Online with doctor Danielle Ofri. St. Louis oldest bookstore is turning 51 years this year we would like to thank all of our supporters, and everyone for the outpouring of love for our bookstore. With the Current Situation are still bring you the things you love most with terms like a pickup and delivery to anywhere in the world are series are virtual we have a way to expand your mind and bring new thoughts to make the world a better place bird we hope you enjoy this event we hopefully will purchase a copy for you and all of your friends. We went to keep our books and staff here so thank you so much for your support. We will taking questions from the audience if you type your questions in the comments and everyone on facebook be sure to like us you can see whats coming up. Can also comment on the watch party 70 here and watching. People go into the medical system they go there thinking its the best place possible. They made enormous strides for suffering but theres also no doubt that treatment can cause harm. A significant portion is preventable. We do harm when theres a medical error and Patient Safety in our National Healthcare conversation. We also want to look at administration, patients, families exploiting the diagnostic, systemic, cognitive issues of medical error to advocate for strategic groups that comes to safety improvements to the Electronic Medical record that focuses on the fullscale required to make eight meaningful dents and medical error. There are stories she is renowned for these errors not everyone argues is possible to minimize and this should be a galvanizing issue. What makes this book special is perceptive and compassionate nature. She portrays them as real people and showing their vulnerability. Its analysis of a challenging problem with a personal touch. Its an essential read for anyone involved her interested in patient care. Danielle ofri is a critical professor with the school of medicine cares for patients for more than two decades. Shes authored seven books in colluding what patients say, what doctors here. What doctors feel doctor Danielle Ofri is a regular contributor to the New York Times writing can be found on twitter shes been working in the covid19 and experience she has shared in the New York Times. Also joining us tonight is doctor damon tweedy. Im very happy he is here tonight especially now we should be looking at the root of the healthcare industry. Doctor damon tweedy is Duke University law school is at the Medical Center and has a staff position varies published articles about race and medicine and the American Medical Association in the annals of internal medicine. His comments have appeared in the New York Times, patient conduct reviews observer. And now im very happy and thankful and would love to welcome doctor Danielle Ofri and doctor damon tweedy. Everyone at home would give them a very hearty welcome round of applause. Thank you. Its great to me to it doctor Danielle Ofri as a fellow physician i have admired your work the breath the you write about i just want to say thank you its great to be with you. Thank you. Host we will start off with why this book . We are going to talk about covid19 and disparity. But we will open up the session more broadly at the beginning to talk about your book so why this book and why now . Guest the only physician in a Publishing House full of english majors you seem to get everybodys questions about medical issues. The couple views of the set mean email and had a study with headlines saying medical errors was the third leading cause of death. When i read that email i thought is this really true . And i have to say i didnt know the answer i hadnt read the study and i didnt know but. Byfield is true i would face that every single day it doesnt feel like i do. Then i wondered are the data wrong . Are they correct them are simply blind to it . In some trying to answer that question and i start began digging into the data. First of all the hard question to answer. So on a death certificate they dont write medical error. So counting the numbers of errors is very difficult. And if its an error cause of death is even higher. Like someone is dying of cirrhosis and is dying and gets an antibody is that the air in the patients death that peaked my interest. Host we see that in our setting, how does it come about that idea that theres a cause of death . Its so hard to track, how did it come up . Guest in fact it really went back to previously published data in that involves taking data from smaller sets and multiplying it out to the whole population. So if there is even a slight error in the study it gets multiplied out for people then its magnified. It was a calculated and predictive study. Seem to be taken after Heart Disease and cancer. So its probably not that high but its also not that low. But we certainly know many errors occur. And even if is not a cause of death was so important to find because its the next thing waiting to cause harm. Even if we dont know the exact number we need to dive in and theatrically make healthcare overall safe and minimize errors periods. Host its hard to keep track of it from a long time doctors certainly talk about it but your recent book talks about how 20 years ago there is a study that sort of landmark study i guess its more about the history of how hard it is for doctors to talk about and the difficult data. Sure if you think about why would doctor ever talk about an error they made . And our country open yourself up for a lawsuit. But even beyond that issue is just the emotional part. Most people in medicine healthcare they certainly see that now, so if youve done something even inadvertently to harm your patient were devastated we dont want to talk about it. And particularly the near misses or the air and affect doctors in my midst someone told me a cat scan report was fine and accepted that before looking at it myself my air was clear i did not look at the skin is a should have. The patient was fine the fact isnt near miss. Its still an error patient could have been dead were lucky nobody died. The error was still there. What interested me was my reaction patient did fine why say anything i didnt tell my resident i didnt tell my intern and i sure didnt or their family and could not imagine a more horrible thing to tell a patient i almost killed you and took me a long time to think about it. You also think about the emotional side to keep errors hidden all of these errors underwater. We dont know what they are hackley possibly fix them . Sounds like your describe it as you assume youre going to the assume certainly went to help everyone to be smart and conscientious mummy assume theres the same part and a lot of this. There is guilt and shame i didnt really understand the difference between them. And i read this cold and fun apology. It was about guilt and shame and what happens. Its you dont make the error again. Its about you not be the person you thought you were pretty when i made this error i felt bad about i swear would never do it again with the shame in one second i was not the doctor thought it was. So i thought of as good as my peers in that was light came crashing down and i thought im a danger to the patient i better quit now and i realize that was paralyzing and prevented me from talking about it and from sharing it to help doctors and the patient and correcting errors because that shame is overpowering i was sure i had made many mistakes that could have been prevented. See when you also talk about how it doesnt go the narrative of medicine medicine is involved in our physicians are heroes but another thing that leading the culture that makes it hard. I think we think about this idea how we look at impressions the history of medicine over the past 200 years is a swashbuckling adventure. Decapitating disease with the medical machetes. Flattening 19th century illnesses. Vaccines, antibiotics, from the 20th century swaggered second half of the 20th century, ordering about executing 360 degrees, chemotherapy, antipsychotics, blood transfusions, birth control, hiv treatment, slaying goliath every dragon. So maybe there be one straight trajectory over the years successes had dominant in medicine and with good reason. Its an afterthought and should not be taken for granted. So much space talk about the medical errors and the outcomes of our treatments. At best, the counseling strife. I think we have this idea that every error we have just get fixed with more research there be more medications. We dont really talk about it. Talked about in the news about mortality and often their punitive. I was a surgical student that just gotten onto the ward. The guy who ran our department he scared everyone. The residence had flatlined and they called on him. Theres a big auditorium pension he said to her, why even bother operating . Why bother operating question i remember the resident turned a ghastly shade of green. I was a medical student and i learned a couple things. One is a better not make any errors. If i do make an error im not telling anyone. I am not getting screamed at by doctor spencer. Im going out of the parking lot. Im staying clear. Its a message we got about medical errors. C1 so with the culture moving forward were going to talk about Something Else. So far we focus in the doctor side of it of course with any medical error there is a patient or a real person. Could you kind of share with her readers a little bit about the patient side of it . Guest one of the challenges is to write about the patient especially when there has been an error. One does not want to be exploited in the situation. On the other hand is what i found those patients in families were eager to have the story told the one to be there situation to be reference for others. I had most of the medical errors and what happened after words was communications. There is a 60 somethingyearold gentleman named glenn was in a rural area he was involved in a fire the controlled burn in a neighborhood. He was at the local hospital is okay entreat her he did not need to go to the burn center. And it comes in overnight the doctor comes in the next day eventually he sadly died about ten days later. And they were devastated and the daughter wanted to know what happened . How did this happen my dad was completely healthy how did he not get transported to the right place and they could not get the answers. Took them five years to try to get information because hospitals when theres a bad outcome is the hardest thing for them. So much more no matter what the reason is we want the chance to mourn and to grieve. Instead, those precious years there fighting to find out what happened because our system does not have an other compensation or something one can do. And of course it brings back the person. Number one thing was a promise and a demonstration they could do better for the next patient. It sounds like when you talk about when people end up finding out medical area think of lawyers. Can you tell us a little bit about misconceptions about that with the general public when you go to see the doctor but theres a lot of misconceptions can assure a little about what you found . Everyone and their peers. I think in theory that can be in malpractice. Experts injuring people it was expensive. So the highest chances of winning in the chance of winning a large settlement they will only take on cases in which there is a severe outcome and the costs and treatment are very high. If it isnt that the case wont ever get its day in court. To the malpractice is a very small if your air did not cause major harm would not present an element you get a legitimate error no not that your day in court. So the truth is the very few patients even the patients who did get their day in court not a day usually drags on for years and years. No matter which side because theres agony for both sides but theres the other end and we serve that many patients they never get their day in court. Quite adversarial. See say most cases the settlement than those who go to trial the majority is that how you see it . Most settle out of court and the ones that do go to court typically the patients is somewhat stacked against them or to difficult to prove. You have to prove the air was negligent. And the negligence because the bad outcome for thats very hard to approve to prove. It with a bad outcome its hard to prove. To prove the error caused the death is very difficult to do. I have a surgery and the surgery doesnt really help is hard to prove if i already had problems that was the case i calving the leg amputated something drastic. Is that how works . Very few patients get that you contrast that like a surgery in denmark. They recognize that the more important thing is patients get some sort of reputation for tha that. Very similar to workers compensation. Note if you are injured on a job you dont go to court. It becomes Administrative Court were what qualifies you get some criticism. And so in denmark they met very separate system that any patient can fire a check file against the physician used for restitutive the harm that was done. So many more patients get compensation. Some modest competenc compensation. The american sessions are which is why we need americans to cover mike if you go through childbirth and the child roundtheclock care its a very expensive theres a reason people do that. And we can do that and many more patients get served. So in the great old land of denmark, are there areas within the u. S. There adopting our their pockets where more of this happening . The vaccine to make a very small Profit Margins that does not take much to get them sued sam not in going to bother doing it. Theres a situation where many vaccine manufacturers pulled off the market is not worth the ris risk. We did not have enough vaccinations for the american public. So the idea they came together there is a vaccine compensation fund. Anyone with an injury and think about the vaccine there is and a pocketbook settlement. The Vaccine Group with the fund theres a small tax on the fox nation. Malpractice insurance is gone so high because of big losses related to injuries that made them stop practicing. Kind of a cooperative fund of course more people to benefit and they see this. I dont think its going to happen. Effectively getting your day in court. Look at the professionals is a different view this child by your peers but most dont get their day in court. I think its so important talk about the concept doing good job of showing the pitfalls in that system for lets switch a little bit now how do we get our way out of some of these problems . One thing for all doctors now with the medical record good and bad slots see that peace. Its funny, april 1 the oneyear anniversary of her hospital was such a nightmare. There were many great things through this crisis we were taking patients to the hospital sometimes 30 or 40 patients at a time. You never know it was going on in these stations. And theres help for preventing medical errors. One is when you have an infection outbreak or the common outbreaks in the hospital is an affectionate transfers on contact and causes death its very hard to eradicate this when there is an outbreak it can be tough to do. To see this outbreak they contract every patient that goes in the hospital who went to g. I g. I. , which doctors and nurses interact with each patient you have to track every single interaction for thousands of patients over many days. Theres a cat scan machine in one hand is not handled properl properly. They made the hospital find it. On the other hand and one example is it prescription. Every time i write a prescription visit interaction with this and that, there are so many i cant read them all. In some of them are ridiculous. Every female could be in your 60s pretty unlikely 55 youre going get pregnant. There are so many things on their end up ignoring it all. It makes me angry because they put everything for a liability accident doctor checks it off there not. That makes me frustrated. Theres so much you just want to make it go away is when the update had in my head recently. One morning in my clinic jose my first patient of the day and i notice theres a difference apparently theyve been something roll out of an update in the middle of the night. My fingers automatically knew that spanish is the most common language. So i had to scroll to the long list of languages somehow another relative had been added in spanish number 42. But in spanish the numbers 41 so all of a sudden it came out speaking a different language and all the sudden there were Food Allergies environmental allergies there all these allergies with anything they want with medications allergies and saying to myself stop that i think latex free environment is unimportant, but it makes it harder. After the patient left the room to the computer is not the focus of my visit. No into the process is grabbing them before they reach the elevator tying about latex gloves and pet dander and everyone was speaking serbian. I had another sheet they had the past medical history since they were 18 they summed it up with Something Else but it put it in automatically and i discovered once you put it in you couldnt take it out so all of my males that week had a ob history attached to their chart forever. [laughter] sue and i guess the question is how do we make the best where listening to talk about moving forward . Guest there are many things we can do ive had moderate success with procedural things like preoperative work making sure we have everything we need is a simple intervention but it works for that kind of thing. Doesnt work so well for things like diagnostic error, how to diagnose a patient you cant have a checklist of how you think. When it comes to that i think we have to consider the time for doctors and nurses and if we have the emr system they can actually talk with the patient, listen to the patient and think about the patient. Those i think are the three biggest things with diagnostic error. So if really, really want to minimize error is how do we do medicine . How did they have more time with their patients to think about i it. The less patient conversation these are the biggest things are Patient Safety. I cant say how many times ive heard patients complain about a doctor who spent the whole time looking at a screen and never looking at them. There are so many things to do if we dont do it we never get through. I think we need to reconfigu