MARCH 2015
Khaas Baat : A Publication for Indian Americans in Florida
Health & Wellness

Preventing Medical Mistakes: PART 3 – ENSURING PATIENT SAFETY

Dr. M. P. Ravindra Nathan

By M. P. Ravindra Nathan,

The release of the landmark publication, “To Err Is Human” by the Institute of Medicine certainly helped to highlight the enormous problem of medical errors and may have transformed American medicine in more ways than we thought. In the past, physicians and surgeons were considered infallible and were beyond being questioned. Indeed, in many countries like India, doctors still wear the mantle of God. Once we realized that all of us make mistakes, it became necessary to take steps to reduce errors. But first, let us analyze how and why these mistakes happen.

Medical mistakes can be divided into three types: 1. Diagnostic errors; 2. Treatment/ medication errors; 3. Procedural errors.

Diagnostic errors: Most physicians are overworked and hence there is time pressure. So they can easily overlook the test results. In addition there is information overload, so it’s difficult to review everything in the patient’s chart. Ignoring the side effects of a drug, improper follow-up, hurried handing over of the patients when you are running away for your weekend off, communication breakdown and more can contribute to the problem.

A case in point is that of Teresa N, 58, who came to the ER of one of our area hospitals during the night with nausea and abdominal discomfort. Clinical examination, initial blood workup and abdominal X-rays were normal and hence the doctor sent her home with a prescription for antacids. Unfortunately, he was unaware of the EKG taken by the nurse during this visit. The following evening, the cardiologist read the “routine” EKG as showing an acute heart attack and the ER was notified and patient was called back immediately. By this time, she had developed some heart failure but eventually recovered. The hospital and the ER doctor had to face a malpractice suit later. Clearly, there was a breakdown of communication at different levels.

Treatment/Medication errors: Patient safety experts agree prescribing errors are common. Using wrong antibiotics especially when a patient is allergic to one that goes unnoticed, drug and drug interactions (for example, the effect of a common blood thinner Warfarin can be accentuated considerably by concomitant use of antibiotics, herbal medicines such as St. John’s Wort, etc.), giving the wrong dose of drug (as in the case of injection of a larger dose of anesthetic for spinal anesthesia that resulted in transient paralysis of both legs in a recently reported case) with disastrous effects, etc., are just a few examples that occur not infrequently.

One of the perennial complaints of pharmacists is that they can’t read the doctor’s handwriting, which may result in dispensing wrong drugs in the wrong dosage. Now that electronic medical records have become mandatory for physicians starting 2015, hopefully the latter problem will resolve itself.

Procedural errors: How many times have we heard people saying, “Oh, he died two days after that operation!” Any surgical procedure or non-surgical interventions, from simple insertion of a subclavian catheter to complex cardiac catheterization and angioplasty, can lead to complications. Done by an experienced operator and with proper precautions, these can be avoided to a great extent. One of our patients who underwent a right subclavian catheter insertion by a junior physician developed a complication called “pneumothorax” (collapsed lung with free air in the chest cavity) that needed chest tube drainage. I have seen a cardiologist, while inserting a catheter in the right femoral artery and pushing it toward the heart, accidentally puncturing a pelvic artery that needed immediate repair. Wrong site surgery including wrong leg amputations have been alluded to earlier. Many of these can be avoided with adequate precaution and enough experience.

There are also less well-known reasons for medical errors.

Using abbreviations: Physicians are fond of using abbreviations in their prescriptions. At one time, it was considered doctor lingo but now this is causing confusion among the nurses and pharmacists, leading to serious complications in the patients. A simple example is QD (daily) being mistaken for QOD (alternate days) and IU (international units) for IV (intravenously).

Follow-up failure: Not getting the feedback from the patients who have been recently diagnosed with serious disease or had surgery can lead to problems. One of my good friends had a pacemaker done and sent home on the second day and the surgeon left town. The following day, when he developed fever and malaise, the ER doctor failed to do further tests like blood culture. Later, he was diagnosed with having “endocarditis” (infection inside the heart), a serious complication that needed prolonged hospitalization.

Missing lab results: Results of the blood tests done as outpatient are sent to the ordering physician and you may not hear from them till they have had a chance to look at them. And if they are busy, they may forget about them altogether. Once an elevated prostate-specific antigen (PSA) of a patient didn’t catch the attention of the doctor and resulted in a delay in the diagnosis of his prostate cancer.

Ignoring side effects of drugs: Many doctors try to minimize the side effects of drugs. An example is “statin” (taken for cholesterol) induced muscle pains. Occasionally, it can be disabling and even lead to serious breakdown of muscles (“myolysis”), leading to kidney failure.

As you can see, it’s important for both the doctor and the patients to be constantly vigilant to prevent medical mishaps.

To be continued …

M.P. Ravindra Nathan, M.D., is a cardiologist and Emeritus Editor of AAPI Journal. His book “Stories from My Heart” was recently released. ( or

Eye Care

March is Eye Safety Month: Protecting your Peepers


Few people realize that eye injuries happen not only in factories and industrial areas but equally so at home, office and healthcare facilities.

Of nearly 2,000 eye injuries occurring at work sites every day, 10-20 percent will cause temporary or permanent vision loss

In my constant desire to always look ahead and into the future, I have classified eye safety related to type of trauma. Eye trauma is usually defined as being physical and therefore protection as advised has always been physical (protective glasses, etc.) These are good but not in synch “with modern times” and concepts.

Looking at our daily lives today where we are exposed to intense sensory challenges (like cellphones, computer screens and tablets, etc.), I found a need to bring the safety concepts to match our present generation.

So, I suggest the following two (which can be further expanded based on further intricate stratification) major categories and protection therein:

  1. Physical trauma: Flying objects, tools, particles and chemicals are the causes of most common physical eye injuries. In many cases, implementing safe work practices and utilizing appropriate personal protective equipment could prevent them entirely:
  1. Sensory trauma:

In addition, I would also like to emphasize here the concept of people who are predisposed to more damage from trauma compared to others.

I have proposed two sub-categories:

In summary then, besides every day basic protection for our most important senses in the physical and sensory manner, people who are more predisposed need to take additional caution and modify their lifestyle accordingly.

So, go to the mall and buy that expensive nee “protective” designer sun glasses you always wanted. Now, you have an excuse!

Arun C. Gulani, M.D., M.S., is director and chief surgeon of Gulani Vision Institute in Jacksonville. He can be reached at or visit

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