Look at anyone’s list of how to improve healthcare, and patient safety will always be mentioned. From overarching issues like overtreatment, undertreatment, and misdiagnoses, to the more granular ones like pharmaceutical mislabeling, hand-washing protocols, and illnesses contracted in the hospital, there are many issues that cause both harm to the patient and unnecessary costs because of delayed or ineffective treatment.
I have a few of these medical missteps in my own healthcare history. The worst was an obvious diagnosis missed because clinicians couldn’t get past the fact that I was presenting symptoms so young, and then ordering an incredibly painful and unnecessary test. Another time, I was prescribed a medication I shouldn’t have been taking because of then-in-remission asthma, and it resulted in a “cardiac incident”. The emergency room staff failed to catch the mistake, which was correctly diagnosed by my primary care physician over the phone a few days later.
Although lots of things in need of improvement fall under the patient safety umbrella, I always thought of it as a rather narrow topic, a concrete one. But recently, I had a conversation in which someone argued that the definition of patient safety should be expanded to include anything that causes harm to the patient. He had practiced medicine in places where they did things that truly horrified me. Patients had been passed off to other hospitals because they had Medicaid and there were maximums that were allowed to be admitted so the hospital could meet projected profit goals. There were clinics literally across the hall from each other, one for private insurance patients and one for those on government assistance, that were so different in staffing levels, equipment, and even the waiting room, that even the inspectors were confused by the stark and inherently discriminatory differences. And once a doctor actually told a patient who had limited access to the tools she needed that she would never get her condition under control. I would have walked out on a doctor who treated me like that, but often people on government assistance have no choice in who they see
As the conversation wove through more and more through his experiences, including a close relative who died because of discriminatory treatment practices, my brain started adjusting to his point of view. He was right. Patient safety was a much broader topic than I had thought. It was not hard to see how these examples endangered patients and caused them harm.
And why is that important? Money and attention. Patient safety is higher profile – has been on government’s and industry’s radar longer – than other categories these issues could fall into, such as health equity. Though reporting is voluntary and incentives are weak, the initial groundwork has been laid. There are frameworks that can be adapted to encompass the additional patient safety issues. From there, standards of quality can be developed and applied. There are organizations that accredit hospitals that incorporate patient safety. As far as I know, there is no accrediting organization that incorporates health equity or other measures that would address the greater discriminatory issues.
Even without expanding the patient safety umbrella, this is a huge and daunting task. But the greater issues my friend was talking about are inextricably interwoven with the ones that more traditionally comprise the definition of patient safety. So, even if we did get to the point where patient safety as we define it now was effectively addressed, the work would be incomplete. As our understanding of what people need to be healthy evolves, it’s worth taking some time to re-examine what we consider to be patient safety.