Ensuring the Care You Get Isn’t Botched Is Up to You

Public concern about medical mistakes has intensified in the past several weeks, spurred by the publication of a bluntly worded report by the Institute of Medicine, a branch of the National Academy of Sciences.

An institute panel concluded that medical errors, many of them preventable, kill an estimated 98,000 Americans annually. That number is more than the toll from breast cancer, traffic accidents or AIDS.

Last week President Clinton ordered more than 300 health plans that sell insurance to federal workers to strengthen programs to reduce errors. Several lawmakers have said they plan to introduce legislation designed to curtail errors when Congress returns in January.

While experts say that many errors are systemic in nature and lie in the way doctors, nurses and pharmacists practice, there are steps individual patients can take to reduce their chances of being hurt or even killed by mistakes.

Some suggestions to reduce medical mistakes:

* Become informed. Too many patients don’t know what’s wrong with them or what they’re being treated for, consumer advocates say. Becoming informed about your medical problems and about treatments is more important than ever, said Arthur Levin, director of the New York-based Center for Medical Consumers and a member of the Institute of Medicine panel.

“There’s a real self-interest here in not being lazy,” Levin said. “People really need to take the time to understand more about their medical issues. If you don’t know why you’re taking medicine, you’re not going to recognize that you might be getting the wrong drug or the wrong dose.”

* Ask questions. Do not assume that you are getting the right drug or the right dose simply because a doctor prescribed it for you or a nurse tells you it’s time to take it.

If you’re in the hospital, ask what you’re taking. If you don’t recognize the name of the medicine, ask why it’s being given.

This is especially important for elderly patients, who tend to take more medications and whose drugs may negatively interact with each other.

If you’re allergic to a drug, make sure you tell everyone with whom you come in contact, and see that this information is written clearly on your chart. Medication errors, such as giving patients drugs to which they have a documented allergy, are among the most common mistakes in hospital settings, the Institute of Medicine found.

Ask similar questions about a procedure or treatment if you’re told one has been scheduled and you don’t know what it’s for or why it’s necessary.

“Don’t be afraid that you’re going to offend the system,” said Michael Millenson, a consultant in the Chicago office of William M. Mercer Inc., an international benefits consulting firm.

* Monitor hand washing. Numerous studies have documented the low rate of hand washing, particularly by doctors.

* Check out your doctor. This is impossible if you’re brought into an emergency room but not if you’re having an elective procedure. A growing number of states have computerized databases that list information about doctors. Avoid any doctor who doesn’t have hospital privileges and wants to perform surgery in his or her office. And think twice about accepting treatment from a doctor practicing outside his or her specialty; many have little experience and limited training.

* Practice full disclosure. Don’t shop around frequently for new doctors, or if you do, tell the doctors who treat you what medications you’re taking, including herbal or over-the-counter products.

Consider using one pharmacy, which is more likely to keep your records in a central location on a computer. A pharmacist who knows you or has access to your complete records is more likely to spot an error and may use software designed to detect harmful drug interactions or allergies.

* Don’t accept illegible prescriptions. If you can’t read a prescription, request a more-legible copy.