I have spoken to or reviewed records for thousands of patients over the years I have been representing people injured by medical malpractice.  I have also read a lot of articles about the incidence of medical malpractice.  I can say with confidence that in any hospital stay of three days or more, the patient will be the victim of at least one instance of medical malpractice.  Fortunately, most of these instances will cause little harm but the fact of that much malpractice should be of concern to all of us.

It is not hard to understand why there is so much malpractice in hospitals.  They are large, complex institutions with many employees performing complicated tasks.  There is a lot of truth to the old adage, “Too many cooks spoil the broth.”  This applies to hospitals as there are lots and lots of cooks helping to care for a patient.

By way of example, I have a friend who is quite sophisticated about malpractice issues as he works for a malpractice insurance company.  He had to be admitted to the hospital a few years ago.  He told me that each night for the first three nights, the nurses brought him the wrong medication.  They insisted it was the medication he took at home and he insisted to them that he had never taken that medication in his life.  You would think that after the first night, the nurses would have discovered their mistake.  You would be wrong.  They just kept coming back night after night with the wrong medication.

Think about a hospital stay for a routine surgical procedure.  This should turn out well.  The surgery is elective and therefore not an emergency.  The doctor, the patient and the hospital should all be well-prepared for the event.

Now think for a moment about all the people who will participate in the care of the patient and how many ways mistakes can be made.  First, the intake people meet the patient and admit her.  Always a chance at this stage for mistakes to be made about patient identity (and what medications they take at home).

Once the patient arrives on the floor, she is introduced to the nurse who will be caring for her on the current shift.  Hospitals run either two or three shifts each day.  Each time there is a shift change, the nurse caring for the patient must give a report to the successor nurse.  This report is to include tests that have been done but not yet reported, scheduled medications, status of the patient and many other things.  When the shifts have been busy, the hand off of the patient from one nurse to another may not go as smoothly as it should and information may get garbled or not given at all.

Even though the patient has been admitted by her surgeon for the procedure and the surgeon is usually the attending physician, many doctors may be involved in the patient’s care.  There may, for example, be a hospitalist, who only sees patients in the hospital for other doctors.  There will likely be other doctors involved, such as radiologists and pathologists as well as many other specialists, if things go a little sideways.  The communications between these doctors can be complicated.  It usually takes place through chart entries.  If one of the doctors does not do a good job charting, it can lead to misunderstandings among the physicians.  Misunderstandings often lead to mistakes in care.

Orders have to be given, recorded and followed.  Often orders are changed as circumstances change.  Doctor A may change the orders given by Doctor B or Doctor A may change them herself.  The old orders must be closed out and the new orders recorded in the chart.  Tests have to be performed, reported and the results evaluated.  Many is the time I have seen important test results that just fell through the cracks.  Many is the time I have seen important orders missed or just plain disregarded.

Most importantly, the nurses who are in direct contact with the patient must keep the doctors fully informed about what is going on with the patient.  Communication is always a problem for human beings.  Even under the best of circumstances, there can be misunderstandings or just plain old failures to act.  I have had a number of cases in which a patient became paralyzed during the night following surgery and, due to a failure on the part of the nurse, the doctor did not learn of the paralysis until he arrived for rounds the following morning, when it was too late to do anything about it.

I recommend to my family and friends that they have someone stay with them in the hospital to monitor things, to act as their advocate, to ask questions and to make sure, to the greatest extent possible, that things go well.  I suggest they be polite but firm in asking questions and insisting people be notified and action taken.  Nothing can guarantee you won’t be the victim of malpractice at the hospital but doing these things will reduce the risk of a major injury.