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Original Research: Anton J. Kuzel, Steven H. Woolf, Valerie J. Gilchrist, John D. Engel, Thomas A. LaVeist, Charles Vincent, and Richard M. Frankel Patient Reports of Preventable Problems and Harms in Primary Health Care Ann Fam Med 2004; 2: 333-340 [Abstract] [Full text] [PDF]

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Electronic letters published:

Patient advocacy and medical errors

Anton J Kuzel   (31 July 2004)

Response To "Patient Reports of Preventable Problems and Harms in Primary Health Care"

Elizabeth E. LaBozetta   (30 July 2004)

Patient advocacy and medical errors 31 July 2004
Anton J Kuzel, Richmond, VA, USA Physician; VCU Send response to journal: Re: Patient advocacy and medical errors	Dear Ms. LaBozetta: Thank you for your comments linking major themes from your experience as a patient advocate to the findings of our study. I want to be clear that our major message was that barriers to access and relationship breakdowns, and emotional harms (rather than physical) were the dominant themes from the more than 200 stories we heard. You seem to understand well that failures in these areas can have significant consequences for other aspects of patient health care. You also point out that physicians fail to relate to patients after they have suffered iatrogenic injury - just when relationship and support is most needed. My coauthors and I appreciate the connections you have made with your knowledge and experience. We hope with you this will add to the impetus to understand the causes and solutions to the problems and harms in primary care reported by patients. Competing interests:   None declared
Response To "Patient Reports of Preventable Problems and Harms in Primary Health Care" 30 July 2004
Elizabeth E. LaBozetta, Columbus, Ohio Central Ohio Patient's-rights Service + Citizens for Medical Safety Send response to journal: Re: Response To "Patient Reports of Preventable Problems and Harms in Primary Health Care"	"Patient Reports of Preventable Problems and Harms in Primary Health Care" Commentary [[in brackets]] by: Elizabeth Eugenia James-LaBozetta Central Ohio Patient's-rights Service Citizens for Medical Safety "The errors reported by interviewed patients suggest that breakdowns in access to and relationships with clinicians may be more prominent medical errors than are technical errors in diagnosis and treatment. Patients were more likely to report being harmed psychologically and emotionally, suggesting that the current preoccupation of the patient safety movement with adverse drug events and surgical mishaps could overlook other patient priorities. " [[I agree with the statement that most medical care is provided by primary care physicians in ambulatory settings. The patient's relationship with the primary care physician is the keystone to all contact with the entire medical profession; if trust and confidence is not created and maintained in this keystone relationship it can color everything that comes after.]] "Based on existing data, the prevailing perception is that medical errors endanger patients primarily through adverse drug events and surgical mishaps." [[This perception may be true but I believe the problem is more complex that. One question is: who actually responds to these mishaps after-the-fact regardless of the origin or reasons why; these mishaps are usually handed off to the primary care physician. Hardly fair, but that is the way it is. The common patient does not possess the advanced technical knowledge to respond to iatrogenic injury and must rely completely on doctors. Therefore the injured patient needs to believe they can count on their primary care physician to put their best-interests first when such mishaps do occur and need to know beyond a shadow of a doubt the doctor can be counted on to respond promptly and ethically. In my thirteen years as a patient's-rights activist, after interviewing hundreds of iatrogenically-injury people, one common thread prevails: surprisingly,those injured by doctors were not so much distressed at the actual injury itself, whether surgical or drug-related, but more so in how that injury was responded to after-the-fact. The consensus is that the unified response we have all gotten from the medical community after iatrogenic injury was so abusive and induced so much anxiety, fear, and distrust it is unlikely any of us can ever fully recover from it! The actual physical injury became secondary to the standardized psychological batteries very quickly.]] "Pain and avoidable personal expense were the most commonly mentioned physical and economic harms, respectively." [[Pain is a symptom that shows few outward manifestations; the only person actually qualified to place value on the level of pain present is the injury victims themselves, yet we are forced to seek relief from our doctors and hope for the best response. In my personal experience, and that of those I have interviewed, it is next-to-impossible to get adequate pain control for iatrogenic injury. Economic harm comes in many forms alongside the obvious: losing a job, losing health insurance, losing a spouse who can't cope with the burden of being saddled with an injury victim. Economic harm can come in myriad ways that can "nickel-and-dime" a person to financial ruin: having to rely on the more-expensive fast food and convenience items instead of cooking from scratch, having to hire household help to perform tasks the injury victim once did for themselves, mothers needing to hire a babysitter for young children because they are too ill to cope...eventually it comes down to the necessity of fumbling to find our own relief, due to lack of response by our allopathic doctors, by trial-and-error usage of over-the- counter medication and alternative medicine's offerings.]] Competing interests:   None declared