Thomas August

Questions and Answers (8) View all

• Answer added in Pharmacology
  70 Are medical errors a sign of incompetence among physicians or can it be reduced through change in medical culture or attitude of the medical professionals?
  By Geir Bjorklund · Umeå University
  Thomas August · United Chemical Technology

  I have written much on this subject however I now propose a way to resolve the issues in a cheap and very efficient manner for both the doctor, pharma... [more]

  I have written much on this subject however I now propose a way to resolve the issues in a cheap and very efficient manner for both the doctor, pharmacist and insurance company, In todays society we see many doctors, go to many pharmacies and an incomplete picture of the patient is seen by all professionals. Patient are consumers of healthcare but the professionals that see the patients usually do not have the ability to completely remember every fact of their health care. Its time that we use technology to apply to our health by having every person have their medical history recorded on a credit card. This would also allow for the standardization of the medical records system and even stop the endless forms that we see with every visit to a doctor. MRI and Xrays have been digitized a standard format or a program that looks at formats such as the formats we see with a PDF or even digital film. Or they can be encoded to prevent personal viewing, THe advantages to this system would be a complete history of the patient including the needed lab and radiography, MRI and other films. Observations from other doctors. Unify the prescription records to one record base. Standardize the information for the doctor and pharmacy on the Insurance information. The technology is present today to do this its just factors such as HIPPA, privacy and whom could spearhead this issue, It would be in the insurance companies interest so that appropriate and effective therapy is given, doctors would know better their patients, Pharmacists could not have to key in the personal information and have a complete allergy and drug history, other professionals would know of the patients needs through their history and even if the HIPPA rules could be met would provide a database of conditions, treatments and other evidence related information to make health care work. This would in essence remove the lack of information about a patient. How would it remove some of the errors- by technology- Every pharmacy uses a computerized drug interaction, allergy and drug dosing information, The insurance companies have a somewhat limited review of the drug data but they too offer dosage information and other requirements of what is covered and the options for the patients. This would effectively remove some of the drug problems. I do think that technology in the doctor's office would also play a role to prevent error. Error will never be removed however if the information is present then much of the problems seen in errors will be reduced. The effort to make error a mistake in the system and not penalize a person and efforts of QCI and monitoring of error will become a major part of every health professional and their effectiveness to practice their profession. THis solution would not change the way the healthcare system works nor change the continual struggle for patient care versus insurance care nor the egos of the professions however at some time the hospital and the costs of having hospitals versus today's expanding technologies such as a ultrasound unit can be plugged into a Apple I Phone and the ultrasound given by the patient directed by a doctor, or home sleep studies will become more pervasive as other ways to do thing from home are discovered and are more cost effective not using the hospital. I do not see the hospital drying but they now are the target for cost reduction and the leveraging of technology at home. Home technology may bring error of another kind however, it has been seen that hospital errors are more prone to mortality or the unnecessary additional hospital stay due to hospital borne infection or other hospital misadventure. How do new doctors learn and the monitoring of their activities especially on those hours in the middle of the night. I remember staying in the hospital with a patient that his last name was my first name and so when the doctor informed me of my kidneys failing- I knew that a serious error had been done besides a HIPPA violation. Error rates should be reported and in the past were swept under the table however now they should be discussed positively and alternatives should be implemented for the betterment of our patients. Hospitals have High risk drugs segregated as well as sound alike drugs- REtail pharmacies should also play be these rules. THe care and health of every patient should be safeguarded.
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• Answer added in Pharmacology
  70 Are medical errors a sign of incompetence among physicians or can it be reduced through change in medical culture or attitude of the medical professionals?
  By Geir Bjorklund · Umeå University
  Thomas August · United Chemical Technology

  Hello to all- the discussion has been enlightening the many views on this subject however I must say that this subject has many facets to it. If you g... [more]

  Hello to all- the discussion has been enlightening the many views on this subject however I must say that this subject has many facets to it. If you go the route of more education and the example of others is good however the flaws are where most of the professions that are mentioned have no room in the course load for additional work on profession values, ethics and changing the system from one that self monitors errors by its own professional organizations to one that looks at the errors and measure them in the quality process manner. The pharmacy profession has the most required coursework of any profession but do we use even 20% of our knowledge or training NO. That's because of the many areas that pharmacy is practiced we have many different pharmacist specialists and the profession does not have a unified body to push on critical issues.The upgrade a decade ago to a Pharm D or doctorate degree for the profession did not add to the respectability of the profession even with the cost effectiveness and enhanced patient care shown in providing clinical pharmacy services. (plus the additional year of school in clinical areas). The costs of educations make the debts of new graduates incredible and so most of the new graduates are going for where they make more money in the retail areas (65% last year) and use less of the clinical aspects of their education, The hospital setting now has residencies where pharmacists are centered in a hospital pharmacy and are provided education through experience in all aspects of the pharmacy clinical services. They have 1 year and 2 year residencies and currently have become the minimum requirement to work in the hospital. They reasons why I place the aspects of the pharmacist in this discussion is because we are the monitors of the doctors medical orders and prescriptions and most of the misadventures of medical error is associated with drugs. We deal with the doctors,question them and their orders and have to perform what they decide or refuse the prescription.We also deal with the insurance company and work hard for the patient's rights for the best care. Doctors are graded in their performance in how their peers would perform . The one in a million chance for a drug interaction or patient adverse reaction may occur however, the legal profession does not accept the defense of a medical error due to human error is present in every profession. The importance of this discussions is that the medical professions affects persons lives and thus has a legal, professional and civil liability, Unless radical changes can be done in our health care system that make all professions a part of a team for patient centered care and avocation of patient rights the system of care in both institutional and public settings may not improve.
  Following
• Answer added in Pharmacology
  70 Are medical errors a sign of incompetence among physicians or can it be reduced through change in medical culture or attitude of the medical professionals?
  By Geir Bjorklund · Umeå University
  Thomas August · United Chemical Technology

  The problem with the errors is that they are too many and also we are talking of human lives that are affected. Why do we not have a system in place t... [more]

  The problem with the errors is that they are too many and also we are talking of human lives that are affected. Why do we not have a system in place to have checks for all processes in place. For example, In the non institutional setting years ago we had a system of one doctor and one pharmacy and so the check of the prescription and the doctors orders was checked. Now we have the convenience of going to many pharmacies which do not interlink our data together and also many specialists that also do not interlink our medical data together. A few years ago it was thought that we could have all of our medical data onto a computerized card where we could carry our medical information to all of our medical caregivers. This would be an excellent idea and save many so called misadventures both pharmacological and medical. In the sciences there has been an explosion of information in genetic, biomarker, proteinomics and other sciences that have given more information about where to attack and maybe cure diseases on a cellular level. Why can't we also work on taking care of the patient without errors. I often wonder with this world of computers and the information era that we need to rethink the health system and use our technologies for the good of the patient. It would be great to have all professions cooperating together as a team. I graduated from Pharmacy School in 1976 where I participated in a project where a team of professionals worked together with an equal voice for our professions including medical residents, pharmacy seniors, nursing seniors,podiatrist residents, nutrition and other fields however we worked as a team and the results said that the team approach was a great advance that should be practiced. Its now many years later and the same idea surfaces patient care teams. How can we reduce the errors made in this system? By checks and balances and making sure that everybody in the system is committed and involved in caring for the patient. Too much emphasis is on the payment by the insurance. Doctors, Nurses,Pharmacists and all other health professions have to look at why they went into healthcare- TO help people and care for their illnesses not for the monetary aspects of the profession.
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• Answer added in Pharmacology
  70 Are medical errors a sign of incompetence among physicians or can it be reduced through change in medical culture or attitude of the medical professionals?
  By Geir Bjorklund · Umeå University
  Thomas August · United Chemical Technology

  The problem in the making of mistakes and errors also lies in the attitudes of the doctors versus the nurses versus the pharmacist. Many times the pha... [more]

  The problem in the making of mistakes and errors also lies in the attitudes of the doctors versus the nurses versus the pharmacist. Many times the pharmacist may call the doctor to change a prescription and the doctor may or may not agree on the change for the patients good. This is especially accurate when the doctor are not seeing the whole picture of the patient - Who may have a financial hardship (large insurance copay or other circumstances) I have also had doctors who disagree entirely with my recommendations and says that I have no reason to question their authority. EGO IS A BIG PART OF NOT HAVING A COOPERATIVE HEALTHCARE TEAM. Every healthcare professional should be treat each other with professional respect and every opinion made by another healthcare provider has value. I remember a fried of mine who had a kidney transplant and was under the care of 5 doctors who developed some heart pains and they thought he had a heart disorder it ended up that three of the doctors prescribe medications that were affecting his heart. Only one drug rather than three would have solved his problem without the unnecessary worry of a heart problem, All medical healthcare professionals should think more in terms of using today's technical wonders can take care of many patients without going to the hospital. For example a portable ultrasound probe can be attached to the I-phone or android phone to get excellent visual scans and with calling the doctor he can get the results he needs without the patient going to the hospital for the scan. I think that the large hospitals or the research hospitals should be centers to develop technology so that they can touch many more patients without having the patient present. This would also make the system more economic and more efficient, Hospitals should be only used for the extremely ill or to have surgery.
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• Answer added in Pharmacology
  70 Are medical errors a sign of incompetence among physicians or can it be reduced through change in medical culture or attitude of the medical professionals?
  By Geir Bjorklund · Umeå University
  Thomas August · United Chemical Technology

  PHARMACISTS AND DOCTORS BY THEIR PROFESSION ARE HELD TO THE HIGHEST STANDARD OF PERFORMING THEIR DUTIES WITHOUT ERROR OR FACE SIGNIFICANT LEGAL SANCTI... [more]

  PHARMACISTS AND DOCTORS BY THEIR PROFESSION ARE HELD TO THE HIGHEST STANDARD OF PERFORMING THEIR DUTIES WITHOUT ERROR OR FACE SIGNIFICANT LEGAL SANCTIONS AS WELL AS LOSE THEIR PROFESSIONAL STATUS. IS THIS A REALISTIC AND ATTAINABLE STANDARD. For years psychologists and other persons who study the human work habits have supported the principle that ERRORS are a part of the Human makeup and cannot be totally removed without developing a different system that relies on a check system and also practices Quality and a total understanding of the adverse events and misadventures that occur within their practice. I am a pharmacist and the factor with error especially in the pharmacy and medical fields is that We are human and are prone to make errors and that the number one problem and concern that doctors or any practicing professional is to make an error and immediately be prone to civil, professional and other legal proceedings. The professions protect their own however the pharmacy profession and in particular some of the Boards of pharmacy use QCI as an manner to address these errors. QCI focuses more on the error factors, does not blame nor place ownership on the person but on the system and is a better way to address the quality aspects of the profession. The requirements are simple in that everybody participates and sometimes the best solutions come from other personnel. A leader is picked who has some knowledge of QCI and how to run the committee. Meeting are held monthly or if needed sooner. The Pharmacy Board requires meetings at least every three months. The errors that the pharmacy made are discussed to creatively create a process and environment that they are not repeated. Nothing said nor discussed at these meetings can be used legally against the pharmacist nor pharmacy. (UNLESS NOTHING IS DONE FROM THE QCI MEETINGS) Doctors should have a system like this where they discuss their errors and have more of a QCI aspect. Too many times the profession protects its own. The fact that pharmacies have had a over 200% increase in the number of prescriptions filled and doctors have increased workload and are forced to spend as little time with their patients and leave the questions to the nurse practitioner or other health care provider. QCI would assist in the development of systems and processes that would not only assist to reduce ERROR but add more Quality into the process.
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