As readers of P&T, you are probably aware of the abundance of articles that have been published on the topic of reducing medical errors and improving patient safety. What, then, makes the Wall of Silence different from all the other published materials and worthy of your time?
The authors, both of whom have written in the health care field, developed the book out of their own experience of losing a friend from medical errors that could have been avoided. As they served as patient advocates for their dying friend, they realized that although the U.S. health system offers excellent care, it is also beset by the occurrence of numerous errors that are potentially devastating to patients and their families.
The authors witnessed firsthand their friend receiving almost three times the usual dose of a prescribed drug; illegible prescriptions; fatigued health care workers; and communication failures between nurses and physicians. It is with a deep passion that they discuss how commonplace medical errors are in the health care system and how the culture of medicine creates a barrier to adequately addressing the problem of avoidable medical errors. The book also reminds the families of patients who have experienced medical errors that they are not alone in coping with such tragic incidents.
The text details several accounts of other victims of medical mistakes. Examples include a 94-year-old grandmother who died of complications following routine surgery after she fell out of bed and broke her hip, a White House official whose career was destroyed from a botched elective procedure, and an eight-year-old girl whose pains from cancer remission were ignored by physicians and resulted in permanent paralysis below the waist.
By relating examples of actual errors, the authors believe that flaws in the system will be exposed and that chief executives, physicians, and patients will be compelled to work together to make changes to improve the system.
The Wall of Silence is well written and paints an overview of the major issues surrounding patient safety that the average reader will be able to appreciate. The book contains 11 chapters and four main parts. The first section, entitled “Breaking the Silence,” discusses the prevalence of medical errors and their impact on individuals. In addition to citing the national statistics on medical error, this part details the scope and nature of mistakes, presents stories of patients who have suffered from errors, and notes that doctors and nurses are often witness to mistakes but are reluctant to discuss them because of fear of losing their jobs and respect among their peers.
“Why Do Medical Mistakes Happen?” discusses the numerous system failures that lead to medical errors. The authors describe how lapses in teamwork, sleep-deprived physicians in training, nursing shortages, and medication mistakes are contributing to the incidence of medical errors.
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“The Silent White Line” emphasizes the culture of secrecy in hospitals and among physicians that leads them to conceal error and shirk responsibility. As in other professions, physicians are inclined to protect each other, even though many of them do witness mistakes. In addition, the training of physicians is centered on being perfect and never making a mistake. For people who are committed to doing things the right way, admitting that they have made a mistake can be psychologically damaging.
The book ends with chapters on “The Courage to Change the Things We Can” and offers suggestions for improving patient safety. The authors recommend a broad array of solutions, ranging from technology to teamwork. They suggest that hospitals adopt computerized physician order entry (CPOE), use simulators for training new physicians and continuing education for practicing physicians, implement bar-code technology, adopt a team approach to caring for patients in the intensive-care unit, and encourage physicians to openly admit their mistakes.
The authors would also like to see patients take more responsibility for improving their own safety. Patients can protect themselves by recognizing the possibility that a medical mistake might occur, by learning as much as they can about the physician who is caring for them, by obtaining a copy of their medical records, and by keeping a journal of all proceedings while they are in the hospital.
This book has something in it for everyone: people or family members who have experienced a medical error, people who are scheduled for an operation in a hospital for the first time, health care providers who face the possibility of making an error, and executives who are responsible for the operations of the hospital. All of these parties have something to learn from this book.
The Wall of Silence represents a powerful reminder of the weaknesses in the health care system and how easy it is to make a mistake, and it elucidates the pain of patients who have experienced a medical mishap. It is yet another wake-up call for everyone who is involved in medical care.