University of Texas Pan American
Terrell Thomas, English 1301, University of Texas Pan American Questions regarding this article may contact Terrell Thomas, University of Texas Pan American, English 1301, Edinburg, Texas, Email: firstname.lastname@example.org
Internal Bleeding Updated
Often times a book like Internal Bleeding is written primarily from a third or fourth person point of view in an effort to inform the American public about something that occurs thousands of times each day in hospitals all over the country. This book however, was written by two doctors, Bob Wachter and Kaveh Shojania, whose real-life accounts of near-miss mistakes could have ended in tragedy, and even more interestingly; their cases happened ten years apart from each other. Robert M. Wachter, a young doctor at the time learned the hard way about ambulances and priority numbers. Kaveh G. Shojania, a resident at his time misdiagnosed a heart attack for rib trauma and gastritis. Wachter and Shojania share a mix of horrifying medical accidents throughout the country by residents and seasoned veteran doctors, and the research that explains what needs to be done to fix or remedy the problems. In chapter four we learn of many popular medications and how remarkably they have similar names. The antidepressant Zyprexa and the antihistamine Zyrtec; the anticonvulsant Cerebyx and the anti-inflammatory Celebrex; and the mood stabilizer Lamictal and the antifungal Lamisil are but three of the many examples where even good penmanship is no substitute for an alert and functioning brain in those who write and fill those prescriptions. Other medication misadventures include: when a drug is used improperly, or when a doctor miscalculates and prescribes an excessive dose, or when the pharmacist misreads a scrawled prescription and prescribes the wrong medicine. Oliver Wendell Holmes (1860) stated it best “…I firmly believe that if the whole materia medica (list of available drugs) could be sunk to the bottom of the sea, it would be all the better for mankind – and all the worse for the fishes”. The use of computerized physician order entry, or CPOE, could potentially eliminate most of the medication errors that occur at the prescribing and order-filling stage. Prescribing doctors can override CPOE suggestions, and sometimes they should. But before they can veto a computerized suggestion for a substitute medicine, doctors must answer “are-you-sure?” type of prompt. “This may not make health care faster or cheaper than it is now, but it will certainly make it safer” (Wachter & Shojania, 2004). Unfortunately, the vast majority of U.S. hospitals still lack any form or CPOE system. Transferring data from one hospital to another and cost are barriers associated with such a system. The most overwhelming hindrances are organizational passivity and resistance to change. “Ultimately, computers will help treat our epidemic of medical mistakes, but they are not a cure-all” (Wachter & Shojania, 2004). In chapter seven, “Of Life and Limb”, Wachter & Shojania go on to describe the horrific story of Willie King; the fifty-one year old diabetic with three kids whose life changed dramatically when the doctor amputated the wrong leg. And the story of Rajeswari Ayyappan who had a tumor on the left frontal lobe of her brain, but the doctor spent hours chiseling through the right side. Both the Willie King and Ayyappan cases involved identification problems. In the first, it was the wrong site; in the second, it was partly the wrong site but also the wrong patient. Since orthopedic surgeons are most likely to perform wrong-site procedures, that field has led the fight against the most outrageous of errors. Dr. Harvey Cushing, the pioneer of modern neurosurgery quoted, “…I would like to see the day when somebody would be appointed surgeon somewhere who had no hands, for the operation part is...