Guest: Dr. Carol Gunn
Presenter: Neal Howard
Guest Bio: Dr Carol Gunn is a physician practicing in Portland, Oregon, whose professional mission changed after the loss of her sister. She is now an outspoken advocate for patient safety and is beginning to collect other patient safety stories. Dr Gunn believes that with strong healthcare leadership, transparency and accountability, the tide will turn on medical errors. She can be contacted at www.CarolGunnMD.com.
Segment overview: In this segment Dr. Carol Gunn discusses her work to turn the tide on medical errors.
Health Professional Radio
Neal Howard: Hello and welcome to Health Professional Radio. Thank you so much for joining us today, I’m your host Neal Howard. Our guest in studio today is returning to speak with us more about the preventable medical errors that take place – Dr. Carol Gunn. She is a physician who practices in Portland, Oregon. And when we were here before we talked about her life and her professional mission was changed after the loss of her sister due to medical errors. Specifically ignoring a patient’s descriptions of pain and other symptoms, and not collaborating with each other especially when the patient has such an extensive medical history. She’s been here with us before and we welcome her back once more. How are you doing today Dr. Gunn?
Dr. Carol Gunn: I’m doing well. Thank you for having me again, I appreciate it.
N: Thank you so much. Everyone makes mistakes. When it comes to medical errors some of those mistakes are large, some of them are small. But when it comes to healthcare professionals doctors, surgeons, specialists we expect you all to minimize the mistakes – to check and double check. Are you saying that it’s on a personal level with physicians that America should be outraged that the number of preventable medical errors that occur or is it the system at large and the physicians themselves have become victims as well?
G: Oh I think it’s the system at large. You know healthcare now is practiced more on teams. And so we need to encourage everybody on the team to speak up if they see something. And after my sister’s death I was the one that went back to the teaching hospital. I went back five separate times to talk to the different doctors to say “Hey you know, you made a mistake here” and it really shouldn’t fall to the patient’s family member to do that, but I was convinced that I couldn’t sleep at night until I talk to each one of her doctors where I thought that they’ve kind of missed that have not done a full evaluation of Anna. And I think that is incumbent upon all of us in healthcare, if we see something that’s not going right, we have to stop, stand up, and say “It’s not going well. I’m afraid for this patient’s safety.” And right now that is not one of the cultural aspects of medicine.
N: Well you began questioning due to a very, very personal connection to the medical errors. What type of reception did you get being your sister, you’re such a close relative being the victim of medical errors as opposed to being a scientist, researcher who discovered this disparity in good care versus bad? What type of reception did you receive when you began going through the records and questioning and what not?
G: At first I got a lukewarm reception. But the more I looked at the medical records and knew I was right, the more I went back and the more I went back and actually had to take it up to a pretty high level and went to their risk management team and said “Someone needs to look at this. It doesn’t feel like the system’s fully evaluated.” And at this institution may have an early resolution program and they got put in to that, and after that they finally said “Yes, we recognize what you’re saying, and yes, there were definitely errors made here.” But it took over a year, just under a year and half of me returning. And I have to know how to read the medical records. And I think I mentioned in the last segment when we were together, it was 14,000 pages of medical records.
G: And it’s an outrageous number. And so I think what most family member should be doing if they think there’s been an error made is one, start collecting medical records. The two go back and talk to the doctor and say, “Are you sure? Could you tell me your reasoning here? I have the symptom and it’s not going away, and I need to know why it’s not going away, and when I should expect it to go away.” So everyone is on the same page because I think she heard it, she said “I have this chest pain.” And they said “Here, take this.” And I’m not sure she went back and didn’t press hard enough and said “That doesn’t make sense to me.”
N: Uh huh.
G: And so I think that’s what we all must be doing to help our doctors get to the right place when we have a symptom that’s not going away.
N: So basically what you’ve just described is what you would do differently if or when faced with the same type of situation. Make sure that family is involved in a very not aggressive way but they’re concerned, they’re knowledgeable about the symptoms that the person’s been describing and everybody’s on, as you say, on the same page.
G: On the same page.
G: Absolutely. And say “I think this is odd, why do I still have this symptom?” And maybe it’s a symptom that you will have for a while, but you need to hear the physician say that back to you versus just saying “Oh here is a medicine, this will treat it.” And then because that wasn’t what was happening for Anna, she said it multiple times in multiple different venues and no one completely evaluated her. And doctors make mistakes, they don’t try to. They work really hard to give the best care typically but we all do make these mistakes. And so having someone raise their hand and say “I’m not sure I understand this,” in a collaborative way that is what’s going to help everyone in the end.
N: Well what you say makes perfect sense – accountability, being upfront and open and persistent to be sure. But when you’re talking about physicians and the people that they serve, sometimes there is a huge gap when it comes to being approachable. Sometimes the patient themselves don’t understand. As an advocate for patient safety what are some of the safeguards that have been put in place since you’ve began to work in this field.
G: Well some of the some of the safeguards and people can find lists on the internet for this. The checklist and in particular, I know they’re using a lot more checklist and a lot more settings. I know the teaching hospital where Anna passed they’ve added a nurse to improve communication, because we found there when I was sitting in the room was it didn’t appear that people were communicating with one another. They’re communicating via the electronic medical record, and that loses in continuity. So they did hire additional people after I brought up some of the issues there, so to include the communication with the family up to the nursing staff, between the nursing staff and the doctors. And just slowing people down a little bit, “Wait, I don’t understand this.” And I think most physicians want people to get well and so if you have to slow them down, you slow them down and it’s your health that’s on the line there.
N: Now you’re talking about the communication. When all of this collaboration is quite a bit easier than when the person or maybe a person that needs to be communicated with is far away. How do you keep someone? Because when somethings happens the family, the family is often called. And depending on the circumstances what would you say about the person that’s 8-9-10 hours away?
G: It’s difficult. I mean I was 600 miles away from Anna and I was making a huge effort to make phone calls on a regular basis. The other thing is this most physicians will allow you to take particular outpatient visits and then you can tape it and put it on the internet and send it off by email to your family and friends and carers also those that are supporting you with your healthcare. But I do think it’s important to have someone with you in the room to have a second set of ears, so someone can ask different questions that you would ask. Anna’s best friend often went with her to her outpatient appointments even though neither of them were a healthcare professional and that helped tremendously. But still it takes the demand of saying “I have a symptom that’s not going away, what should I be doing about that?”
N: Now you call for strong healthcare leadership, and recently you were speaking at the Oregon Patient Safety Commission. Could you talk a little bit about some of the points that were touched upon and some of the changes that maybe coming down the line?
G: Well the Oregon Patient Safety Commission is one of the few states that has a program where patients and doctors can get together after either the patient or the healthcare professional identifies that there is an error made and they or get together in a room to be able to talk about it in the hope that the issue resolved earlier and without malpractice. I spoke there sharing Anna’s story, I do believe that transparency, that easy conversation back and forth is critical so that the doctors learn what they’ve done wrong and can make changes for the future and the patient actually understands from the doctor’s point of view, how they perceive what went on. The other part of that has to do with money, as I saw was the case, we need more money filtered in so that more data that there are ways of handling some issues can, so that say like when in Anna’s case if they had pulled the EKG sooner, then it would made a big difference. So why wasn’t that set up in there in the electronic medical record? She said “Chest pain, error alert you should be ordering EKG.” And so there are ways to use electronic medical records so there are alerts and things to that extent, but that’s gonna take money and we need to be donating that money to find safer ways to deliver care.
N: When you’re talking about money for delivering better patient care and what not, you’re also talking possibly about money when it comes to accountability. I mean, does the sanction always fit the infraction monetarily on the institution or the healthcare professionals themselves?
G I’m not sure, I’m not. In our family we chose not to pursue malpractice because it wasn’t gonna change anything. The teaching hospital didn’t charge us for any health pays after, she still have an outstanding bill and that all went away of course. But I’m not sure with regards to transparency and money. I think sometimes having a softer approach versus a malpractice approach, you actually generate people listening to you and more likely to make changes. And so in those times I went back to the teaching hospital, when the last time I went back I talked specifically to the group of individuals that missed the chest pain and told them “You can’t miss chest pain, this just can’t happen. It’s too much of a red flag symptom, everybody knows you need to go to the ER if you have chest pain. You can’t have a patient tell you – you have chest pain, without evaluating it further.”
N: So basically are you saying that and I hear you saying that people need to listen to what other people are saying? There needs to be collaboration and understanding, communication across the board back and forth. This hasn’t been a culture in medicine for so long.
G: No, it’s not been the culture. I mean, I remember as a resident in training where I had this one physician who said “Oh well this cardiologist said this primary physician wasn’t dosing their mutual patient but occasions correctly.” And I said to him “Are we gonna go back and tell him?” and he said “No, we don’t do that.” So open communication has not been the culture and we’ve got to change that, we absolutely got to change that.
N: Absolutely. Could you tell our listeners where they can gain more information? I mentioned a website earlier, but why don’t you go ahead and let us know where we can get more information?
G: Sure, so my website www.carolgunnmd.com as well as I just concluded a TEDx talk called Medical Errors, The Silent Killer in Medicine. And using google TEDx Carol Gunn and find that.
N: Great. You’ve been listening to Health Professional Radio, I’m your host Neal Howard. It’s been a pleasure talking once again in studio with Dr. Carol Gunn, practicing in Portland Oregon who’s an outspoken in advocate for strong healthcare leadership transparency and accountability especially as those things relate to preventable medical errors. It’s been great talking with you again Dr. Gunn.
G: Thank you for having me.
N: Thank you so much. Transcript and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm and you can subscribe to our podcast on iTunes.