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.”
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.
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.
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.
Much, much more on this a bit later. A few websites to check out in the meantime:
“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.
Bravo! Hats off to Brigham and Women’s Hospital for taking this first step!
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.
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. SchmidtRose 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