Internal Bleeding: The Truth Behind America's Terrifying Epidemic of Medical Mistakes Hardcover – May 1, 2005
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From the Inside Flap
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.
From the Back Cover
""Internal Bleeding is ER meets "Fast Food Nation. By pulling back the curtain to show us the hidden world of doctors and nurses, it paints a remarkable and unforgettable picture of how medical mistakes happen, and what must be done to cure this modern epidemic. It is a fascinating and essential read for both patients and medical professionals." --David Kessler, M.D., J.D., Commissioner of the United States Food and Drug Administration, 1990-1997.
"The authors have achieved something quite special. The lay reader will journey inside the complex world of medical care today and gain an understanding of the strengths, weaknesses and humanity behind the headlines about medical errors. For any healthcare professional laboring every day to make what they do for patients better and safer, this book is invaluable. It is full of insights, learning and guidance that will help them create and keep the 'culture of safety' that hospitals must achieve for patients in spite of shrinking resources and increasingly complex technology. Read this book." --Dick Davidson, President, American Hospital Association
"Health care could be far, far safer than it is today, but not without widespread public understanding of the nature and extent of its risks. Which brings us to "Internal Bleeding-a disciplined, vivid, responsible, and appropriately disturbing exploration of the problems, and the possibilities, in patient safety. Read it, and then demand-and expect-a safer health care system." --Don Berwick, M.D., President, Institute for Healthcare Improvement
- Item Weight : 1.69 pounds
- Hardcover : 441 pages
- ISBN-10 : 1590710738
- Dimensions : 5.9 x 1.48 x 9.1 inches
- ISBN-13 : 978-1590710739
- Publisher : Rugged Land (May 1, 2005)
- Language: : English
- Best Sellers Rank: #1,003,960 in Books (See Top 100 in Books)
- Customer Reviews:
Top reviews from the United States
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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.
Very well written and although the errors described are deplorable and terrible, I felt compassion in most cases for the medical personnel who committed the errors. That could be me the next time, if we all don't work together to minimize the chance for a mistake. There are errors I would have committed had not a nurse or pharmacist questioned my order, and Thank God they did.
I borrowed a copy, read it in one week and bought this copy for myself. Outstanding book. Should be required reading in all medical schools.
I cannot praise the quality of the writing enough. The authors accomplish just the right blend of fascinating case studies and theoretical analysis. They make their basic point (that any system run by humans is fallible and medical mistakes are inevitable) very effectively in the beginning pages of the book by describing two case studies where mistakes were made...with the punch line being that the mistakes were committed by the authors themselves. Beginning the book this way was in part so effective because it gets across the message that the vast majority of mistakes that are made are not the result of negligent, careless, or malicious physicians; rather, they are the inevitable consequence of a system that struggles to cope with the complexity of the ever-changing demands of a never-ending stream of patients.
The second most admirable feature of this book, in my opinion, is that it does not merely criticize but also offers suggestions for improving the delivery of medical services to eliminate errors, from such simple steps as physicians "signing their sites" (to prevent, say, amputation of the wrong limb) to computerizing medication orders (to prevent errors due to physicans' notoriously poor handwriting) to more systemic changes in malpractice law. I thought the authors' suggestions on this latter topic to be highly intriguing and novel. The idea of adopting a modified no-fault system for compensating patients injured by medical errors is, in my mind, a terrific idea, and I would love to see the authors' recommendations in this regard enter the national debate on malpractice litigation reform.
Perhaps the only part of the book I found even slightly disappointing was the authors' reluctance to deal more bluntly with the problem of incompetent or alcoholic/drug dependent doctors. The authors acknowledge that these "bad apples" exist, but they do little beyond saying that hospitals and physicians tend to cover up for the incompetents in their ranks. My mother-in-law died from botched surgery; after she died, the hospital risk manager told us to our faces that this particular surgeon had had "other surgeries that did not turn out as he had planned." I think if I had read this book before my mother-in-law died, I would have been more proactive in pressing our complaints about this surgeon, who--a scary thought--is still operating on people but probably should not be.
But these kinds of physicians are in the minority, and the contribution this book makes is to describe the much more common ways in which patients end up being hurt by medical care designed to help them.
I read a lot of nonfiction, and this book is one of the rare examples of nonfiction that can keep you glued to your chair and turning the pages eagerly. I think it ranks right up there with Jon Krakauer's "Into thin air" and Richard Preston's "The hot zone" in terms of readability and interest value. Yet it also probably outranks those and other books in terms of potential social value. It could well be one of the few books with potential to inform and enable real changes in social policy that has been published lately.
Kay Burningham, Attorney
Author of "An American Fraud: One Lawyer's Case against Mormonism."