they estimated an annual prescription rate of 506 per 1,000 population.
Furthermore, of those 506 prescriptions, only 353 were considered likely to be
appropriate. In other words, almost one-third of antibiotics prescribed were
not warranted. This sounds like one of those medical errors the first article was
talking about, and we haven’t even gotten to the topic of Fluoroquinolones yet.
Fluoro-what?
Cipro, Levaquin, and all their generic
counterparts: Levofloxacin, etc.
“Common medication errors to avoid”
The American College of Physicians (ACP) seems to agree that Fluoroquinolones are often a mistake for non-life threatening conditions, given their serious and sometimes permanent side effects. As published on Healio on May 5, 2016, at last week’s ACP Internal Medicine Meeting, doctors were cautioned on their serious side effects, and advised to rethink how they are prescribed.
***NEWS FLASH***
And now, even the FDA agrees, issuing
a public statement today (May 12, 2016) on their website:
“The
U.S. Food and Drug Administration is advising that the serious side effects
associated with fluoroquinolone antibacterial drugs generally outweigh the
benefits for patients with sinusitis, bronchitis, and uncomplicated urinary
tract infections who have other treatment options. For patients with these
conditions, fluoroquinolone should be reserved for those who do not have
alternative treatment options.”
“An
FDA safety review has shown that fluoroquinolones when used systemically (i.e.
tablets, capsules, and injectable) are associated with disabling and
potentially permanent serious side effects that can occur together. These side
effects can involve the tendons, muscles, joints, nerves, and central nervous
system.”
“As
a result, we are requiring the drug labels and Medication Guides for all
fluoroquinolone antibacterial drugs to be updated to reflect this new safety
information. We are continuing to investigate safety issues with
fluoroquinolones and will update the public with additional information if it
becomes available.”
“Patients
should contact your health care professional immediately if you experience any
serious side effects while taking your fluoroquinolone medicine. Some signs and
symptoms of serious side effects include tendon, joint and muscle pain, a “pins
and needles” tingling or pricking sensation, confusion, and hallucinations.
Patients should talk with your health care professional if you have any
questions or concerns.”
“Health
care professionals should stop systemic fluoroquinolone treatment immediately
if a patient reports serious side effects, and switch to a non-fluoroquinolone
antibacterial drug to complete the patient’s treatment course.”
FDA
Drug Safety Communication: FDA advises restricting fluoroquinolone antibiotic
use for certain uncomplicated infections; warns about disabling side effects
that can occur together
This is the culmination of years, if not
decades, of advocacy work by many groups and individuals, which led to the testimony
by impacted patients to the FDA advisory panel in November 2015 (as reported in The Wall Street Journal),
and a growing visibility in the media over the past few months.
A March 2016 article by Teresa Carr in
Consumer Reports also sounded the
alarm on the “rampant” over-prescribing of fluoroquinolone antibiotics:
“Fluoroquinolones Are Too Risky for Common Infections”
Even Dr. Oz offered a caution on fluoroquinolone
antibiotics in the April 2016 issue of his magazine, The Good Life, due to their potential serious side effects.
Patients:
****************************************
“Why one top hospital is going public
with its mistakes.”
As reported on STATnews, Brigham and
Women’s Hospital in Boston has announced that it is going to share medical
errors and lessons learned on its blog site, Safety Matters. Precisely what I
had suggested in my prior post!
This is revolutionary in the medical field,
where the system barely wants to acknowledge mistakes, let alone air them
publicly. Errors are typically close-hold matters because of fears regarding malpractice,
lawsuits, and loss of reputation. Without bringing such mistakes into the light
of day, there is limited opportunity for improving the state of the practice. Medical
errors, in addition to their human toll (deaths, adverse health effects), also
exact a heavy price on the cost of medical care, due to both the increased
medical care for those adversely affected, and the pass-through costs of
litigation and malpractice insurance. It is sad but not surprising that
becoming a doctor is no longer seen as the highly desirable career path it once
was, given the associated financial and legal burdens. If things don’t change,
we run the risk of a doctor shortage in the coming decades. We all need a
system that allows doctors to continue to grow and learn in their practice of
medicine.
Coming
Next
HUBweek Day 1, Part 2: Fenway Forum: A
Master Class with Professor Michael Sandel
HUBweek is currently accepting idea
submissions for this year’s HUBweek, through May 20, 2016.
References
Benson, Herbert, M.D., with Miriam Z.
Klipper. 1975. The Relaxation Response.
New York: Avon Books, a Division of The Hearst Corporation.
Burton, Thomas. 2015. FDA
Panel Seeks Tougher Antibiotic Labels. The Wall Street Journal, 6 November
2015, p. A6.
Carr, Teresa. 2016.
Fluoroquinolones are Too Risky for Common Infections. Consumer Reports, March
2016.
Fiumara, Karen. 2016. Why
one hospital is going public with its mistakes. STATnews. May 3, 2016.
Fleming-Dutra KE, Hersh AL,
Shapiro DJ, et al. 2016. Prevalence of Inappropriate Antibiotic Prescriptions
Among US Ambulatory Care Visits, 2010-2011. JAMA. 2016;315(17):1864-1873.
doi:10.1001/jama.2016.4151.
Laday, Jason. 2016. Common
medication errors to avoid. Healio.com 2016 (Published 5 May 2016).
Levenson, Michael, 2014. Institutions
formally announce HUBweek festival. The
Boston Globe. December 12, 2014.
Makary, Martin A., and
Michael Daniel, 2016. Medical error – the third leading cause of death in the
US. BMJ 2016; 353:i2139 doi:
http://dx.doi.org/10.1136/bmj.i2139 (Published 03 May 2016)
Oz, Mehmet. 2016. If you get
an Rx for a strong antibiotic like Cipro, should you push back? The Good Life. April 2016.
Swetlitz, Ike, 2016. Medical
errors are third-leading cause of death in the US. STATnews. May 3, 2016.
Weintraub, Karen, 2015. Stress may
make you more likely to cheat. The Boston
Globe. August 15, 2015.
©
2016 Rosemary A. Schmidt
Rose
Schmidt is the author of “Go Forward, Support! The Rugby of Life” (Gainline
Press 2004). Use of individual quotes with proper citation and attribution,
within the limits of fair use, is permitted. If you would like to request
permission to use or reprint any of the content on the site, please contact me.
Twitter: Rosebud@GainlineRS