Patient Power How to Protect Yourself from Medical Error
by Proctor, William; Podell, Richard N.Format: Paperback
Pub. Date: 1996-07-16
Publisher(s): Touchstone
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Summary
Offers readers the knowledge, vocabulary, and techniques needed to make informed decisions about medical care, providing sections on identifying symptoms, pre-surgical questions, and getting second opinions. Reprint. 17,500 first printing.
Author Biography
Richard N. Podell, M.D., is Clinical Professor in the Department of Family Medicine at the University of Medicine and Dentistry of New Jersey's Robert Wood Johnson Medical School and lives in Short Hills, New Jersey. William Proctor is the coauthor of Controlling Cholesterol and several other books. He lives in Vero Beach, Florida.
Table of Contents
| Foreword | p. 25 |
| A Program to Protect Yourself from Medical Error | p. 27 |
| Danger in the Heart Zone | p. 45 |
| Special Alerts: Cardiovascular Conditions | p. 47 |
| Blood Pressure | p. 49 |
| Errors | |
| Your doctor says you have hypertension, but you don't | p. 49 |
| The meaning of the blood pressure numbers | p. 52 |
| Your doctor doesn't warn you about possible drug interactions between high blood pressure medications and other drugs | p. 53 |
| Undertreatment of older people with high blood pressure | p. 55 |
| Not emphasizing nondrug treatments for your high blood pressure | p. 56 |
| How to calculate the sodium content in your daily diet | p. 59 |
| A hypertensive asthmatic on beta-blockers may face sudden death | p. 60 |
| High blood pressure medicines and their main side effects | p. 62 |
| Matching patient needs with blood pressure medicines | p. 64 |
| A hypertensive diabetic on beta-blockers may be in danger of a stroke | p. 66 |
| Not discussing decreased sexual performance as a side effect of blood pressure medicines | p. 68 |
| Blood Thinning | p. 70 |
| Errors | |
| Neglectful prescribing and overseeing the use of an anticoagulant, or blood-thinning medication | p. 70 |
| Overlooking the interaction of a blood-thinning drug with other medications | p. 72 |
| Selected drugs that interact with warfarin (Coumadin) | p. 73 |
| Your pharmacist gives you the incorrect-strength warfarin (Coumadin) pill | p. 74 |
| Nondrug factors that may interact with warfarin (Coumadin) | p. 75 |
| You are on a blood thinner, and your doctor fails to train you to detect and report signs of bleeding | p. 76 |
| Stroke | p. 79 |
| Errors | |
| Failing to recognize the most important early warning sign of a stroke | p. 79 |
| Symptoms of a transient ischemic attack (TIA), the most important signal of an impending stroke | p. 80 |
| Automatically treating a stroke patient with a blood thinner | p. 81 |
| Your doctor not testing for a traveling blood clot (embolism) as the cause of a TIA or stroke | p. 83 |
| Sloppy medical and nursing care sets back recovery from a stroke | p. 84 |
| Cholesterol | p. 87 |
| Errors | |
| Your doctor relies only or mainly on total cholesterol measurements to prescribe cholesterol-lowering medications | p. 87 |
| General cholesterol and triglyceride guidelines | p. 88 |
| Undertreatment of patients with low levels of "good" HDL cholesterol | p. 91 |
| Your doctor ignores your triglyceride levels | p. 93 |
| Mistakes involving cholesterol-lowering medications | p. 95 |
| Pros and cons of the main types of cholesterol-lowering medications | p. 97 |
| Your doctor fails to monitor fish-oil capsules, vitamins, and other alternative over-the-counter cholesterol medications | p. 99 |
| Heart Attack | p. 103 |
| Errors | |
| Your doctor fails to rehearse you for a heart attack | p. 103 |
| Failing to follow an effective emergency room drill | p. 107 |
| Assuming a lax approach to patient care after a heart attack | p. 109 |
| Unnecessary invasive tests for heart disease | p. 111 |
| Your doctor oversells heart surgery or angioplasty | p. 114 |
| Your doctor refers you for heart surgery, angioplasty, or another invasive procedure to a specialist with less than optimal experience or skill | p. 116 |
| Your doctor concludes that worsening heart symptoms always mean that your heart disease is getting worse | p. 118 |
| Outdated treatment for congestive heart failure, heart enlargement, or ventricular hypertrophy | p. 120 |
| Noncardiac conditions that worsen heart disease symptoms | p. 120 |
| Common medications that worsen heart disease | p. 121 |
| Common errors and smart patient responses related to popular heart disease medications | p. 123 |
| The Question of Cancer | p. 127 |
| Special Alerts Cancer | p. 129 |
| Prevention and Early Detection of Cancer | p. 131 |
| Errors | |
| Your doctor tries to cover too many health concerns in one checkup and fails to focus on cancer risks | p. 131 |
| Guidelines for early detection of cancer in symptomless, average-risk men | p. 132 |
| Guidelines for early detection of cancer in symptomless, average-risk women | p. 133 |
| Failing to consider family history factors that put you at high risk for certain forms of cancer | p. 134 |
| How to tell if you're at high risk for different cancers | p. 135 |
| Your doctor fails to ask you about common but frequently overlooked cancer symptoms | p. 138 |
| During a routine medical exam, your doctor fails to ask you to show how you examine your own breasts | p. 140 |
| Common symptoms that could arise from cancer or other causes | p. 141 |
| Your doctor says you shouldn't worry about a small hard spot in your breast because it hasn't shown up on any mammogram | p. 142 |
| Your doctor tells you that because you've had one baseline mammogram before menopause, there is no reason for you to have another mammogram until you are past menopause | p. 144 |
| You've noticed some changes in the appearance or shape of your breast, but your doctor tells you not to worry | p. 146 |
| Your doctor sends you to an unqualified mammography center | p. 147 |
| The technician fails to ask you if you have a silicone breast implant before giving you a mammogram | p. 149 |
| Neglecting to schedule a Pap smear for very young or very old patients | p. 150 |
| Your doctor fails to order a second Pap test after a normal first test, even though you are experiencing spotting or other symptoms between periods | p. 151 |
| Endangering a woman's ability to have a successful pregnancy by not referring her for a colposcopy procedure after an abnormal Pap smear | p. 153 |
| You were born during the period 1945 to 1971, and your doctor fails to check your vagina carefully for cancer | p. 155 |
| Translating old Pap names into the new Bethesda system for Pap smears | p. 155 |
| Your doctor fails to ask if you are experiencing any itching or other discomfort in the vulva area | p. 156 |
| Relying only on a Pap smear and pelvic exam to check for cancer of the uterus | p. 157 |
| Overlooking subtle health signals that may indicate the presence of ovarian cancer | p. 160 |
| Relying only on a negative stool sample test in screening for colon and rectal cancer | p. 163 |
| You are injured during a sigmoidoscopy or colonoscopy by an unskilled physician | p. 165 |
| Your doctor omits the rectal exam as a screening procedure for prostate cancer | p. 167 |
| You aren't given a PSA blood test to check for prostate cancer | p. 169 |
| You are a smoker, and your doctor fails to recommend a chest X-ray during your regular checkup | p. 170 |
| You are a smoker, but your doctor never hassles you about your habit | p. 171 |
| Your regular medical exam doesn't include a systematic viewing of all your skin surfaces | p. 173 |
| Treatment of Cancer | p. 176 |
| Errors | |
| You are being treated for cancer, and your doctor fails to refer you to an oncologist | p. 176 |
| Key questions to ask when you are first diagnosed with cancer | p. 178 |
| You are scheduled for breast surgery, and your doctor offers you a mastectomy rather than a lumpectomy | p. 179 |
| Your doctor fails to recommend radiation treatment after a lumpectomy | p. 181 |
| Your doctor does not offer you the option of preventive chemotherapy after breast surgery | p. 182 |
| Your doctor doesn't measure estrogen hormone receptors on malignant breast tissue | p. 184 |
| You are diagnosed with prostate cancer, and your doctor immediately recommends surgery without exploring the possibility of radiation therapy | p. 185 |
| Your doctor fails to treat advanced, spreading prostate cancer aggressively enough | p. 187 |
| Your doctor fails to refer aggressive lymphoma and Hodgkin's disease to a specialized cancer center | p. 188 |
| How to distinguish between lymphoma, Hodgkin's disease, and leukemia | p. 191 |
| Your doctor doesn't tell you that your cancer doesn't respond well to chemotherapy | p. 192 |
| Your doctor fails to educate you about signs of chemotherapy toxicity | p. 193 |
| Your doctor doesn't suggest behavioral techniques to overcome side effects of chemotherapy | p. 195 |
| Your doctor doesn't explain the hospice option | p. 196 |
| Not confronting the insurance implications of your treatment early enough to take assertive action | p. 197 |
| What's Going On with My Gut? | p. 201 |
| Special Alerts: The Digestive System | p. 203 |
| Abdominal Pain | p. 205 |
| Errors | |
| Your doctor tries to diagnose your abdominal pain over the telephone | p. 205 |
| Organs that may cause abdominal pain | p. 208 |
| You have pain in your right shoulder, but your doctor misses the real source of the pain--your gallbladder | p. 209 |
| Your doctor fails to do a rectal exam when you complain about abdominal distress and misses your appendicitis, diverticulitis, or another serious condition | p. 211 |
| Your doctor fails to do a pelvic exam and evaluate your menstrual and pregnancy status when you complain of lower abdominal distress | p. 212 |
| You have steady pain in the upper abdomen, which your doctor misdiagnoses as gastritis instead of pancreatitis | p. 213 |
| Assuming too quickly that the burning in your upper abdomen is from your ulcer rather than your heart | p. 214 |
| In diagnosing your abdominal pain, your doctor fails to check your medication schedule or exposure to toxic substances | p. 215 |
| Failing to do a urinalysis and blood count in evaluating lower abdominal distress | p. 217 |
| Your doctor tells you to wait a day for treatment for a painful stomachache, but an emergency room doctor identifies a potentially fatal blood vessel problem | p. 218 |
| You are placed "under observation" in an emergency room as a result of abdominal pain, but more than thirty minutes elapse before you are checked by a physician or nurse | p. 220 |
| Your doctor does not treat your chronic "acid" problems with antibiotics | p. 222 |
| Constipation and Diarrhea | p. 223 |
| Errors | |
| Your doctor orders many fancy tests for ordinary constipation | p. 223 |
| Ignoring significant worsening of your constipation | p. 224 |
| The basics of promoting regular bowel movements | p. 225 |
| Your doctor fails to recognize that your constipation is a symptom of anxiety or depression | p. 227 |
| Drugs that often cause constipation | p. 228 |
| Not recognizing diarrhea caused by antibiotics as a potentially life-threatening emergency | p. 229 |
| What kind of laxative should you take? | p. 230 |
| Irritable Bowel Syndrome | p. 233 |
| Errors | |
| Your doctor overtests you for Irritable Bowel Syndrome | p. 233 |
| Insisting that you continue a high-fiber diet even though your IBS seems to be getting worse | p. 235 |
| Typical signs and symptoms of IBS | p. 235 |
| Your doctor lacks the patience to help you identify a particular food that may be causing IBS | p. 236 |
| An enzyme deficiency, which your doctor has overlooked, is contributing to your IBS | p. 238 |
| Your doctor overlooks a possible psychological component to your IBS | p. 240 |
| Your doctor diagnoses you as having IBS when you really have parasites | p. 241 |
| Hepatitis | p. 243 |
| Errors | |
| Although you are sexually active, you haven't been immunized against hepatitis | p. 243 |
| Your teenager receives a hepatitis shot but in the wrong part of the body | p. 245 |
| Your doctor forgets that hepatitis may be involved when you have flulike symptoms | p. 245 |
| Failing to monitor your liver inflammation | p. 246 |
| Your doctor prescribes standard doses of medicine despite your having liver disease | p. 248 |
| Your doctor prescribes a drug that makes your liver damage worse | p. 249 |
| You are infected with hepatitis through contaminated medical or dental instruments | p. 250 |
| After you are exposed to hepatitis, you are given the wrong kind of gamma globulin | p. 251 |
| Failing to take an accurate alcohol history from patients with hepatitis | p. 252 |
| Your elderly father, a heavy drinker, is placed on an intravenous feeding line, but he is not given a shot of thiamine (vitamin B1) | p. 253 |
| Gallbladder Complaints | p. 255 |
| Errors | |
| Your doctor immediately suggests surgery when he finds you have gallstones | p. 255 |
| You are given an X ray instead of an ultrasound test of your gallbladder | p. 257 |
| You are assigned an inexperienced surgeon for your gallbladder operation | p. 258 |
| Your aunt is on a low-calorie weight loss diet, but the doctor doesn't warn her about an increased risk for gallstones | p. 260 |
| When Your Problems Are Respiratory | p. 261 |
| Special Alerts: Respiratory Problems | p. 263 |
| Errors | |
| Your doctor prescribes antibiotics for your upper respiratory viral infection | p. 264 |
| Failing to link your sore throat to strep throat | p. 265 |
| Your doctor assumes you have the flu when you really are suffering from endocarditis | p. 266 |
| Not recommending an influenza vaccination if you are at high risk | p. 267 |
| Your doctor chooses the wrong antibiotic for pneumonia | p. 268 |
| Your doctor mistakes the serious nature of your cough | p. 269 |
| Your doctor overlooks sinusitis as the cause of your lingering "cold" or postnasal drip | p. 271 |
| Your doctor overtests for allergies | p. 273 |
| Assuming that an anxious patient's shortness of breath is caused by anxiety rather than by a serious physical problem | p. 275 |
| Causes of shortness of breath | p. 276 |
| Your doctor treats the allergy while ignoring the trigger | p. 277 |
| Your doctor allows you to overuse quick-relief asthma drugs and neglect slower-acting antiinflammatory preventive drugs | p. 279 |
| Your doctor fails to instruct you in the proper use of your asthma inhaler | p. 281 |
| Your doctor prescribes theophylline for your asthma but fails to measure your blood levels of the drug | p. 282 |
| Your doctor fails to recognize a bacterial infection as the cause of worsening chronic lung disease | p. 283 |
| You have emphysema or chronic bronchitis, and you overdose on oxygen | p. 284 |
| Your doctor fails to order a tuberculosis test | p. 285 |
| Checking Out Your Bones and Joints | p. 287 |
| Special Alerts: Bones and Joints | p. 289 |
| Errors | |
| Your doctor treats you for osteoarthritis when you really have another disease | p. 290 |
| Your doctor prescribes powerful drugs for treatment of rheumatoid arthritis, without explaining their poisonous potential | p. 292 |
| DMARDs: their major adverse reactions and recommended monitoring by your physician | p. 293 |
| Your doctor fails to recommend a bone density measurement to detect osteoporosis at the time you go through menopause | p. 294 |
| Your doctor uses the right drug--estrogen--along with a wrong drug to treat osteoporosis | p. 296 |
| Your doctor has been too quick to recommend surgery for your carpal tunnel syndrome | p. 297 |
| Common work injuries: their symptoms and likely victims | p. 298 |
| Your doctor wrongly diagnoses your backache as a simple muscle spasm | p. 300 |
| Your doctor thinks your back or leg pain is caused by a disk or muscle spasm when the real problem is an artery blockage | p. 302 |
| Missing a change in back symptoms that can signal a dangerous emergency | p. 303 |
| Your orthopedist is too quick to recommend back surgery | p. 304 |
| Your doctor is ignorant about identifying and treating fibromyalgia | p. 306 |
| Your doctor fails to educate you about the early symptoms of Lyme disease | p. 308 |
| Is the Lyme disease test reliable? | p. 310 |
| Your doctor treats you with the right antibiotics for Lyme disease but for too short a period of time | p. 311 |
| Some Anti-error Strategies for Women Only | p. 313 |
| Special Alerts: For Women Only | p. 315 |
| Errors | |
| Your doctor gives you medication without taking into account your birth control pills | p. 316 |
| Your doctor prescribes an intrauterine device, even though you have a past history of pelvic infections | p. 317 |
| Your doctor fails to check how you insert your diaphragm | p. 318 |
| Your chances of becoming pregnant with different methods of contraception | p. 319 |
| Rules for proper diaphragm use | p. 320 |
| Your doctor treats you for vaginitis without checking whether you are pregnant | p. 321 |
| Your doctor doesn't take your premenstrual syndrome symptoms seriously | p. 322 |
| Your doctor overlooks the possibility that your pelvic, rectal, or back pain may be caused by endometriosis | p. 324 |
| Your doctor overlooks that flulike symptoms with a peeling, red rash may actually be toxic shock syndrome | p. 325 |
| Your doctor tries to make the estrogen decision for you | p. 326 |
| The benefits and risks of estrogen and progesterone therapy | p. 328 |
| Your doctor fails to tell you that you can get pregnant during menopause | p. 330 |
| Your doctor attributes too little significance to your pattern of menstrual bleeding during menopause | p. 331 |
| Your doctor recommends an unnecessary hysterectomy | p. 332 |
| Eliminating Errors Involving Your Eyes, Endocrine System, and Urinary Tract | p. 335 |
| Special Alerts: The Eyes, Endocrine System, and Urinary Tract | p. 337 |
| Errors | |
| Your doctor recommends operating on your cataracts just because they are there | p. 338 |
| Your doctor suggests you may want to have an operation for cataracts in your second eye before vision has been fully restored in the first eye | p. 339 |
| Failing to do a blood test for thyroid function on every person who feels unwell when the source of the problem can't otherwise be identified | p. 340 |
| Your doctor overlooks potential interactions between thyroid hormone supplements and other drugs | p. 341 |
| Common symptoms of overactive and underactive thyroid | p. 342 |
| Your doctor fails to recognize thyroid cancer | p. 342 |
| You are sexually active, but your doctor resists giving you preventive antibiotics to counter possible urinary tract infections | p. 344 |
| At the first sign of a urinary tract infection, your doctor immediately orders a sophisticated urine culture or other expensive test instead of a simple urinalysis | p. 345 |
| Your doctor mistakes your urinary tract infection for a prostate problem | p. 347 |
| The hospital staff has missed that an elderly father's malaise and loss of appetite are caused by a urinary tract infection | p. 348 |
| You have juvenile-onset diabetes, and your doctor fails to inform you that a high blood pressure drug can slow the onset of kidney disease | p. 349 |
| Your doctor doesn't tell you that your oral diabetic medicine may increase your risk of heart disease | p. 350 |
| Your doctor fails to recognize that high blood sugar in the morning may result from too much insulin | p. 351 |
| Special alert for those with juvenile-onset diabetes | p. 351 |
| Receiving the wrong diabetes drug at the pharmacy | p. 353 |
| Your doctor prescribes medicine that will interact with your diabetes medicine | p. 353 |
| Is It Your Body or Your Mind? | p. 357 |
| Special Alerts: Body or Mind? | p. 359 |
| Errors | |
| Your doctor fails to identify you as an abuser of alcohol | p. 360 |
| You have an alcohol problem, and your doctor fails to warn you about ending drinking too abruptly | p. 361 |
| Your doctor is too quick to diagnose Alzheimer's disease | p. 362 |
| Your doctor is unable or unwilling to recognize physical symptoms of stress | p. 363 |
| Mini-mental status exam | p. 364 |
| Causes of senility other than Alzheimer's disease | p. 366 |
| Your psychiatrist is unwilling to try psychotherapy without drugs | p. 367 |
| Do you have stress-related symptoms? | p. 367 |
| Your doctor doesn't sufficiently explore whether you are depressed | p. 369 |
| Not recognizing when you and your therapist make a poor match | p. 370 |
| A screening test for depression | p. 371 |
| Your doctor lacks an organized approach to dealing with your chronic fatigue | p. 373 |
| Your doctor misses an elusive physical cause of your chronic fatigue | p. 374 |
| When you complain of chronic fatigue, your doctor fails to check for sleep apnea | p. 375 |
| Easily missed physical conditions that can cause fatigue | p. 376 |
| Your doctor prescribes sleeping pills unwisely | p. 379 |
| Your doctor doesn't recognize that your headache relief medicine is actually causing your headaches | p. 381 |
| Your doctor misses the possibility that your worsening headache could signal a medical emergency | p. 382 |
| Making the Health Care System Work for You | p. 385 |
| Acknowledgments | p. 393 |
| Index | p. 395 |
| Table of Contents provided by Syndetics. All Rights Reserved. |
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