The best day to have surgery and other tips for dodging medical errors

Can you remain healthy during a hospital stay? It’s not as easy as you think. This column is not intended to make you run for the woods rather than seek medical attention. But being well-informed will help decrease the risk of falling into hospital traps.

Hospital statistics make your hair stand on end. Consumer Reports on Health states that in 1999, the Institute of Medicine (IOM) claimed errors by hospital staff in the U.S. resulted in 100,000 deaths and 500,000 injuries. Another study in 2004 of 37 million Medicare patients there claimed hospital errors killed and hurt twice as many as the IOM reported. The Canadian Adverse Events Study published in 2004 estimated poor outcomes in 185,000 hospital admissions out of 2.5 million. The researchers reckoned 70,000 of these adverse events were preventable. And older patients appeared to be more at risk.

Today, contracting hospital infections is high on the list of dangers. But it’s always been a problem. In 1846, when the first obstetrical hospital opened in Vienna, one in eight pregnant women died from puerperal (childbirth) fever. Professor Ignacz Semmelweiss damatically ended these deaths by demanding that doctors wash their hands after doing an autopsy and before delivering a baby.

Several studies show this lesson has not been fully learned. Doctors, even infectious disease specialists, often fail to wash their hands spreading germs from one patient to another. I admit it requires a brave patient to ask his doctor to wash his hands before an examination. But doing so could prevent an infection.

Cast a wary eye at urinary catheters if you have one following surgery. They often set the stage for urinary infection, so the sooner they’re removed the better. In fact, ask your doctor when it will be removed and if it’s not done, ask the nurse if the order has been overlooked.

Medication errors are nothing new. Unfortunately, putting an end to them is easier said than done. For instance, few patients are able to detect that a medication prescribed in grams should have been written and administered in milligrams. If you have diabetes or another chronic disease, make sure your drugs are continued. Many hospitals routinely stop medications on admission.

Give up smoking if you are scheduled for an operation. This will decrease the risk of anesthesia complications and post-operative lung infections.

In Wheels, a novel set in Detroit, Arthur Hailey warned readers not to buy cars built on Mondays or Fridays. Monday cars, he said, have a bit of the weekend hangover built in. Friday’s cars often lack nuts and bolts left out by a worker anxious to get away for the weekend.

Does Hailey’s Law apply to surgery? Doctors are as subject to fatigue and other factors as anyone else. So consider yourself lucky if you’re booked for surgery on a Tuesday at 8 a.m. when everyone is fresh. A Tuesday start also means you will have regular staff looking after your immediate post-operative care. Surgery on a Friday usually means being cared for by weekend staff, which may be short-handed.

Have you ever asked your surgeon for an autograph on the surgical site before the operation? Probably not, as most physicians are not rock stars. But this can stop disastrous errors. Amputating the wrong leg or repairing a hernia on the wrong side is a very rare mistake, but it does happen. It can be prevented by having the surgeon sign the site where the operation is to be performed.

Don’t be a hero if you’re having post-operative pain. Patients with uncontrolled pain require longer hospital stays and have more complications. Some doctors, however, resist giving adequate doses of painkillers for fear of addiction. Yet addiction does not occur when you use narcotics to ease pain, not for pleasure. Ask if patient-controlled intravenous analgesia is available so you can administer your own painkiller by pushing a button on a computerized pump.

Get moving after surgery as soon as possible to prevent blood clots forming in your legs. And be kind and courteous to overworked nurses and other staff. They will return the favour.

Dr. W. Gifford-Jones is the pen name of Ken Walker, MD, who practises medicine in Toronto.