Patient Power How to Protect Yourself from Medical Error

, by Proctor, William; Podell, Richard N.

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ISBN: 9780684815152 | 068481515X
Cover: Paperback
Copyright: 7/16/1996

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For the increasingly confused patient, this empowering, informative, and easy-to-understand guide is for patients anticipating, preventing, and overcoming common errors in medical tests, diagnoses, and procedures.

Patient Power: How to Protect Yourself from Medical Error "confronts the tough, practical issues which most popular medical guides omit or gloss over" (Dr. Gerald Lazar, Associate Professor, Harvard Medical School).

Foreword	p. 25
A Program to Protect Yourself from Medical Error	p. 27
Danger in the Heart Zone	p. 45
Special Alerts: Cardiovascular Conditions	p. 47
Blood Pressure	p. 49
Errors
Your doctor says you have hypertension, but you don't	p. 49
The meaning of the blood pressure numbers	p. 52
Your doctor doesn't warn you about possible drug interactions between high blood pressure medications and other drugs	p. 53
Undertreatment of older people with high blood pressure	p. 55
Not emphasizing nondrug treatments for your high blood pressure	p. 56
How to calculate the sodium content in your daily diet	p. 59
A hypertensive asthmatic on beta-blockers may face sudden death	p. 60
High blood pressure medicines and their main side effects	p. 62
Matching patient needs with blood pressure medicines	p. 64
A hypertensive diabetic on beta-blockers may be in danger of a stroke	p. 66
Not discussing decreased sexual performance as a side effect of blood pressure medicines	p. 68
Blood Thinning	p. 70
Errors
Neglectful prescribing and overseeing the use of an anticoagulant, or blood-thinning medication	p. 70
Overlooking the interaction of a blood-thinning drug with other medications	p. 72
Selected drugs that interact with warfarin (Coumadin)	p. 73
Your pharmacist gives you the incorrect-strength warfarin (Coumadin) pill	p. 74
Nondrug factors that may interact with warfarin (Coumadin)	p. 75
You are on a blood thinner, and your doctor fails to train you to detect and report signs of bleeding	p. 76
Stroke	p. 79
Errors
Failing to recognize the most important early warning sign of a stroke	p. 79
Symptoms of a transient ischemic attack (TIA), the most important signal of an impending stroke	p. 80
Automatically treating a stroke patient with a blood thinner	p. 81
Your doctor not testing for a traveling blood clot (embolism) as the cause of a TIA or stroke	p. 83
Sloppy medical and nursing care sets back recovery from a stroke	p. 84
Cholesterol	p. 87
Errors
Your doctor relies only or mainly on total cholesterol measurements to prescribe cholesterol-lowering medications	p. 87
General cholesterol and triglyceride guidelines	p. 88
Undertreatment of patients with low levels of "good" HDL cholesterol	p. 91
Your doctor ignores your triglyceride levels	p. 93
Mistakes involving cholesterol-lowering medications	p. 95
Pros and cons of the main types of cholesterol-lowering medications	p. 97
Your doctor fails to monitor fish-oil capsules, vitamins, and other alternative over-the-counter cholesterol medications	p. 99
Heart Attack	p. 103
Errors
Your doctor fails to rehearse you for a heart attack	p. 103
Failing to follow an effective emergency room drill	p. 107
Assuming a lax approach to patient care after a heart attack	p. 109
Unnecessary invasive tests for heart disease	p. 111
Your doctor oversells heart surgery or angioplasty	p. 114
Your doctor refers you for heart surgery, angioplasty, or another invasive procedure to a specialist with less than optimal experience or skill	p. 116
Your doctor concludes that worsening heart symptoms always mean that your heart disease is getting worse	p. 118
Outdated treatment for congestive heart failure, heart enlargement, or ventricular hypertrophy	p. 120
Noncardiac conditions that worsen heart disease symptoms	p. 120
Common medications that worsen heart disease	p. 121
Common errors and smart patient responses related to popular heart disease medications	p. 123
The Question of Cancer	p. 127
Special Alerts Cancer	p. 129
Prevention and Early Detection of Cancer	p. 131
Errors
Your doctor tries to cover too many health concerns in one checkup and fails to focus on cancer risks	p. 131
Guidelines for early detection of cancer in symptomless, average-risk men	p. 132
Guidelines for early detection of cancer in symptomless, average-risk women	p. 133
Failing to consider family history factors that put you at high risk for certain forms of cancer	p. 134
How to tell if you're at high risk for different cancers	p. 135
Your doctor fails to ask you about common but frequently overlooked cancer symptoms	p. 138
During a routine medical exam, your doctor fails to ask you to show how you examine your own breasts	p. 140
Common symptoms that could arise from cancer or other causes	p. 141
Your doctor says you shouldn't worry about a small hard spot in your breast because it hasn't shown up on any mammogram	p. 142
Your doctor tells you that because you've had one baseline mammogram before menopause, there is no reason for you to have another mammogram until you are past menopause	p. 144
You've noticed some changes in the appearance or shape of your breast, but your doctor tells you not to worry	p. 146
Your doctor sends you to an unqualified mammography center	p. 147
The technician fails to ask you if you have a silicone breast implant before giving you a mammogram	p. 149
Neglecting to schedule a Pap smear for very young or very old patients	p. 150
Your doctor fails to order a second Pap test after a normal first test, even though you are experiencing spotting or other symptoms between periods	p. 151
Endangering a woman's ability to have a successful pregnancy by not referring her for a colposcopy procedure after an abnormal Pap smear	p. 153
You were born during the period 1945 to 1971, and your doctor fails to check your vagina carefully for cancer	p. 155
Translating old Pap names into the new Bethesda system for Pap smears	p. 155
Your doctor fails to ask if you are experiencing any itching or other discomfort in the vulva area	p. 156
Relying only on a Pap smear and pelvic exam to check for cancer of the uterus	p. 157
Overlooking subtle health signals that may indicate the presence of ovarian cancer	p. 160
Relying only on a negative stool sample test in screening for colon and rectal cancer	p. 163
You are injured during a sigmoidoscopy or colonoscopy by an unskilled physician	p. 165
Your doctor omits the rectal exam as a screening procedure for prostate cancer	p. 167
You aren't given a PSA blood test to check for prostate cancer	p. 169
You are a smoker, and your doctor fails to recommend a chest X-ray during your regular checkup	p. 170
You are a smoker, but your doctor never hassles you about your habit	p. 171
Your regular medical exam doesn't include a systematic viewing of all your skin surfaces	p. 173
Treatment of Cancer	p. 176
Errors
You are being treated for cancer, and your doctor fails to refer you to an oncologist	p. 176
Key questions to ask when you are first diagnosed with cancer	p. 178
You are scheduled for breast surgery, and your doctor offers you a mastectomy rather than a lumpectomy	p. 179
Your doctor fails to recommend radiation treatment after a lumpectomy	p. 181
Your doctor does not offer you the option of preventive chemotherapy after breast surgery	p. 182
Your doctor doesn't measure estrogen hormone receptors on malignant breast tissue	p. 184
You are diagnosed with prostate cancer, and your doctor immediately recommends surgery without exploring the possibility of radiation therapy	p. 185
Your doctor fails to treat advanced, spreading prostate cancer aggressively enough	p. 187
Your doctor fails to refer aggressive lymphoma and Hodgkin's disease to a specialized cancer center	p. 188
How to distinguish between lymphoma, Hodgkin's disease, and leukemia	p. 191
Your doctor doesn't tell you that your cancer doesn't respond well to chemotherapy	p. 192
Your doctor fails to educate you about signs of chemotherapy toxicity	p. 193
Your doctor doesn't suggest behavioral techniques to overcome side effects of chemotherapy	p. 195
Your doctor doesn't explain the hospice option	p. 196
Not confronting the insurance implications of your treatment early enough to take assertive action	p. 197
What's Going On with My Gut?	p. 201
Special Alerts: The Digestive System	p. 203
Abdominal Pain	p. 205
Errors
Your doctor tries to diagnose your abdominal pain over the telephone	p. 205
Organs that may cause abdominal pain	p. 208
You have pain in your right shoulder, but your doctor misses the real source of the pain--your gallbladder	p. 209
Your doctor fails to do a rectal exam when you complain about abdominal distress and misses your appendicitis, diverticulitis, or another serious condition	p. 211
Your doctor fails to do a pelvic exam and evaluate your menstrual and pregnancy status when you complain of lower abdominal distress	p. 212
You have steady pain in the upper abdomen, which your doctor misdiagnoses as gastritis instead of pancreatitis	p. 213
Assuming too quickly that the burning in your upper abdomen is from your ulcer rather than your heart	p. 214
In diagnosing your abdominal pain, your doctor fails to check your medication schedule or exposure to toxic substances	p. 215
Failing to do a urinalysis and blood count in evaluating lower abdominal distress	p. 217
Your doctor tells you to wait a day for treatment for a painful stomachache, but an emergency room doctor identifies a potentially fatal blood vessel problem	p. 218
You are placed "under observation" in an emergency room as a result of abdominal pain, but more than thirty minutes elapse before you are checked by a physician or nurse	p. 220
Your doctor does not treat your chronic "acid" problems with antibiotics	p. 222
Constipation and Diarrhea	p. 223
Errors
Your doctor orders many fancy tests for ordinary constipation	p. 223
Ignoring significant worsening of your constipation	p. 224
The basics of promoting regular bowel movements	p. 225
Your doctor fails to recognize that your constipation is a symptom of anxiety or depression	p. 227
Drugs that often cause constipation	p. 228
Not recognizing diarrhea caused by antibiotics as a potentially life-threatening emergency	p. 229
What kind of laxative should you take?	p. 230
Irritable Bowel Syndrome	p. 233
Errors
Your doctor overtests you for Irritable Bowel Syndrome	p. 233
Insisting that you continue a high-fiber diet even though your IBS seems to be getting worse	p. 235
Typical signs and symptoms of IBS	p. 235
Your doctor lacks the patience to help you identify a particular food that may be causing IBS	p. 236
An enzyme deficiency, which your doctor has overlooked, is contributing to your IBS	p. 238
Your doctor overlooks a possible psychological component to your IBS	p. 240
Your doctor diagnoses you as having IBS when you really have parasites	p. 241
Hepatitis	p. 243
Errors
Although you are sexually active, you haven't been immunized against hepatitis	p. 243
Your teenager receives a hepatitis shot but in the wrong part of the body	p. 245
Your doctor forgets that hepatitis may be involved when you have flulike symptoms	p. 245
Failing to monitor your liver inflammation	p. 246
Your doctor prescribes standard doses of medicine despite your having liver disease	p. 248
Your doctor prescribes a drug that makes your liver damage worse	p. 249
You are infected with hepatitis through contaminated medical or dental instruments	p. 250
After you are exposed to hepatitis, you are given the wrong kind of gamma globulin	p. 251
Failing to take an accurate alcohol history from patients with hepatitis	p. 252
Your elderly father, a heavy drinker, is placed on an intravenous feeding line, but he is not given a shot of thiamine (vitamin B1)	p. 253
Gallbladder Complaints	p. 255
Errors
Your doctor immediately suggests surgery when he finds you have gallstones	p. 255
You are given an X ray instead of an ultrasound test of your gallbladder	p. 257
You are assigned an inexperienced surgeon for your gallbladder operation	p. 258
Your aunt is on a low-calorie weight loss diet, but the doctor doesn't warn her about an increased risk for gallstones	p. 260
When Your Problems Are Respiratory	p. 261
Special Alerts: Respiratory Problems	p. 263
Errors
Your doctor prescribes antibiotics for your upper respiratory viral infection	p. 264
Failing to link your sore throat to strep throat	p. 265
Your doctor assumes you have the flu when you really are suffering from endocarditis	p. 266
Not recommending an influenza vaccination if you are at high risk	p. 267
Your doctor chooses the wrong antibiotic for pneumonia	p. 268
Your doctor mistakes the serious nature of your cough	p. 269
Your doctor overlooks sinusitis as the cause of your lingering "cold" or postnasal drip	p. 271
Your doctor overtests for allergies	p. 273
Assuming that an anxious patient's shortness of breath is caused by anxiety rather than by a serious physical problem	p. 275
Causes of shortness of breath	p. 276
Your doctor treats the allergy while ignoring the trigger	p. 277
Your doctor allows you to overuse quick-relief asthma drugs and neglect slower-acting antiinflammatory preventive drugs	p. 279
Your doctor fails to instruct you in the proper use of your asthma inhaler	p. 281
Your doctor prescribes theophylline for your asthma but fails to measure your blood levels of the drug	p. 282
Your doctor fails to recognize a bacterial infection as the cause of worsening chronic lung disease	p. 283
You have emphysema or chronic bronchitis, and you overdose on oxygen	p. 284
Your doctor fails to order a tuberculosis test	p. 285
Checking Out Your Bones and Joints	p. 287
Special Alerts: Bones and Joints	p. 289
Errors
Your doctor treats you for osteoarthritis when you really have another disease	p. 290
Your doctor prescribes powerful drugs for treatment of rheumatoid arthritis, without explaining their poisonous potential	p. 292
DMARDs: their major adverse reactions and recommended monitoring by your physician	p. 293
Your doctor fails to recommend a bone density measurement to detect osteoporosis at the time you go through menopause	p. 294
Your doctor uses the right drug--estrogen--along with a wrong drug to treat osteoporosis	p. 296
Your doctor has been too quick to recommend surgery for your carpal tunnel syndrome	p. 297
Common work injuries: their symptoms and likely victims	p. 298
Your doctor wrongly diagnoses your backache as a simple muscle spasm	p. 300
Your doctor thinks your back or leg pain is caused by a disk or muscle spasm when the real problem is an artery blockage	p. 302
Missing a change in back symptoms that can signal a dangerous emergency	p. 303
Your orthopedist is too quick to recommend back surgery	p. 304
Your doctor is ignorant about identifying and treating fibromyalgia	p. 306
Your doctor fails to educate you about the early symptoms of Lyme disease	p. 308
Is the Lyme disease test reliable?	p. 310
Your doctor treats you with the right antibiotics for Lyme disease but for too short a period of time	p. 311
Some Anti-error Strategies for Women Only	p. 313
Special Alerts: For Women Only	p. 315
Errors
Your doctor gives you medication without taking into account your birth control pills	p. 316
Your doctor prescribes an intrauterine device, even though you have a past history of pelvic infections	p. 317
Your doctor fails to check how you insert your diaphragm	p. 318
Your chances of becoming pregnant with different methods of contraception	p. 319
Rules for proper diaphragm use	p. 320
Your doctor treats you for vaginitis without checking whether you are pregnant	p. 321
Your doctor doesn't take your premenstrual syndrome symptoms seriously	p. 322
Your doctor overlooks the possibility that your pelvic, rectal, or back pain may be caused by endometriosis	p. 324
Your doctor overlooks that flulike symptoms with a peeling, red rash may actually be toxic shock syndrome	p. 325
Your doctor tries to make the estrogen decision for you	p. 326
The benefits and risks of estrogen and progesterone therapy	p. 328
Your doctor fails to tell you that you can get pregnant during menopause	p. 330
Your doctor attributes too little significance to your pattern of menstrual bleeding during menopause	p. 331
Your doctor recommends an unnecessary hysterectomy	p. 332
Eliminating Errors Involving Your Eyes, Endocrine System, and Urinary Tract	p. 335
Special Alerts: The Eyes, Endocrine System, and Urinary Tract	p. 337
Errors
Your doctor recommends operating on your cataracts just because they are there	p. 338
Your doctor suggests you may want to have an operation for cataracts in your second eye before vision has been fully restored in the first eye	p. 339
Failing to do a blood test for thyroid function on every person who feels unwell when the source of the problem can't otherwise be identified	p. 340
Your doctor overlooks potential interactions between thyroid hormone supplements and other drugs	p. 341
Common symptoms of overactive and underactive thyroid	p. 342
Your doctor fails to recognize thyroid cancer	p. 342
You are sexually active, but your doctor resists giving you preventive antibiotics to counter possible urinary tract infections	p. 344
At the first sign of a urinary tract infection, your doctor immediately orders a sophisticated urine culture or other expensive test instead of a simple urinalysis	p. 345
Your doctor mistakes your urinary tract infection for a prostate problem	p. 347
The hospital staff has missed that an elderly father's malaise and loss of appetite are caused by a urinary tract infection	p. 348
You have juvenile-onset diabetes, and your doctor fails to inform you that a high blood pressure drug can slow the onset of kidney disease	p. 349
Your doctor doesn't tell you that your oral diabetic medicine may increase your risk of heart disease	p. 350
Your doctor fails to recognize that high blood sugar in the morning may result from too much insulin	p. 351
Special alert for those with juvenile-onset diabetes	p. 351
Receiving the wrong diabetes drug at the pharmacy	p. 353
Your doctor prescribes medicine that will interact with your diabetes medicine	p. 353
Is It Your Body or Your Mind?	p. 357
Special Alerts: Body or Mind?	p. 359
Errors
Your doctor fails to identify you as an abuser of alcohol	p. 360
You have an alcohol problem, and your doctor fails to warn you about ending drinking too abruptly	p. 361
Your doctor is too quick to diagnose Alzheimer's disease	p. 362
Your doctor is unable or unwilling to recognize physical symptoms of stress	p. 363
Mini-mental status exam	p. 364
Causes of senility other than Alzheimer's disease	p. 366
Your psychiatrist is unwilling to try psychotherapy without drugs	p. 367
Do you have stress-related symptoms?	p. 367
Your doctor doesn't sufficiently explore whether you are depressed	p. 369
Not recognizing when you and your therapist make a poor match	p. 370
A screening test for depression	p. 371
Your doctor lacks an organized approach to dealing with your chronic fatigue	p. 373
Your doctor misses an elusive physical cause of your chronic fatigue	p. 374
When you complain of chronic fatigue, your doctor fails to check for sleep apnea	p. 375
Easily missed physical conditions that can cause fatigue	p. 376
Your doctor prescribes sleeping pills unwisely	p. 379
Your doctor doesn't recognize that your headache relief medicine is actually causing your headaches	p. 381
Your doctor misses the possibility that your worsening headache could signal a medical emergency	p. 382
Making the Health Care System Work for You	p. 385
Acknowledgments	p. 393
Index	p. 395
Table of Contents provided by Syndetics. All Rights Reserved.

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Patient Power How to Protect Yourself from Medical Error

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