University of Southern California Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy
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Medical Complications

There are few things more frustrating than when something goes wrong for a person because of something someone else did. And when this comes to medical care, it can be more than frustrating; it could be dangerous. Although health care professionals try their best to help all their patients, and even take an oath to "do no harm," sometimes mistakes do happen. If a person thinks that a "medical blunder" has been made, it's very important, first of all, it's important to get proper treatment, so a person's health doesn't get any worse; next, to understand if it was really a mistake or just that a particular treatment was not effective; and then, once the person has gone to another medical professional who is helping them, learn if there was any harm done that needs to be fixed with better medical care.

Many times in situations regarding health, something that might look like an error or mistake is actually just part of the standard treatment, not unusual or unexpected at all. For example, there are times when a treatment doesn't work as it's supposed to, which can be because of how the individual patient reacts to the treatment, or because the illness is more complicated or more advanced than it had appeared in the first tests. Some treatments simply work better for a particular patient than another treatment. That is why so many illnesses or injuries can be treated in a number of different ways, with a choice of medications, procedures, and even treatment styles - for example, long-term pain can be treated by a physician with pain medications, by a therapist with stress reduction or pain tolerance techniques such as "biofeedback," by a physical therapist or occupational therapist with ice, heat, ultrasound or therapeutic movement, by a massage therapist or by an acupuncturist. But it can happen that the first, or even the second or third, types of treatments tried don't work for that particular person. It isn't that a mistake has been made; it's just that the best treatment for this person hasn't been found yet. On the other hand, some medical problems have a treatment that is so effective, it's the only treatment a person should get; for example, even an acupuncturist will tell you that if you break your leg, you should get a cast put on it!

It's important to remember that just because it's frustrating when a health problem continues despite getting treatment, which is certainly enough to make a person feel angry, afraid or even sad or depressed, it does not automatically mean that the health care provider made a mistake. An example of this was when a home health nurse gave one of our study participants, Alley, a DuoDERM® patch to put on a pressure ulcer (which means the same thing as "pressure sore" or "bedsore") and told her not to change the dressing even if the wound smelled bad; although DuoDERM® heals some wounds, this was not the right choice for Alley's pressure ulcer, and the result was that it got infected. If you have a health problem that is continuing when it shouldn't, when you are having treatments for a problem that should clear up but it hasn't, or is even getting worse, the first person to tell is the health care provider who prescribed this form of treatment. They may have alternatives to offer for you that could get you on the right track - a different medication, physical or occupational therapy, and so on. The problem might also be that your illness is more serious than it seemed at first, and a more extreme form of medical treatment is needed, such as intravenous drugs that need to be given in a hospital, or even surgery. If your health problem is not an emergency, this could also be a good time to get a "second opinion," that is, to meet with another health care professional and find out what they recommend for your problem. Some insurance policies even require a second opinion before giving approval for serious procedures like surgery. And just because another medical specialist has a different opinion than the first one, it doesn't mean the first person made a mistake; it just means there is more than one manner to deal with this illness. Some people even end up going to a third practitioner before getting medical care that works well for them; it's definitely frustrating, but not proof that the other people were making mistakes.

Then there are mistakes that are definitely mistakes. Sometimes they are accidental, such as when Charlie, who participated in our study, fell out of a hospital bed and injured his shoulder because a bedrail slipped, or when Judy went into autonomic dysreflexia when someone had left a stopper in her latex leg bag, which prevented urine from flowing out of her body. Sometimes they are because a medical professional is careless, even just for a moment, like when Brenda's thigh bone was broken while she was having range of motion exercises done, and the break wasn't noticed until a pressure ulcer formed, or when Judy developed a pressure ulcer at a spot where a sliding board had been repeatedly jabbed too roughly. Unfortunately, there are even times when professionals do so little to help their patients that they are neglectful, such as when Rachel's care attendant didn't change her diapers, letting Rachel remain in waste for so long that a Stage 4 pressure ulcer developed, or when Howard lost the six-hour sitting tolerance he had built up in the hospital because workers at his convalescent home never put him up in his chair. If you are hurt or get sick because of an obvious mistake, let someone know immediately. Find out if the person who caused you harm has a colleague (that is, someone on the same level) or a supervisor you can talk to about their mistake, and who can give you better care. Get an appointment to see another medical care professional as soon as possible, or, if you are already in the hospital, talk to the head of the nursing shift for your ward or floor if you can, as they often have a great deal of information about how the hospital works and who the personnel are. In either case, contact your case worker for advice, and let friends and loved ones know you are having a problem. The idea is to get good medical care as soon as possible, and to get as much support as you can.

If you think a medical mistake has been made and you no longer feel comfortable with your health care professional or you don't trust them, first to try to resolve problems with them; if that doesn't work, find someone new. Some good guidelines for trying to work things out, or for deciding if you do want to change doctors or not, can be found at the Internet website of Craig Hospital, a well-respected rehabilitation facility in Denver, Colorado, or by phoning the hospital at 303-789-8202, or writing to them at: Craig Hospital, Attention: Health Resources, 3425 S. Clarkson St., Englewood, CO 80113. The two brochures they make available on this topic are You And Your Doctor: Rights and Responsibilities, and Changing or Choosing Your Doctor.

Choosing a High-Quality Medical Rehabilitation Program was prepared by Melinda T. Neri at the National Rehabilitation Hospital Center. It is a detailed, easy-to-read guide to learning what is involved in rehabilitation following an injury that creates a disability, how to choose the right rehabilitation team for your needs, and the basic components of health insurance plans, including private insurance, Medicare and Medicaid. These tips for finding health care providers can help if you are looking for a new doctor. A free copy of this booklet is also available by phoning toll-free at 1-866-380-4344.

A quick word on legal action: Although it is tempting to take out your anger about a medical mistake, and there are many people who sue each other in American courts every day, be aware that filing a lawsuit is a very time-consuming process. If cases get to court at all, it can truly take years, and the doctor or hospital being sued (who probably have an insurance company protecting them) will have skilled lawyers of their own who have a good chance of winning the case. If the person suing wins their case, any money they receive is divided with the lawyers, who take their fees out first, then anything left over goes to the client. The multimillion dollar settlements that are talked about on television or written about in newspapers are the rare exceptions, not the average result. If a case is lost, any legal fees could leave a person bankrupt. The worst part is, a lawsuit does not guarantee that proper medical care will be given to the person who is suing. It's much more important to spend your energy getting proper treatment first, then think about any other actions later.

If a medical mistake has truly happened, it is very serious and has to be taken care of right away. But it's important to ask yourself if it was really a mistake or was it something else, like an unexpected accident that will probably never happen again, or a case where the first medical intervention that was tried was reasonable but just not the most effective one for you. If a medical professional has given you good care in the past, it's possible that a one-time error, especially if it is minor, is just an accident or oversight and will not happen again. The bottom line is to get yourself reliable medical care from a health practitioner you trust, no matter what your health status or diagnosis!

More information on the subject of medical blunders can be found on the Internet, but be aware that many of these websites are sponsored by attorneys or law firms, who have a lot to gain from convincing people to bring lawsuits. Information with less bias might be found at sites maintained by universities (these end in ".edu"), hospitals or the government (these end in ".gov"), or pages written by individuals with spinal cord injuries about their own experiences, such as on message boards.