INTERNAL BLEEDING: The Truth Behind America's Terrifying Epidemic of Medical Mistakes

INTERNAL BLEEDING: The Truth Behind America's Terrifying Epidemic of Medical Mistakes | Robert M. Wachter, Kaveh Shojania | A Must Read for All Medical Employees

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INTERNAL BLEEDING:...

	INTERNAL BLEEDING: The Truth Behind America's Terrifying Epidemic of Medical Mistakes Robert M. Wachter, Kaveh Shojania Rugged Land, 2005 - 460 pages average customer review:based on 20 reviews view larger image
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highly recommended

This updated edition includes the latest findings on patient safety by two of the foremost authorities on medical mistakes.
Two dynamic physician-professors investigate (and re-investigate) the rampant errors endemic to modern medical care and suggest ways to prevent hospitals and doctors from inadvertently killing their patients. Emerging from these compelling stories and provocative insights is a powerful case for change?by policymakers, hospitals, doctors, nurses, and even patients and their families. Wachter & Shojania underscore the depth and breadth of dangers in medical care; more important, they suggest basic safety procedures and hard-nosed remedies that could make erratic systems fail-safe and save countless lives.

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Internal Bleeding

Excellent book for both the medical field and lay people alike.
Great ideas for improving health care in the USA.

A Must Read for All Medical Employees

This is a top notch book required for all our first year medical students. It will change the way you think about medical mistakes. Guarenteed to save lives . . .Not only that, but it reads like a thriller novel, so you get all the benifit while it feels like you're goofing off!
Dr. Imber Coppinger, 15 years in medicine

"Culture Eats Strategy For Lunch."

"Internal Bleeding" is a good primer on medical culture. The authors focus on the issues related to medical errors. The book is largely well written, but occasionally the authors resort to hyperbole to make points; terms like "crisis" and "epidemic" are occasionally warranted, but their overuse tends to occlude important nuances within the issues discussed.

I was particularly interested in the analogies the authors made to the aerospace field, and found the cultural comparisons insightful. The discussion of the space shuttle accidents (pp. 49-51) are a proper indictment of NASA management, and makes the argument that in medicine and aerospace as well, taking routinely good outcomes as positive reinforcement of perceived infallibility is asking for disaster. ("NASA had forgotten how to be afraid.") On pp. 88-89 the authors discuss the differences between "slips" and "mistakes" and include a valuable commentary on trapping errors, much like the latest iteration of aviation training attempts to trap errors with "Threat and Error Management".

The authors provide excellent commentary on the makings of master diagnosticians, hypothesis testing, and the applicability of Bayes' theorem to medical reasoning on pp. 110-112 and p.117. This section provides an excellent view into the minds of doctors as they make challenging evaluations in complex cases: although not specifically stated at this point, similar thought processes are used in other highly skilled, tightly-coupled professions, such as aviation. The authors also explain why overreliance on automation and underreliance on physician wisdom is certain to result in bad medicine, despite the utility of computer systems in medicine. ("Any doctor who could be replaced by a computer should be.")

The authors return to their aviation subtext on p.147 in their discussion of pilot selection versus medical school selection; the conclusion reached is that the real-world evaluations given to pilot candidates would be a much better template for medical school applicants than what is currently used. On pp.156-157 the authors discuss doctors as being psychological perfectionists, and provide examples from other professions which tend to validate their hypothesis. The crux of the discussion is the intolerance for mistakes within the profession and within the psyche of individual surgeons, a trait common to pilots. Furthering the discussion of error-intolerance is a discussion (p. 176; p. 366) of one of the most common types of errors in both aviation and medicine: communications and the handoff error, a theme that is common throughout the remainder of the book. The authors make clear that while pilots are lauded for soliciting input from others (it wasn't always so), surgeons are known for being exceedingly inflexible (p. 191; p.222) to the detriment of the patient. When coupled with communication issues and power-distance problems, inflexibility is not a desirable trait in a surgeon. On pp. 222-224 there is an informative discussion of the roles of communications in both medical and aviation errors, concluding with a recounting of the worst aviation accident in history at Tenerife, which was caused largely by communication problems.

All of chapter 20 is laudable as it really distills the culture of safety concept down to the essentials. Notably, pp. 348-349 discusses the potential usefulness of Failure Mode and Effects Analysis, a longstanding aviation tool, in medicine, while p. 351 serves to recap the aviation safety from a historical vantage point.

Finally, the authors detail one of the most potentially beneficial changes that could be made in American healthcare (pp. 342-343) where they discuss the advantages of a no fault system of compensation for victims of bad healthcare.

This book is really a study of safety systems in a hospital environment, with relevant discussions of other germane industries (especially aviation) throughout. It is not a dry, academic tome; it is quite accessible to anyone who is interested in healthcare in the US. I recommend the book for safety professionals in any field, to physicians and medical professionals, and to anyone else with an interest in curbing errors in medicine. No book is perfect, but "Internal Bleeding" does cover the most salient points in the dialogue that is taking place (or should be taking place) in hospitals across the country.

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Horror story

When you're in the hospital if you think docs are going to do every thing they can to save your life, you're may be dead wrong.

The majority of docs and hospital workers resist every new quality program that can improve outcomes. Look how low the adoption of six sigma is in healthcare. Most of the major quality control programs created in industry are absent in hospitals. Often the programs they have run at such a low level they don't provide much benefit.

Do some research and find out how many errors are made that kill people in hospitals. Estimates range between 100,000 and 250,000 deaths per year, and that doesn't include those that are injured or crippled up.

If somebody makes a mistake in Iraq and 3 soldiers are killed, it's national news and every politician is calling for somebody's head. Kill a 100,000 people in the hospital every year with mistakes, who cares.

Yes, there are a few people who are trying to fix the problems, but not enough are trying. Half the time hospitals don't even know how to measure outcomes, errors and problems. A lot of hospitals use bogus quality programs to tout how they comply with xyz blah, blah, blah, but the truth is these programs have little or no impact on errors, mortality or morbidity.

This book is a good place to start if you're interested in the subject.

60,000 people killed in auto accidents every year, more than 100,000 killed annually in hospital accidents, why aren't the politicians screaming and hollering about those dead bodies? Well, it doesn't get them any votes!

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self-serving doctors write book

Why their way is the best way. I suggest you read What your doctor Won't Tell You. This is a gutsy non self-serving and tell all book that will help you get through our terrible health system

reviews: page 1, 2, 3, 4

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