The Human Patient

Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. That's more than die from motor vehicle accidents, breast cancer, or AIDSâ€"three causes that receive far more public attention. Indeed, more people die annually from medication errors than from workplace injuries. Add the financial cost to the human tragedy, and medical error easily rises to the top ranks of urgent, widespread public problems. To Err Is Human breaks the silence that has surrounded medical errors and their consequenceâ€"but not by pointing fingers at caring health care professionals who make honest mistakes. After all, to err is human. Instead, this book sets forth a national agendaâ€"with state and local implicationsâ€"for reducing medical errors and improving patient safety through the design of a safer health system. This volume reveals the often startling statistics of medical error and the disparity between the incidence of error and public perception of it, given many patients' expectations that the medical profession always performs perfectly. A careful examination is made of how the surrounding forces of legislation, regulation, and market activity influence the quality of care provided by health care organizations and then looks at their handling of medical mistakes. Using a detailed case study, the book reviews the current understanding of why these mistakes happen. A key theme is that legitimate liability concerns discourage reporting of errorsâ€"which begs the question, "How can we learn from our mistakes?" Balancing regulatory versus market-based initiatives and public versus private efforts, the Institute of Medicine presents wide-ranging recommendations for improving patient safety, in the areas of leadership, improved data collection and analysis, and development of effective systems at the level of direct patient care. To Err Is Human asserts that the problem is not bad people in health careâ€"it is that good people are working in bad systems that need to be made safer. Comprehensive and straightforward, this book offers a clear prescription for raising the level of patient safety in American health care. It also explains how patients themselves can influence the quality of care that they receive once they check into the hospital. This book will be vitally important to federal, state, and local health policy makers and regulators, health professional licensing officials, hospital administrators, medical educators and students, health caregivers, health journalists, patient advocatesâ€"as well as patients themselves. First in a series of publications from the Quality of Health Care in America, a project initiated by the Institute of Medicine

Increased concern for patient safety has put the issue at the top of the agenda of practitioners, hospitals, and even governments. The risks to patients are many and diverse, and the complexity of the healthcare system that delivers them is huge. Yet the discourse is often oversimplified and underdeveloped. Written from a scientific, human factors

The occurrence of failures and mistakes in health care, from primary care procedures to the complexities of the operating room, has become a hot-button issue with the general public and within the medical community. Around the Patient Bed: Human Factors and Safety in Health Care examines the problem and investigates the tools to improve health care quality and safety from a human factors engineering viewpoint—the applied scientific field engaged in the interaction between the human operator (functionary, worker), task requirements, the governing technical systems, and the characteristics of the work environment. The book presents a systematic human factors-based, proactive approach to the improvement of health care work and patient safety. The proposed approach delineates a more direct and powerful alternative to the contemporary dominant focus on error investigation and care providers' accountability. It demonstrates how significant improvements in the quality of care and enhancement of patient safety are contingent on a major shift from efforts and investments driven by a retroactive study of errors, incidents, and adverse events, to an emphasis on proactive human factors-driven intervention and the development of corresponding conceptual approaches and methods for its systematic implementation. Edited by Yoel Donchin, representing the medical profession, and Daniel Gopher, from the human factors engineering field, the book brings together experts who have collaborated to present studies that reveal a wide range of problems and weaknesses of the contemporary health care system, which impair safety and quality and increase workload. The book presents practical solutions based on human factors engineering components and cognitive psychology, and explains their driving principles and methodologies. This approach provides tools to significantly reduce the number of errors, creates a safe environment, and improves the quality of health care.

Healthcare is very much dependent on the model of the patient that is assumed by healthcare providers. The current model derives from a chemical/mechanical view of the patient body. Simply put: we are healthy if all of our mechanical parts are working properly and if all of the chemicals in our body are in the right proportions and have the appropriate reactions. This view is based on philosophical accounts of the body that go back to Paracelsus, Descartes, Boyle and others. It became the central basis of medical practice only in the late 19th Century after several hundred years of research and professional politics. The Mechanical Patient traces the intellectual development of the chemical/mechanical model of the patient and its implementation. This book names the problem that we have with the mechanical patient and prepares us to respond to its exaggerated place in our society. It provides a historical and conceptual background and explains how the chemical/mechanical model of health gained such a strong hold over our thinking and took the place of the earlier Galenic humoral model. It sketches a promising outline of a more humanized model for understanding health and calls for help to fully articulate it. In that way, it joins a growing movement to go beyond our current chemical/mechanical orientation.

A difficult and recalcitrant phenomenon, medical error causes pervasive and expensive problems in terms of patient injury, ineffective treatment, and rising healthcare costs. Simple heightened awareness can help, but it requires organized, effective remedies and countermeasures that are reasonable, acceptable, and adaptable to see a truly significant drop in the intolerable rate of medical mistakes. Only with better understanding, knowledge, and directed techniques can there be rapid and marked improvement in medical error management discipline. Since medical error is situation specific and involves diverse variables in equipment, environment, and human performance, the correct choice of preventive and corrective techniques is critical. Providing a wealth of useful ideas, concepts, and techniques, Medical Error and Patient Safety: Human Factors in Medicine uses abroad perspective to present more than 500 remedies that can be applied and tailored to your unique circumstances. This detailed review of so many measures enables you to correctly identify needs and undertake appropriate actions to achieve a success that can be measured in avoided injuries, improved healthcare, and reduced cost. Thought provoking and useful, this book considers the potential for error and the possibility for improvement in every aspect of healthcare. After an introduction to general concepts and approaches, it examines vulnerabilities in medical services, including emergency services, healthcare facilities, and infection control. It covers risks in medical devices and product design; human factors such as fatigue and stress; management errors; errors in communication at all levels of the healthcare hierarchy; as well as mistakes in drug delivery including faulty labels and warnings. The authors also compare and contrast several analytical methods, their interpretation, and their translation into a plan of action.

“Oliver Sacks meets Stephen King”* in this propulsive, haunting journey into the life of the most studied human research subject of all time, the amnesic known as Patient H.M. For readers of The Immortal Life of Henrietta Lacks comes a story that has much to teach us about our relentless pursuit of knowledge. Winner of the PEN/E.O. Wilson Literary Science Writing Award • Los Angeles Times Book Prize Winner NAMED ONE OF THE BEST BOOKS OF THE YEAR BY The Washington Post • New York Post • NPR • The Economist • New York • Wired • Kirkus Reviews • BookPage In 1953, a twenty-seven-year-old factory worker named Henry Molaison—who suffered from severe epilepsy—received a radical new version of the then-common lobotomy, targeting the most mysterious structures in the brain. The operation failed to eliminate Henry’s seizures, but it did have an unintended effect: Henry was left profoundly amnesic, unable to create long-term memories. Over the next sixty years, Patient H.M., as Henry was known, became the most studied individual in the history of neuroscience, a human guinea pig who would teach us much of what we know about memory today. Patient H.M. is, at times, a deeply personal journey. Dittrich’s grandfather was the brilliant, morally complex surgeon who operated on Molaison—and thousands of other patients. The author’s investigation into the dark roots of modern memory science ultimately forces him to confront unsettling secrets in his own family history, and to reveal the tragedy that fueled his grandfather’s relentless experimentation—experimentation that would revolutionize our understanding of ourselves. Dittrich uses the case of Patient H.M. as a starting point for a kaleidoscopic journey, one that moves from the first recorded brain surgeries in ancient Egypt to the cutting-edge laboratories of MIT. He takes readers inside the old asylums and operating theaters where psychosurgeons, as they called themselves, conducted their human experiments, and behind the scenes of a bitter custody battle over the ownership of the most important brain in the world. Patient H.M. combines the best of biography, memoir, and science journalism to create a haunting, endlessly fascinating story, one that reveals the wondrous and devastating things that can happen when hubris, ambition, and human imperfection collide. “An exciting, artful blend of family and medical history.”—The New York Times *Kirkus Reviews (starred review)

Based on Medicine as a human experience / David E. Reiser, David H. Rosen. c1984.