Celebrating 51 years this year. Wed like to thank our supporters, and everyone whether outpouring of love for our bookstore. The Current Situation and things we love most. Pickup and delivery to anywhere in the world. Expanding our mind and bring them new thoughts to make the world a better place. We hope you enjoy this event and we hope you like these books by purchasing a copy for you and your friends. Purchasing a copy of the book here in the most unusual times so thank you so much for your support. In the event coordinator. We will take questions from the audience. Follow on facebook to be motivated. Let your friends know youre here. Patients entering the medical system will receive the best care possible. Its a profound and painful breach. Medical science is made in north strides of increasing mortality but theres no doubt it can cause harm. A significant portion can be prevented. Medical errors and Patient Safety in our National Healthcare conversations. Professional experience and extensive interviews and administrators, researchers and patients and families and they suffered systemic common issues and medical error. She advocates for strategic use intervention. Prior to making numerical errors. The stories that they are renowned for. It ranges from medical problems. Its possible to minimize harm. What makes this book special is receptive and compassionate nature, she sees her patients is real people. For anyone involved for interested. Clinical professor for more than two decades. What doctors hear and feel and some of the intimacies. A regular contributor to the New York Times as well as medicine. Working and shes shared what was in the New York Times. This is one of my personal favorites 2015 and im happy to do this tonight. Systemic racism, especially now, we should be looking at the roots of the Healthcare Industry and i think the book will definitely help. Of the medical school and yale law school, a professor at the Medical Center and Medical Center. The journal of the American Medical Association and internal medicine. Theyve appeared in the New York Times, observer and constitutions. Now i am very happy and thankful to welcome doctor daniel. Its very special that we are here tonight. Thank you. Im pleased to meet you. Ive admired your work. Want to say thank you and its great to be with you. Thanks. To start off, why this book and why now . Were going to talk about covid19. Impressions about medical issues so years ago, they sent me an email she sent a text saying medical error is the third leading cause of death. The email said is it really true . Have to say and give an answer. I really didnt know. It doesnt feel like i do but i wondered to answer that question but i quickly learned, medical error so counting was very difficult. Its pretty hard to answer but thats what piques my interest. How do you go about this . How did it come up . They went back to the data and reanalyzed it which is not on kosher at all but it involves taking smaller sets and multiplying it out to the whole population so theres slight error in terms of the study, 300 Million People so is a bigger study, there seems to be number three after cancer and heart disease. We certainly know many errors occur. Even if they dont cause death, its so important to find because they are waiting to cause harm even if we dont know the exact number, medical care needs to be overall safe. Earlier this year, longtime doctors talk about how theres a study but its something that should be talked about. You think about, why would a doctor ever talk about errors theyve made . You naturally dont want to talk about that. Even beyond that, theres the emotional side. Most people in healthcare certainly see that, if youve done something, even inadvertently to make a mistake, youd be ashamed and cumulated dont want to talk about. I once made a mistake or someone told me something that i missed something in my error was clear but errors are calculated. The air was still there but what interested me was that why should i say anything . I didnt tell my intern for my attending for the family. I couldnt imagine a more horrible scene where i would say i almost killed you. It took me years to write about and speak about it so we need to think about the emotional side that keeps errors hidden. If we dont know where they are, how could we fix them. The idea of this helping everyone sort of this. Is training, i read this wonderful book and he made a clue between shame and guilt of this happening it makes you want to fix it and not make the error again. This error, feeling bad, never doing it again the shame releasing in one second, i wasnt the doctor i said i was. The moment it came crashing do down, i entered a patient. I realize it prevented me from talking about it. Correcting the errors, i was sure i could never make another mistake that could have been prevented. People involved and it makes it hard. How you look at the policy. Over the past 200 years, feature films, captivating study, sanitation and anesthesia. Vaccines, antibiotics the 20th century. The second half of the 20th century, worrying about this, chemotherapy, blood transfusions, hiv treatment, its one away from victory. There is good reason. Talking about medical errors and outcomes of the treatment, at best, doing this constantly. This idea that more research and medication and we dont really talk about it, think about as a medical student. With the error and understandi understanding, we said to her, i cant quite get this, why even bother . Remember, the residence turned. I learned a couple things. One, i better not make any errors and if i do, i would be more screwed. Im going to stay clear. Thats a message about medical error. So far, the doctors side, personal workers being affected. The things we have to move forward, we are going to talk about some of that later. So far, we focus on the doctors side but at the heart of any medical error, theres potentially a patient or a real person affected. Your book does a great job of humanizing that. Could you share a bit about the patient side . One of the challenges is to write about a patient particularly in a vulnerable moment because one doesnt want to exploit a tender situation and on the other hand, most patients and families were eager to have their story told because many of them, they wanted their situation to be lessons to other and most of medical errors and experience of sorting it out had to do with communication, getting information and what happened. One example, 67yearold gentleman in the midwest was involved in a fire, a controlled burn in a community and he went to the local hospital and they said he looks okay, we will treat him. He didnt know need to go to the burn center. He went to the burn center by the next day have a terrible course. The doctor said, why didnt you bring them right away . Eventually died about ten days later. The family, wife and daughter were devastated, of course. They wanted to know, what happened . How did the healthy father and husband and up here . How did he not get transferred to the right place in the couldnt get the answers. It took them years, for five years of arduous work to get information. Hospitals, committed theres a bad outcome, they clamp up and do not want to speak and it was the hardest thing for them and it made the pain so much more because if youve lost somebody in your family, no matter the reason, you want the chance to breathe and instead, those months in years trying to find out what happened, it seems like something bad has happened because our system doesnt have an easy way to say heres what happened, heres what were doing to fix it, heres our acknowledgment, restitution others compensation, i think these things are important and it never brings back the person in the one thing the promise and demonstration that this will be better for the next patient. Makes sense. Sounds like one of the things you talk about was the way in which people end up finding out the information from the have to get a lawyer and think about medical error and lawyers, its a big mess. Tell us a little bit about that because there are a lot of misconceptions on television. Theres a lot of misconceptions from our and patient and. In the u. S. , we have this perception that everyone gets a day in court and everyone deserves a jury of their peers and in theory or ideally, that is the case but it doesnt really work that way for malpractice so if you think about it, in order for a case to go forward, its a very expensive process. Legal team has to hire experts, its very expensive. Unless the case has a high chance of winning a large settlement, its not worth the effort and cost so lawyers will only take on cases in which there is a severe outcome, death or severe disability and the cost in treatment are very high and if it isnt that, the case will ever get its day in court so malpractice is only a small segment of people harmed. If your error did cause major harm or wouldnt result in a large settlement, nobody will take it on even if its a legitimate error that needs to be public, he will not get your day in court so the truth is, now practice works for very few patients and even those who do get their day in court, its not a pleasant day, its usually dragging on for years and years. There is no easy resolution and even if you do win, with the word win, it doesnt matter which side wins because its typically years of agony for both sides, theres no maybe this settlement will help people with their bills but no one feels better at the other end. Usually its just a terrible wound but never healed. Although we have this, it doesnt serve the many patients and the truth is, most lose the case or settle out of court so they never get a day in court as you see in the movies. Would you say most cases, there settlement and those who go to trial, majority done in favor of the physician . Is not typically how you see it . That is correct, historically by whats happened in the u. S. The ones who do go to court, typically the patient, the plaintiff loses. Theres so much stacked against them, you have to prove the error was negligent, the doctor did something deliberate wrong and the negligence caused the bad outcome and it can be difficult to prove even if its seeming obvious if you cant prove it, the patient needs an antibiotic and they die, to prove the antibiotic caused the death is quite difficult. Would say i have knee pain and i have a surgery and it doesnt help may be from a mistake in surgery, it would be hard to prove if i already had existing problems. Having your leg amputated, something drastic, isnt that how it works . Very few patients get served by that. That was my next question, tell us about that. They did away with that because they recognize most patients dont get the case representative in the more important things patient is some kind of restitution for that so they switched to a system similar to workers compensation. In the u. S. , if you have an injury on the job, you dont necessarily go to work, you have Administrative Court where they look at what happened, theres a formula if it qualifies and you get some kind of settlement. In denmark, committed separate from a legal system that any patient can file and so can a physician and nothing in the report can be used for legal attack, only for prostituting the harm that was done so many more patients get compensation. His modest but its fast, it doesnt have to be big because people in europe, you have the bills american patients do. Thats why americans sue, to cover if theres a bad outcome in childbirth and a child is around the clock care for many years, theres a lot of costs with that. Many more patients get served whether its a small amount or not. Sounds like denmark so it seems like theres other areas in the u. S. Adopting that. In a malpractice is buried by state but are there any pockets we see this happen . There are a few, one example is vaccines. Vaccines, when Companies Make vaccines, theres a small profit margin so it doesnt take much no way of getting sued to say manufacturers wont even bother doing it and we have a situation where many vaccine manufacturers will out of the market because it wasnt worth the risk theres a real possibility we wouldnt have enough vaccinations for the public so they had the idea to make a vaccine compensation fund. Anyone with an injury that they think is related to a vaccine would simply get an analysis and possible settlement in all vaccine makers would contribute to the fund will small tax and every vaccination to keep you out of the court system. Same thing in florida with the obstetricians and now practice insurance went so high because of the big lawsuits related to injuries that many stopped practicing and there is a theory you couldnt deliver a baby in florida so the state stepped in and formed a cooperative fund that everyone contribute to that would settle these cases out of court and the truth is, more people who have benefited, i dont think its going to happen and the u. S. Congress, getting your day in court and in a book, she notes Congress People used to be trial lawyers so they have a different view. Most patients dont actually get their day in court. So its important as you say, we talking about these but these are affecting real people in your stories do a great job of showing the pitfalls of the system. Lets switch, how do we get our weight some of these . One thing is the emr, electrified medical record so is here that. We are equal first, one Year Anniversary in our hospitals switching to a new emr. It was such a nightmare. Imagine if it happened this year when there are many great things about it. During this covid crisis, we were taking patients from other harder hit hospitals, somebody sometimes 30 or 40 patients. We never know what was going on with the patients show it can help with these things, not having to get a paper chart and it would help for presenting medical error. One example is when you have a break in one of the common outbreaks is called c. Diff, and infection spreads are gone contact. Its hard to eradicate so when theres an outbreak in the hospital anywhere, people try to find a source but can be tough to do. One hospital, his outbreak, they use medical record. The emr contract for every patient went in the hospital, radiology. Day and time . Went to g. I. . Which doctors and nurses interacted with each patient, they can track each interaction with thousands of patients, pinpointing the outbreak to a single cat scan machine in one area of the hospital not cleaned properly. Its probably beyond what we could do as human beings trying to calculate that so in the enabled them to find and solve this source of patient harm. On the other hand, it produces all kinds of things. One example is the medication alerts, every time i write a prescription, 50 alert, about interactions of this and that and age and sex and drug things, theres so many that he cant read them all. Some of them are ridiculous. Every female, you can be in your 60s and if so says pregnancy alert. I dont know when it would say its unlikely a 55yearold would get pregnant but its there. Theres so many alerts, it ignores them all. It makes me angry because and others probably one or two pertinent ones, they can cover themselves for liability or the doctor checked it off so we are not responsible so makes me frustrated and then the annoyance or flow, theres so much being drove at you, use one at all to go away. Our share an update from recent. One morning in my clinic, i was seeing my first patient of the day and i noticed the emr looked a bit different, apparently, some sort of rollout in various updates in the wee hours of the night. A bunch of minor things were out of order and tripping me up. For example, my fingers are radically new spanish was number 41. When it came to the way of the patient. As the most common language. Knowing the number by heart, saving allocation of going to the long list of thing which but another language had been added. Bumping spanish to number 42. My fingers though, still went to 41. Every patient that day came out speaking serbian. Then all of a sudden, three brandnew field popped up that i had never seen before. Latex allergies, Food Allergies and environmental allergies. You can enter anything he wanted, medications, food and allergies, even emr allergy but i refrained myself. Its not that i think they text food and environmental allergies are important but they are hard making it even harder. Avoiding having to have a computer being the focus of the visit but now face the prospect of sprinting out of the room, liking them before they enter the elevator, hollering about latex gloves, kiwifruit and cat dander, smack in the middle of the day when everyone was speaking serbian. The other change that date was the past medical history was number 18, they bumped it up to Something Else and now 18 was sexual history but was automatically and once you put in, you cant take it out so all of my male patients had passed ob charts attached to their charts forever. Ive seen Something Like that as well myself. The question is, how do we make the best in emr but avoid all these things that could potentially make things worse . Theres lots of things we can do, there are things like checklists, a lot of success with procedural things like central line, preoperative work, make sure you have everything you need, its a simple intervention but it works for that kind of thing. Doesnt work so well like diagnostic error, you cant checklist how you think so when it comes to that, we have to consider how much time we give for doctors and nurses to be with their patients and if we have the emr bombard them with lots of uses fields, they cant actually talk with the patient. Listen to the patient and think about the patient and those are the three biggest things for minimizing diagnostic error so if we really want to minimize error, we cant just pass it, we have to rethink how we do medicine and give them more time with their patients to think about it and talk with them because the doctorpatient conversation, nurse patient conversation, these are the biggest in situ safety. I cant tell you how many times ive heard patients complain about a doctor looking at a screen and never at them. There are so many fields to fill in that if we dont, wed be there until 3 00 a. M. , we never get through it so i think we can reconfigure the system to use the emr for what its good at but not completely so we cant talk with our patients. The second thing is this cultural shift that when we make an error, is our duty to speak about that and think about it, i was intrigued by an article last week with the new york about the cultural shift it will take to make it safe for the opening. Doctors typically,