The Elizabeth Wettlaufer case should serve as a warning to all of us about the issue of patient safety
By Fiona MacDonald
and Karine Levasseur EvidenceNetwork.ca
We've
all been there: it's 3 a.m. and your partner, child, sibling or parent
becomes ill suddenly and needs medical care. Will they be safe?
The ongoing public inquiry into the safety and security of residents
in the long-term care homes system is shedding new light on the
employment history of an Ontario nurse whose career in long-term care
ended after the murders of eight patients and attempted murder and/or
assault of six more.
The inquiry, which began recently, has revealed new aspects of the case.
One
such detail is that Wettlaufer had a history of medical errors that
went largely ignored. This is important not just in this case, but in
understanding patient safety more generally.
Canadians have a high level of trust in their medical system. A 2011 EKOS research study suggested 81 per cent of respondents believed they would receive the appropriate care if they were seriously ill.
While
these findings suggest the highest level of public confidence in over a
decade, research also suggests that medical errors are common in
Canadian medical systems.
A 2016 report
from the Canadian Institute for Health Information concludes that for
every 18 hospitalizations, one patient will experience harm that was
preventable. Yet the true number of errors is difficult to track because
most studies rely on medical records or critical incident reports. Many errors are not captured with this methodology since records are often incomplete or errors aren't recognized as official critical incidents.
While the numbers are disturbing, there are positive signs of change.
One important shift involves apology legislation now in place in most jurisdictions throughout Canada.
The
legislation gives medical professionals the opportunity to apologize
for a medical error or mistreatment without fear of becoming legally
liable. The legislation still allows patients to pursue a lawsuit if
they choose but it prevents people from using the apology as evidence of
fault in a legal proceeding.
Reception of the legislation has been mixed but numerous patient safety groups have heavily advocated for it.
With
funding from the University of Manitoba and the Law Foundation of B.C.,
we are interviewing patients who have experienced medical errors or
mistreatment to explore the impact medical apologies may have on those
involved. Our research shows that medical errors are not unusual and
that patients often hit a wall of denial when trying to hold clinicians
accountable.
Many
patients we've interviewed are now committed to promoting safe,
high-quality health care. Some work with patient safety and quality
organizations, some filed complaints with a college of physicians and
surgeons, some wrote lengthy letters to administrators, and others met
with clinicians and administrators to demand changes.
The Wettlaufer case demonstrates a complete breakdown in accountability that resulted in senseless and tragic loss. Records from the inquiry
show Wettlaufer was disciplined multiple times for harassment, failure
to complete assigned duties, failure to meet the needs of patients and
medication errors. Yet she continued to work in the field.
The inquiry suggests a need for cultural change. This finding is consistent with our research.
Patients
we interviewed often spoke of feeling dehumanized in the health-care
culture. They also emphasized the need to recognize the humanity of
clinicians to allow for more open interactions and transparency.
If
we want to find some meaning in these tragic events, we must remember
that we're no different from the patients victimized in this case.
Patients are not a small special interest group and we would benefit
from remembering that everyone is, in some ways, a patient in waiting.
Fiona
MacDonald is associate professor, Department of Political Science,
University of the Fraser Valley. Karine Levasseur is associate
professor, Department of Political Studies, University of Manitoba. They
are expert advisers with EvidenceNetwork.ca, which is based at the University of Winnipeg. |
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Tuesday, July 3, 2018
Medical errors too common but patients are paving the way for change
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